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SMOKING AND CANCER

The Government Examines Smoking

While scientists and physicians were generally convinced of the link between cancer and cigarettes by the early 1960s, the government was not. Political pressure from congressmen representing states where tobacco was grown delayed a Public Health Service report on the subject. In 1962 President John F. Kennedy asked U.S. Surgeon General Luther L. Terry to resolve the matter. Terry appointed a committee of ten, including three cigarette smokers, one cigar smoker, and one pipe smoker to review the findings of others rather than conduct their own research. Over a period of nearly two years committee members pored over eight thousand articles in the National Medical Library in Bethesda, Maryland. During the course of the inquiry Terry, who smoked cigarettes when the study started, switched to a pipe.

The Results

The report of the surgeon general was presented in the auditorium of the old State Department building on a Saturday morning, when the stock exchanges were closed, so that the findings would not have an immediate effect on tobacco company prices. The 387-page, 150,000-word report had disastrous news about the dangers of smoking. The committee found that cigarette smoking increased the rate of death and caused serious illnesses such as heart disease and emphysema. Findings were based on the number of cigarettes smoked and the number of years of smoking; there was not yet enough evidence to determine if filtered versus unfiltered cigarettes made a difference. Interestingly, former smokers seemed to face reduced risk from smoking-related illnesses. Smoking pipes and cigars seemed to raise slightly the risk of developing (rare) lip cancer but other-wise seemed less hazardous than cigarettes. The only benefit of smoking found was the psychological pleasure it gave smokers. The surgeon general's Advisory Committee on Smoking and Health advised that "appropriate remedial action is warranted."

Tobacco Industry Opposition

Tobacco industry groups quickly pointed out that a statistical association did not prove cause and effect. The committee agreed but noted they had used more than a statistical association to reach their conclusions. They had relied on animal studies, human autopsy studies, and clinical evaluations on noncancer patients, as well as epidemiological (statistical) studies. Growers and marketers of the $8-billion-per-year tobacco industry were not satisfied and decided to take the fight into the political arena.

The Report's Impact

An immediate effect was noted on cigarette sales. Sales decreased by 10 percent after release of the report, but this decline was temporary. Total 1964 sales of cigarettes were only about 3 percent less than 1963 sales. Tobacco company stocks fell initially, but prices then rose again to previous levels. Overall there was some reduction in smoking. Only 52 percent of American males smoked cigarettes in 1964 compared to 59 percent in 1955. Among senior medical students only 55 percent smoked in 1964; 44 percent had quit smoking.

Caveat Emptor

Various bills were proposed in Congress after the 1964 report, including a requirement that the tobacco industry provide a warning to consumers. This bill was opposed by southern (tobacco state) legislators, and a compromise was reached that required manufacturers to place the words "Caution: Cigarette smoking may be hazardous to your health" on cigarette packs beginning 1 January 1966. President Johnson gave a speech to Congress on health priorities in 1965 in which he proposed action on all major diseases, but he failed to mention cigarette smoking.

Advertising Ban?

The National Interagency Council on Smoking and Health, composed of representatives from twelve voluntary health agencies and three government agencies, was chaired by Emerson Foote, a former advertising executive who had worked for the tobacco industry, In the wake of the surgeon general's report the council recommended a total ban on cigarette advertising. The American Medical Association (AMA) opposed that action as being taken too hastily. It later became known that the AMA had received a large grant from the tobacco industry to conduct a five-year study of smoking and health.