January 14, 2014 Kim Krisberg 16Comment

It’s probably my earliest public health memory — the image of Surgeon General C. Everett Koop and his grandfatherly beard on the television warning my elementary school self about the dangers of smoking. He was the first doctor I knew by name.

But while Koop may be the surgeon general that people of my generation most likely associate with the public health movement to reduce smoking, he wasn’t the first to speak out against tobacco. Koop was carrying on a legacy that began decades before with the nation’s ninth surgeon general, Luther Terry, who on Jan. 11, 1964, released the first surgeon general’s report on smoking and health and said unequivocally: “Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action.” On the 50th anniversary of that declaration, public health advocates are celebrating hard-fought declines in the smoking rate and warning that it’s no time to retreat.

“We have made enormous progress in the past 50 years, preventing millions of deaths and tens of millions of illnesses,” said Centers for Disease Control and Prevention Director Tom Frieden. “But we have much further to go — tobacco remains, by far, the single leading preventable cause of death in the United States and the world.”

In that first surgeon general’s report, the authors wrote:

In the early part of the 16th century, soon after the introduction of tobacco into Spain and England by explorers returning from the New World, controversy developed from the differing opinions as to the effects of the human use of the leaf and the products derived from it by combustion or other means. Pipe-smoking, chewing and snuffing of tobacco were praised for pleasurable and reputed medicinal actions. At the same time, smoking was condemned as a foul-smelling, loathsome custom, harmful to the brain and lungs. The chief question was then as it is now: is the use of tobacco bad or good for health or devoid of effects on health? Parallel with the increasing production and use of tobacco, especially with the constantly increasing smoking of cigarettes, the controversy has become more and more intense. Scientific attack upon the problems has increased proportionately. The design, scope and penetration of studies have improved and the yield of significant results has been abundant.

Considering that this report is just 50 years old, it’s amazing how much public health has achieved (and keep in mind how enormously difficult it is to change people’s behavior, especially when public health has been continuously and enormously outspent by tobacco marketers). In fact in 1999, CDC ranked the declines in smoking and the lives saved as one of the greatest public health achievements of the 20th century. According to the agency, smoking rates declined from more than 42 percent in 1965 to less than 25 percent in 1997, and the percentage of adults who never smoked went up from 44 percent to 55 percent. About half the country is now protected by smoke-free workplace laws.

A more recent study published Jan. 8 in the Journal of the American Medical Association found that tobacco control efforts (education, cigarette taxes, smoke-free laws, media campaigns, sales and marketing restrictions, and cessation programs) have saved 8 million lives in the last five decades, with more than half of the lives saved younger than 65. In all, a gain of 157 million years of life is associated with tobacco control efforts. Without tobacco control, the study found that life expectancy among both men and women would be shorter by two to four years.

Still, more than 40 million adults and 3 million youth smoke in the U.S., and tobacco use results in hundreds of billions of dollars in medical costs and lost productivity. Worldwide, it’s estimated that 1.3 billion people smoke and 4.9 million people die every year from tobacco-related disease. On top of that, tobacco companies still spend billions on advertising every year — $8.37 billion on cigarette marketing in 2011 in the U.S. alone. At the same time, state spending on tobacco prevention doesn’t meet CDC recommendations. For example, officials estimated that although states collected more than $25 billion in tobacco taxes and legal settlements in 2013, lawmakers spent less than 2 percent of that on cessation and prevention. Plus, public health agencies continue to struggle with tight budgets and service cuts (see our previous coverage of how budget cuts are affecting health department tobacco efforts here).

In other words, there’s no doubt that continued tobacco use prevention is a steep climb. Luckily, public health folks aren’t used to easy victories.

“We still have an industry that continues to sell a product that we know is harmful and from which children are at enormous risk,” said Georges Benjamin, executive director of the American Public Health Association. “This anniversary marks an important public health success, yet we need to make sure the victory we celebrate today is not hollow.”

Since that first surgeon general’s report in 1964, 30 additional surgeon general reports have been released on the dangers of tobacco and secondhand smoke, and another is expected this year.

