In 1958, Luther Terry became the Assistant Director of the National Heart Institute and he came to public prominence when President John F. Kennedy selected him as Surgeon General of the Public Health Service, effective March 2, 1961.
Although there had always been an awareness of the negative health effects of smoking, it was not until the 1950s that evidence began to be published suggesting that cigarette smoking caused lung cancer and other diseases. At the end of the decade, the Royal College of Physicians in Britain appointed a committee to investigate the relationship between smoking and health. The committee’s report, issued on March 7, 1962, clearly indicated cigarette smoking as a cause of lung cancer and bronchitis and argued that it probably contributed to cardiovascular disease as well. The RCP has also published a new report, Fifty years since smoking and health – progress, lessons and priorities for a smoke-free UK, which includes papers presented by leading international experts at a conference held in March 2012 to commemorate fifty years since the publication of the 1962 report. You can order printed copies of the new report or download the pdf here.
Shortly after the release of this report, Terry established the Surgeon General’s Advisory Committee on Smoking and Health, which he chaired, to produce a similar report for the United States. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the United States, released on January 11, 1964, concluded that lung cancer and chronic bronchitis are causally related to cigarette smoking.
The report also noted out that there was suggestive evidence, if not definite proof, for a causative role of smoking in other illnesses such as emphysema, cardiovascular disease, and various types of cancer. The committee concluded that cigarette smoking was a health hazard of sufficient importance to warrant appropriate remedial action.
In a recent publication for the 50th anniversary of that report, Anthony Komaroff, M.D., Editor in Chief, Harvard Health Publications wrote:
Terry, himself a longtime smoker, spoke at a press conference unveiling Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service. That press conference was held on a Saturday in part to minimize the report’s effect on the stock market. After all, in 1964 smoking was common, fashionable, and done everywhere. In the U.S., tobacco was an even bigger business than it is today.
Anthony Komaroff, MD also wrote:
I vividly remember hearing about the Surgeon General’s report on the CBS Evening News. At the time, I was a first-year medical student. Between two-thirds and three-quarters of my fellow students were smokers. By the time we graduated, only 10% remained smokers. The report was one big reason why.
In June 1964, the Federal Trade Commission voted by a margin of 3-1 to require that cigarette manufacturers “clearly and prominently” place a warning on packages of cigarettes effective January 1, 1965, stating that smoking was dangerous to health, in line with the warning issued by the Surgeon General’s special committee. The same warning would be required in all cigarette advertising effective July 1, 1965.
The landmark Surgeon General’s report on smoking and health stimulated a greatly increased concern about tobacco on the part of the American public and government policymakers and led to a broad-based anti-smoking campaign. It also motivated the tobacco industry to intensify its efforts to question the scientific evidence linking smoking and disease. The report was also responsible for the passage of the Cigarette Labeling and Advertising Act of 1965, which, among other things, mandated Surgeon General’s health warnings on cigarette packages.
Cigarette smoking of nicotine was defined as not an addiction in the Surgeon General’s first report on smoking (published by a committee of doctors who were largely smokers themselves). I am glad this part of the report is no longer the science.
The 1970s also saw the birth of a movement to protect nonsmokers from cigarette fumes, with no-smoking sections on airplanes, in restaurants and in other places. Those eventually gave way to complete smoking bans. Cigarette machines disappeared, cigarette taxes rose, and restrictions on the sale of cigarettes to minors got tougher.
Tobacco companies also came under increasing legal attack. In the biggest case of them all, more than 40 states brought lawsuits demanding compensation for the costs of treating smoking-related illnesses. Big Tobacco settled in 1998 by agreeing to pay about $200 billion and curtail marketing of cigarettes to youths.
In 1998, while the settlement was being completed, tobacco executives appeared before Congress and publicly acknowledged for the first time that their products can cause lung cancer and be addictive.
Even though the report was based on data already known, experts agree the Terry report clearly triggered decades of changes that whittled the smoking rate down.