Personal Health
Jane Brody on health and aging.
Fifty years ago this month, Dr. Luther L. Terry issued the first "Surgeon General's Report on Smoking and Health," which cited smoking as a cause of lung cancer in men. The hefty report landed like a bombshell on a complacent public, bombarded daily by tobacco advertising and surrounded at work, home and play by people who smoked.
On Friday, Dr. Boris D. Lushniak, the acting surgeon general, issued the 32nd edition, applauding a half-century of progress during which smoking rates have fallen by more than half. Still, he lamented that "smoking remains the leading preventable cause of premature disease and death in the United States."
Kathleen Sebelius, the secretary of health and human services, noted in a statement that "this year alone, nearly one-half million adults will still die prematurely because of smoking."
The new report greatly expands the list of disorders now known to be casually linked to smoking to include age-related macular degeneration, diabetes, colorectal cancer, liver cancer, tuberculosis, erectile dysfunction, cleft palate, ectopic pregnancy, rheumatoid arthritis, inflammation and impaired immune function. Exposure to secondhand smoke is now deemed a cause of stroke.
In 1964, smoking seemed like the thing to do, socially and legally accepted nearly everywhere. If you were not around back then, you'd be shocked by what it was like. Every car was a smoking car. On flights, passengers inhaled recirculated smoke-filled air. The aroma of exquisite restaurant meals were tainted by tobacco smoke.
Hospital visitors smoked in patients' rooms, as did many patients themselves. Movies were watched through a smoky haze. Cigarette samples were widely distributed on college campuses, and students smoked freely in their dorms.
Young people associated smoking with glamour and sophistication. I tried it in college myself, but quickly gave it up, deterred by the odor, the eye irritation and the nagging worry that my mother's fatal ovarian cancer might have been related to this terrible habit.
Although the surgeon general's report prompted Congress in 1965 to pass a cigarette labeling and advertising law, it took six years for that famous warning — "The Surgeon General Has Determined That Cigarette Smoking Is Dangerous to Your Health" — to appear on packs. Cigarette advertising was banned on radio and television, whereupon the ads moved to magazines.
I was a cub reporter at The Minneapolis Tribune when the historic report landed in the newsroom. I was assigned to interview the smoking "man in the street," to assess his reaction to the news that what many nonsmokers viewed as a noxious habit was actually a killer.
Several told me they'd cut back, and a few thought they would try to quit. But the overwhelming majority defended their right and intent to continue smoking. As more than one put it, "By the time I get lung cancer, they'll know how to cure it."
Well, a half-century later, we still don't know how to cure lung cancer, and we may still not know in another 50 years. Furthermore, in the decades since the 1964 report, damning evidence for the health hazards of smoking has continued to mount. The consequences include damage to nearly every organ in the body; one in three cancer deaths; risk to the health and lives of unborn babies; and disease and death among nonsmokers exposed to secondhand smoke.
Smoking causes one in five deaths in the United States, more than 440,000 each year, according to the Centers for Disease Control and Prevention. "Tobacco is in a league of its own in terms of the sheer numbers and varieties of ways it kills and maims people," Dr. Thomas R. Frieden, the C.D.C. director, wrote in JAMA.
And as millions of women came "a long way, baby" — egged on by this slogan for Virginia Slims and a desire to control their weight and achieve gender equity— smoking-related risks caught up to them. More women now die each year from lung cancer than breast cancer — about 28,000 more, though annual walks, runs or ribbons devoted to conquering this runaway killer are lacking.
Many women were misled by a prevailing belief that they were somehow protected from smoking's health effects. In fact, the risk of death for women who smoke parallels that of male smokers and "is 50 percent higher than the estimates reported in the 1980s," Dr. Steven A. Schroeder wrote last January in The New England Journal of Medicine.
The good news is that we've made dramatic progress in curbing this huge contributor to disease, disability and death and in reducing billions of dollars in health care expenditures and lost productivity from smoking.
Smoking prevalence is down to 18 percent today from 43 percent of adults 50 years ago. Smoking is banned in public buildings; on public airplanes, trains and buses; inside restaurants, hospitals and most workplaces; and even banished from most private homes.
From 1964 to 2012, "eight million premature deaths have been prevented because of tobacco control measures," Theodore R. Holford, a Yale statistician, and his co-authors reported in JAMA. They attributed about one-third of the gains in life expectancy since 1964 to the decline in smoking.
Still, the industry spends billions of dollars each year — nearly $23 million a day — to keep smokers at it and entice new ones to start. Although manufacturers say they do nothing to attract young smokers, they have managed to infiltrate smoking into movies popular among teens, subliminally suggesting that this is socially desirable behavior.
While teen smoking has declined, still nearly one in five teens is a regular smoker. Feeling invulnerable, teens often ignore warnings about health risks, wrinkles and premature death decades in the offing. And though told repeatedly that smoking is addictive, many still believe they can quit whenever they want.
Of the nearly 42 million Americans still hooked on cigarettes, about 70 percent have said they want to quit. Many have tried quitting one or more times without success. Some experts believe that those who still smoke represent a particularly challenging group of committed smokers.
But I've known several hardcore smokers who have quit in spite of themselves. My husband, Richard, was one. He smoked for 50 years, starting at age 11, and repeatedly insisted that he couldn't quit. (Happily, he persuaded our sons never to start.)
Even after a two-week hiatus following a cardiac scare, Richard resumed smoking. He finally quit once and for all at age 61, after one session with a hypnotist and a few sticks of nicotine gum. He then became an ardent proselytizer, chastising every teenager he saw with a cigarette about having a death wish.
Although Richard succumbed to a smoking-induced lung cancer 15 years later, statistics suggest that quitting when he did gave him four extra years to enjoy life and our four darling grandsons.
This is the first of two columns on smoking.
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