Chirurg se algemene verslae oor rook - geskiedenis

Chirurg se algemene verslae oor rook - geskiedenis

(4/10/63) In die ergste na-oorlogse Amerikaanse duikbootramp het die USS Tresher in die Altantic gesink met alle mense aan boord. Nie een van die mans is teruggevind nie. (1/16/64) Die chirurg -generaal van die Verenigde State het 'n verslag uitgereik waarin gerapporteer word dat sigaretrook 'n duidelike gesondheidsgevaar vir rokers inhou. So het 'n gesamentlike poging begin om rook in die Verenigde State te verminder.

Hoe 'n waarskuwing 'n nasie gehelp het om die gewoonte af te skop

Voorstanders van gesondheid vier die 50ste herdenking van die 1964 -chirurg -generaal se verslag oor rook met 'n oproep om meer aggressiewe optrede om mense teen tabak te beskerm.

Daardie belangrike verslag, tesame met die daaropvolgende verslae van die chirurg -generaal oor die verslawingskrag van nikotien en die gevare van tweedehandse rook, het gelei tot 'n seeverandering in die land se houding teenoor tabak. Rooksyfers het met 59%gedaal, en baie gemeenskappe verbied rook op openbare plekke.

Geen ander enkele verslag het so 'n groot uitwerking op die openbare gesondheid gehad nie, sê Thomas Frieden, direkteur van die Centers for Disease Control and Prevention.

'Ek kan aan niks anders dink wat naby gekom het nie,' sê Theodore Holford, professor aan die Yale University School of Public Health.

Maar met soveel bewyse van die skade aan rook - wat kanker, hartaanvalle, beroertes en 'n magdom ander siektes veroorsaak - sê sommige advokate dat die land baie verder moet gaan.

"Die 50ste herdenking van die verslag van die Chirurg-generaal behoort 'n katalisator te wees om te sê: 'Ons kan nie nog 50 jaar wag om die dood en siektes wat deur rook veroorsaak word' te beëindig nie, 'sê Matthew Myers, president van die Campaign for Tobacco-Free Kids, 'n voorspraakgroep.

Byna 42 miljoen Amerikaners rook steeds, volgens die CDC. Meer as 5 miljoen mense wêreldwyd sterf jaarliks ​​aan rookverwante siektes, volgens 'n hoofartikel deur dokters Steven Schroeder en Howard Koh in Dinsdag se Tydskrif van die American Medical Association.

Elke dag haal meer as 3 000 tieners hul eerste sigarette op, sê Robin Koval, president en hoof uitvoerende beampte van Legacy, 'n groep teen rokers wat gestig is deur die hoofooreenkomsooreenkoms tussen tabakmaatskappye en staatsadvokate in 1998.

In sommige opsigte is die bestryding van tabak selfs meer uitdagend as die bestryding van aansteeklike siektes, het Frieden in 'n onderhoud gesê. Frieden het opgemerk dat meer mense sou ophou rook het as dit nie was vir aggressiewe pogings deur die tabakbedryf om mense verslaaf te hou nie.

'Ek het meer as 'n dekade lank aan tuberkulose beheer gewerk,' het Frieden gesê. "Maar tuberkulose het nie 'n lobby wat werk teen die beheer van tuberkulose nie."

Die tabakbedryf werk steeds hard daaraan om mense sy produkte te laat gebruik, en bestee meer as $ 8 miljard per jaar aan bemarking in die VSA alleen, volgens Schroeder en Koh se hoofartikel.

In 'n verwante hoofartikel merk Frieden op dat nuwe produkte, soos elektroniese sigarette, sowel geleenthede as risiko's inhou. Sommige gesondheidsleiers sê dat elektroniese sigarette - wat nikotien bevat, maar geen tabak - rokers kan help om op te hou. Maar Frieden sê hy is bekommerd dat e-sigarette die aantal mense wat aan nikotien verslaaf is, kan toeneem deur kinders aan te trek. Frieden is ook bekommerd dat e-sigarette sommige rokers kan laat staak, omdat hulle hul gewoontes kan toelaat, selfs in rookvrye gebiede.

Voorstanders van gesondheid merk egter ook op dat die kulturele landskap rondom rook sedert die 1960's geweldig verander het.

Destyds kon passasiers op enige vliegtuig rook, en stewardesses het gratis sigarette saam met etes uitgedeel. Skoolkinders het asbakkies gemaak vir moedersdaggeskenke.

