Surgeon General Reports on Smoking - History

Surgeon General Reports on Smoking - History

(4/10/63) In the worst post-war US submarine disaster, the USS Tresher sunk in the Altantic with all men aboard. None of the men were recovered.(1/16/64) The United States Surgeon General issued a report in which it was reported that cigarrette smoking posed a clear health danger to smokers. Thus began a concerted effort to reduce smoking in the United States.

How a warning helped a nation kick the habit

Health advocates are marking the 50th anniversary of the 1964 Surgeon General report on smoking with a call for more aggressive action to protect people from tobacco.

That landmark report, along with subsequent Surgeon General reports on the addictive power of nicotine and the dangers of secondhand smoke, led to a sea change in the country's attitude toward tobacco. Smoking rates have dropped by 59%, and many communities now ban smoking in public places.

No other single report has had this large of an effect on public health, says Thomas Frieden, director of the Centers for Disease Control and Prevention.

"I can't think of anything else that has come close," says Theodore Holford, a professor at the Yale University School of Public Health.

But with so much evidence of the harms of smoking — which causes cancer, heart attacks, strokes and a multitude of other illnesses — some advocates say the country needs to go much further.

"The 50th anniversary of the Surgeon General report should be a catalyst to say, 'We can't wait another 50 years to end death and disease caused by smoking,' " says Matthew Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group.

Nearly 42 million Americans still smoke, according to the CDC. More than 5 million people around the world die each year of smoking-related illnesses, according to an editorial by physicians Steven Schroeder and Howard Koh in Tuesday's Journal of the American Medical Association.

Every day, more than 3,000 teens pick up their first cigarettes, says Robin Koval, president and CEO of Legacy, an anti-smoking advocacy group created by the 1998 Master Settlement Agreement between tobacco companies and state attorneys general.

In some ways, combating tobacco is even more challenging than fighting infectious diseases, Frieden said in an interview. Frieden noted that more people would have stopped smoking if not for aggressive efforts by the tobacco industry to keep people addicted.

"I spent over a decade working on tuberculosis control," Frieden said. "But tuberculosis doesn't have a lobby working against tuberculosis-control measures."

The tobacco industry continues to work hard to keep people using its products, spending more than $8 billion a year on marketing in the USA alone, according to Schroeder and Koh's editorial.

In a related editorial, Frieden notes that new products, such as electronic cigarettes, present both opportunities and risks. Some health leaders say electronic cigarettes — which contain nicotine but no tobacco — may help smokers quit. But Frieden says he's concerned that e-cigarettes could increase the number of people addicted to nicotine by attracting kids. Frieden is also concerned that e-cigarettes could lead some smokers to avoid quitting, by allowing them to feed their habits even in smoke-free areas.

Yet, health advocates also note that the cultural landscape around smoking has changed enormously since the 1960s.

Back then, passengers could smoke on any plane, and flight attendants distributed free cigarettes along with meals. School kids sculpted ash trays for Mother's Day presents.

Tobacco companies formed one of the most powerful industries in the world, employing stars such as Ronald Reagan, Humphrey Bogart and Louis Armstrong to sell their products.

Today, tobacco companies are "convicted racketeers," says Stanton Glantz, a professor at the University of California-San Francisco, referring to the 2006 ruling by U.S. District Judge Gladys Kessler, who found that tobacco companies defrauded the American people by lying about the health risks of smoking.

UCSF's archive includes 82 million pages of tobacco-industry documents, revealing cigarette makers' strategies for marketing to children and the fact that they knew that cigarettes caused cancer and nicotine was addictive.

The surgeon general in 1964, Luther Terry, described the report's effect as a "bombshell."

At the time, and for decades afterward, the tobacco industry tried to "poke holes" in research documenting the harms of smoking, Frieden says.

With the surgeon general's report, "this was the first time that the government was saying, 'No. There is no doubt that smoking causes cancer,' " Frieden says.

The report's conclusions — based on more than 7,000 documents — were almost immediately accepted by nearly everyone, except for the tobacco industry, Myers say.

American attitudes toward the safety of smoking changed quickly.

In 1958, only 44% of American believed smoking caused lung cancer, according to a Gallup survey. By 1968, that percentage had risen to 78%.

In 1965, Congress passed legislation requiring the now-familiar "Surgeon General's warning" on cigarette packages, although it took six years to implement. In 1971, cigarette makers stopped advertising on TV.

"The tobacco industry thought they were just going to be crushed," says Glantz, author of a history of the tobacco industry called The Cigarette Papers. "The government and others didn't have the nerve to do what the tobacco industry had feared, which is come up with major regulation. . Politics has always saved the tobacco industry."

The tobacco industry also fought fiercely to protect its business, says Glantz, likening the battles over smoking to "trench warfare." For years, he notes, the tobacco industry funded bogus research suggesting that cigarettes and secondhand smoke were safe.

Smoking rates briefly rose in some of the first few years after the Surgeon General report's release, as the tobacco industry ramped up advertising to women and minorities, says Mark Pertschuk, a long-time anti-tobacco activist and director of the advocacy group Grassroots Change.

It was another surgeon general, C. Everett Koop, who "really got us where we are today," says Otis Brawley, chief medical officer of the American Cancer Society.

In 1986, Koop issued a Surgeon General report on "involuntary smoking," or secondhand smoke, that provided the scientific basis for protecting non-smokers from tobacco, Brawley says.

"When people realized that smoking hurts more than just the smoker, that's what led to change," Brawley says.

Flight attendants such as Kate Jewell — forced to breathe smoky, recirculated air during long plane trips — began to call for smoking bans on plane flights. Jewell recalls brown water dripping from the air vents. "It was so smoky, you couldn't see from one end of the cabin to another," Jewell says.

Long before the research was completed, Jewell says she and her fellow flight attendants knew that secondhand smoke was toxic. Jewell, whose career spanned 1970 to 2007, recalls keeping her airline uniform in the garage, because it smelled too awful to allow in her home.

"I would pull into the garage and strip down before I went into my house, because I didn't want to bring that into my house," says Jewell, 64, of Orcas Island, Wash.

In 1989, Congress banned smoking on domestic flights. Communities across the country began banning indoor smoking, as well.

As fewer Americans smoked, the tide began to turn toward cleaner air.

The tobacco industry's image took a beating in the 1990s, with the leak of industry documents showing that cigarette companies had hidden evidence that nicotine was addictive, Glantz says.

But the industry hasn't gone away.

Tobacco companies continue to oppose tobacco taxes and smoking bans. They're also still fighting implementation of the 2006 racketeering ruling, which required them to fund ad campaigns acknowledging that they lied about the addictiveness of nicotine, Glantz says.

"That is still being fought in the courts to this day," Glantz says. "The industry is still out there being as aggressive as (it) can be."

R.J. Reynolds, one of the leading tobacco companies, declined to comment.

David Sylvia, a spokesman for Altria, the parent company of tobacco giant Philip Morris, said his company welcomes regulation. Sylvia said Altria has no interest in marketing to kids, and simply hopes to sells its cigarettes to current smokers.

"The reason that tobacco remains such a problem isn't because the American public has failed to respond" to the surgeon general's warning, Myers says. "It's because the tobacco industry has used its economic, scientific and political might."

