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Smoking and Health Report of the Advisory Committee to the Surgeon General of the Public Health Service - Part 2 of 3
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- PSCI, SCIENTIFIC PUBLICATION
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- Document File
- 03763512/03766002/S H Re 1979 Surgeon General S Report.
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- LEGAL DEPT FILE ROOM
- Alias
- 03765573/03765726
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- 03764103/6002
- 03764105
- 03764106
- 03764107-4109 Bibliography on Smoking and Health
- 03764110-4112 the Health Consequences of Smoking
- 03764129-4257 the Health Consequences of Smoking 750000 - Part 1 of 2
- 03764200-4257 the Health Consequences of Smoking 750000 - Part 2 of 2
- 03764260-4261 Statement by Horace R. Kornegay, President of Tobacco Institute, on the 740000 Health Consequences of Smoking, Hew Report to Congress Released 740628
- 03764266-4273
- 03764274-4551 the Health Conseguences of Smoking - Part 1 of 3
- 03764350-4451 the Health Consequences of Smoking - Part 2 of 3
- 03764452-4551 the Health Conseguences of Smoking - Part 3 of 3
- 03764552-4727 the Health Consequences of Smoking A Report of the Surgeon General: 720000 - Part 1 of 3
- 03764555
- 03764567-4666 the Health Consequences of Smoking A Report of the Surgeon General: 720000 - Part 2 of 3
- 03764667-4727 the Health Consequences of Smoking A Report of the Surgeon General: 720000 - Part 3 of 3
- 03764729
- 03764730-4735
- 03764736-4737
- 03764739-4740
- 03764747-4748
- 03764749-4961 The Health Consequences of Smoking A Public Health Service Review] 670000
- 03764962-5073 the Health Consequences of Smoking 690000 Supplement to the 670000 Public Health Service Review
- 03765074-5541 the Health Consequences of Smoking Part 1 of 4
- 03765309-5541 The Health Consequences of Smoking Part 3 of 4
- 03765543
- 03765545-5546
- 03765548
- 03765549 Informational Memo
- 03765550-5553 for Simultaneous Use with 710000 Surgeon General's Report on Smoking and Health
- 03765554-5556 Smoking Is Very Debonair
- 03765557
- 03765558-5965 Smoking and Health Report of the Advisory Committee to the Surgeon General of the Public Health Service - Part 1 of 3
- 03765727-5965 Smoking and Health Report of the Advisory Committee to the Surgeon General of the Public Health Service - Part 3 of 3
- 03765966
- 03765967-6000 Report to Surgeon General's Advisory Committee on Smoking and Health - Materials on Cigarette Filtration
- 03766001-6002
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LEi7CHTENBERGER, RUDOLF, M.D.-Professor Eidgenossische Technische
Hochschule, Institut fiir Aligemeine Botanik, Zurich, Switzerlan&
LEVIN, MORTON L., M.D.-Professor of Epidemiology, Roswell Park Me-
moriall Institute, Buffalo, N.Y.
LIEBOw, AVERILL A., M.D.-Professor of Pathology, Yale.University School
of Medicine, New Haven, Conn.
LIGGETT & MYERS, INC., New York, N.Y.
LILIENFELD,, ABRAHAM, M.D.-Professor of Chronic Diseases, The Johns
Hopkins School of Hygiene and Public: Health, Baltimore, Md.
Lisco, HERMAN, M.D.-Cancer Research Institute, New England Deaconess
Hospital, Boston, Mass.
LITTLE, CLARENCE Cootc, M.D.-Scientific Director, Tobacco Institute Re-
searchi Committee, New York, N:Y.
LouDON, R. G., M.B.-Assistant Professor of Internal Medicine, The Uni«
versity of Texas Southwestern Medical'School, Dallas, Tex.
MxNOS, NICxoLAS E.-Statistician, Division of Occupationall Health, U.S.
Public Health Service, Washington, D.C.
MARDER, MARTIN, Ph: D.-Research Psychologist Behavioral Sciences Sec-
tion, Division of Community Health Services, U.S. Public Health Service,
Washington, D.C..
MATARAZZO, J. D., Ph. D.-Professor of Medicall Psychology, Department of
Medical Psychology, University of Oregon Medical School, Portland,
Oreg.
McFARLAND, JAIaIES J.,, M.D: Professor of Otolaryngology, School of Medi-
cine, George Washington University Hospital, Washington, D.C.
McGILU, HENRY C., M.D.-Professor of Pat'hology, Louisiana State Uni-
versity School of Medicine, New Orleans, La.
McHucH, RICHARD B., PhL D.-Associate Professor of BiostatistScs, School
of Public Health, University of Minnesota, Minneapolis, Minn.
McKENNIS, HERBERT, Jr.-Professor of Pharmacology, Medical College of
Virginia, Richmond, Va.
MEDALIA, NAHUM Z,, Ph. D.-Executive Secretary, Mental HealYh~ Small
Grants Committee,,N'ational Institute of Mental Health, U.S. Public Health
Service, Bethesda, Md.