Tabakondernemings vorm een ​​van die kragtigste nywerhede ter wêreld en gebruik sterre soos Ronald Reagan, Humphrey Bogart en Louis Armstrong om hul produkte te verkoop.

Vandag is tabakmaatskappye 'veroordeelde afpersers', sê Stanton Glantz, 'n professor aan die Universiteit van Kalifornië-San Francisco, met verwysing na die uitspraak van 2006 deur die Amerikaanse distriksregter Gladys Kessler, wat bevind het dat tabakmaatskappye die Amerikaanse volk bedrieg het deur te lieg oor die gesondheidsrisiko's van rook.

UCSF se argief bevat 82 miljoen bladsye tabak-industrie dokumente, waarin sigaretmakers se strategieë vir bemarking aan kinders onthul word en die feit dat hulle geweet het dat sigarette kanker en nikotien veroorsaak, is verslawend.

Die chirurg -generaal in 1964, Luther Terry, beskryf die uitwerking van die verslag as 'n 'bom'.

Destyds, en dekades daarna, het die tabakbedryf probeer om 'gate te steek' in navorsing wat die nadele van rook dokumenteer, sê Frieden.

Volgens die verslag van die chirurg -generaal, 'was dit die eerste keer dat die regering sê:' Nee. Daar is geen twyfel dat rook kanker veroorsaak nie ',' sê Frieden.

Die gevolgtrekkings van die verslag - gebaseer op meer as 7 000 dokumente - is byna almal byna onmiddellik aanvaar, behalwe die tabakbedryf, sê Myers.

Amerikaanse houding teenoor die veiligheid van rook het vinnig verander.

In 1958 het slegs 44% van die Amerikaners geglo dat rook longkanker veroorsaak, volgens 'n Gallup -opname. Teen 1968 het die persentasie tot 78%gestyg.

In 1965 het die Kongres wetgewing goedgekeur wat die nou bekende "waarskuwing van die chirurg" op sigaretpakkette vereis, hoewel dit ses jaar geneem het om dit in werking te stel. In 1971 het sigaretmakers opgehou om op TV te adverteer.

"Die tabakbedryf het gedink dat hulle net verpletter sou word," sê Glantz, skrywer van 'n geskiedenis van die tabakbedryf genaamd Die sigaretpapiere. "Die regering en ander het nie die moed gehad om te doen wat die tabakbedryf gevrees het nie, wat met groot regulasies vorendag kom. Politiek het nog altyd die tabakbedryf gered."

Die tabakbedryf het ook hard geveg om sy besigheid te beskerm, sê Glantz en vergelyk die stryd oor rook met 'loopgraafoorlog'. Hy merk op dat die tabakbedryf jare lank vals navorsing befonds het wat daarop dui dat sigarette en tweedehandse rook veilig is.

Rookpryse het in die eerste paar jaar na die vrystelling van die verslag van die Chirurg-generaal kortliks gestyg, aangesien die tabakbedryf advertensies vir vroue en minderhede verhoog het, sê Mark Pertschuk, 'n jarelange aktivis teen tabak en direkteur van die voorspraakgroep Grassroots Change. .

Dit was nog 'n chirurg -generaal, C. Everett Koop, wat 'ons regtig gebring het waar ons vandag is', sê Otis Brawley, mediese hoof van die American Cancer Society.

In 1986 het Koop 'n chirurg-algemene verslag oor "onwillekeurige rook" of tweedehandse rook uitgereik, wat die wetenskaplike basis bied vir die beskerming van nie-rokers teen tabak, sê Brawley.

'Toe mense besef dat rook meer as net die roker seermaak, het dit gelei tot verandering,' sê Brawley.

Stuurpersoneel soos Kate Jewell - gedwing om rokerige, hersirkuleerde lug in te asem tydens lang vliegtuie - het 'n beroep op rookverbod op vliegtuigvlugte gedoen. Jewell onthou bruin water wat uit die lugopeninge drup. 'Dit was so rokerig dat u nie van die een kant van die kajuit na die ander kon sien nie,' sê Jewell.

Lank voordat die navorsing voltooi is, sê Jewell dat sy en haar medevliegtogte geweet het dat passiewe rook giftig is. Jewell, wie se loopbaan van 1970 tot 2007 strek, onthou dat sy haar lugdiens uniform in die motorhuis gehou het omdat dit te vreeslik ruik om in haar huis toe te laat.

'Ek sou by die motorhuis inklim en afsny voordat ek by my huis ingaan, want ek wou dit nie in my huis inbring nie,' sê Jewell (64) van Orcas Island, Wash.