The tobacco industry has made technological improvements in cigarettes, for example, to make them less harsh, so that new smokers don't cough as much as in the past. That makes cigarettes more appealing to kids and first-time users, Myers says. The industry continues to sell menthol-flavored cigarettes, as well, which mask the harshness of tobacco with a minty flavor. "Fifty years later, cigarettes look sleeker, but they are no safer," Myers says.

Myers and others say they're disappointed that the Food and Drug Administration has not yet banned menthol cigarettes, although Congress has given it the power to regulate tobacco.


The 1964 Report on Smoking and Health

No single issue has preoccupied the Surgeons General of the past four decades more than smoking. The reports of the Surgeon General have alerted the nation to the health risk of smoking, and have transformed the issue from one of individual and consumer choice, to one of epidemiology, public health, and risk for smokers and non-smokers alike.

Debate over the hazards and benefits of smoking has divided physicians, scientists, governments, smokers, and non-smokers since Tobacco nicotiana was first imported to Europe from its native soil in the Americas in the sixteenth century. A dramatic increase in cigarette smoking in the United States in the twentieth century called forth anti-smoking movements. Reformers, hygienists, and public health officials argued that smoking brought about general malaise, physiological malfunction, and a decline in mental and physical efficiency. Evidence of the ill effects of smoking accumulated during the 1930s, 1940s, and 1950s. Epidemiologists used statistics and large-scale, long-term, case-control surveys to link the increase in lung cancer mortality to smoking. Pathologists and laboratory scientists confirmed the statistical relationship of smoking to lung cancer as well as to other serious diseases, such as bronchitis, emphysema, and coronary heart disease. Smoking, these studies suggested, and not air pollution, asbestos contamination, or radioactive materials, was the chief cause of the epidemic rise of lung cancer in the twentieth century. On June 12, 1957, Surgeon General Leroy E. Burney declared it the official position of the U.S. Public Health Service that the evidence pointed to a causal relationship between smoking and lung cancer.

The impulse for an official report on smoking and health, however, came from an alliance of prominent private health organizations. In June 1961, the American Cancer Society, the American Heart Association, the National Tuberculosis Association, and the American Public Health Association addressed a letter to President John F. Kennedy, in which they called for a national commission on smoking, dedicated to "seeking a solution to this health problem that would interfere least with the freedom of industry or the happiness of individuals." The Kennedy administration responded the following year, after prompting from a widely circulated critical study on cigarette smoking by the Royal College of Physicians of London. On June 7, 1962, recently appointed Surgeon General Luther L. Terry announced that he would convene a committee of experts to conduct a comprehensive review of the scientific literature on the smoking question. Terry invited representatives of the four voluntary medical organizations who had first proposed the commission, as well as the Food and Drug Administration, the Federal Trade Commission, the American Medical Association, and the Tobacco Institute (the lobbying arm of the tobacco industry) to nominate commission members. Ten were finally chosen, representing a wide swath of disciplines in medicine, surgery, pharmacology, and statistics, though none in psychology or the social sciences. Candidates qualified only if they had taken no previous stand on tobacco use.

Meeting at the National Library of Medicine on the campus of the National Institutes of Health in Bethesda, Maryland, from November 1962 through January 1964, the committee reviewed more than 7,000 scientific articles with the help of over 150 consultants. Terry issued the commission's report on January 11, 1964, choosing a Saturday to minimize the effect on the stock market and to maximize coverage in the Sunday papers. As Terry remembered the event, two decades later, the report "hit the country like a bombshell. It was front page news and a lead story on every radio and television station in the United States and many abroad."

The report highlighted the deleterious health consequences of tobacco use. Smoking and Health: Report of the Advisory Committee to the Surgeon General held cigarette smoking responsible for a 70 percent increase in the mortality rate of smokers over non-smokers. The report estimated that average smokers had a nine- to ten-fold risk of developing lung cancer compared to non-smokers: heavy smokers had at least a twenty-fold risk. The risk rose with the duration of smoking and diminished with the cessation of smoking. The report also named smoking as the most important cause of chronic bronchitis and pointed to a correlation between smoking and emphysema, and smoking and coronary heart disease. It noted that smoking during pregnancy reduced the average weight of newborns. On one issue the committee hedged: nicotine addiction. It insisted that the "tobacco habit should be characterized as an habituation rather than an addiction," in part because the addictive properties of nicotine were not yet fully understood, in part because of differences over the meaning of addiction.

The 1964 report on smoking and health had an impact on public attitudes and policy. A Gallup Survey conducted in 1958 found that only 44 percent of Americans believed smoking caused cancer, while 78 percent believed so by 1968. In the course of a decade, it had become common knowledge that smoking damaged health, and mounting evidence of health risks gave Terry's 1964 report public resonance. Yet, while the report proclaimed that "cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action," it remained silent on concrete remedies. That challenge fell to politicians. In 1965, Congress required all cigarette packages distributed in the United States to carry a health warning, and since 1970 this warning is made in the name of the Surgeon General. In 1969, cigarette advertising on television and radio was banned, effective September 1970.


Methods

Two reports of the Surgeon General on smoking and health that applied causal criteria to the four cancers at different points in time (1964 and 1982) [1, 24] form the basis of our investigation. We chose these two reports because they applied the same causal criteria yet also represent a time period during which evidence linking smoking and some cancers was growing substantially. We chose to examine the evidence for the causal role of smoking in the development of cancer at four sites in particular for which there was adequate evidence available to apply the causal criteria: lung, larynx, esophagus, and bladder.

Both the 1964 and 1982 reports documented their evaluation of causality using the same five causal criteria: consistency, strength, specificity, temporal relationship, and coherence. Coherence was a broad category that assessed whether all the evidence makes sense taken together, including information about dose response, mortality trends, and biologic plausibility. Definitions given for these criteria are essentially the same in both reports, although the definitions provided in the 1982 report are more thorough. However, our interpretation of the application of the causal criteria relies largely on descriptions provided in the reports. Official records in the National Archives from the Surgeon General's Advisory Committee on Smoking and Health, which authored the 1964 report, did not yield additional details about the committee's causal reasoning. [25]

In both reports, cohort mortality and case-control study data were available for all cancers. In order to clearly summarize the case-control evidence available to the 1964 and 1982 committees, we conducted our own pooled analysis of the case-control data. While the two committees did not make use of formal, quantitative meta-analytic tools to assess the case control data, we do so for the purpose of representing the body of data in a straightforward manner to the reader who may not be as familiar with the data as the authors of the reports were. We follow the Surgeon General reports in discussing case-control and cohort data separately rather than pooling different types of studies together. The reports did not provide p-values or confidence intervals when summarizing data, and they did not consistently report whether or not positive results were statistically significant. We did not conduct a similar pooled analysis for the cohort data because some of these studies were not yet published at the time although the Committee had access to the raw data for some studies, these were not available to us. However, the 1964 report included a simple unadjusted pooled analysis of cohort data upon which we draw.