MEHLER, MRS. ANN-Resear& Assistant, National Cancer Institute, U.S.
Public Health Service, Bethesda, Md.
MILLER, JACK, M.D.-Research Fellow in Medicine, The University of Texas
Southwestern Medical School, Dallas, Tex.
MILLER, ROBERT W., M.D.-Chief, Epid'emiology Section,, National Cancer
Institute, U.S. Public Health Service, Bethesda, Md.
MILLER, WILLIAM F., M.D.-Associate Professor of Internal Medicine, The
University of Texas Southwestern Medical School, Dallas, Tex.
MITCHELL, ROGER S., M.D.-Associate Professor, University of Colorado
School of Medicine, Denver, Colo:
MURPHY, EDMOND A., M.D.-Attending Physician,, The Moore Clinic, The
Johns Hopkins University Hospital, Baltimore, Md.
NASH, HARVEY, Ph. D.-Illinois State Psychiatric Institute, Northwestern
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xiv
NELSON; NORTON, Ph~ D.-Professor an& Chairman, Department of Indus-
trial b'Iedicine,, New York University Medical Center, New York, N:Y.
ORCHIN, MILTON, Ph. D.-Professor of Chemistry, University of Cincinnatiy
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PAFFENBARGER, RALPH S., Jr., M.D.-Medical Director, Field Epidemiology
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PAUL, OGLESBY, M.D.-Chairman, Committee on Epid'emiological Studies,.
Passavant Memorial Hospital, Chicago, 111.
PFAELZER, ANNE I.-Concord, Mass.
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PICKREN, JOHN W., M.D.-Chiefy Department of Pathology, Roswell Park
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PIERCE, JOHN A., M.D.-Associate Professor, Department of Medicine, Uni-
versityof Arkansas Medical Center, Little Rock, Ark.
POTTS, ALBERT M., M.D.-Professor of' Ophthalmology, University of! Chi-
cago Sehool of Medicine, Chicago, Ill.
PftINDLE; RICHARD A., M.D.-Chief, Division of Public Health Methods,
US. Public Health Service, Washington, D.C.
R. J. REYNOLDS TOBACCO Co., Winston-Salem; N.C.
REED, SHELDON C., Ph. D.-Professor of Zoology, Departmentl of Zoology,
University of Minnesota, Minneapolis, Minn.
REMINGTONRAND, LaD:(Ottawa).
Roos, CHARLES A.-Head, Reference Services Section,, National Library of!
Medicine, U.S, Public Health Service, Bethesda, Md.
ROSEN, S.aM[iEL, M.D.-Chief, Pulmonary Mediastinall and ENT Pathology
Branch, Armed Forces Institute of Pathology, Washington, D.C.
ROSENsnATT ,, MILTON B., M.D.-Associate Clinical Professor of Medicine,
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Ross, JOSEPH,N'I.D.-Associate Professor of Medicine, University of Indiana
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versity of Texas Southwestern Medical Schooly Dallas, Tex.
SAVAGE, I. RICHARD, Ph. D.-Professor of Statistics, Florida State University,
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SaHNEIDERMAN,, MARVIN. A-Associate Chief, Biometry Branch, National
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SCHWARTZ, JOHN THEODORE; M.D.-Head, Ophthalmology Project, Na-
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SCOTT, OWEN-Executive Officer, National Institute of General Medical Sci-
ences, U.S. Public Health Service, Bethesda, Md.
SELIGMAN, ARNOLD M., M.D.-Chairman, Department of Surgery, Sinai' Hos-
pital, Baltimore, Md.
0
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xv
SELTSER; RAYMOND, M.D.-The Johns Hopkins University School of Public
Health, Baltimore, Md.
SELTZER, CARL C., Ph. D.-Research Associate in Physical Anthropology,.
Peabody Museum, Harvard Uhiversity Cambridge, Mass.
SHAPIRO, HARRY, M.D.-Curator of Anthropolbgy., American Museum of
Natural History, New York, N.Y.
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SILVETTE, HERBERT, Ph. D.-Visiting Professor of Pharmacology, Medical
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STALLONES, REUEL, M.D.-University of California Schooll of Public Health,
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STEWART, HAROLD L., M.D.-Chief, Laboratory of Pathology, National Can-
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STOUT, ARTHUR P., M.D.-Professor Emeritus of'~ Surgery, Laboratory of Sur-
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STOWELL, ROBERT, M.D., Ph. D.-Scientific Director, Armed Forces Institute
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SYME, SHERMAN LEONARn-Sociologist, San Francisco Field and Training
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TAEUBER, K. E.-Research Associate, Population Research and Training
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TOKUHATA, GEORGE, Ph. D., D.P.H.-Chief of Epidemiolbgy, St. Jude Re-
search Hospital, Institute of Biology and Pediatrics, Memphis. Tenny and
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lege of Medicine, Memphis; Tenn.
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Texas Southwestern Medical' School, Dallas, Tex., and Director of Medical
Education Baylor University Medical Center, Dallas, Tex.