For more on the 50th anniversary, click here. And check out Celeste Monforton’s Public Health Classics piece on the 1964 surgeon general’s smoking report here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

16 thoughts on “Fifty years and 8 million lives saved since the first surgeon general’s smoking report

  1. Not 1 Death or Sickness Etiologically Assigned to Tobacco. All the diseases attributed to smoking are also present in non smokers. It means, in other words, that they are multifactorial, that is, the result of the interaction of tens, hundreds, sometimes thousands of factors, either known or suspected contributors – of which smoking can be one.

    7 October, the COT meeting on 26 October and the COC meeting on 18
    November 2004.

    “5. The Committees commented that tobacco smoke was a highly complex chemical mixture and that the causative agents for smoke induced diseases (such as cardiovascular disease, cancer, effects on reproduction and on offspring) was unknown. The mechanisms by which tobacco induced adverse effects were not established. The best information related to tobacco smoke – induced lung cancer, but even in this instance a detailed mechanism was not available. The Committees therefore agreed that on the basis of current knowledge it would be very difficult to identify a toxicological testing strategy or a biomonitoring approach for use in volunteer studies with smokers where the end-points determined or biomarkers measured were predictive of the overall burden of tobacco-induced adverse disease.”

    In other words … our first hand smoke theory is so lame we can’t even design a bogus lab experiment to prove it. In fact … we don’t even know how tobacco does all of the magical things we claim it does.

    The greatest threat to the second hand theory is the weakness of the first hand theory.

  2. This pretty well destroys the Myth of second hand smoke:


    Lungs from pack-a-day smokers safe for transplant, study finds.

    By JoNel Aleccia, Staff Writer, NBC News.

    Using lung transplants from heavy smokers may sound like a cruel joke, but a new study finds that organs taken from people who puffed a pack a day for more than 20 years are likely safe.

    What’s more, the analysis of lung transplant data from the U.S. between 2005 and 2011 confirms what transplant experts say they already know: For some patients on a crowded organ waiting list, lungs from smokers are better than none.

    “I think people are grateful just to have a shot at getting lungs,” said Dr. Sharven Taghavi, a cardiovascular surgical resident at Temple University Hospital in Philadelphia, who led the new study………………………

    Ive done the math here and this is how it works out with second ahnd smoke and people inhaling it!

    The 16 cities study conducted by the U.S. DEPT OF ENERGY and later by Oakridge National laboratories discovered:

    Cigarette smoke, bartenders annual exposure to smoke rises, at most, to the equivalent of 6 cigarettes/year.


    A bartender would have to work in second hand smoke for 2433 years to get an equivalent dose.

    Then the average non-smoker in a ventilated restaurant for an hour would have to go back and forth each day for 119,000 years to get an equivalent 20 years of smoking a pack a day! Pretty well impossible ehh!

  3. 8 million SAMMEC COMPUTER LIVES SAVED……….ALL MYSTICAL STATISTICAL MANIPULATED LIES! Not one name in the entire sack of propaganda!

  4. @harleyrider1978

    Are you daft? The topic of the first document you referenced is not what you think it is:

    The Committees (COT/COC/COM) were asked to provide advice on these areas of toxicological assessment with reference to the assessment of Potentially Reduced Exposure Products (PREPS) and in particular tobacco based PREPS which are smoked.

    Basically, they investigated the possibility of determining the effectiveness of these PREPS in-vivo and in-vitro. They specifically state that in now way should any of this distract from measures intended to reduce the prevalence of smoking.

    “The Committees agreed that it was important to state that the ideal way forward to reduce risks and hazards of tobacco smoke was to encourage smokers to stop or people not to start in the first place any attempt to reduce
    toxicity should not be allowed to detract from that.”

    The health effects of smoking is a very nice example of a subject where in-vitro tests are less applicable due to the complexity and difficulty of extrapolating to actual health effects. Furthermore, double blind placebo controlled studies are unethical: it is generally frowned upon to force people to smoke, as we have convincing epidemiological data that smoking = horror death.

    Regarding the lungs of smokers as transplant donors, what is your point exactly? As they state: having slightly black lungs is better then having no lungs.

    Lung transplants in no way resemble physiological conditions. 50 percent of lung transplant recipients are dead after 5.6 years. In the face of this chronic rejection of lung tissue and diseases manifesting due to the necessary immune suppression, having pre-smoked lungs apparently no longer really matters. Strange? No.