We obtained all original research papers for the case-control studies cited in the reports as studies of cigarette smoking and the four cancers. We conducted meta-analyses on the published data from the case-control studies using the DerSimonian-Laird method [26]. We excluded the case-control studies that included only women, since the smoking habits for men and women were quite different at the time, and we excluded studies that did not report numbers of cases and controls and numbers of smokers and nonsmokers within these groups, as these did not allow calculation of an odds ratio for example, some papers only reported percentages or ratios without providing the actual numbers used to calculate them. Seven out of 61 studies (11%) were excluded for insufficient data. The studies included employed a diverse range of data collection and reporting procedures to describe smoking status in this study comparisons were made only between smokers and non-smokers. Estimates were not adjusted for age or other potential confounders.

Separate meta-analyses were conducted for each cancer site, namely lung, esophagus, larynx and bladder, and summary odds ratios and confidence intervals were obtained. Additionally, separate meta-analyses were conducted for bladder and esophageal cancer for those studies included in the 1964 report and those included in the 1982 report. Each of the six meta-analyses was summarized graphically by boxplots showing the summary odds ratio and confidence interval for each meta-analysis.


Contents

The health effects of tobacco had been debated by users, medical experts, and governments alike since its introduction to European culture. [1] Hard evidence for the ill effects of smoking became apparent with the results of several long-term studies conducted in the early to middle twentieth century, such as the epidemiology studies of Richard Doll and pathology studies of Oscar Auerbach. On June 12, 1957, then-Surgeon General Leroy Burney "declared it the official position of the U.S. Public Health Service that the evidence pointed to a causal relationship between smoking and lung cancer". [1] A committee of the United Kingdom's Royal College of Physicians issued a report on March 7, 1962, [3] which "clearly indicted cigarette smoking as a cause of lung cancer and bronchitis" and argued that "it probably contributed to cardiovascular disease as well." [4] After pressure from the American Cancer Society, the American Heart Association, the National Tuberculosis Association, and the American Public Health Association, President John F. Kennedy authorized Surgeon General Terry's creation of the Advisory Committee. The committee met from November 1962 to January 1964 and analyzed over 7,000 scientific articles and papers.

The Surgeon General's Advisory Committee on Smoking and Health: [5]

  • Stanhope Bayne-Jones, M.D., LL.D. (Retired).
    • Former Dean. Yale School of Medicine (1935–40), former President. Joint Administrative Board. Cornell University. New York Hospital Medical Center (1947–52): former president. Society of American Bacteriologists (1929). and American Society of Pathology and Bacteriology (1940). Field: Nature and Causation of Disease in Human Populations.
    • Head of Department of Surgery. University of Utah, School of Medicine. Salt Lake City. Fields: Clinical and Experimental Surgery Genetics.
    • Professor of Statistics. Harvard University. Field: Mathematical Statistics with: Special Application to Biological Problems.
    • Chairman. Department of Pathology. University of Pittsburgh. Field: Experimental and Clinical Pathology.
    • Sheldon Emory. Professor of Organic Chemistry. Harvard University. Field: Chemistry of Carcinogenic Hydrocarbons.
    • Professor of Pathology. Columbia University. and Director of Pathology Laboratories, Francis Delafield Hospital, New York. Field: Cancer Biology.
    • Chairman, Department of Internal Medicine. Indiana University, Indianapolis. Fields: Internal Medicine. Physiology of Cardiopulmonary Disease.
    • Professor of Internal Medicine, The University of Texas Southwestern Medical School. and Medical Director. Woodland Hospital. Dallas, Texas. Fields: Internal Medicine. Pulmonary Diseases, Preventative Medicine.
    • Professor of Epidemiology. University of Minnesota School of Public Health. Minneapolis. Field: Health and its relationship to the Total Environment.
    • Chairman. Department of Pharmacology University of Michigan, Ann Arbor. Department of Pharmacology. Field: Pharmacology of Anesthesia and Habit-Forming Drugs.
    • Surgeon General of the United States Public Health Service

    The report's conclusions were almost entirely focused on the negative health effects of cigarette smoking. It found:

    • cigarette smokers had a seventy percent increase in age-corrected mortality rate
    • cigarette smoke was the primary cause of chronic bronchitis
    • a correlation between smoking, emphysema, and heart disease.
    • a causative link between smoking and a ten- to twenty-fold increase in the occurrence of lung cancer
    • a positive correlation between pregnant women who smoke and underweight newborns. [1]

    As did the World Health Organization during this period, but possibly influenced by the fact that they were all smokers themselves, [6] the Committee defined cigarette smoking as a "habituation" rather than an overpowering "addiction". [6] Committee members agreed with most Americans that this habit (though often strong) was possible for individuals to break.

    In the years that followed the Surgeon General's report, millions of Americans successfully chose to quit smoking, with two-thirds to three-quarters of ex-smokers quitting unaided by nicotine replacement methods. In addition, the "cold turkey," or sudden-and-rapid-cessation, method has been found to be the most successful in terms of stopping smoking over long periods of time. [7] However, in a controversial move in 1989, a later Surgeon General, Dr. C. Everett Koop, M.D., shifted course and redefined cigarette smoking as "an addiction" rather than a habit. [8]

    The report's publication had wide effects across the United States and the world. It was deliberately published on a Saturday to minimize the negative effect on the American stock markets, while maximizing the coverage in Sunday newspapers. [1] The release of the report was one of the top news stories of 1964. It led to policy and public opinion changes such as the Federal Cigarette Labeling and Advertising Act of 1965 and the Public Health Cigarette Smoking Act of 1969, which mandated warning labels on cigarettes and instituted a ban on the broadcasting of cigarette advertisements on radio and/or television. [9]


    U.S. Surgeon General announces definitive link between smoking and cancer

    United States Surgeon General Luther Terry knew his report was a bombshell. He intentionally chose to release it on January 11, 1964, a Saturday, so as to limit its immediate effects on the stock market. It was on this date that, on behalf of the U.S. Government, Terry announced a definitive link between smoking and cancer.

    The link had long been suspected. Anecdotal evidence had always pointed to negative health effects from smoking, and by the 1930s physicians were noticing an increase in lung cancer cases. The first medical studies that raised serious concerns were published in Great Britain in the late 1940s. 

    LISTEN NOW: What happened this week in history? Find out on the HISTORY This Week Podcast. Episode 1: U.S. Surgeon General Announces that smoking is bad for us after all

    American cigarette companies spent much of the next decade lobbying the government to keep smoking legal and advertising reduced levels of tar and nicotine in their products. 44 percent of Americans already believed smoking caused cancer by 1958, and a number of medical associations warned that tobacco use was linked with both lung and heart disease. Despite all this, nearly half of Americans smoked, and smoking was common in restaurants, bars, offices, and homes across the country.

    Dr. Terry commissioned the report in 1962, and two years later he released the findings, titled Smoking and Health, which stated a conclusive link between smoking and heart and lung cancer in men. The report also stated the same link was likely true for women, although women smoked at lower rates and therefore not enough data was available.

    The news was major, but hardly surprising—the New York Times reported the findings saying "it could hardly have been otherwise." Still, the Surgeon General&aposs report was a major step in health officials&apos crusade against smoking. Though tobacco companies spent millions and millions and were largely successful in fending off anti-smoking laws until the 1990s, studies have shown that the report increased the percentage of Americans who believed in the cancer link to 70 percent, and that smoking decreased by roughly 11 percent between 1965 and 1985. California became the first state to ban smoking in enclosed public spaces in 1995. 25 more states have now passed similar laws, including 50 of the 60 largest cities in America. In 2019, the Surgeon General announced a link between serious disease and e-cigarettes, an alternative to smoking in which traditional tobacco companies have invested heavily.


