Public Health’s Answer to the Cigarette Epidemic 1940-1966 Dr. Michael DeBakey “It had become more frequent than cancer of the stomach, that was very impressive, from 1912 to 1939 a period of just a couple of decades, lung cancer had now become from the rarest of disease to one of the most commons…” By the end of the 1930’s the increasing number of lung cancer diagnosis in their patience alarmed two American surgeons Drs. Alton Oschner and Michael DeBakey. In just a couple of decades lung cancer, one of the most rarest diseases became one of the most common. In 1940 Drs. Alton Oschner and Michael DeBakey an international renown heart surgeon, unsettled with the fact that most of the patience with lung cancer were smokers published “Carcinoma of the Lung” in Archives of Surgery. The Reader's Digest did not take tobacco advertising money. In 1941 they published "Nicotine Knockout" by prizefighter Gene Tunney. Mr. Tunney wrote, “A great athlete and conditioner of men indicts tobacco for poison and fraud.” In the following year 1942 the Reader's Digest publishes "Cigarette Advertising Fact and Fiction," claiming that cigarettes were essentially all the same, - deadly. World War II The second world war internationalized cigarettes, everywhere the solider went the American cigarette brands followed. By the end of WWII, 82% of British men smoked. However the troops returned home to find a newly emerging epidemic disease; Lung Cancer in men had increased 5000 % in less than 40 years. What was causing the increase in Lung Cancer? • Motor traffic? • Wood burning stoves? The 1950’s were watershed years, there were 3 major publication released awakening the public to the fact the smoking was connected to lung cancer. • Hill and Doll • Graham and Wynder • Morton Levin In 1948 the First Report on Smoking and Lung Cancer Smoking and Carcinoma of the Lung Preliminary Report by Sir Richard Doll and Bradford Hill was published in The British Medical journal. “In other words, it must be concluded that there is a real association between carcinoma of the lung and smoking.” Wynder Study Ernst L. Wynder and Evarts A. Graham (JAMA USA) Tobacco Smoking as a Possible Etiologic Factor in Bronchogenic Carcinoma “An elaborate, careful study of 687 lung cancer victims and more than 700 ‘controls’ reveals cigarettes to be “an important factor in the induction of bronchogenic carcinoma.” 1952 The Reader‘s Digest: Cancer by The carton Republishes Roy Norr's "Cancer by the Carton" article (December, 1952) from the October, 1952 Christian Herald. Norr was the publisher of possibly the first modern anti-smoking periodical, the "Norr Newsletter about Smoking and Health" (NYC) 1953 Biological Evidence - Mouse Painting June, 1953 Ernst L. Wynder, Evarts A. Graham & Adele B. Croninger Experimental Production of Carcinoma with Cigarette Tar Cancer Research 13:855-864 Of 81 tarred mice, 44 per cent developed histologically proved carcinomas. Of 62 mice alive at 12 months, 58 per cent developed cancer.” Wynder & Graham Study (1953) Life Magazine 1954 Prospective Epidemiological Studies “Though the numbers of deaths at present available are small the resulting rates reveal a significant and steadily rising mortality from deaths due to cancer of the lung as the amount of tobacco smoked increases.” 1954 E. Cuyler Hammond & Daniel Horn (US) The relationship between human smoking habits and death rates; a follow-up study of 187,766 men JAMA 1954 Aug 7;155(15):1316-1328 “All of the evidence we have seen seems to be consistent with the hypothesis that the association between smoking habits and death rates from lung cancer and diseases of the coronary arteries results from a cause and effect relationship. We know of no alternative hypothesis that is consistent with all of the known facts.” 1954 Richard Doll & A. Bradford Hill (BMJ UK) The Mortality of Doctors in Relation to Their Smoking Habits – A Preliminary Report 1954: Harpers Magazine Leonard Engel, a popular medical writer, stated in Harper's Magazine article Get a Good Scientist…and let him alone that "the case against cigarettes is by no means proved" and that cigarettes may have "little or nothing to do with cancer of the lung." Engel conceded that cigarettes were "dirty, expensive, and no contribution to physical health," but he also believed that the evidence made available to him was not yet enough "for a firm conclusion." 1955 Federal Trade Commission tells cigarette manufacturers to make no health implications in there advertising. The FTC publishes rules prohibiting health references in cigarette advertising; references to the "throat, larynx, lungs, nose, or other parts of the body" or to "digestion, energy, nerves, or doctors." 1957 Pathologic Evidence 1957 Oscar Auerbach (NEJM USA) Changes in the bronchial epithelium in relation to smoking and cancer of the lung. A report of progress. Dose-Response Relationship “This histological study shows that among people who died of causes other than lung cancer, basal-cell hyperplasia, stratification, squamous metaplasia and carcinoma-in-situ were least frequent in the group that never smoked regularly, with a progressive increase in the moderate and heavy smokers. The same but more extensive changes were observed in those who died of carcinoma of the lung. The findings are also fully consistent with the theory that cigarette smoking is an important factor in the causation of bronchogenic carcinoma.” 