In 1989 het die Kongres rook op binnelandse vlug verbied. Gemeenskappe regoor die land het ook begin om binnenshuise rook te verbied.

Namate minder Amerikaners rook, begin die gety na skoner lug draai.

Die beeld van die tabakbedryf het in die 1990's 'n pak slae gekry, met die lek van bedryfsdokumente wat toon dat sigaretondernemings bewyse het dat nikotien verslawend is, sê Glantz.

Maar die bedryf het nie weggegaan nie.

Tabakmaatskappye gaan steeds teen tabakbelasting en rookverbod teen. Hulle beveg ook nog steeds die implementering van die 2006 -uitspraak oor afpersing, wat vereis het dat hulle advertensieveldtogte moet finansier waarin hulle erken dat hulle gelieg het oor die verslawing van nikotien, sê Glantz.

'Dit word nog steeds in die howe bestry,' sê Glantz. 'Die bedryf is nog steeds so aggressief as wat dit kan wees.'

R.J. Reynolds, een van die voorste tabakmaatskappye, wou nie kommentaar lewer nie.

David Sylvia, 'n woordvoerder van Altria, die moedermaatskappy van die tabakreus Philip Morris, het gesê sy maatskappy verwelkom regulering. Sylvia het gesê Altria stel geen belang in bemarking aan kinders nie, en hoop net om sy sigarette aan huidige rokers te verkoop.

"Die rede dat tabak so 'n probleem bly, is nie omdat die Amerikaanse publiek nie daarop reageer het nie" op die waarskuwing van die chirurg -generaal, sê Myers. 'Dit is omdat die tabakbedryf sy ekonomiese, wetenskaplike en politieke mag gebruik het.'

Die tabakbedryf het tegnologiese verbeterings in byvoorbeeld sigarette aangebring om hulle minder hard te maak, sodat nuwe rokers nie soveel hoes as in die verlede nie. Dit maak sigarette meer aantreklik vir kinders en eerste gebruikers, sê Myers. Die bedryf verkoop ook steeds sigarette met mentholgeur, wat die hardheid van tabak met 'n mintgeur bedek. 'Vyftig jaar later lyk sigarette slanker, maar dit is nie veiliger nie,' sê Myers.

Myers en ander sê hulle is teleurgesteld dat die Food and Drug Administration nog nie menthol -sigarette verbied het nie, hoewel die Kongres hom die mag gegee het om tabak te reguleer.


Die verslag van 1964 oor rook en gesondheid

Geen enkele kwessie het die Chirurge -generaal van die afgelope vier dekades meer as rook gerig nie. Die verslae van die chirurg-generaal het die land gewaarsku oor die gesondheidsrisiko van rook, en die probleem is verander van 'n individuele en verbruikerskeuse na epidemiologie, openbare gesondheid en die risiko vir rokers en nie-rokers.

Die debat oor die gevare en voordele van rook het dokters, wetenskaplikes, regerings, rokers en nie-rokers verdeel sedert Tabak nicotiana Dit is in die sestiende eeu vir die eerste keer uit sy geboorteland in Amerika na Europa ingevoer. 'N Dramatiese toename in sigaretrook in die twintigste eeu in die Verenigde State roep bewegings teen rook op. Hervormers, higiëniste en amptenare vir openbare gesondheid het aangevoer dat rook algemene ongemak, fisiologiese wanfunksie en 'n afname in geestelike en fisiese doeltreffendheid teweeggebring het. Bewyse van die slegte gevolge van rook het gedurende die 1930's, 1940's en 1950's opgehoop. Epidemioloë het statistieke en grootskaalse, langtermyn-ondersoeke gebruik om die toename in sterftes in longkanker aan rook te koppel. Patoloë en laboratoriumwetenskaplikes het die statistiese verband tussen rook en longkanker sowel as ander ernstige siektes, soos brongitis, emfiseem en koronêre hartsiektes, bevestig. Rook, het hierdie studies voorgestel, en nie lugbesoedeling, asbesbesmetting of radioaktiewe materiale nie, was die hoofoorsaak van die epidemiese styging van longkanker in die twintigste eeu. Op 12 Junie 1957 verklaar chirurg -generaal Leroy E. Burney dit as die amptelike standpunt van die Amerikaanse openbare gesondheidsdiens dat die getuienis dui op 'n oorsaaklike verband tussen rook en longkanker.