    The Origins of the Office on Smoking and Health

    SG William H. Stewart (Oct. 2, 1965 to Aug. 1, 1969)

    Stewart was involved in anti-smoking since the 1955 National Health Survey, carried out by the U.S. Census Bureau. The National Opinion Research Center did opinion polls of physicians and other health personnel for the National Clearinghouse on Smoking and Health during his tenure.

    Stewart was the first to testify at the Federal Trade Commission hearing on "Proposed Rulemaking Requiring Health Warning in Cigarette Advertising," July 1, 1969. "As you know, our Department has urged this from the beginning. We supported this when it was included in the ruling which you proposed in 1964 and we have three times urged the Congress to achieve this and through legislation, in 1967, 1968, and now in 1969."

    Later, he was a member of Work Group 5, "High Priority Federal Government Initiatives," of the 1981 National Conference on Smoking or Health.

    The National Interagency Council on Smoking and Health

    "On July 13, 1964, announcement came of the formation of the National Interagency Council on Smoking and Health, later to be headed by Emerson Foote. Heading the list of national agencies and organizations are the United States Public Health Service and the American Cancer Society. They are joined by sixteen other prominent groups in the fields of health and education, all with the avowed purpose 'develop and implement plans and programs aimed at combatting smoking as a health hazard.' Signficiantly, the American Medical Association, which has not officially adopted the Surgeon General's Report, refused to accept the Council's invitation to become a member. Serving as the principal communication medium for the Council is the National Clearinghouse on Smoking and Health, a unit of the U.S. Public Health Service, and recent recipient of a $2,000,000 appropriation from Congress." "Key staff members of the Division of Chronic Diseases [CDC] play important roles in the Clearinghouse's activities: Dr. Guthrie and Dr. Daniel Horn, formerly of the American Cancer Society (Hammond-Horn Report) and now Assistant Chief of the Division's Cancer Control Branch." (Where the Industry Now Stands. Dec., 1965.)

    Emerson Foote of the American Cancer Society was chairman of the National Interagency Council on Smoking and Health, which included the American Heart Association, American Public Health Association, and National Tuberculosis Association (predecessor of the American Lung Association) as well as the American Cancer Society. (Smoking and Health Newsletter, 1965 Jul-Aug1(1). National Interagency Council on Smoking and Health, 8600 Wisconsin Avenue, Bethesda, Maryland [the address of the building built in 1962 to house the National Library of Medicine of the National Institutes of Health].)

    The National Clearinghouse for Smoking and Health began in the "Regional Medical Programs"

    The National Clearinghouse for Smoking and Health, which compiled the data for the Surgeon General reports, was established in 1965 in the "Regional Medical Programs." The legislation had been promoted by the President's Commission on Heart Disease, Cancer, and Stroke. "The president later indicated that he had created the commission 'at the insistence of the lovely lady, Mrs. Mary Lasker.'" The Commission was dominated by Mrs. Lasker's associates and friends. Dr. Michael DeBakey of Houston was the chairman. Other members included Emerson Foote, Mrs. Florence Mahoney, Dr. Sidney Farber, Dr. R. Lee Clark, Mrs. Harry Truman, whom Mary Lasker had known since the Truman White House days, and Dr. J. Willis Hurst of the Emory University Medical School, the president's personal heart specialist. Mr. Boisfeuillet Jones was a key consultant. Farber, Clark, and Dr. Frank Horsfall, of the Sloan-Kettering Institute for Cancer Research, were the principal members of the cancer subcommittee. Farber and Clark had been active in the late 1950s in organizing an association of cancer institutes. Four major cancer institutes existed then - Memorial Sloan-Kettering Cancer Institute, M.D. Anderson Hospital and Tumor Institute, Roswell Park Memorial Institute, and the National Cancer Institute's intramural laboratories and clinical research facilities." There were approximately ten other smaller centers around the country also engaged in these activities. "The legislation was introduced on January 19, 1965, and considered by Sen. Hill's subcommittee on health on February 9 and 10. The subcommittee made few changes in the proposed bill and the full committee reported the bill to the Senate on June 24. The bill was adopted by the Senate a few days later." Dr. Hugh Hussey, the American Medical Association's director of scientific activities, had resigned from the commission in 1964 "because of potential conflict between AMA policy and the commission's recommendations," and the AMA had been distracted with opposing Medicare legislation in 1965. (The Benevolent Plotters. In: Cancer Crusade: The Story of the National Cancer Act of 1971. By Richard Rettig, Joseph Henry Press 1977, pp. 35-41.)

    In 1964, anti-smoker Dr. George James was the chairman of the White House Task Force on Health, which worked in parallel with the President's Commission on Heart Disease, Cancer and Stroke. "This was not announced to the public it worked in secret." The two groups were coordinated in the office of Boisfeuillet Jones.

    From the National Library of Medicine website: "On December 6, 1991, NLM sponsored and hosted a conference titled Regional Medical Programs: Legislation and Activities in the U.S. (1965-1976). As background for the conference, print and photographic materials were assembled at NLM, and interviews of 24 individuals were videotaped. Subsequent to the conference, a website was mounted that provides transcripts of conference activities, photographs, transcripts and short clips of video interviews, digital images of selected archival materials, selections from a history of the Programs, and a bibliography." Numerous interviews refer to the activities of the Laskerites. However, there is virtually no menition of the Clearinghouse for Smoking and Health in the interviews. Like the Nazi persecution of Jews, it's something people don't talk about.

    Interview with Dr. William Kissick by Stephen P. Strickland: "The key player in the early days of RMP was -- like the voice, or its father -- was Wilbur Cohen. Wilbur Cohen was a key player in everything of the Great Society. There were two parallel activities in '64. The President's Commission on Heart Disease, Cancer and Stroke, was appointed, as I recall in March of 1964, and then in April, Johnson created a dozen task Forces to craft his agenda for the Great Society. There were people who were small on the commission, but they also had a lot of real heavyweights, some like John Gardner who chaired the education task force.

    Strickland: This was 1964? Who was the Assistant Secretary?

    Kissick: Beaufeuillet Jones. [sic - "Boisfeuillet" Jones, who was the father of the Washington Post publisher and CEO with the same name. He had been a Lasker crony since the Eisenhower administration, see Rettig p. 27: "Hill selected the members of the outside review committee with some assistance from Mary Lasker. The chairman was Boisfeullet [sic] Jones, then vice president for medical affairs at Emory University, and relatively unknown to Hill. The other members, however, included a number of stalwarts among the citizen witnesses for medical research. " [This committee reported in May 1960.]

    Strickland: He never actually held the title.

    Kissick: No, he had the title of Special assistant to the Secretary for Health and Medical Affairs. Beaufeuillet [sic] was the De Facto Assistant Secretary and his office consisted of three people: Bo, Bill Stewart, and myself. The White House task force on health had eight members and George James chaired it.

    Strickland: He was the health official of New York?