1957 President Dwight D. Eisenhower talks at a press conference about his battle to quit smoking after suffering a heart attack. "I'm a little like the fellow who said I don't know whether I'll start again, but I'll never stop again." 1957 July Surgeon General Burney says ''It is clear that there is an increasing and consistent body of evidence that excessive cigarette smoking is one of the causative factors in lung cancer.'‘ Senator Bennett (Utah) introduces bill requiring cigarette packs carry label, “warning: prolonged use of this product may result in cancer, in lung, heart and circulatory ailments and in other diseases.” 1957 The Blatnik Hearings The Blatnik hearings were the first testimony presented to Congress on smoking and health. The hearings center on whether the FTC should regulate advertising claims of filtered cigarettes. John A. Blatnik was chairman of the Legal and Monetary Affairs Subcommittee of the House Government Operations Committee. After hearing that filtered cigarettes deliver about as much tar and nicotine as unfiltered due to the stronger tobaccos used, the subcommittee moves to grant the FTC injunctive powers over deceptive cigarette advertising. The Blatnik Report concludes, "The cigarette manufacturers have deceived the American public through their advertising of cigarettes." Shortly after the report is issued, Blatnik is stripped of his chairmanship and his subcommittee is dissolved. 1958 Blatnik Commission report February 20, 1958 Blatnik Commission report is delivered to Congress. “The cigarette manufacturers have deceived the American public through their advertising of filter-tip cigarettes . . . Without specifically claiming that the filter tip removes the agents alleged to contribute to heart disease or lung cancer, the advertising has emphasized such claims as 'clean smoking,' 'snowy white,' 'pure,' 'miracle tip,' '20,000 filter traps,' 'gives you more of what you changed to a filter for' and other phrases implying health protection, when actually most filter cigarettes produce as much or more nicotine and tar as cigarettes without filters. . . The Federal Trade Commission has failed in its statutory duty to 'prevent deceptive acts or practices' in filter-cigarette advertising." False And Misleading Advertising (Filter-tip Cigarettes). Twentieth Report By The Committee On Government Operations Very shortly afterwards, Blatnik's commission was unceremoniously dissolved 1958 Senator Maurine Neuberger proposes bill providing state grants, educating school children on “harmful effects of tobacco, alcohol and other potentially deleterious consumables.” The 1960’s American Cancer Society and other fundraising groups request president Eisenhower to establish commission to study tobacco and health questions. With no answer within the Eisenhower administration, on June 1, 1961 the presidents of the American Cancer Society, the American Heart Association, the National Tuberculosis Association, and the American Public Health Association submitted a joint letter to President Kennedy, pointing out the increasing evidence of the health hazards of smoking and urging the President to establish a commission. The result will be the landmark 1964 SG report. In 1962 the British royal college of physicians released the First report on Smoking and Health. 1962 Surgeon General Luther Terry Announces formation of Advisory Committee on Smoking and Health. 1963 Sen. Moss (Utah) introduces measure to five FDA same power to police content, advertising, and labeling of cigarettes as FDA has over food, drugs and cosmetics. Surgeon General Luther Terry and his Advisory Committee The members for the Surgeon General’s advisory Committee were announced on October 27, 1962. Dr. Peter Hamill was medical coordinator and pulled together this team of experts. • • • • • • • • • • Dr. Walter J. Burdette, head of the Department of Surgery, University of Utah Dr. Stanhope Bayne-Jones, former dean, Yale School of Medicine William G. Cochran, professor of Statistics, Harvard University Dr. Emmanuel Farber, chairman, Department of Pathology, University of Pittsburgh Louis F. Fieser, professor of Organic Chemistry, Harvard University Liggett consultant Dr. Jacob Furth, professor of Pathology, Columbia University Dr. John B. Hickam, chairman, Department of Internal Medicine, Indiana University Dr. Charles LeMaistre, professor of Internal Medicine, the University of Texas Southwestern Medical School CONSULTANT FOR BW???” Dr. Leonard M. Schuman, professor of Epidemiology, University of Minnesota Dr. Maurice H. Seevers, chairman, Pharmacology, University of Michigan Industry consultant Peter Hamill picture needed January 11, 1964 The Surgeon General releases report linking cigarettes to lung cancer U.S. Surgeon General, Luther Terry, M.D.