    Would you be surprised if I told you smoking does not affect the survival of Ebola infected patients?

    Really, I don’t understand why of all the things you can be contrarian about is has to be something obvious as this.

  5. @ThankyouForSmoking

    The point is they admit there is no proof of disease for any claim made against smoking NONE NADA! Are you daft to think epidemiology proves causation! Epidemiology has been so abused by the anti-smoking crowd its value is now considered JUNK SCIENCE!
    Epidemiologists Vote to Keep Doing Junk Science

    Epidemiology Monitor (October 1997)

    An estimated 300 attendees a recent meeting of the American College of
    Epidemiology voted approximately 2 to 1 to keep doing junk science!

    Specifically, the attending epidemiologists voted against a motion
    proposed in an Oxford-style debate that “risk factor” epidemiology is
    placing the field of epidemiology at risk of losing its credibility.

    Risk factor epidemiology focuses on specific cause-and-effect
    relationships–like heavy coffee drinking increases heart attack risk. A
    different approach to epidemiology might take a broader
    perspective–placing heart attack risk in the context of more than just
    one risk factor, including social factors.

    Risk factor epidemiology is nothing more than a perpetual junk science machine.

    But as NIEHS epidemiologist Marilyn Tseng said “It’s hard to be an
    epidemiologist and vote that what most of us are doing is actually harmful
    to epidemiology.”

    But who really cares about what they’re doing to epidemiology. I thought
    it was public health that mattered!

    we have seen the “SELECTIVE” blindness disease that
    Scientist have practiced over the past ten years. Seems the only color they
    see is GREEN BACKS, it’s a very infectious disease that has spread through
    the Scientific community with the same speed that any infectious disease
    would spread. And has affected the T(thinking) Cells as well as sight.

    Seems their eyes see only what their paid to see. To be honest, I feel
    after the Agent Orange Ranch Hand Study, and the Slutz and Nutz Implant
    Study, they have cast a dark shadow over their profession of being anything
    other than traveling professional witnesses for corporate hire with a lack
    of moral concern to their obligation of science and truth.

    The true “Risk Factor” is a question of ; will they ever be able to earn
    back the respect of their profession as an Oath to Science, instead of
    corporate paid witnesses with selective vision?
    Oh, if this seems way harsh, it’s nothing compared to the damage of peoples
    lives that selective blindness has caused!

  6. Don’t fret over list of cancer ‘risks’

    “We are being bombarded” with messages about the dangers posed by common things in our lives, yet most exposures “are not at a level that are going to cause cancer,” said Dr. Len Lichtenfeld, the American Cancer Society’s deputy chief medical officer.
    Linda Birnbaum agrees. She is a toxicologist who heads the government agency that just declared styrene, an ingredient in fiberglass boats and Styrofoam, a likely cancer risk.
    “Let me put your mind at ease right away about Styrofoam,” she said. Levels of styrene that leach from food containers “are hundreds if not thousands of times lower than have occurred in the occupational setting,” where the chemical in vapor form poses a possible risk to workers.
    Carcinogens are things that can cause cancer, but that label doesn’t mean that they will or that they pose a risk to anyone exposed to them in any amount at any time.

    Now,Im glad to see the ACS admitting to the dose response relationship finally!

    So now we understand why the following is factual:

    are hundreds if not thousands of times lower than have occurred in the occupational setting,” where the chemical in vapor form poses a possible risk to workers.

    Regulatory Toxicology and Pharmacology, Vol. 14, No. 1. (August 1991), pp. 88-105.

    ETS between 10,000- and 100,000-fold less than estimated average MSS-RSP doses for active smokers


    OSHA the components in tobacco smoke are diluted below existing Permissible Exposure Levels (PELS.) as referenced in the Air Contaminant Standard (29 CFR 1910.1000)…It would be very rare to find a workplace with so much smoking that any individual PEL would be exceeded


  7. Regarding the lungs of smokers as transplant donors, what is your point exactly? As they state: having slightly black lungs is better then having no lungs.

    The point was written right below it had you bothered to read!

    No comment on that………….

    Then the smokers lungs had the same survival rates and rejection rates along with basically the same cancer rates as the non-smoking lungs used!