    Kissick: Yes, he, Bill Steward [sic] and I. Funny compared with Hillary's cast of 500. So there were eight members of the task force and three of us on the staff. And the link between the task force and the Commission was through Bo's office because Bo had been a member of the last two task forces.

    Strickland: A close friend of Florence Mahoney.

    Kissick: Yes, on good terms with Mary Lasker, very good terms with Senator Hill and a comfortable associate of Mike DeBakey and all of the key Lasker people. And Bo stayed as the de facto assistant secretary through the work of the commission, through the elevation and he was there when we presented the report to Johnson. Then he left to take a foundation presidency.

    Bill Stewart was really the lynch pin.

    Strickland: At that point, was he also the Surgeon General of the Public Health Service?

    Kissick: No, he was Surgeon General in October of '65, after the legislation had passed, Bill and Karl Yordie were together in the Heart Institute and they had been trying to implement the Regional Medical Programs and Bill was in the process of being recruited out to the Heart Institute when he was made assistant deputy. At that point I was in Phil Lee's office. Phil was one of the key players because as the new official assistant secretary he designed the commission.

    Boisfeuillet Jones was a correspondent of Florence Mahoney from 1961-1984.

    Interview with Dr. Stanley W Olson, Director of the Division of Regional Medical Programs 1968-70, by John Parascandola (presently a PHS historian): ". What can you tell us about how and why RMPs got started?"

    Olson: I guess the chief source of information that I had prior to becoming involved myself was in my capacity as Dean of Baylor University College of Medicine, of which Michael DeBakey was professor of surgery. As you probably know, Dr. DeBakey was the chairman of the commission that developed the report on heart disease, cancer, and stroke.

    But even prior to that time, there is some background information that might be useful. The New Yorker magazine had an interesting article called "The Noble Conspiracy." It described how Senator Lister Hill, who had oversight of both the authorization and the appropriations committee for the Senate, and Congressman John Fogerty had similar responsibility in the House, how those two worked with Dr. Jim Shannon, who was Director of NIH [National Institutes of Health], Mike DeBakey in heart disease, Sidney Farber from the Boston Children's Hospital, in cancer, Mike Gorman, who was with the Mental Health Association, and, very notably, Mary Lasker, who was very much interested in health generally. They frequently got together to talk about both legislation and appropriations, and it was often said that the budget of NIH was set by that group rather than the Congress.

    Interview with Dr. Paul Sanazaro by Diane Rehm (Rehm is presently a talk show host with NPR station WAMU in Washington DC): "Talk a little about what the RMPs were. What was the thinking behind them? How did they come into being?"

    Sanazaro: That's a tangled tale. It goes back to the late fifties. Mary Lasker at that time was a strong advocate of clinical research. She had a great deal to do with the funding of the National Institutes of Health. Late in the fifties, she became particularly focused on heart disease and cancer as very important conditions. She happened to be a close friend of the Kennedys, and she suggested to President Kennedy at that time that he look into this, but he was occupied by things like the Bay of Pigs and so forth, and nothing much came of that.

    But after Kennedy's assassination, President Johnson was also interested in these issues, and he took up this theme and appointed Michael DeBakey, who is also from Texas and Houston, as chairman of this [President's] Commission on Heart Disease, Cancer, and Stroke (now), because the senior Kennedy had had a stroke. That commission completed its work in a very short time, less than a year.

    In 1970, five of the nine original chronic disease programs were phased out: cancer, diabetes and arthritis, chronic respiratory disease, heart disease and stroke, neurological and sensory disease. This left only the RMPs, the kidney disease program, and the National Clearinghouse for Smoking and Health. However, these were peak years of funding for the program.

    National Clearinghouse for Smoking and Health Cancer Control Project Grants Active As of October 1, 1967:

    The Public Health Cigarette Smoking Act of 1969

    In 1970, the Public Health Cigarette Smoking Act of 1969 amended the 1965 law. The reports, "The Health Consequences of Smoking, A Report of the Surgeon General" of 1971 through 1980 followed.

    Criticism by Rep. David E. Satterfield, from Rep. Harley Staggers Report from committee of the Public Health Cigarette Smoking Act of 1969: "There is criticism that the Surgeon General and others have concentrated upon the single hypothesis that cigarette smoking is the cause of lung cancer, coronary heart disease, emphysema and other diseases whereas there are other hypotheses, compatible with existing data, which, it is felt, should receive equal consideration.

    "For example, there is the constitutional hypothesis based upon heredity, genetics, and emotional makeup of the individual. Some suspect that there may be a connection between these features and susceptibility to certain diseases that an individual, for example, might inherit weaknesses in certain organs that makes them susceptible to a given disease. This hypothesis is receiving particular attention today in connection with studies relating to coronary heart disease being conducted with identical twins by Dr. R___ Cederlof and others.

    "A second hypothesis holds that cancer may be caused by a virus. A third related hypothesis deals with the suspicion that cancer may be caused by an antecedent virus, and still another that emphysema may be caused by polluted air. There are many other such hypotheses. Each of these hypotheses is the subject of active research today. Certainly they deserve the same attention generated by the Surgeon General's acceptance of the cigarette hypothesis and ought not to be summarily discarded.

    "Public Health Cigarette Smoking Act of 1969 Report Together With Additional and Minority Views (To Accompany HR 6543)."Rep. Harley Staggers, House Committee on Interstate and Foreign Commerce (Dead link http://www.tobaccodocuments.org/ctr/894.html)

    The Surgeon General Reports 1971-1981

    SG Jesse Steinfeld (Dec. 18, 1969 to Jan. 20, 1973)

    (No Surgeon General)

    The Clearinghouse moves to the new Bureau of Health Education

    The National Clearinghouse for Smoking and Health was moved to the new Bureau of Health Education in the Centers for Disease Control in 1976. The Bureau was "created as an offshoot. of the President's Committee on Health Education" [in the Nixon administration, which was chaired by R. Heath Larry, with Victor Weingarten in charge of the staff]. At the Bureau, "The second part of the action has been to incorporate and continue as best we can the ongoing activities of the National Clearinghouse on Smoking and Health. The Clearinghouse, in effect, the old Clearinghouse, constitutes two of the three divisions of the new Bureau. One division is still called the National Clearinghouse on Smoking and Health, and it is carrying on the scientific and technical information and also public response services that the Clearinghouse initiated. This group is responsible for the production of the annual report to the Congress on the health consequences of smoking. It is responsible for running the Technical Inforation Center and bibliographic and library services to the world at large, both to professional and to private citizen kinds of audiences. The second piece is called the Community Program Development Division, which indeed is what it was called when it was within the Clearinghouse framework." The Bureau of Health Education allocated about $1.5 to 2 million for the Clearinghouse. (Testimony of Horace Ogden, Director of the Bureau of Health Education. Hearings Before a Subcommittee of the Committee on Appropriations, House of Representatives, 94th Congress. Feb. 20, 1976.)