Die impuls vir 'n amptelike verslag oor rook en gesondheid kom egter van 'n alliansie van prominente private gesondheidsorganisasies. In Junie 1961 het die American Cancer Society, die American Heart Association, die National Tuberculosis Association en die American Public Health Association 'n brief gerig aan president John F. Kennedy, waarin hulle 'n nasionale rookkomissie opdrag gee om 'n 'n oplossing vir hierdie gesondheidsprobleem wat die minste sou inmeng met die vryheid van die industrie of die geluk van individue. Op 7 Junie 1962 het die aangestelde chirurg -generaal Luther L. Terry onlangs aangekondig dat hy 'n komitee van deskundiges sal belê om 'n omvattende oorsig van die wetenskaplike literatuur oor die rookvraag te doen. Terry het verteenwoordigers van die vier vrywillige mediese organisasies wat die kommissie eers voorgestel het, asook die Food and Drug Administration, die Federal Trade Commission, die American Medical Association en die Tobacco Institute (die lobby -arm van die tabakbedryf) genooi om aan te wys kommissielede. Tien is uiteindelik gekies, wat 'n wye reeks dissiplines in medisyne, chirurgie, farmakologie en statistiek verteenwoordig, alhoewel geen in die sielkunde of die sosiale wetenskappe nie. Kandidate kwalifiseer slegs as hulle geen vorige standpunt oor die gebruik van tabak ingeneem het nie.

Die komitee het van November 1962 tot Januarie 1964 by die National Library of Medicine op die kampus van die National Institutes of Health in Bethesda, Maryland, vergader en meer as 7 000 wetenskaplike artikels met behulp van meer as 150 konsultante hersien. Terry het die kommissieverslag op 11 Januarie 1964 uitgereik en 'n Saterdag gekies om die effek op die aandelemark te verminder en die dekking in die Sondagkoerante te maksimeer. Terwyl Terry die gebeurtenis onthou het, het die verslag twee dekades later die land soos 'n bom opgehou. Dit was nuus op die voorblad en 'n hoofverhaal op elke radio- en televisiestasie in die Verenigde State en baie in die buiteland. & Quot

Die verslag beklemtoon die nadelige gevolge vir die gesondheid van tabakgebruik. Rook en gesondheid: Verslag van die advieskomitee aan die chirurg -generaal het sigaretrook verantwoordelik gehou vir 'n styging van 70 persent in die sterftesyfer van rokers as nie-rokers. Die verslag beraam dat gemiddelde rokers 'n nege tot tienvoudige risiko het om longkanker te ontwikkel in vergelyking met nie-rokers: swaar rokers het minstens 'n twintigvoudige risiko. Die risiko het gestyg met die duur van rook en verminder met die staking van rook. Die verslag noem ook rook as die belangrikste oorsaak van chroniese brongitis en dui op 'n verband tussen rook en emfiseem, en rook en koronêre hartsiektes. Dit het opgemerk dat rook tydens swangerskap die gemiddelde gewig van pasgeborenes verminder. Die komitee het oor 'n kwessie gesê: nikotienverslawing. Dit het daarop aangedring dat die & quottobacco -gewoonte eerder as 'n verslawing as 'n verslawing gekenmerk moet word, deels omdat die verslawende eienskappe van nikotien nog nie ten volle verstaan ​​is nie, deels as gevolg van verskille oor die betekenis van verslawing.

Die verslag van 1964 oor rook en gesondheid het 'n impak op die openbare houding en beleid gehad. 'N Gallup -opname wat in 1958 uitgevoer is, het bevind dat slegs 44 persent van die Amerikaners geglo het dat rook kanker veroorsaak het, terwyl 78 persent dit in 1968 geglo het. Terry's 1964 meld openbare resonansie. Alhoewel die verslag verklaar dat 'sigaretrook' 'n gesondheidsgevaar van voldoende belang is in die Verenigde State om gepaste regstellende maatreëls te regverdig, 'het dit stilgebly oor konkrete middels. Die uitdaging het politici te beurt geval. In 1965 het die kongres vereis dat alle sigaretpakkette wat in die Verenigde State versprei is, 'n gesondheidswaarskuwing moet dra, en sedert 1970 word hierdie waarskuwing in die naam van die chirurg -generaal gemaak. In 1969 is sigaretreklame op televisie en radio verbied, met ingang van September 1970.


