Fifty years ago, a landmark study by the U.S. Surgeon General identified the links between tobacco use, cancer and death. In the half century since, smoking rates in the U.S. have been cut by nearly 50 percent and an estimated 8 million American lives have been saved from premature smoking-related deaths.
The number of tobacco-related illnesses and fatalities remains too high, however, and new products such as electronic cigarettes raise new questions and challenges.
Prior to the report, there had been evidence for at least a decade of higher incidences of lung cancer among heavy smokers; in 1954 the American Cancer Society announced that smokers had a higher risk of cancer. Three years later, and again in 1959, the U.S. surgeon general, the country’s highest ranking government health official, said heavy smoking caused lung cancer.
The tobacco industry fought back, inserting filters into cigarettes that it claimed would eliminate toxins before they got to smokers’ lungs. At the same time, they commenced a huge public relations campaign that charged that the evidence linking tobacco and cancer was inconclusive or bad science.
The counter-offensive worked: In the early 1960s, more than 40 percent of American adults smoked cigarettes; roughly half the adult male population and roughly 40 percent of women lit up.
Troubled by the evidence, then surgeon general Dr. Luther Terry organized an expert panel to assess the evidence and conclude the debate. To ensure that its 10 members were above reproach, he gave the tobacco industry veto over proposed members. Indeed, half the members — including Terry himself — smoked.
Two years later, on Jan. 11, 1964, the final report was released. It concluded that smoking causes illness and death, that it was responsible for the rising incidence of cancer in the United States and that filters were ineffective.
More importantly it asserted that the government had to take action to limit the harm. That decision was controversial, and not just because of the science: The tobacco industry was powerful. The press conference announcing the report was held on a Saturday to avoid spooking the stock market.
Cigarette consumption plunged 15 percent in the three months after the report was released, but the drop was only temporary. More substantive action would be required.
Within a year, legislation required warning labels on packs of cigarettes. In 1967, TV and radio stations were obliged to provide free air time for anti-smoking public service announcements. In 1971, cigarette commercials were banned outright. Legislation to protect nonsmokers from secondhand smoke spread, culminating in outright bans in many areas.
Most significantly state governments sued big tobacco companies, alleging that they know about but covered up the ills associated with smoking. The governments demanded compensation for the costs of treating smoking-related illnesses.
The industry settled those legal actions in 1998, agreeing to pay some $200 billion and end the marketing of cigarettes to young people. In landmark testimony before Congress that year, senior tobacco industry executives conceded that their products were both addictive and could cause cancer.
Today just 20 percent of American adults smoke. Experts reckon that the fall in the number of people who light up has saved 8 million lives. Many smokers started up when they were young. Generally speaking, the younger people are when they stop smoking, the more years they add to their lives.
Cumulatively the fall in the number of smokers has lengthened the average American life span by two years.
That’s only a start, however. More than 43 million people smoke in the U.S. and smoking is the leading preventable cause of death in that country. Lung cancer remains the deadliest form of cancer in the U.S., accounting for 25 percent of cancer deaths. A new report by the surgeon general says smoking kills 480,000 Americans a year from such diseases as diabetes, colorectal cancer and liver cancer, and that it can lead to rheumatoid arthritis, erectile dysfunction and macular degeneration, a major cause of age-related blindness.
More troubling still is the growth of smoking worldwide. Today some 1.3 billion people smoke, most of them in low and middle-income countries. China alone consumes 2 trillion of the 6 trillion cigarettes produced each year.
Experts reckon that smoking results in one-eighth to one-quarter of all deaths of middle-aged men in China, India, Bangladesh and South Africa, and these numbers are set to rise.
It is not yet clear what impact electronic cigarettes will have on health, but experts worry that they will still hook users on tobacco.
In Japan, tobacco consumption has been falling since it peaked in 1996, mainly because of the adoption of healthier lifestyles and the proliferation of no-smoking areas in public. Yet, 32.2 percent of Japanese men smoked in 2013 as well as 10.5 percent of women.
For a number of reasons, lung cancer mortality is not as high as it is in the U.S., but that should not be an excuse to keep from reducing those numbers.
One quick way to cut tobacco consumption is to raise taxes. Researchers estimate that tripling tobacco taxes would cut worldwide consumption by about a third, and prevent 200 million premature deaths this century from lung cancer and other smoking-related diseases.
Moreover, it would increase government revenues from tobacco by a third, from $300 billion a year to $400 billion, as well as ease the strain smoking adds to health care systems, to say nothing of the suffering caused to smokers and their families.
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