    Department of Health, Education and Welfare Secretary Joseph Califano crowed about new appropriations for the Office on Smoking and Health: "Much of the authority for the activities of this new Office comes from the landmark legislation, 'The National Consumer Health Information and Health Promotion Act of 1976', which was sponsored by House Health Subcommittee Chairman Paul Rogers." The old National Clearinghouse for Smoking and Health became the nucleus of the new Office, and it got a $23 million boost in funding. (Address by Joseph A. Califano, Secreatary of HEW, Before the National Interagency Council on Smoking and Health, Jan. 11, 1978.)


    This surgeon general’s famous report alerted Americans to the deadly dangers of cigarettes

    Dozens of distinguished physicians have served as the U.S. surgeon general in our nation’s history. That said, we rarely remember their names, including the surgeon general who may have had the farthest-reaching influence on our collective health.

    That man was Luther Terry. On this day in 1964, he released an earth-shaking, 150,000-word report entitled, “Smoking and Health.”

    The study identified cigarette smoking as the chief cause of lung cancer in men (and later, as the gender gap between smokers narrowed, women too). Smoking was also named as the most important cause of chronic bronchitis in men and women and a major culprit for laryngeal cancer. Heading up a committee of 10 scientific experts, (which included five smokers and five non-smokers) Gen. Terry hammered a few more nails in the tobacco-lined coffin by declaring that smokers were 70 percent more likely to die of a fatal heart attack than nonsmokers, and that there was a strong association between cigarette smoking and cancer of the esophagus and bladder, emphysema, peptic ulcers, and premature babies.

    His conclusion was clear and chilling in a country where at least 42 percent of all adults were smokers.

    “It is the judgment of the Committee that cigarette smoking contributes substantially to mortality from certain specific diseases and to the overall death rate,” read the report.

    Unfortunately, the public’s health has long been stymied on this issue by the powerful tobacco industry, a business so ingrained in the American fabric that tobacco leaves are inscribed in stone on the façade of the U.S. Capitol building.

    Nevertheless, the brave Dr. Terry orchestrated a 14-month review of more than 7,000 scientific and public health studies on the topic, or as he referred to it, “the most comprehensive analysis ever taken.” Upon introducing this seminal document, he promised to “move promptly” in taking bold steps to “advise anyone to discontinue smoking” or, at least, recognize “the health hazard” of cigarettes. Although a number of roadblocks were put in his and his successors’ way, he was responsible for one of the most famous warnings ever made in this history of medicine and public health:

    “Cau­tion: Ci­gar­ette smoking may be haz­ard­ous to your health.”

    The following year, Congress passed legislation requiring this warning to be prominently displayed on every package of cigarettes. On July 27, 1965, President Lyndon Johnson, a notorious smoker himself, signed the act into law. Sadly, it took another six years to fully implement. In 1971, cigarette manufacturers were finally banned from advertising on television. In each of these years, and up to the present, roughly half a million or more Americans died from the results of smoking.

    It was not until the 1980s that cigarette smoking finally began to be banned from airplanes, hospitals, restaurants and other public spaces. File photo by REUTERS/Shannon Stapleton

    Cigarette manufacturers did their best (or worst) to poke holes and discredit the 1964 study’s scientific findings, which have only proved to be more ominous in the decades that followed. The tobacco industry also stepped up the marketing of their products not only to the millions of Americans who were already hooked on smoking, but also to women and minorities who had not previously taken up the habit. And they put millions of dollars into lobbying congressmen and senators to keep their products profitable and widely used. A few decades after the Terry report, the cigarette manufacturers tried to discredit subsequent scientific research on the dangers of second hand smoke and the addictive nature of nicotine. It was not until the 1980s, during the term of Surgeon General C. Everett Koop, that cigarette smoking finally began to be banned from airplanes, hospitals, restaurants and other public spaces.

    Long after Dr. Terry stepped down from his federal government appointment, he continued to warn the American public about the dangers of smoking. In 1967, for example, in his role as chairman of the National Interagency Council on Smoking and Health, he said, “The period of uncertainty is over. There is no longer any doubt that cigarette smoking is a direct threat to the user’s health. There was a time when we spoke of the smoking and health ‘controversy.’ To my mind, the days of argument are over…Today we are on the threshold of a new era, a time of action, a time for public and private agencies, community groups and individual citizens to work together to bring his hydra-headed monster under control.”

    That era came closer in the 1990s after a coalition of state attorneys general successfully sued the tobacco industry for the harm they had caused to so many addicted smokers.

    And yet, we are nowhere near ending the profitable sales of these toxic and deadly products. According to the U.S. Centers for Disease Control, cigarette smoking remains the leading cause of preventable disease and death in the United States more than 480,000 deaths every year, or one of every five deaths, are attributed to smoking. In 2015, 15 out of every 100 American adults aged 18 years or older (15.1 percent) smoked cigarettes. This means that about 36.5 million adults in the United States currently smoke cigarettes. More than 16 million Americans live with a smoking-related disease.

    We can take heart in the fact that current smoking has declined from nearly 21 of every 100 adults (20.9 percent) in 2005 to about 15 of every 100 adults (15.1 percent) in 2015. But even with the advent of electronic-cigarettes and medical treatments to stop smoking, we still have a long way to go in ending this preventable scourge.

    Take a tip from this aging doctor, if not from Surgeon General Terry: If you do smoke, get some help to kick the habit. If you have not yet picked up your first cigarette — DON’T! You will likely live longer as a result of this sound decision.

    Discarded cigarette butts are seen beneath a sidewalk grating in New York City, May 8, 2017. Photo by REUTERS/Mike Segar


    The Origins of the Office on Smoking and Health

    SG William H. Stewart (Oct. 2, 1965 to Aug. 1, 1969)

    Stewart was involved in anti-smoking since the 1955 National Health Survey, carried out by the U.S. Census Bureau. The National Opinion Research Center did opinion polls of physicians and other health personnel for the National Clearinghouse on Smoking and Health during his tenure.

    Stewart was the first to testify at the Federal Trade Commission hearing on "Proposed Rulemaking Requiring Health Warning in Cigarette Advertising," July 1, 1969. "As you know, our Department has urged this from the beginning. We supported this when it was included in the ruling which you proposed in 1964 and we have three times urged the Congress to achieve this and through legislation, in 1967, 1968, and now in 1969."

    Later, he was a member of Work Group 5, "High Priority Federal Government Initiatives," of the 1981 National Conference on Smoking or Health.

    The National Interagency Council on Smoking and Health

    "On July 13, 1964, announcement came of the formation of the National Interagency Council on Smoking and Health, later to be headed by Emerson Foote. Heading the list of national agencies and organizations are the United States Public Health Service and the American Cancer Society. They are joined by sixteen other prominent groups in the fields of health and education, all with the avowed purpose 'develop and implement plans and programs aimed at combatting smoking as a health hazard.' Signficiantly, the American Medical Association, which has not officially adopted the Surgeon General's Report, refused to accept the Council's invitation to become a member. Serving as the principal communication medium for the Council is the National Clearinghouse on Smoking and Health, a unit of the U.S. Public Health Service, and recent recipient of a $2,000,000 appropriation from Congress." "Key staff members of the Division of Chronic Diseases [CDC] play important roles in the Clearinghouse's activities: Dr. Guthrie and Dr. Daniel Horn, formerly of the American Cancer Society (Hammond-Horn Report) and now Assistant Chief of the Division's Cancer Control Branch." (Where the Industry Now Stands. Dec., 1965.)

