Smoking and Tobacco Control Monograph No. 7 
basic point is there is a lot of labeling that pertains to risks that are only 
approximately known. 
DR. FREEMAN: Dr. Benowitz? 
DR. BENOWITZ: To follow up on Dr. Zacny's comments, what we really 
would like to know is not brands vs. risk; we would like to know actual 
exposure level. If we were able to measure cotinine or adducts of different 
compounds or whatever in smokers vs. their yields, then we would have the 
basis for recommending that individuals should reduce their exposure. Since 
there is such an overlap with the yields as marketed now, 1 do not think we 
are ever going to see a difference by yield — that does not mean that the 
rationale for an individual reducing their intake is not valid, and so at this 
point in time we may have to go forward based on scientific rationale and 
plausibility for reducing exposure to toxic materials. 
DR. FREEMAN: Dr. Hoffmann? 
DR. HOFFMANN: 1 think there is a misunderstanding. It has been shown 
in dozens of studies that there is a dose response with respect to cancer of 
the lungs and the upper respiratory tract by number of cigarettes smoked 
per day, length of time smoking, and groups of cigarettes. This continues 
for ultralow, low, and average cigarettes. There is a dose response with 
respect to cancer but not with respect to coronary artery disease. Any 
cigarette is harmful. But ultralow cigarettes have a lower risk than 
nonfiltered regular cigarettes when you smoke them for 10 or more years. 
We should not say that there is no dose response. 
DR. FREEMAN: Dr. Hoffmann, just to follow up on what you said, as far as 
the science is concerned, you indicated that in there is no apparent dose 
response for coronary heart disease? 
DR. HOFFMANN: We do not know from the literature any benefit with 
respect to coronary heart disease. 
DR. STITZER: Dr. Benowitz can speak to this. Is there a dose effect based 
on light vs. heavy smoking for coronary disease? 
DR. BENOWITZ: No, there is not. I would like to add that 1 agree with 
Dr. Hoffmann that this dose response would provide a rationale for what 
we are doing here today. There are data in pregnancy showing the dose 
response between cotinine level and the weight reduction of the newborn, 
and therefore that is another rationale for another disease that there is a 
dose-response relationship, and therefore, even though we cannot say that a 
particular brand is going to be less hazardous than some other brand, we can 
say that lowering your exposure in general will be beneficial, and then we 
just have to help people to do that. 
DR. FREEMAN: Didn't Dr. Samet state yesterday that there is no evidence 
that coronary heart disease is reduced by lowering the nicotine or tar content 
in cigarettes? 
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