Mr. WAXMAN. Thank you for your testimony. Dr. Maves, we've heard today a lot of testimony about some of the health aspects of ETS, especially cancer, heart disease, asthma and respiratory infections. You represent the ear, nose and throat specialists and one of the most significant and often most neglected adverse health effects is its effect on the ears and ear infections. Can you explain what environmental tobacco smoke does to the ears and how serious this problem might be? Mr. MAVES. Thank you. This is a very serious problem. The tobacco smoke, particularly the particulate matter and the irritating effects of that particulate matter, can cause asthmatic children to ventilate through their nose and also ventilation of the ear. There's a small tube that goes from the back of the nose to the middle ear which provides ventilation in these children. With irritation from tobacco smoke, that tube can be cut off and so the child will not have adequate ventilation of the ear. As a result, fluid builds up, and this is a problem because this causes a hearing loss. This is of particular concern to us simply because these children, particularly children of 1, 2, 3 years of age, which are the most likely to get this problem anyway, are at a risk for language development, for learning development. It hits them at a particularly critical time in their life. This is a problem that is one that our membership deals with frequently, that physicians who treat these children have to do quite commonly. Removing tobacco smoke as an environmental hazard would lessen the impact of this problem on children and so obviously lessen the number of cases that we see of children with middle ear infusions. Mr. WAXMAN. What are the medical consequences of children with these middle ear infections? Mr. MAVES. A child who gets a middle ear infection obviously will have a problem where they may need some antibiotics. They may well require decongestants. If medical therapy fails, and it does so in about 25 to 30 percent of these children, they will then need to have tympanostomy tubes. These are little small tubes that are put in the eardrums of children. So as we're talking about health care reform and, if you will, the cost of medicine, this is one thing we can do to lessen the impact of this particular environmental hazard on these children, and, if you will, indirectly impact the cost of medicine for us all. Mr. WAXMAN. At one time I had heard some discussion that frequent infections in the middle ear could cause learning disabilities. Do you have any information on that? Mr. MAVES. Yes, sir, it can. You just need to realize that a child learns by imitation. Language development is a very delicate process that begins with the child imitating his mother as a newborn and then eventually hopefully culminates in that child acquiring language at an age of 3 to 5 years so that they're ready to enter school. Children that have difficulties hearing, be that from middle ear infections, be that a deafness that occurs as a result of either hereditary conditions or metabolic conditions, will slow down that child's process of learning at the most critical time in their entire life. Mr. WAXMAN. Are language processing problems in any way related? Mr. MAVES. I don't have any information on that. I don't believe that is linked in any way to this particular problem. No, sir. Mr. WAXMAN. Mr. Eisenberg, the tobacco industry witnesses argue that better ventilation is a more effective response to reducing health risks from tobacco smoke. Apparently, you don't agree and have testified that environmental tobacco smoke cannot be totally removed from indoor air except by removing the smoking itself. You've noted that most ventilation systems in public and commercial spaces recirculate much of the contaminated indoor air. Isn't a prohibition on smoking or the restriction of smoking to areas that are separately ventilated the most effective way to minimize the health risks of ETS? Mr. EISENBERG. We believe that to be the case. The problem is you can engineer just about anything. You can engineer systems to reduce the hazards from smoke. You can't get rid of it. The more you engineer, the higher the cost. You can engineer moon travel, but most of us don't travel to the moon. The testimony that I think is in most opposition to us on this panel emphasizes comfort, not health and how people feel about the environment. Whether they can feel the health hazard doesn't seem to be material here. What is material in this testimony is comfort. We think health has got to be material to this and when you're dealing with the existing standards and the fact that you cannot get rid of all the smoke, you are still left with a health problem. Again, to reemphasize something that we said before, since this is such a significant indoor pollutant and, at the same time, is one where you know the source, it's also the easiest to get rid of. You just don't allow it or you separately ventilate it. That's all there is to it. Mr. WAXMAN. Thank you very much. Mr. Pallone, do you have something? Mr. PALLONE. No. Mr. WAXMAN. I want to thank you all very much for your participation in this hearing today. Thank you for being with us. That concludes the hearing today and we stand adjourned. [Whereupon, at 2:43 p.m., the hearing was adjourned.] [The following statements and letters were submitted for the record:] American Academy of Otolaryngology-Head and Neck Surgery, Inc. DEDICATED TO CARE OF THE EARS, NOSE, THROAT AND RELATED STRUCTURES OF THE HEAD AND NECK One Prince Street Alexandria, VA 22314 (703) 838-4444 FAX: (703) 883-5100 