    I know it destroys your tiny world of anti-tobacco scienc eon its face but ehh that’s how it is when you spread 60 years of lies and longer! Old age diseases is what your so called smokeing related diseases actually are!

  8. They don’t state this you did……………

    having slightly black lungs is better then having no lungs.

    I know what they wouldn’t state it as nobody can tell the diference between smoker slungs and non-smokers lungs as blackening of lungs occurs when breathing in carbon particles and since tobacco smoke contains no carbon it does not blacken the lungs whatsoever!

    The great black lung lie!

    Dr. Duane Carr – Professor of Surgery at the University of Tennessee College of Medicine, said this: “Smoking does not discolor the lung.”

    Dr. Victor Buhler, Pathologist at St. Joseph Hospital in Kansas City: “I have examined thousands of lungs both grossly and microscopically. I cannot tell you from exmining a lung whether or not its former host had smoked.”

    Dr. Sheldon Sommers, Pathologist and Director of Laboratories at Lenox Hill Hospital, in New York: “…it is not possible grossly or microscopically, or in any other way known to me, to distinguish between the lung of a smoker or a nonsmoker. Blackening of lungs is from carbon particles, and smoking tobacco does not introduce carbon particles into the lung.”

    This was confirmed by Dr Jan Zeldenrust, a Dutch pathologist for the Government of Holland from 1951 – 1984. In a television interview in the 1980′s he stated that, translated from Dutch, “I could never see on a pair of lungs if they belonged to a smoker or non-smoker. I can see clearly the difference between sick and healthy lungs. The only black lungs I’ve seen are from peat-workers and coal miners, never from smokers”.

  9. @melanie P

    Kids shouldn’t partake in adult activities until they’re of age to make an informed decision for themselves.

    Maybe Thai kids and kids from many other nations should instead be asking smoker controllers and governments why there is still no legal age for use and possession of tobacco. A legal age to buy tobacco never stopped any kid from getting their hands on it. Granted a legal age for use and possession won’t prevent every kid from experimenting with tobacco but what is it that tobacco controllers say about if it only saves one life…..

  10. This is why I will not fill out a donor card, your “black lung lie” has gone on long enough, and who would want my “dirty” blood

  11. There is a simple & straightforward solution to the health risks of smoking:

    Total up the empirical costs of the added health care for tobacco use on a yearly basis (separated into categories: cigarettes, cigars, pipe tobacco, snuff, chew), divide by the quantity of each type of tobacco sold per year, factor in the expected rate of inflation for the coming year, and charge it as a “health risk internalization tax.” Thus every unit of tobacco consumed pays for its probable cost to the health care system.

    While we’re at it, charge health risk internalization tax on every product or service that has a measurable cost impact on the health system. Alcohol is the obvious first candidate, corn syrup is another, and certain types of fats, salt, etc.

    At the same time, eliminate the “sin taxes” on tobacco, alcohol, etc. Government has no business persecuting “sin” any more than it does protecting “sanctimony” (discriminatory marriage laws). The fact that those terms are not the “official” language, is irrelevant: the language is commonplace, the meaning is well understood, and is derived from inherently religious moralistic views that have no place in the public policies of a secular society.

    If we want to reinforce the message, to encourage behavior change without indulging in tawdry manipulative tactics such as putting graphic pictures of corpses on packaging, we need only label the taxes as such on the packaging, e.g. “$4.50 of the cost of this $8.00 pack of cigarettes is a health risk internalization tax, to offset the health costs of cigarette smoking.”

    Rationalists and empiricists should be eager to get onboard with health risk internalization taxes and the removal of quasi-religious moralizing from public policy. It’s directly fact-based, it directly covers the costs in question, it immediately relieves individuals of paying for others’ risky behaviors, and it provides a rational incentive for behavior change.

    If there’s any tradeoff to this proposal, it’s that it denies puritans and other control-freaks the pleasure of their overweening sense of superiority over “sinners.” But IMHO that’s an additional benefit.

  12. I would just like to add, that the taxes that where imposed on cigarettes where suppose to go strictly to smoking related costs incurred by the state to include stop smoking efforts. Only a small portion goes into this pot, as usual the intentions portrayed to create the law are exploited in the end.

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