Confronting America’s Smoking Pandemic, Part 1: 1939–1966
Ahead of the World Tobacco Congress, Dr. Alan Blum and Cancer Network have partnered to assemble a four-part slideshow series addressing the history of America’s smoking pandemic. Part 1 examines the early evidence linking smoking with cancer.
Confronting America’s Smoking PandemicPart 1: From Early Evidence to Global Battle, 1939â1966Part 2: An Era of Activism, 1967â1985Part 3: Regulation, Legislation, Litigation, 1986â1999Part 4: Failures and Successes 2000â2016
References:
1. Ochsner A, DeBakey M. Primary pulmonary malignancy: treatment by total pneumonectomy; analysis of 79 collected cases and presentation of 7 personal cases. Surg Gynecol Obstet. 1939;68:435-51.
2. Ochsner Health System. Living the legacy: who was Alton Ochsner and why are we living his legacy? January 18, 2011.
3. Ventura HO. Alton Ochsner, MD: physician. Ochsner J. 2002;4:48-52.
4. Nelson J. Advertising bans, US. EH.Net Encyclopedia. Whaples R, editor. May 20, 2004.
5. Justia US Supreme Court. Valentine v. Chrestensen, 316 U.S. 52 (1942).
6. Wynder EL, Graham EA. Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma; a study of 684 proved cases. J Am Med Assoc. 1950;143:329-36.
7. Levin ML, Goldstein H, Gerhardt PR, et al. Cancer and tobacco; a preliminary report. J Am Med Assoc. 1950;143:336-8.
8. Doll R, Hill AB. Smoking and carcinoma of the lung. Preliminary report. Br Med J. 1950;2:739-48.
9. Ochsner A, DeCamp PT, DeBakey ME, Ray CJ. Bronchogenic carcinoma; its frequency, diagnosis, and early treatment. J Am Med Assoc. 1952;148:691-7.
10. Norr R. Cancer by the carton. Christian Herald, October 1952; a condensed version was published in Reader’s Digest by the Reader’s Digest Association, Pleasantville, New York. December 1952, p. 7,8. Available from the Legacy Tobacco Documents Library, University of California, San Francisco.
11.A frank statement to cigarette smokers. Tobacco Industry Research Committee, New York, NY. [Image shows advertisement as it was printed in the Indianapolis News, January 4, 1954.]
12. Hammond EC, Horn D. Smoking and death rates-report on forty-four months of follow-up of 187,783 men. J Am Med Assoc. 1958;166:1294-308.
13. Burney LE. Smoking and lung cancer. A statement of the public health service. J Am Med Assoc. 1959;171:1829-37.
14. Welcome to the five-day plan to stop smoking: even to better living. General Conference of Seventh-Day Adventists. Washington, DC. 1962. p. 52.
15. McFarland JW, Folkenberg EJ. How to stop smoking in five days. Englewood Cliffs, NJ: Prentice-Hall; 1964. p. 92.
16. McFarland JW, Gimbel HW, Donald WAJ, Folkenberg EJ. The five-day program to help individuals stop smoking. Conn Med. 1964;28:885-90.
17.
. London: Pitman Publishing Co. Ltd.; 1962.
18. Neuberger MB. Smoke screen: tobacco and the public welfare. Englewood Cliffs, NJ: Prentice-Hall; 1963. p. 151.
19. US Public Health Service, Office of the Surgeon General, Surgeon General’s Advisory Committee on Smoking and Health. Smoking and health: report of the Advisory Committee to the Surgeon General of the Public Health Service. PHS publication 1103. 1964. Subsequent reports from the Surgeon General.
20. Tobacco Control Legal Consortium. Federal Trade Commission and Tobacco.
Dr. Alan Blum and Cancer Network have partnered to assemble a four-part slideshow series addressing the history of America’s smoking epidemic. Part 1 examines the early evidence linking smoking with cancer.
Ochsner and DeBakey cite over 400 references from peer-reviewed journals and correlate the increased sale of cigarettes with an increased prevalence of lung cancer. An influential anti-smoking crusader, Dr. Ochsner was an early proponent of surgical removal of the cancerous lung and of regular chest x-rays for those who smoke cigarettes in order to detect cancer of the lung.[1-3]
The ruling was in response to a complaint that the Brown and Williamson Tobacco Company had claimed Kools would keep the head clear in winter and protect against colds. This view was applied in 1971 when the courts upheld the ban of broadcast advertising of cigarettes. (The US Federal Trade Commission [FTC] was first given the authority to regulate “unfair or deceptive advertising” in 1939 and held hearings in the early 1940s on health claims in cigarette advertising.)[4-5]
Wynder and Graham conclude that tobacco smoking is “a possible etiologic factor” in the increased incidence of bronchogenic carcinoma since the early 1900s. In their study, they find that “among 605 men with bronchogenic carcinoma, other than adenocarcinoma, 96.5% were moderately heavy smokers to chain smokers for many years, compared with 73.7% among the general male hospital population without cancer” but that the incidence of lung cancer among male nonsmokers or minimal smokers is rare (2%).[6]
The report was based on a study of 1,650 men with (n = 1,045) and without (n = 605) cancer.[7]
Ruling out any selection bias, they write that “it must be concluded that there is a real association between carcinoma of the lung and smoking.” They find that heavy smokers were 50 times as likely as nonsmokers to contract lung cancer. However, the cancer advisory committee of the Ministry of Health concludes that Drs. Doll and Hill have established an association and not a cause, and advises the government to do nothing.[8]
The authors conclude, “It is probable that bronchogenic carcinoma soon will become more frequent than any other cancer of the body, unless something is done to prevent its increaseâ¦It is frightening to speculate on the possible number of bronchogenic cancers that might develop as the result of the tremendous number of cigarettes consumed in the two decades from 1930 to 1950.”[9]
This widely read and influential article was seen as contributing to the drop in cigarette consumption the following year, the first time this had occurred in decades.[10]
Image shows advertisement as it was printed in the Indianapolis News, January 4, 1954.[11]
Deaths from lung cancer accounted for 360 (13.5%) of the reported excess deaths among regular smokers.[12]
In the December 12 issue of the Journal of the American Medical Association, editor John H. Talbott, MD, questions the validity of the statement by Dr. Burney.[13]
In 1962, McFarland and Folkenberg release the plan in book form. During the 1960s, they conduct smoking cessation seminars throughout the nation.[14-16]
Following this request to develop a national commission on smoking and health, the National Clearinghouse for Smoking and Health was established in 1965. It is currently known as the Office on Smoking and Health, a division within the National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention (CDC).
This query sets in motion the events that lead to the formation of an expert scientific committee by the Surgeon General, Luther Terry, MD, to study the issue.[17]
She is assisted on the book by her legislative aide, Michael Pertschuk, who helps develop tobacco control legislative strategies at the federal level for the rest of the century. In 1976, Pertschuk is named Chair of the Federal Trade Commission.[18]
The report, Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service, recognizes the proven link between smoking and lung cancer.[19]
In 1966, the bill is enacted. The National Clearinghouse for Smoking and Health is established by the National Library of Medicine under the Regional Medical Programs bill enacted by Congress. The Clearinghouse publishes annual bibliographies of research articles and edits the reports of the Surgeon General on smoking. In 1978, it is renamed the Office on Smoking and Health (OSH) and gradually expands in size and scope to become a division within the National Center for Chronic Disease Prevention and Health Promotion, located within the Centers for Disease Control and Prevention (CDC) Coordinating Center for Health Promotion in Atlanta. OSH is the lead federal agency for tobacco control and prevention.[20]