TT(TDD); (703) 519-1585 March 15, 1994 The Honorable J. Dennis Hastcrt U.S. House of Representatives Dear Congressman Hastert: We are writing to urge you to vote yes on H.R: 3434, "The Smoke Free The American Academy of Otolaryngology-Head and Neck Surgery is the world's The business community has already expressed its support for H.R. 3434. The National Council of Chain Restuarants (including Dunkin' Donuts and Hardee's), and the Building Owners and Managers Association bave both voiced their endorsement of the legislation. McDonald's is not only supporting the bill, but is making all of its 1,400 company-owned restaurants smoke-free. In light of all this, the Surgeon General's warnings, and the Environmental Protection Agency's recommendation that "cvery company have a smoking policy that effectively protects nonsmokers from involuntary exposure to tobacco smoke," we urge you to vote yes on H.R. 3434, and help protect the health of nonsmokers. especially children, for whom clean air is essential to their health growth and development. Statement of the American Hotel & Motel Association The American Hotel & Motel Association is a federation of associations representing lodging's interests in the fifty states, the District of Columbia, Puerto Rico and the Virgin Islands. The Association federation has a membership in excess of 10,000 individual lodging properties which represents approximately 1,300,000 rooms and 1,500,000 jobs. On behalf of the lodging industry we wish to express our concern about HR 3434, the "Smoke-Free Environment Act of 1993." The lodging industry has long been in the vanguard of responding to the evolving wants of our guests for non-smoking accommodations. Voluntarily we have provided and continually increased our percentage of non-smoking rooms in response to guest preference. Also, we have willingly designated non-smoking areas in restaurants and are prepared to continue to modify and adapt our non-smoking policies in response to changing public demand. We believe this market-oriented response to guest needs is the correct way to deal with the smoking issue. A recent USA TODAY/CNN/Gallup survey, reported in the March 16 USA TODAY, reflects a similar view. The majority of those polled believed that non-smoking areas should be set aside as opposed to having a total ban imposed. The poll also showed that the percentage of those calling for an outright ban in hotels was substantially less than those seeking bans in other environments. We believe the above statistics reflect the fact that hotels are unique in one particular facet of our public dealings. We are quite figuratively and literally a traveler's "home away from home." In our sleeping rooms and, to a lesser extent, in our meeting rooms there is a de facto conversion of a public area to a private area. When we "rent" a meeting room to a group, whether as part of a large convention or single meeting, they expect to exercise a large degree of control over the activities that take place in those spaces. Those areas are no longer public in the commonly accepted usage, and no one disputes the right of a group conducting a meeting to exclude the general public from its meeting room. The right of those conducting their private meeting to determine whether or not they will have a smoking meeting would be lost and seemingly the hotel would have the responsibility to insinuate itself into private meetings to ensure compliance with the law. More and more attendees at meetings are voluntarily choosing to make them non-smoking. They should continue to have that right. This idea of privacy is nowhere more evident than in an individual's sleeping room. The guest expects an environment that closely resembles home. Hotels strive to create that "home away from home" environment, but HR 3434 would deny that right. The idea that a guest in his or her room for up to 12 hours in a day should be forbidden the right to smoke by the federal government and that the hotel should police guest activity is unreasonable. To hold out the possibility of imposing fines of up to $5,000 for failure to enforce an unenforceable law is disingenuous. As one of the key components of the hospitality industry, and the host to millions of foreign visitors a year, the hotel industry is aware that there are widely held views on smoking in the world and that foreign visitors are often more likely to be smokers. A blanket federal mandate, beyond giving the wrong signal to our foreign guests, is again likely to be unenforceable. Efforts to address smoking issues from a legislative or regulatory perspective are underway in many states. Of particular interest are the efforts in California which have sought a reasonable balance between the concerns of smokers and non-smokers and have refrained from putting commercial establishments such as hotels in the middle of a no win situation by making them active enforcers of public policy. While we believe that the best approach is one that lets the demands of the public shape the status of smoking facilities, we do not condemn a reasonable approach by local governments to balance differing views. Unfortunately, we can not agree with a heavy-handed, unenforceable, blanket federal ban on all smoking that leaves hotels, among others, to be its enforcers under pain of staggering fines. We commend this Committee for its commitment to preserving the health of our citizens but call on it to eliminate any further consideration of HR 3434 in its present form. The Board of Directors of the California Restaurant Association at its Our endorsement of HR 3434 is consistent with the position adopted by |