Metodes

Twee verslae van die chirurg -generaal oor rook en gesondheid wat op verskillende tydstip (1964 en 1982) [1, 24] oorsaaklike kriteria op die vier kankers toegepas het [1, 24], vorm die basis van ons ondersoek. Ons het hierdie twee verslae gekies omdat dit dieselfde oorsaakkriteria toegepas het, maar ook 'n tydperk is waarin bewyse wat rook en sommige kankers verbind, aansienlik toegeneem het. Ons het gekies om die bewyse vir die oorsaaklike rol van rook in die ontwikkeling van kanker op vier plekke te ondersoek, veral waarvoor voldoende bewyse beskikbaar was om die oorsaaklike kriteria toe te pas: long, larinks, slukderm en blaas.

Beide die verslae van 1964 en 1982 dokumenteer hul evaluering van kousaliteit aan die hand van dieselfde vyf oorsaaklike kriteria: konsekwentheid, sterkte, spesifisiteit, tydelike verhouding en samehang. Koherensie was 'n breë kategorie wat bepaal het of al die bewyse saamgevoeg is, insluitend inligting oor dosisrespons, sterftetendense en biologiese aanneemlikheid. Definisies wat vir hierdie kriteria gegee word, is in beide verslae in wese dieselfde, alhoewel die definisies wat in die verslag van 1982 verskaf is, deegliker is. Ons interpretasie van die toepassing van die oorsaaklike kriteria berus egter grootliks op beskrywings in die verslae. Amptelike rekords in die nasionale argief van die advieskomitee van die chirurg -generaal oor rook en gesondheid, wat die verslag van 1964 opgestel het, het geen bykomende besonderhede oor die oorsaaklike redenasie van die komitee gegee nie. [25]

In beide verslae was data oor kohortsterfte en gevallebeheerstudie beskikbaar vir alle kankers. Om die bewyse van saakbeheer wat beskikbaar was vir die komitees van 1964 en 1982 duidelik op te som, het ons ons eie saamgevoegde ontleding van die saakbeheerdata gedoen. Alhoewel die twee komitees nie van formele, kwantitatiewe meta-analitiese instrumente gebruik gemaak het om die saakbeheerdata te beoordeel nie, doen ons dit met die doel om die gegewens op 'n eenvoudige manier voor te stel aan die leser wat moontlik nie so vertroud is met die data soos die outeurs van die verslae was. Ons volg die verslae van die Chirurg-generaal in die bespreking van gevallebeheer en kohortdata afsonderlik eerder as om verskillende tipes studies saam te voeg. Die verslae het nie p-waardes of vertrouensintervalle verskaf tydens die opsomming van data nie, en hulle het nie konsekwent gerapporteer of positiewe resultate statisties beduidend was nie. Ons het nie 'n soortgelyke saamgestelde analise vir die kohortdata gedoen nie, omdat sommige van hierdie studies destyds nog nie gepubliseer is nie, hoewel die komitee toegang tot die rou data vir sommige studies gehad het, maar dit was nie vir ons beskikbaar nie. Die verslag van 1964 bevat egter 'n eenvoudige, onaangepaste saamgestelde analise van kohortdata waarop ons gebruik maak.

Ons het alle oorspronklike navorsingsdokumente gekry vir die gevalle-kontrole-studies wat in die verslae genoem word, as studies oor sigaretrook en die vier kankers. Ons het meta-analises uitgevoer op die gepubliseerde data uit die gevalbeheerstudies met behulp van die DerSimonian-Laird metode [26]. Ons het die gevallebeheerstudies wat slegs vroue ingesluit het, uitgesluit, aangesien die rookgewoontes vir mans en vroue destyds heel anders was, en ons het studies uitgesluit wat nie die aantal gevalle en kontroles en die aantal rokers en nie-rokers in hierdie groepe aangemeld het nie, Aangesien dit byvoorbeeld nie die berekening van 'n kansverhouding moontlik gemaak het nie, het sommige vraestelle slegs persentasies of verhoudings gerapporteer sonder om die werklike getalle te verskaf wat gebruik is om dit te bereken. Sewe uit 61 studies (11%) is uitgesluit vir onvoldoende data. Die studies bevat 'n uiteenlopende reeks data-insamelings- en rapporteringsprosedures om rookstatus te beskryf in hierdie studie, vergelykings is slegs tussen rokers en nie-rokers gemaak. Skattings is nie aangepas vir ouderdom of ander moontlike verwarrers nie.

