Spring 2001; Volume 2, Number 1
Smoking and Health: The 1964 U.S. Surgeon General's Report as a Turning Point in the Anti-Smoking Movement
page 1 | page 2 | references
On Saturday, January 11, 1964, the U.S. Surgeon General Luther Terry approached the podium of the State Department auditorium to deliver the results of an exhaustive literature review through a 387-page report entitled "Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service." There, the government sealed off 200 reporters and the ten members of the Surgeon General's Advisory Committee on Smoking and Health from the rest of the world. Inside the auditorium, Terry offered a two-hour exegesis on the report, which amplified the one paramount judgment that "cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action."1 The committee's report made front-page headlines throughout the country and was featured prominently on news broadcasts. Nevertheless, the press almost uniformly predicted that while smoking rates might decline in the immediate future, the smoking habit would inevitably prevail and the American public would not permanently change their use of tobacco products. More than thirty years later, smoking rates of American adults have been cut almost in half from 46% to 25% and it appears inevitable that this decline will continue. What caused the media to make such erroneous predictions? What separated this report from the numerous other reports and studies that had been written long before it?
Three major explanations emerge to distinguish this striking phenomenon: (1) the legitimacy, authority, and objectivity of the Surgeon General; (2) the meticulous accumulation and aggregation of scientific evidence that characterized the study; and (3) the widespread campaign that publicized the findings of the report. As a result, despite its rather predictable conclusions, Luther Terry's famous announcement marked an important turning point in the anti-smoking movement, precipitating a decline in smoking that has lasted to the present day.The Report
In May of 1962, President John F. Kennedy spoke at the very same podium in the State Department auditorium. In response to a question about health hazards attributed to smoking, he responded, "That matter is sensitive enough and the stock market is in sufficient difficulty without my giving you an answer that is not based on complete information, which I don't have."2 A few weeks later, after examining material gathered by the Public Health Service, Kennedy instructed Terry to go ahead with a plan he had proposed in April to appoint an Advisory Committee on Smoking and Health. After consulting with the tobacco industry, private health organizations, and several federal agencies, Terry picked ten distinguished scientists (who had not taken public positions on the health effects of smoking) to hold nine meetings between November 1962 and December 1963. They reviewed more than 7,000 articles, including 3,000 research reports, and reported its findings two months after Kennedy's assassination.3
On Saturday, January 11, 1964, newsmen, government workers, and tobacco industry spokesmen "puffed self-consciously on cigarettes" in the lobby and corridors outside the State Department auditorium after nine "no smoking" signs had been fastened to the walls inside.4 Meanwhile, Terry delivered the conclusions of the project for which the principal finding was as follows:
Cigarette smoking is associated with a 70% increase in the age-specific death rates of males. The total number of excess deaths causally related to cigarette smoking in the U.S. population cannot be accurately estimated. In view of the continuing and mounting evidence from many sources, it is the judgment of the Committee that cigarette smoking contributes substantially to mortality from certain specific diseases and to the overall death rate.5
The committee also found that "cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking far outweighs all other factors. In comparison with non-smokers, average male smokers of cigarettes have approximately a 9- to 10-fold risk of developing lung cancer and heavy smokers at least a 20-fold risk."6 Additionally, the committee concluded that "cigarette smoking is the most important of the causes of chronic bronchitis in the United States, and increases the risk of dying from chronic bronchitis and emphysema."7 Furthermore, it "established that male cigarette smokers have a higher death rate from coronary artery disease than non-smoking males."8 It even went on to state that while the causative role of cigarette smoking in deaths from coronary artery disease had not yet been proven, "the committee considers it more prudent from the public health viewpoint to assume that the established association has causative meaning than to suspend judgment until no uncertainty remains."9 This statement revealed the rather liberal nature of the committee, which chose to assume a causative role in the absence of more evidence rather than taking a wait-and-see stance. In doing so, the committee implicated cigarette smoking as a leading cause of heart attacks, which was the nation's number one killer at the time (577,000 deaths in 1962). Overall, the report indicted cigarette smoking on a number of different offenses and constituted very bad news for the more than seventy million regular smokers in the U.S.
