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Smoking And Health

John Wayne Ad For Camel Cigarettes, 1950

The year 1964 marked the last time that anyone in America relaxed with a cigarette. The date, to be exact, was January 10, 1964. On the next day Surgeon General Luther L. Terry released his advisory panel's report on smoking and health. After that, people could still smoke, of course, but never again in the hazy delusion that cigarettes were harmless.

The connection between smoking and disease had been noted early on. When European explorers brought tobacco home from the New World in the sixteenth century, smoking - that is to say, inhaling the smoke - was quickly recognized as a dangerous habit. Puffing on a long pipe was medically acceptable then, as were snorting snuff and working a chaw. For hundreds of years, though, smoking was something apart, something for "fiends," deckhands, and exotic foreigners.

The idea of smoking was taken up again in the late nineteenth century, thanks in part to the development of one of the most lethal inventions of all time. It was a machine that could mass-produce cigarettes, making them cheap and easy to buy. Anyway, the turn of the century was a nervous age in America, ripe for a habit that was at once reckless and reassuring. People may have been calling cigarettes "coffin nails" and "cancer sticks," but they were lighting them up all the same. The trick was never quite coming to admit that smoking was a slow form of suicide. That was possible because the evidence of tobacco's relation to early death was entirely anecdotal. For every comment from some old nag about cigarettes giving Cousin Jo cancer, a person could take a long puff and then cite Great-uncle Lars, who smoked three packs a day and outlived his doctors.

Irrefutable evidence was wanting. Even if the incidence of lung cancer did rise in neat proportion to the number of smokers through the first half of the century, such figures didn't actually establish a cause-and-effect relationship. Likewise, the fact that mice whose backs were smeared with nicotine developed tumors didn't prove anything at all, except perhaps that to be on the safe side, people oughtn't smear their backs with nicotine.

While medical science continued to gather data in the 1950s, the nation's six major cigarette companies introduced filter cigarettes. The smokers who did worry about their health made them bestsellers. The habit flourished as never before: More Americans took up smoking, and those who did smoked, on average, more cigarettes. The incidence of lung cancer, undistracted by the cunning of filter cigarettes, more than doubled between 1950 and 1960. It was an epidemic of willing comers.

The situation was untenable to health officials. They decided that since American smokers had yet to be convinced of the risk of smoking, a kind of supreme court of medicine would have to convene and issue an official government statement on the issue. In June 1962 Surgeon General Terry announced the formation of an advisory panel of 10 physicians and scientists representing a wide range of specialties. They examined previous studies but didn't conduct any new research. The single greatest contribution was the work of a Veterans Administration pathologist named Oscar Auerbach. Dr. Auerbach and a band of colleagues undertook to study actual tissue samples from the respiratory passages of 1,500 deceased people. Correlating patient histories with analysis of the slides, Auerbach presented evidence that was anything but anecdotal. The slides revealed not only cancerous growths but precancer conditions.

Abnormalities in the tissue were consistent across the statistical model, in relation to the amount of tobacco used. Medical science finally had irrefutable, human evidence of the danger of smoking. The advisory panel released its findings in a book titled Smoking and Health: The Report of the Advisory Committee to the Surgeon General of the Public Health. Most of the 387 pages read like a biology textbook, but the panel was clever enough to put the conclusions up front.

The first conclusion was the most potent, with news value based not so much in what was said as in who said it. According to the Surgeon General, "Cigarette smoking is causally related to lung cancer ..." With that, a line was finally drawn.

Some people took the Surgeon General's report very seriously. Emerson Foote, one of the nation's top advertising men, responded by quitting his position as chairman of the McCann-Erickson agency, so that he would no longer have to handle tobacco company accounts. Meanwhile, cigarette sales dropped by as much as 25 percent in some parts of the country. The cigarette companies, which immediately refuted the report, did their best to throw the issue back into the gray area that had proved so congenial to them for so long. In the short run they succeeded, as what became known as the "Great Forswearing" of January and February was followed by the "Great Relapse" of March. Cigarette sales in 1965 and 1966 set new records.

The Surgeon General's report was one of those triumphs of science upon which the sixties built its hopes. Indeed, the report was eventually successful in reversing the trend. The percentage of American adult smokers dropped from about 40 percent in 1960 to about 20 percent today. The report is credited with extending the lives of more than two million people who either quit smoking or never took it up. The fact that everyone didn't quit in the face of the Surgeon General's report is even more intriguing, though, pointing up a fallacy in the panel's 1964 viewpoint. The basic assumption was that all Americans wanted to live longer. That, apparently, just wasn't true.

Julie M. Fenster's book Ether Day won the Anesthesia Foundation Award in 2004. Hazardous To Your Health. . October 2006.

The German Contribution

While accusations about the health damaging effects of tobacco stretch back over the centuries, a particularly strong tradition of scientific investigation emerged in Weimar Germany and was developed during the Nazi period. Take, for example, the case of smoking and lung cancer.