    Emerson Foote of the American Cancer Society was chairman of the National Interagency Council on Smoking and Health, which included the American Heart Association, American Public Health Association, and National Tuberculosis Association (predecessor of the American Lung Association) as well as the American Cancer Society. (Smoking and Health Newsletter, 1965 Jul-Aug1(1). National Interagency Council on Smoking and Health, 8600 Wisconsin Avenue, Bethesda, Maryland [the address of the building built in 1962 to house the National Library of Medicine of the National Institutes of Health].)

    The National Clearinghouse for Smoking and Health began in the "Regional Medical Programs"

    The National Clearinghouse for Smoking and Health, which compiled the data for the Surgeon General reports, was established in 1965 in the "Regional Medical Programs." The legislation had been promoted by the President's Commission on Heart Disease, Cancer, and Stroke. "The president later indicated that he had created the commission 'at the insistence of the lovely lady, Mrs. Mary Lasker.'" The Commission was dominated by Mrs. Lasker's associates and friends. Dr. Michael DeBakey of Houston was the chairman. Other members included Emerson Foote, Mrs. Florence Mahoney, Dr. Sidney Farber, Dr. R. Lee Clark, Mrs. Harry Truman, whom Mary Lasker had known since the Truman White House days, and Dr. J. Willis Hurst of the Emory University Medical School, the president's personal heart specialist. Mr. Boisfeuillet Jones was a key consultant. Farber, Clark, and Dr. Frank Horsfall, of the Sloan-Kettering Institute for Cancer Research, were the principal members of the cancer subcommittee. Farber and Clark had been active in the late 1950s in organizing an association of cancer institutes. Four major cancer institutes existed then - Memorial Sloan-Kettering Cancer Institute, M.D. Anderson Hospital and Tumor Institute, Roswell Park Memorial Institute, and the National Cancer Institute's intramural laboratories and clinical research facilities." There were approximately ten other smaller centers around the country also engaged in these activities. "The legislation was introduced on January 19, 1965, and considered by Sen. Hill's subcommittee on health on February 9 and 10. The subcommittee made few changes in the proposed bill and the full committee reported the bill to the Senate on June 24. The bill was adopted by the Senate a few days later." Dr. Hugh Hussey, the American Medical Association's director of scientific activities, had resigned from the commission in 1964 "because of potential conflict between AMA policy and the commission's recommendations," and the AMA had been distracted with opposing Medicare legislation in 1965. (The Benevolent Plotters. In: Cancer Crusade: The Story of the National Cancer Act of 1971. By Richard Rettig, Joseph Henry Press 1977, pp. 35-41.)

    In 1964, anti-smoker Dr. George James was the chairman of the White House Task Force on Health, which worked in parallel with the President's Commission on Heart Disease, Cancer and Stroke. "This was not announced to the public it worked in secret." The two groups were coordinated in the office of Boisfeuillet Jones.

    From the National Library of Medicine website: "On December 6, 1991, NLM sponsored and hosted a conference titled Regional Medical Programs: Legislation and Activities in the U.S. (1965-1976). As background for the conference, print and photographic materials were assembled at NLM, and interviews of 24 individuals were videotaped. Subsequent to the conference, a website was mounted that provides transcripts of conference activities, photographs, transcripts and short clips of video interviews, digital images of selected archival materials, selections from a history of the Programs, and a bibliography." Numerous interviews refer to the activities of the Laskerites. However, there is virtually no menition of the Clearinghouse for Smoking and Health in the interviews. Like the Nazi persecution of Jews, it's something people don't talk about.

    Interview with Dr. William Kissick by Stephen P. Strickland: "The key player in the early days of RMP was -- like the voice, or its father -- was Wilbur Cohen. Wilbur Cohen was a key player in everything of the Great Society. There were two parallel activities in '64. The President's Commission on Heart Disease, Cancer and Stroke, was appointed, as I recall in March of 1964, and then in April, Johnson created a dozen task Forces to craft his agenda for the Great Society. There were people who were small on the commission, but they also had a lot of real heavyweights, some like John Gardner who chaired the education task force.

    Strickland: This was 1964? Who was the Assistant Secretary?

    Kissick: Beaufeuillet Jones. [sic - "Boisfeuillet" Jones, who was the father of the Washington Post publisher and CEO with the same name. He had been a Lasker crony since the Eisenhower administration, see Rettig p. 27: "Hill selected the members of the outside review committee with some assistance from Mary Lasker. The chairman was Boisfeullet [sic] Jones, then vice president for medical affairs at Emory University, and relatively unknown to Hill. The other members, however, included a number of stalwarts among the citizen witnesses for medical research. " [This committee reported in May 1960.]

    Strickland: He never actually held the title.

    Kissick: No, he had the title of Special assistant to the Secretary for Health and Medical Affairs. Beaufeuillet [sic] was the De Facto Assistant Secretary and his office consisted of three people: Bo, Bill Stewart, and myself. The White House task force on health had eight members and George James chaired it.

    Strickland: He was the health official of New York?

    Kissick: Yes, he, Bill Steward [sic] and I. Funny compared with Hillary's cast of 500. So there were eight members of the task force and three of us on the staff. And the link between the task force and the Commission was through Bo's office because Bo had been a member of the last two task forces.

    Strickland: A close friend of Florence Mahoney.

    Kissick: Yes, on good terms with Mary Lasker, very good terms with Senator Hill and a comfortable associate of Mike DeBakey and all of the key Lasker people. And Bo stayed as the de facto assistant secretary through the work of the commission, through the elevation and he was there when we presented the report to Johnson. Then he left to take a foundation presidency.

    Bill Stewart was really the lynch pin.

    Strickland: At that point, was he also the Surgeon General of the Public Health Service?

    Kissick: No, he was Surgeon General in October of '65, after the legislation had passed, Bill and Karl Yordie were together in the Heart Institute and they had been trying to implement the Regional Medical Programs and Bill was in the process of being recruited out to the Heart Institute when he was made assistant deputy. At that point I was in Phil Lee's office. Phil was one of the key players because as the new official assistant secretary he designed the commission.

    Boisfeuillet Jones was a correspondent of Florence Mahoney from 1961-1984.

    Interview with Dr. Stanley W Olson, Director of the Division of Regional Medical Programs 1968-70, by John Parascandola (presently a PHS historian): ". What can you tell us about how and why RMPs got started?"

    Olson: I guess the chief source of information that I had prior to becoming involved myself was in my capacity as Dean of Baylor University College of Medicine, of which Michael DeBakey was professor of surgery. As you probably know, Dr. DeBakey was the chairman of the commission that developed the report on heart disease, cancer, and stroke.

    But even prior to that time, there is some background information that might be useful. The New Yorker magazine had an interesting article called "The Noble Conspiracy." It described how Senator Lister Hill, who had oversight of both the authorization and the appropriations committee for the Senate, and Congressman John Fogerty had similar responsibility in the House, how those two worked with Dr. Jim Shannon, who was Director of NIH [National Institutes of Health], Mike DeBakey in heart disease, Sidney Farber from the Boston Children's Hospital, in cancer, Mike Gorman, who was with the Mental Health Association, and, very notably, Mary Lasker, who was very much interested in health generally. They frequently got together to talk about both legislation and appropriations, and it was often said that the budget of NIH was set by that group rather than the Congress.