Nevertheless, the report itself did not mark a dramatic shift from the conclusions that most other projects studying smoking had made. This was the case for the two reasons stated specifically in the discussion of the project's phases. First, the committee was to make an "objective assessment of the nature and magnitude of the health hazard by critically reviewing all available data but would not conduct new research."10 In other words, no original research was performed in conjunction with this study and all conclusions were subsequently drawn from literature that had already been made publicly available. Second, "recommendations for actions were not to be a part of the committee's responsibility" as it was recognized that "the many possible recommendations for action would extend beyond the health field and into the purview and competence of other Federal agencies."11 Terry's call for "appropriate remedial action" was the limit of the report's policy recommendations as it went no further than any other scientific studies of a similar nature. For these reasons, the Surgeon General's report did not represent a significant departure from the findings of previous work on the effects of smoking.The Initial Reaction
At the conclusion of the press conference, reporters rushed to the phones to call in the story. The next day, the report received front-page coverage throughout the country.12 After devoting several pages to discussing the content of the report and the details of Luther Terry's speech, all major media sources made their own predictions regarding the short- and long-term effects of his announcement. In its January 12, 1964 issue, the New York Times ran an article entitled "Cigarettes Peril Health, U.S. Report Concludes; 'Remedial Action' Urged" which included a sub-section entitled "Smoker in Street Largely Defiant" that described the reaction of smokers to the report. In a series of interviews, almost all smokers said that they would continue to smoke unfettered by the new information. As justification for this stance, they gave such reasons as, "I can stop drinking, but not smoking," "Because I've got strong lungs," "I love these stinkers," and "Everyone needs a certain amount of pleasure and smoking is a little pleasure I think I'll continue."13 The article concluded by saying that while smoking rates might drop temporarily, they would almost certainly rebound shortly thereafter and continue to rise as they had in the decade prior to 1964.
The January 12, 1964 issue of the Los Angeles Times featured the headline "Report Calls Smoking Definite Health Peril." It included two smaller articles with the titles "Americans Knew Smoking Hazards Long Before Report Was Started" and "Tobacco Report Effects Awaited: Initial Drop in Sales Predicted but Habit is Expected to Prevail." The first began by explaining that "Americans received plenty of advance warning about the hazards of cigarette smoking long before the Surgeon General's report was released Saturday in Washington."14 It cites numerous studies conducted by the Public Health Cancer Association, American Cancer Society, World Health Organization, American Heart Association, and American Medical Association that had been conducted years before and arrived at conclusions almost identical to those of the Surgeon General's report. The second article predicts that "the government's report on smoking and health will probably cut significantly into sales - perhaps 10 % initially...but experience both here and in Britain suggests that the drop will be short-lived."15 The article points out that tobacco was the nation's fifth largest crop whose revenues in 1963 brought in $8.08 billion of which 40% went to taxes and the article's author simply could not foresee a sizeable decrease in store for this rapidly-growing industry.
Moreover, these predictions weren't limited to major newspapers as the major magazines such as Newsweek and U.S. News & World Report made very similar statements. In the January 20, 1964 issue of Newsweek, an article called "Cigarette Smoking is a Health Hazard..." includes a lengthy description of the Surgeon General's report is followed by a brief discussion of the public's initial reaction. The authors state that "although tobacco stocks no doubt will dip and cigarette sales drop in the initial public reaction to the report, there is every reason to believe the industry will survive, as the British industry did after the equally strong Royal College of Physicians report in 1962."16 Similarly, the January 20, 1964 issue of U.S. News & World Report includes an article entitled "Here's the Latest on Tobacco and Health" which discusses the committee's findings after which it states the following:
Experience suggests that, every time a special study like the present one is published, there is a period when smoking declines. This is followed by a renewed, even steeper, rise in smoking. This happened in the U.S. in 1954. It happened most recently in Britain in 1962, where a Government report was followed by an official campaign urging people to cut down, or cut out, their cigarette smoking. In both countries, the slump in cigarette sales lasted only about a year. After that period, the only change in smoking habits that held on was a switch to filter cigarettes.17
Both Newsweek and U.S. News & World Report use the British example as justification for the claim that this report would not significantly alter smoking rates in the country, at least in the long run.
Upon examination of four separate media sources written directly after the Surgeon General's report, it appears remarkable that all of them make very similar forecasts concerning the fate of the smoking habit and the tobacco industry. Their justifications may have varied considerably as some stated that Americans already knew about the health risks of smoking, while others asserted that Americans simply could not give up a habit so ingrained in their culture, and still others pointed out that previous experience with similar reports has shown that the short-term decline in smoking would not be sustained for very long. Regardless, the media generally agreed that the report generated by the Surgeon General's Advisory Committee on Smoking and Health could not possibly make a permanent dent in an industry that had generated record profit levels year after year since World War II.page 1 | page 2 | references
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