(23) Quit Smoking
What are the Surgeon General’s Reports?
By the 1960s, there was growing pressure for the U.S. Public Health Service to take some kind of action against smoking. Several anti-smoking advocacy groups, for example, TheAmerican Lung Association and The American Heart, proposed to President Kennedy that he appoint a commission to study the implications of tobacco use in the United States.
Luther Terry, then Surgeon General, appointed a committee to fully investigate the ongoing questions about smoking and health.
Persistent denials of a causal link between smoking and lung cancer by the tobacco industry stimulated the need to develop a consensus report. At that time, the consensus method was unprecedented in medicine. It became the model for evidence-based medicine (EBM) to help guide medical practice based on the consensus of researchers.
The WHO Framework Convention on Tobacco Control
Topic – Measure- Articles
Demand reduction - Tax and other measures to reduce tobacco demand - Articles 6 & 7
Passive smoking - Obligation to protect all people from exposure to tobacco smoke in indoor workplaces, public transport, and indoor public places – Article 8
Regulation - The contents and emissions of tobacco products are to be regulated and ingredients are to be disclosed – Article 10
Packaging and labeling - Large health warning (at least 30% of the packet cover, 50% or more recommended); deceptive labels (“mild,” “light,” etc.) are prohibited - Articles 9 & 11
Awareness - Public awareness for the consequences of smoking – Article 12
Tobacco advertising - Comprehensive ban, unless the national constitution forbids it – Article 13
Addiction - Addiction and cessation programs – Article 14
Smuggling - Action is required to eliminate illicit trade of tobacco products – Article 15
Minors - Restricted sales to minors – Article 16
Research Tobacco-related research and information sharing among the parties - Articles 20, 21, & 22
Committee members came from a variety of disciplines. Members included a pharmacist, a statistician, a pulmonary medicine specialist, an internist, a surgeon, a pathologist, a biologist who was a cancer specialist, a toxicologist, a chemist, a bacteriologist, an epidemiologist, and a tobacco industry spokesperson. Each member was a renowned expert in his o her field. Any individual who had already published on the issue or had publicly taken a stand was not eligible to be on the investigative committee, in order to ensure that the findings would be unbiased.
The committee included smokers and nonsmokers. After conducting a lengthy study, the committee members concluded that there is a strong link between smoking and cancer. This conclusion was based on a wide range of evidence and included both statistical and epidemiological findings. (Statistics is the study of numerical data. Epidemiology is the study of the incidence, distribution, and control of a disease found in a population.) The committee found that the death rate from cancer among male smokers was 1,000 times higher than among nonsmokers. The tobacco industry refuted the findings, calling the causal link between smoking and lung cancer a “mathematical aberration.”
The Surgeon General’s Report was released in January 1964. This was a pivotal document in the history of public health. The report provided legitimacy to the allegations that smoking is harmful. The consensus report became a model for other reports on health concerns because of the independence and the integrity of the committee members and their findings.
The next Surgeon General’s Report focused on secondhand smoke or environmental smoke. Two major reports were issued in 1986, one from Surgeon General Koop and the other from an independent research institution, The National Academy of Sciences (NAS). Both addressed the effects of environmental smoke on nonsmokers. The two reports each confirmed the other’s findings.
First, mainstream smoke exhaled into the air by smokers mixed with smoke released directly from the burning end of a cigarette, and constituted approximately 85% of the nonsmoker’s intake of tar and nicotine. Second, secondhand smoke also posed risks not only to vulnerable individuals, such as those with respiratory problems, but also to healthy adults and children. What had been considered an environmental nuisance became a recognized and validated risk to the health of anyone exposed to the polluted air. The conclusion was that the simplest expansive and most effective way to prevent diseases from secondhand smoke was to establish smoke-free environments, including work-sites.