    Interview with Dr. Paul Sanazaro by Diane Rehm (Rehm is presently a talk show host with NPR station WAMU in Washington DC): "Talk a little about what the RMPs were. What was the thinking behind them? How did they come into being?"

    Sanazaro: That's a tangled tale. It goes back to the late fifties. Mary Lasker at that time was a strong advocate of clinical research. She had a great deal to do with the funding of the National Institutes of Health. Late in the fifties, she became particularly focused on heart disease and cancer as very important conditions. She happened to be a close friend of the Kennedys, and she suggested to President Kennedy at that time that he look into this, but he was occupied by things like the Bay of Pigs and so forth, and nothing much came of that.

    But after Kennedy's assassination, President Johnson was also interested in these issues, and he took up this theme and appointed Michael DeBakey, who is also from Texas and Houston, as chairman of this [President's] Commission on Heart Disease, Cancer, and Stroke (now), because the senior Kennedy had had a stroke. That commission completed its work in a very short time, less than a year.

    In 1970, five of the nine original chronic disease programs were phased out: cancer, diabetes and arthritis, chronic respiratory disease, heart disease and stroke, neurological and sensory disease. This left only the RMPs, the kidney disease program, and the National Clearinghouse for Smoking and Health. However, these were peak years of funding for the program.

    National Clearinghouse for Smoking and Health Cancer Control Project Grants Active As of October 1, 1967:

    The Public Health Cigarette Smoking Act of 1969

    In 1970, the Public Health Cigarette Smoking Act of 1969 amended the 1965 law. The reports, "The Health Consequences of Smoking, A Report of the Surgeon General" of 1971 through 1980 followed.

    Criticism by Rep. David E. Satterfield, from Rep. Harley Staggers Report from committee of the Public Health Cigarette Smoking Act of 1969: "There is criticism that the Surgeon General and others have concentrated upon the single hypothesis that cigarette smoking is the cause of lung cancer, coronary heart disease, emphysema and other diseases whereas there are other hypotheses, compatible with existing data, which, it is felt, should receive equal consideration.

    "For example, there is the constitutional hypothesis based upon heredity, genetics, and emotional makeup of the individual. Some suspect that there may be a connection between these features and susceptibility to certain diseases that an individual, for example, might inherit weaknesses in certain organs that makes them susceptible to a given disease. This hypothesis is receiving particular attention today in connection with studies relating to coronary heart disease being conducted with identical twins by Dr. R___ Cederlof and others.

    "A second hypothesis holds that cancer may be caused by a virus. A third related hypothesis deals with the suspicion that cancer may be caused by an antecedent virus, and still another that emphysema may be caused by polluted air. There are many other such hypotheses. Each of these hypotheses is the subject of active research today. Certainly they deserve the same attention generated by the Surgeon General's acceptance of the cigarette hypothesis and ought not to be summarily discarded.

    "Public Health Cigarette Smoking Act of 1969 Report Together With Additional and Minority Views (To Accompany HR 6543)."Rep. Harley Staggers, House Committee on Interstate and Foreign Commerce (Dead link http://www.tobaccodocuments.org/ctr/894.html)

    The Surgeon General Reports 1971-1981

    SG Jesse Steinfeld (Dec. 18, 1969 to Jan. 20, 1973)

    (No Surgeon General)

    The Clearinghouse moves to the new Bureau of Health Education

    The National Clearinghouse for Smoking and Health was moved to the new Bureau of Health Education in the Centers for Disease Control in 1976. The Bureau was "created as an offshoot. of the President's Committee on Health Education" [in the Nixon administration, which was chaired by R. Heath Larry, with Victor Weingarten in charge of the staff]. At the Bureau, "The second part of the action has been to incorporate and continue as best we can the ongoing activities of the National Clearinghouse on Smoking and Health. The Clearinghouse, in effect, the old Clearinghouse, constitutes two of the three divisions of the new Bureau. One division is still called the National Clearinghouse on Smoking and Health, and it is carrying on the scientific and technical information and also public response services that the Clearinghouse initiated. This group is responsible for the production of the annual report to the Congress on the health consequences of smoking. It is responsible for running the Technical Inforation Center and bibliographic and library services to the world at large, both to professional and to private citizen kinds of audiences. The second piece is called the Community Program Development Division, which indeed is what it was called when it was within the Clearinghouse framework." The Bureau of Health Education allocated about $1.5 to 2 million for the Clearinghouse. (Testimony of Horace Ogden, Director of the Bureau of Health Education. Hearings Before a Subcommittee of the Committee on Appropriations, House of Representatives, 94th Congress. Feb. 20, 1976.)

    Department of Health, Education and Welfare Secretary Joseph Califano crowed about new appropriations for the Office on Smoking and Health: "Much of the authority for the activities of this new Office comes from the landmark legislation, 'The National Consumer Health Information and Health Promotion Act of 1976', which was sponsored by House Health Subcommittee Chairman Paul Rogers." The old National Clearinghouse for Smoking and Health became the nucleus of the new Office, and it got a $23 million boost in funding. (Address by Joseph A. Califano, Secreatary of HEW, Before the National Interagency Council on Smoking and Health, Jan. 11, 1978.)


    History of the Surgeon General’s Reports on Smoking and Health

    The release of the report was the first in a series of steps, still being taken more than 40 years later, to diminish the impact of tobacco use on the health of the American people.

    For several days, the report furnished newspaper headlines across the country and lead stories on television newscasts. Later it was ranked among the top news stories of 1964.

    During the more than 40 years that have elapsed since that report, individual citizens, private organizations, public agencies, and elected officials have pursued the Advisory Committee’s call for “appropriate remedial action.”

    Early on, the U.S. Congress adopted the Federal Cigarette Labeling and Advertising Act of 1965 and the Public Health Cigarette Smoking Act of 1969. These laws—

    • Required a health warning on cigarette packages
    • Banned cigarette advertising in the broadcasting media
    • Called for an annual report on the health consequences of smoking

    In September 1965, the Public Health Service established a small unit called the National Clearinghouse for Smoking and Health.

    Through the years, the Clearinghouse and its successor organization, the Centers for Disease Control and Prevention’s Office on Smoking and Health, have been responsible for 29 reports on the health consequences of smoking.

    In close cooperation with voluntary health organizations, the Public Health Service has—

    • Supported successful state and community programs to reduce tobacco use
    • Disseminated research findings related to tobacco use
    • Ensured the continued public visibility of antismoking messages

    Within this evolving social milieu, the population has given up smoking in increasing numbers. Nearly half of all living adults who ever smoked have quit.

    The antismoking campaign is a major public health success with few parallels in the history of public health. It is being accomplished despite the addictive nature of tobacco and the powerful economic forces promoting its use.

    However, more than 45 million American adults still smoke, more than 8 million are living with a serious illness caused by smoking, and about 438,000 Americans die prematurely each year as a result of tobacco use.

    Efforts to implement proven interventions must be continued and expanded.


    Watch the video: Αδιόρθωτοι 18ο Επεισόδιο: Κάπνισμα