January 11, 2014 marked the 50th anniversary of the publication of the first "Surgeon General's Report on Smoking and Health ." In part its summary states that: " On the basis of more than 7,000 articles relating to smoking and disease already available at that time [1964!] in the biomedical literature, the Advisory Committee concluded that cigarette smoking is: a cause of lung cancer and laryngeal cancer in men; a probable cause of lung cancer in women; the most important cause of chronic bronchitis." Fifty years later we know that not only is cigarette smoking causative of a broad range of diseases in addition to those mentioned above, but also that "second-hand smoke" is a major killer as well.
The Marlboro Man's Killer. (Actually, there were five of them who died of smoking-related disease.)
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Certainly progress has been made, but major problems remain. As Howard Koh, Assistant Secretary for Health of the Department of Health and Human Services says in the cited Executive Summary of the 50th Anniversary Surgeon General's Report:
" The nation stands poised at the crossroads of tobacco control. On one hand, we can celebrate tremendous progress 50 years after the landmark 1964 Surgeon General's report: Smoking and Health. Adult smoking rates have fallen from about 43% (1965) to about 18% today. Mortality rates from lung cancer, the leading cause of cancer death in this country, are declining. Most smokers visiting health care settings are now routinely asked and advised about tobacco use. On the other hand, cigarette smoking remains the chief preventable killer in America, with more than 40 million Americans caught in a web of tobacco dependence. Each day, more than 3,200 youth (younger than 18 years of age) smoke their first cigarette and another 2,100 youth and young adults who are occasional smokers progress to become daily smokers [emphasis added]. Furthermore, the range of emerging tobacco products complicates the current public health landscape."
So why do we still have wide-spread cigarette smoking and why do we still have close to 500,000 deaths per year linked to smoking, in this country alone? There is only one reason: the power of the tobacco industry and its political and corporate allies. From the time of the publication of the first papers based on irrefutable evidence, in this country and Great Britain in the 1950s, cited in that first Surgeon General's Report in 1964, until the end of the 20th century, the tobacco industry, aided by some powerful and clever public relations companies, kept up a constant drumfire of denial and distraction. This despite the fact that documents obtained by the legal process of discovery during the major legal action carried out in the 1990s against the tobacco industry by a group of states' Attorneys General showed that the companies knew in the 1950s just how carcinogenic their products were. And by the 1960s they were fully aware of the high level of addictiveness of nicotine. It was into the late 1990s that the companies were still in public full denial of both the relationship between smoking and disease and the addictive nature of nicotine, facts they had known for decades.
Because of a wide variety of measures, including a marked reduction in advertising, public anti-smoking campaigns, significant price increases due to taxation, the banning of smoking in many indoor spaces in many parts of the country, package labeling, and others, the prevalence of smoking in the adult population has declined significantly. But because of the long lag time, the smoking-related death rate has actually increased. Nevertheless, the tobacco companies are still at it. A recent editorial in The New York Times says it all:
" The [2014 Surgeon General's] report , issued last Friday, finds that cigarette smoking kills even more Americans than previously estimated (about 480,000 a year, up from 443,000), and is a cause, though not necessarily the major cause, of even more diseases than previously recognized, including liver and colorectal cancers. These add to the long list of other cancers caused by smoking, as well as rheumatoid arthritis and other ailments. The report newly identifies exposure to secondhand smoke as a cause of strokes. The report estimates that smoking costs the United States between $289 billion and $333 billion a year for medical care and lost productivity, well above the previous estimate of $193 billion. Most shocking, the report finds that today's smokers have a much higher risk for lung cancer and chronic obstructive pulmonary disease than smokers in 1964, despite smoking fewer cigarettes. It reports that the risk of developing adenocarcinoma of the lung, the most common type of lung cancer, has increased substantially over the past several decades because of changes in the design and composition of cigarettes. These include ventilated filters that lead to more puffing of noxious materials and blended tobaccos that contain carcinogenic nitrosamines. There is no doubt who is to blame for this mess, the report says. It is the tobacco industry which "aggressively markets and promotes lethal and addictive products," continues to recruit youth and young adults as new customers, and has "deliberately misled the public on the risks of smoking cigarettes" [emphasis added].
For 50 years the tobacco industry managed to fend off wide-spread action against its product based on scientific evidence that it already knew in the 1950s was correct. They did this through a public relations campaign led by the major firm of Hill & Knowlton to create what has been called Manufactured Doubt . It just so happens that the continuing campaign against the scientifically-proven facts of human-caused global warming/climate change uses exactly the same techniques as were honed in the "tobacco does NOT cause disease and nicotine is NOT addictive" campaign. I wonder if, when major US coastal cities and half the state of Florida are under water, while much of California has become a desert, it will be found that Big Oil and Gas knew the truth all along.
A sad footnote to all of this is that on January 26, 2014, the fifth "Marlboro Man" to die of smoking-related disease, the former actor Eric Lawson, passed away at the age of 72 of chronic obstructive pulmonary disease, known to be smoking-related. It is doubly ironic, in the light of the last sentence in the New York Times editorial above, that Mr. Lawson, illustrating the addictive nature of nicotine, a smoker almost to the end, began smoking when he was 14. And oh yes, the principal gateway drugs to the use of the currently illicits? You guessed it, nicotine in tobacco products and ethyl alcohol in alcoholic beverages.
And in a second sad footnote, the great actor, Philip Seymour Hoffman, tragically dies of a heroin overdose. Were heroin available legally, either by prescription or at retail, in a "government store," so that purity and dosage would be known, such an outcome would be highly unlikely. Nonetheless, along with all of his pro-drug war colleagues, ranging from the prison-industrial complex to the drug cartels, the director of the Office of National Drug Control Policy breathes a sigh of relief. After all, he's still got a job. And the media go crazy. CBS, NBC, The Wall Street Journal, USA Today, the LA Times, the New York Times, Bloomberg News, and so on and so forth, all report vast percentage increases both in heroin use and heroin-related deaths. Only The New York Times gave an absolute number: in New York City, heroin-related deaths were all the way up to 382, for the whole year of 2012. In that year, nationally to be sure, there were about 1200 tobacco-use related deaths per day and about 180 alcohol-use related deaths, per day. Tell me, please, which are the real killer drugs? And tell me please, which drug dealers should be being locked up for up for decades, those who peddle the low-use illicits, or those conscious killers who peddle the truly lethal legal drugs?
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