Afsonderlike meta-ontledings is vir elke kankerplek gedoen, naamlik long, slukderm, larinks en blaas, en opsommingskansverhoudings en vertrouensintervalle is verkry. Daarbenewens is afsonderlike meta-ontledings uitgevoer vir blaas- en slukdermkanker vir die studies wat in die 1964-verslag ingesluit is en die wat in die 1982-verslag ingesluit is. Elkeen van die ses meta-ontledings is grafies saamgevat deur boksplotte wat die samevattende kansverhouding en vertrouensinterval vir elke meta-analise toon.


Inhoud

Gebruikers, mediese kundiges en regerings het die gesondheidsgevolge van tabak bespreek sedert die bekendstelling daarvan in die Europese kultuur. [1] Harde bewyse vir die slegte gevolge van rook het aan die lig gekom met die resultate van verskeie langtermynstudies in die vroeë tot middel van die twintigste eeu, soos die epidemiologiese studies van Richard Doll en patologiese studies van Oscar Auerbach. Op 12 Junie 1957 verklaar die destydse chirurg-generaal Leroy Burney "die amptelike standpunt van die Amerikaanse openbare gesondheidsdiens dat die getuienis dui op 'n oorsaaklike verband tussen rook en longkanker". [1] 'n Komitee van die Royal College of Physicians van die Verenigde Koninkryk het op 7 Maart 1962 'n verslag uitgereik [3] wat "sigaretrook duidelik as 'n oorsaak van longkanker en brongitis beskuldig" en aangevoer het dat "dit waarskynlik bygedra het tot kardiovaskulêre siektes ook." [4] Na druk van die American Cancer Society, die American Heart Association, die National Tuberculosis Association en die American Public Health Association, het president John F. Kennedy toestemming verleen dat chirurg -generaal Terry die advieskomitee stig. Die komitee het van November 1962 tot Januarie 1964 vergader en meer as 7 000 wetenskaplike artikels en referate ontleed.

Die advieskomitee van die chirurg -generaal oor rook en gesondheid: [5]

  • Stanhope Bayne-Jones, M.D., LL.D. (Afgetree).
    • Voormalige dekaan. Yale School of Medicine (1935–40), voormalige president. Gesamentlike bestuursraad. Cornell Universiteit. New York Hospital Medical Center (1947–52): voormalige president. Society of American Bacteriologists (1929). en American Society of Pathology and Bacteriology (1940). Veld: Aard en oorsaak van siektes by mense.
    • Hoof van die Departement Chirurgie. Universiteit van Utah, Skool vir Geneeskunde. Salt Lake City. Gebiede: Genetika vir kliniese en eksperimentele chirurgie.
    • Professor in Statistiek. Harvard Universiteit. Veld: Wiskundige statistiek met: Spesiale toepassing op biologiese probleme.
    • Voorsitter. Departement Patologie. Universiteit van Pittsburgh. Veld: Eksperimentele en kliniese patologie.
    • Sheldon Emory. Professor in organiese chemie. Harvard Universiteit. Veld: Chemie van kankerverwekkende koolwaterstowwe.
    • Professor in patologie. Columbia Universiteit. en direkteur van patologie -laboratoriums, Francis Delafield -hospitaal, New York. Veld: Kankerbiologie.
    • Voorsitter, Departement Interne Geneeskunde. Indiana Universiteit, Indianapolis. Gebiede: Interne medisyne. Fisiologie van kardiopulmonêre siekte.
    • Professor in interne geneeskunde, die Universiteit van Texas Southwestern Medical School. en mediese direkteur. Woodland -hospitaal. Dallas, Texas. Gebiede: Interne medisyne. Longsiektes, voorkomende medisyne.
    • Professor in epidemiologie. Universiteit van Minnesota School of Public Health. Minneapolis. Veld: Gesondheid en die verband daarmee met die totale omgewing.
    • Voorsitter. Departement Farmakologie Universiteit van Michigan, Ann Arbor. Departement Farmakologie. Veld: Farmakologie van narkose en gewoontevormende middels.
    • Chirurg -generaal van die Verenigde State se Openbare Gesondheidsdiens

    Die gevolgtrekkings van die verslag was byna geheel en al gefokus op die negatiewe gevolge vir die rook van sigaret op die gesondheid. Dit het gevind:

    • sigaretrokers het 'n toename van sewentig persent in die ouderdomskorrigeerde sterftesyfer
    • sigaretrook was die belangrikste oorsaak van chroniese brongitis
    • 'n verband tussen rook, emfiseem en hartsiektes.
    • 'n oorsaaklike verband tussen rook en 'n tien- tot twintigvoudige toename in die voorkoms van longkanker
    • 'n positiewe korrelasie tussen swanger vroue wat rook en ondergewig pasgeborenes. [1]

    Net soos die Wêreldgesondheidsorganisasie gedurende hierdie tydperk, maar moontlik beïnvloed deur die feit dat hulle almal self rokers was, [6] het die komitee sigaretrook gedefinieer as 'n "gewoontes" eerder as 'n oorweldigende "verslawing". [6] Komiteelede was dit met die meeste Amerikaners eens dat hierdie gewoonte (hoewel dikwels sterk) moontlik is vir individue om te breek.