From the late 1920s on, Fritz Lickint published a series of detailed reviews of smoking and lung cancer trends, of ecological associations, autopsy series, experimental annual studies, and clinical reports which, he already considered in 1929, left no doubt that tobacco smoke was a major cause of lung cancer. In 1939, Franz Muller, from Cologne, performed what is generally recognised as the earliest controlled study, in which the smoking histories of 80 male lung cancer cases were compared with those of 86 ill defined control subjects. A markedly higher proportion of the former were found to be heavy smokers.

This activity occurred against a backdrop of official concern regarding the health damaging effects of smoking. Conti, the Reich Health Führer, established the "Bureau Against the Dangers of Alcohol and Tobacco" in 1939. In 1942 an "Institute for the Struggle against the dangers of Tobacco" was established at the University of Jena, under the directorship of Professor Karl Astel.

Originating from this institute in 1943 was the first formal case-control study of smoking and lung cancer, a convincing investigation in which Schairer and Schuniger showed a sophisticated understanding of the potential biases which could distort the findings. They included both population and clinical control series and examined whether changes in smoking pattern consequent upon illness could lead to artifictious results. The institute from which this study came was supported by 100,000 Reichmarks of Adolf Hitler's personal finances.

The investigation of the health effect of smoking was not restricted to lung cancer. The 1938 annual report of the Public Health Service (Offentliche Gesundheltsdiesnt) considered that "the nervous disorders of every sort which are being reported in increasing numbers from nearly every part of Germany are for the larger part due to excessive indulgence in tobacco and alcohol"

In 1939, Lickint's monumental 800 page study "Tabak und Organlsmus" was published by Hyppokrates Verlag, the editorship of which the censorious Kurt Klare had taken over from Erwin Liek, a doyen of Nazi medicine from the early years. This reviewed a huge body of work on the association between smoking and ill health, much of it carried out or published in Germany. In the same year, research into the effect of smoking on chromosomes was commissioned by the Reich Health Office.

Tobacco had long been considered a potential "genetic poison" by the Racial Hygiene movement in Germany, clearly the high level of concern regarding the health effects of smoking was strongly connected to the goal of general improvement of the Arian "race".

In March 1939 there was an attendance of 15,000 at a conference on the effects of tobacco and alcohol consumption. At this meeting Hans Reiter, president of the Reich Health Office, charged all the medical societies of Germany with the responsibility for determining scientifically the degree to which tobacco caused disease. At the official opening of the Institute for the Struggle Against the Dangers of Tobacco, Reiter outlined a research agenda which should guide its work: statistical inquires, clinical research into the effects of tobacco in humans, and experimental animal research. HEALTH PROMOTION UNDER THE NAZIS

The scientific research into the health effects of smoking went hand in hand with extensive health promotion activities aimed at reducing the prevalence of the habit. Popular health magazines such as Gesundes Volk (Healthy people: Journal for the Health and Entertainment of the Workforce), Volksgesundheit (People's Health), and Gesundes Leben (Healthy Life) contained warnings against the dangers of smoking. There was also a Journal Die Volksgifte (The Popular Poison) devoted to the campaign against alcohol and tobacco. General interest magazines and newspapers also drove home the message, which clearly meshed well the goals of racial hygiene: the improvement of national-biological resource of the health of the population.

Propaganda against smoking was also disseminated by the Hitler Youth and the League of Germany Girls. In 1939, Göring issued a decree forbidding the military to smoke on the streets, on marches, and on brief off duty periods and in the summer of 1942 the Federation of German Women launched a campaign against tobacco and alcohol abuse.

Self restraint was supplemented through restaurants and cafés being forbidden to sell cigarettes to women customers. Smoking was banned - for pupils and teachers alike - in many schools. Teachers were also expected to set an example to pupils outside of schools by not smoking. In July 1943, a law was passed forbidding tobacco use in public places by anyone under 18 years of age.

Transportation, workplaces, and public buildings became targets for smoking reduction campaigns. Thus it was considered criminal negligence if drivers were involved in accidents while smoking, and in 1944 smoking was banned on trains and buses. Aside from work-related antismoking propaganda, smoking was prohibited in many individual workplaces and public buildings, including government bureaus, hospitals, and rest homes.

The advertising of tobacco products also came under strict control. Advertisement could not give the impression that smoking had any :hygienic values". Furthermore, tobacco manufacturers could not "represent the use of tobacco as a sign of manliness, nor ridicule opponents of tobacco. They may not make advertising appeal to women and those interested in sports, nor picture smokers at the wheel of automobiles.

In accord with much current health proclamation theory, there was considerable endorsement of the goal of smoking cessation from role models. Thus, Robert Ley, the leader of the German Labour Front, attested personally the benefits of non smoking. While many other influential figures joined this roster, the state performer in antismoking propaganda was Adolf Hitler. As one magazine put it: "brother national socialist, do you know that our Führer is against smoking and think that every German is responsible to the whole people for all his deeds and emissions, and does not have the right to damage his body with drugs?"

Smoking And Health Promotion In Nazi Germany. FORCES (Fight Ordinances and Restrictions to Control and Eliminate Smoking) International - Powered by reason, driven by passion.

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