This is certainly turning out to be quite the year for 50th anniversaries. Fifty years ago next month, the Beatles made their U.S. debut on “The Ed Sullivan Show.” In 1964, President Lyndon Johnson started the War on Poverty. And 50 years ago last Saturday, the surgeon general of the United States issued the single most important report that would ever come out of that office. It linked cigarette smoking to illness and death.
It’s hard to remember now just how prevalent smoking used to be. In the mid-1960s, around half the men in the country smoked; for women, the number was 35 percent. People smoked in their offices, smoked in restaurants, smoked on airplanes. Indeed, Paul Billings of the American Lung Association recalls that the airlines often gave passengers small packets of cigarettes when they boarded the plane.
But by the 1950s, scientists were beginning to equate cigarettes with lung cancer and other fatal diseases, a linkage the tobacco industry vehemently denied. In 1962, the prestigious Royal College of Physicians in Britain issued a report connecting smoking and lung cancer. After seeing that report, Luther Terry, who was then the surgeon general, put together an advisory board and asked it to report back to him on the potential dangers of cigarettes.
Did it ever: The advisory board’s subsequent report not only linked smoking to lung cancer but also to emphysema and cardiovascular disease. It labeled cigarettes a health hazard. “In general,” it concluded, “the greater the number of cigarettes smoked daily, the higher the death rate.”
“It was a landmark report,” says Scott Ballin, a longtime tobacco control and public health advocate. For the first time, the full weight of the federal government stood behind the notion that smoking killed. Anti-tobacco groups felt empowered and pressed for changes.
In 1965, Congress passed legislation banning cigarette advertising on television — while also forcing the tobacco companies to put a surgeon general’s warning on every pack of cigarettes. The tobacco companies fought the legislation, while continuing to deny that cigarettes killed.
And so it went for the next 30 years. The surgeon general would issue reports on, say, nicotine addiction or secondhand smoke. The tobacco companies would deny the obvious. And anti-tobacco activists would push for change.
This culminated with the tobacco wars in the 1990s. With the activists continuing to push hard, and whistle-blowers leaking damning documents, attorneys general around the country sued the tobacco companies and wound up settling for a staggering $246 billion over 25 years.
And all the while, as Americans learned more about the dangers of tobacco, cigarette smoking dropped, and dropped again. By 2005, the percentage of Americans who smoked was down to 21 percent, a remarkable achievement.
But since then, the percentage drops have been much smaller; today, it is estimated that around 18 percent of the country smokes. “Seven out of 10 smokers say they want to quit,” says Billings at the lung association, but their addiction is too powerful. More than 400,000 Americans still die prematurely each year from smoking.
Today, thanks to a law passed in 2009, the Food and Drug Administration has the power to regulate tobacco. (Its first set of tobacco regulations has been sitting at the Office of Management and Budget since October.) It’s a different environment now, not only because of FDA regulation but because there are now “harm reduction” products, like e-cigarettes, that potentially make it easier for people who want to quit.
Yet many in the public health community have pushed for e-cigarettes to be treated the same as combustible cigarettes; when you have been fighting a war for nearly half a century, it is hard to put down your weapons. Instead of focusing on the potential for e-cigarettes to save lives, they worry instead that the new products will serve as a gateway to smoking — a fear that has yet to show up in any study.
In honor of the 50th anniversary of the surgeon general’s report, the Journal of the American Medical Association devoted much of its current issue to tobacco and tobacco control. It published a study showing that the report may have saved as many as 8 million lives.
Another article in the current issue of the journal is by David Abrams, executive director of the Schroeder Institute for Tobacco Research and Policy Studies. He had been among those who had fought in the tobacco wars, but, in recent years, he had come around to the idea that a new way was needed.
Yes, he wrote, there needed to be more science around e-cigarettes, and, yes, they should be kept away from minors, and, yes, their advertising shouldn’t resemble the old tobacco come-ons. But, he concluded, with proper regulation, e-cigarettes “have the potential to make the combusting of tobacco obsolete.”
Which was the whole point of the exercise back in 1964. Maybe it’s time for another surgeon general’s report.