    In die jare wat gevolg het op die verslag van die chirurg-generaal, het miljoene Amerikaners suksesvol gekies om op te hou rook, met twee derdes tot driekwart van die oud-rokers wat sonder hulp deur nikotienvervangingsmetodes opgehou het. Boonop is gevind dat die metode "koue kalkoen" of skielike en vinnige staking die suksesvolste was om te stop met rook oor lang tydperke. [7] In 'n omstrede stap in 1989 het 'n latere chirurg -generaal, dr. C. Everett Koop, M.D. egter van koers verander en sigaretrook herdefinieer as ''n verslawing' 'eerder as 'n gewoonte. [8]

    Die publikasie van die verslag het wye gevolge in die Verenigde State en die wêreld gehad. Dit is doelbewus op 'n Saterdag gepubliseer om die negatiewe uitwerking op die Amerikaanse aandelemarkte te verminder, terwyl die dekking in Sondagkoerante maksimeer word. [1] Die bekendmaking van die verslag was een van die belangrikste nuusberigte van 1964. Dit het gelei tot veranderinge in beleid en openbare mening, soos die Federal Sigaret Labelling and Advertising Act van 1965 en die Public Health Cigarette Smoking Act van 1969, wat waarskuwing vereis het etikette op sigarette en 'n verbod ingestel op die uitsaai van sigaretadvertensies op radio en/of televisie. [9]


    Die Amerikaanse chirurg -generaal kondig 'n definitiewe verband tussen rook en kanker aan

    Die Amerikaanse chirurg -generaal Luther Terry het geweet dat sy verslag 'n bom was. Hy het opsetlik besluit om dit op 11 Januarie 1964, 'n Saterdag, vry te stel om die onmiddellike uitwerking daarvan op die aandelemark te beperk. Op hierdie datum het Terry namens die Amerikaanse regering 'n definitiewe verband tussen rook en kanker aangekondig.

    Die verband is al lank vermoed. Anekdotiese bewyse dui altyd op 'n negatiewe uitwerking op die gesondheid van rook, en teen die dertigerjare het dokters 'n toename in longkankergevalle opgemerk. Die eerste mediese studies wat ernstige kommer veroorsaak het, is in die laat veertigerjare in Groot -Brittanje gepubliseer.  

    LUISTER NOU: Wat het hierdie week in die geskiedenis gebeur? Lees meer oor die podcast van GESKIEDENIS hierdie week. Afdeling 1: Amerikaanse chirurg -generaal kondig aan dat rook tog sleg is vir ons

    Amerikaanse sigaretondernemings bestee die grootste deel van die volgende dekade aan die regering om lobby te hou en te adverteer en teer en nikotien in hul produkte te verminder. 44 persent van die Amerikaners het reeds geglo dat rook teen 1958 kanker veroorsaak het, en 'n aantal mediese verenigings het gewaarsku dat tabakgebruik verband hou met long- en hartsiektes. Ondanks dit alles het byna die helfte van die Amerikaners gerook, en rook was algemeen in restaurante, kroeë, kantore en huise regoor die land.

    Dr Terry het die verslag in 1962 opgestel, en twee jaar later het hy die bevindings met die titel bekend gemaak Rook en gesondheid, wat 'n afdoende verband tussen rook en hart- en longkanker by mans verklaar het. Die verslag het ook gesê dat dieselfde verband waarskynlik vir vroue geld, hoewel vroue teen laer dosisse rook en daar dus nie genoeg data beskikbaar is nie.

    Die nuus was groot, maar amper nie verbasend nie New York Times het die bevindings gerapporteer deur te sê dat 'aanhaling' skaars anders kon gewees het. Alhoewel tabakondernemings miljoene en miljoene bestee het en tot in die negentigerjare grootliks daarin geslaag het om wette teen rook af te weer, het studies getoon dat die verslag die persentasie Amerikaners wat in die kankerverskil geglo het, tot 70 persent verhoog het en dat rook met ongeveer 11 verminder het persent tussen 1965 en 1985. Kalifornië het in 1995 die eerste staat geword wat rook in geslote openbare ruimtes verbied het. 25 ander state het nou soortgelyke wette aanvaar, waaronder 50 van die 60 grootste stede in Amerika. In 2019 kondig die chirurg-generaal 'n verband aan tussen ernstige siektes en e-sigarette, 'n alternatief vir rook waarin tradisionele tabakondernemings baie belê het.


