The year 2014 marks the 50th anniversary of Surgeon General Luther Terry’s report linking cigarette smoking to lung cancer.
Cigarette smoking rates peaked in 1965 at around 42 percent and declined in the half-century since to 18 percent in the United States.
Terry, although at least a pack-a-day man himself, approached the smoking issue with gravitas and impartiality. Indeed, half of the members of Terry’s advisory panel smoked, which was the typical percentage among men of that era. In the 1980s, Surgeon General C. Everett Koop further advocated for smoking cessation, current Acting Surgeon General Boris Lushniak is now following suit.
Earlier this month, Lushniak issued a 980-page report, linking smoking to a number of additional conditions. For example, colorectal cancer, liver cancer, rheumatoid arthritis and diabetes now appear linked to cigarette smoking.
One-third of cancer deaths in our country are caused at least in part by cigarette smoking, and smoking is a major risk factor for heart disease, our nation’s leading cause of death. Perhaps 20 million deaths occurred in our country due to cigarette smoking, since the 1964 surgeon general’s report was issued. Moreover, the list of diseases associated with cigarettes gets longer all the time, now also including erectile dysfunction, macular degeneration of the eyes, and even birth defects such as cleft palate. Moreover, we now are able to correlate second-hand cigarette smoke with more maladies. Spouses of smokers, for example, appear to develop lung cancer more frequently.
As a rheumatologist, I diagnose rheumatoid arthritis less and less frequently, and epidemiological studies suggest a slow decline in the incidence of this disabling condition. Although the decline probably began decades before smoking rates began to decline, one has to wonder if smoking cessation contributed to this phenomenon. Smoking is also linked to chronic low back pain. Lushniak recently noted that we spend about a buck-and-a-half on smoking cessation per American smoker. Lushniak argues for raising that figure to $12 per smoker, an approach that might pay future dividends in terms of lower health care costs. Most smokers want to quit.
Nearly nine out of 10 smokers take their first puff before 18 years of age. Yet I still note high rates of smoking in young and glamorous actors in popular movies. A more immediate concern, highlighted by the surgeon general, is the advent of so-called “e-cigarettes.” These products are sold as “safe” alternatives to cigarettes. But are they?
Definitive studies of the health impact of e-cigarettes are lacking. Moreover, I am not aware of these devices being medically regulated as smoking cessation tools. Moreover, they serve to promulgate smoking behavior in public venues. Do toddlers and children respond to such cues? Could e-cigarettes become a gateway drug for curious teenagers, who subsequently turn to old-fashioned smokes? I harbor similar concerns about marijuana, which I have seen openly smoked in some Bay Area locations. Marijuana smoking, it appears, is gaining acceptance at a time when society tends to marginalize cigarette smokers.
Lushniak stated, “It is my sincere hope that 50 years from now we won’t need another surgeon general’s report on smoking and health, because tobacco-related disease and death will be a thing of the past.”
Americans did, in fact, overcome the 19th century habit of public spitting, which spreads tuberculosis, based in part on public health campaigns.
Cigarette smoking, however, is an addictive process, and therefore harder to battle. Public education, beginning at a young age, may be the key to lowering smoking rates to the single digits.
As the surgeon general noted, “It’s never too late to stop. It’s best to quit smoking completely. Talk to your doctor.”
Scott T. Anderson, M.D., Ph.D. (firstname.lastname@example.org) is clinical professor of medicine, U.C. Davis. This column is informational, and does not constitute medical advice.