On this day in medical history: Smoking declared a health hazard

On January 11, 1964, Surgeon General Luther L. Terry, MD, released a report that “hit the country like a bombshell,” he later recalled. The report affirmed that smoking cigarettes caused higher mortality in smokers as well as an increased incidence of lung cancer, chronic bronchitis, and emphysema.

The Surgeon General chose a Saturday to release the report to minimize the effect on the stock market and to maximize coverage in Sunday newspapers.

“It was front page news and a lead story on every radio and television station in the United States and many abroad,” Dr. Terry said in later years.

More than 70 million Americans at that time—about 42% of the national population—were regular tobacco users.

Seeking a solution

The report, “Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service,” got its start a few years earlier when the American Cancer Society, the American Heart Association, the National Tuberculosis Association, and the American Public Health Association joined forces to send a letter to President John F. Kennedy in June 1961. In the letter, these medical organizations called for a national commission on smoking, charged with “seeking a solution to this health problem that would interfere least with the freedom of industry or the happiness of individuals.”

A year later, Dr. Terry—the Kennedy administration’s recently-appointed Surgeon General—announced that he would convene an advisory committee to conduct a comprehensive review of the scientific literature on smoking. Ten experts—representing a variety of disciplines in medicine, surgery, pharmacology, and statistics—were finally chosen for the committee. Between November 1962 and January 1964, these experts reviewed more than 7,000 scientific articles with the help of at least 150 consultants.

Smoking causes cancer

Here are some of the advisory committee’s principal findings, as stated in the 387-page report:

• “Cigarette smoking is associated with a 70% increase in the age-specific death rates of males, and to a lesser extent with increased death rates of females…The death rates increase with the amount smoked.”

• “Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking far outweighs all other factors. The data for women, though less extensive, point in the same direction.”

• “The risk of developing lung cancer increases with duration of smoking and the number of cigarettes smoked per day, and is diminished by discontinuing smoking. In comparison with non-smokers, average male smokers of cigarettes have approximately a 9- to 10-fold risk of developing lung cancer and heavy smokers at least a 10-fold risk.”

• “Cigarette smoking is the most important of the causes of chronic bronchitis in the United States, and increases the risk of dying from chronic bronchitis and emphysema.”

• “[M]ale cigarette smokers have a higher death rate from coronary artery disease than non-smoking males.”

Kicking the cigarette habit in the butt

Almost every year since the first one in 1964, the Surgeon General has released a new report on the health effects of smoking. In 1965, Congress required that all cigarette packages in the United States carry a health warning; since 1970, this warning has been made in the name of the Surgeon General. In 1969, cigarette advertising on television and radio was banned, which took effect in September 1970.

But more than provoking regulations, the Surgeon General’s report has saved millions of lives and lengthened the lives of those who kicked the habit. A 2014 JAMA article—released on the 50th anniversary of the Surgeon’s Generals first report on smoking—estimated that about 8 million premature deaths due to smoking had been prevented since 1964. This resulted in an estimated 157 million years of life that were saved—an average of 19.6 years per beneficiary.

But, the effort continues. Although cigarette smoking rates are less than half what they were in 1965, nearly 40 million American adults still smoke cigarettes, and cigarette smoking remains the leading preventable cause of death in the US.

On January 9, 2018, the Centers for Disease Control and Prevention’s (CDC) anti-smoking campaign, Tips From Former Smokers™, began its sixth year. At least half a million Americans have quit cigarettes for good because of the campaign, CDC estimated.

Click here to read the original 1964 “Smoking and Health” report from the Surgeon General’s Advisory Committee.