    Die oorsprong van die kantoor oor rook en gesondheid

    SG William H. Stewart (2 Oktober 1965 tot 1 Aug. 1969)

    Stewart was betrokke by anti-rook sedert die 1955 National Health Survey, wat deur die Amerikaanse Sensusburo uitgevoer is. Die National Opinion Research Center het tydens sy ampstermyn meningspeilings onder dokters en ander gesondheidspersoneel vir die National Clearinghouse oor rook en gesondheid gedoen.

    Stewart was die eerste om te getuig tydens die verhoor van die Federale Handelskommissie oor "Voorgestelde reëls wat gesondheidswaarskuwing in sigaretadvertensies vereis", 1 Julie 1969. "Soos u weet, het ons departement dit van die begin af aangespoor. Ons het dit ondersteun toe dit ingesluit is in die uitspraak wat u in 1964 voorgestel het, en ons het die kongres drie keer versoek om dit te bereik en deur wetgewing, in 1967, 1968 en nou in 1969. "

    Later was hy lid van Werkgroep 5, 'High Priority Federal Government Initiatives', van die 1981 Nasionale Konferensie oor Rook of Gesondheid.

    Die National Interagency Council on Smoking and Health

    "Op 13 Julie 1964 het 'n aankondiging gekom van die stigting van die National Interagency Council on Smoking and Health, later onder leiding van Emerson Foote. Aan die hoof van die lys van nasionale agentskappe en organisasies staan ​​die United States Public Health Service en die American Cancer Society. Hulle word vergesel deur sestien ander prominente groepe op die gebied van gesondheid en opvoeding, almal met die doel om 'planne en programme te ontwikkel en uit te voer wat daarop gemik is om rook as 'n gesondheidsgevaar te bestry'. Die Amerikaanse mediese vereniging, wat die verslag van die chirurg -generaal nie amptelik aanvaar het nie, weier om die uitnodiging van die Raad om lid te word, te aanvaar. Amerikaanse Openbare Gesondheidsdiens, en onlangs 'n toewysing van $ 2,000,000 van die kongres ontvang. " "Belangrike personeellede van die afdeling vir chroniese siektes [CDC] speel 'n belangrike rol in die aktiwiteite van die Clearinghouse: dr. Guthrie en dr. Daniel Horn, voorheen van die American Cancer Society (Hammond-Horn Report) en nou assistent-hoof van die afdeling Kanker Beheertak. " (Waar die nywerheid nou staan. Desember 1965.)

    Emerson Foote van die American Cancer Society was voorsitter van die National Interagency Council on Smoking and Health, wat die American Heart Association, American Public Health Association en National Tuberculosis Association (voorganger van die American Lung Association) sowel as die American Cancer Society insluit . (Smoking and Health Newsletter, 1965 Jul-Aug1 (1). National Interagency Council on Smoking and Health, 8600 Wisconsin Avenue, Bethesda, Maryland [die adres van die gebou wat in 1962 gebou is om die National Library of Medicine van die National Institutes of Gesondheid].)

    Die National Clearinghouse for Smoking and Health het begin met die 'Regional Medical Programs'

    Die National Clearinghouse for Smoking and Health, wat die data vir die Chirurg -algemene verslae saamgestel het, is in 1965 gestig in die 'Regional Medical Programs'. Die wetgewing is bevorder deur die presidentskommissie vir hartsiektes, kanker en beroerte. 'Die president het later aangedui dat hy die kommissie' op aandrang van die lieflike dame, mev. Mary Lasker ', gestig het.' Die kommissie word oorheers deur mev. Dr. Michael DeBakey van Houston was die voorsitter. Ander lede was Emerson Foote, mev. Florence Mahoney, dr. Sidney Farber, dr. R. Lee Clark, mev Harry Truman, wat Mary Lasker sedert die dae van die Withuis in Truman geken het, en dr. J. Willis Hurst van die Emory University Medical School, die president se persoonlike hartspesialis. Boisfeuillet Jones was 'n belangrike konsultant. 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 Cru sade: 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.