TbTTEN; ROBERT S., M.D.-Associate Professor of! Pathology, University of
Pittsburgh School of Medicine, Pittsburgh, Pa.
TURNER, CLAUnE G.-Director, Tobacco Policy Staff, Agriculture Stabiliza
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xvi
M
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VINCENT, WILLIAM J.-Student, University of California, Los Angeles, Calif.
VON SALLMANN, LUDWIG, MsD.-Chief, Ophthalmology Branch, National In-
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VORWALD, ARTHUR M.D.-Chairman, Department! of IndustrialJ Medicine
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WALKER, C. B., B.A.-Biostatistics Section, Research and Statistics Division,
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WEBB, BLAIR M., M.D.-Otolaryngologist and ENT Consultant at the
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WE1:vSTEIrr, HOWARD I., M.D.-Director, Division of Medical Review, Foo&
and Drug,Administration, Washingtony D.C.
WOOLSEY, THEODORE D.-Assistant Director, National Center for Health~
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WYATT, JOHN P., M.D.-Professor of Pathology, St. Louis University Schooll
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7.UKEL, WTLLIAni, M.D.-Associate Director, Collaborative Studies, Nationall
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714-422' 0-64'-2'
xvii
9
Introduction,.
Summaries,, and
Conclusions
:.wrr~ , . _._ ... ,,4 ..-« _ .. .. _+. .-..--.,
Y
649994E0
---
Chapter 1
Realizing that for the convenience of all' types of serious readers it~ would
be desirable to simplify language, condense chapters and bring opinions
to the forefront. t'be Committee offers Part I as'sueh a presentation. This
Part includes: (a) ani introduction comprising, among other items, a chro-
nology especially pertinent to the subject of this study and to the establish-
ment and activities of the Committee, (b)! a short account ofl how the study
was conducted, (c) the chief criteria used in making jNd=ments, and' (d)
a brief overview of the entire Report.
HISTORICAL NOTES AND CHRONOLOGY
In the early part of the 16th century, soon after the introductSon, of'
tobacco into Spain and England by explorers returning from t'he New World,
controversy developed from differing opinions as to the effects of the human
use of the leaf and prodhcts derived from it by combustion or other means.
Pipe-smoking, chewing, and snuffing of tobacco were praised for pleasura-
ble and reputed medicinal actions. At the same time, smoking was con-
demned as a foul-smeliing, lbathsome custom, harmful to the brain and'
lungs. The chief question was then as it is now: is the use of tobacco bad
or `rood for health, or devoid of effects on health? Parallel with~ the increas-
ing prodtiction and use of t'obacco, especiall~, with the constantly increasing
smoking of ci-arettes, the controversy has become more and more intense.
Scientific attack upon the problems has increased proportionately. The
design, scope and penetration of studies have improved, and the yield of
significant results has been abundant.
The modern~ period of' inuestigatiom of smoking and healthis include&
within the past sixty-three years. In 1900 an increase in cancer of the
lung was notedl particularly by vital statisticians, andl their data are usually
taken as the st'arting point for studies on the possible relationship of smoking
and other uses of tobacco t'o cancer of the lung and of cert'aini other organs,
to diseases of the heart and blood vessels (cardiovascular diseases in gen-
eral; coronary artery disease in, particular) and to the non-cancerious (non-
neoplastic) diseases of the lower respiratory tract (especially chronic
bronchitis and! emphysemal . The next important basic date for starting
comparisons is 1930, when the definite trends in mortality and disease-inci-
dence considered in this Report became more eonspicuous. Since then a:
areat variety of investigations have been carried out. Many of the chem-
ical compounds in~ tohacco, andd in tobacco smoke havebeem isolatedl and
tested. Numerous experimental studies in lower animals have been made
by exposing them to smokeand'~ to tars, gases and various constituents in
tobacco~ and tobacco smoke. It is not feasible to~ submit human beings to
5
-4::-. v-.::.e";:,:,.: ik'AM .._
experiments that might produce cancers or other serious damage, or to
expose them to possibly noxious agents over the prolonged periods under
strictly controlled conditions that wouldl be necessary for a valid test.
Therefore, the main evidence of the effects of smoking andl other uses of
tobacco upon the health of human beings has been secured through clinical
and pat!holbgical observations of conditions occurring in men, women and
children in the course of their lives, and by the application of epid'emio-
logiealand statistical methods by which a vast array of information has been
assembled and analyzed~
Among the epidemiolbgical methods which have been used in attempts to
determine whether smoking and other uses of tobacco affect! the health of
man, two types have been particularly useful and have furnished information
of the greatest value for the work ofl this Committee. These are (!l ) retro-
spective studies which deal with data from the personal histories and medical
and mortalityrecords of human individuals in groups; and (2)~ prospeetit;estudies, in~ which men and
women are chosen randomly or f'rom~ somee
special group; such as a profession, and are follbaed from the time of their
entry into the study for an indefinite period, or until they die or are lost
on account of other event's.
Since 1939 there have been 29 retrospectiive studies of lung cancer alone
which have varying degrees of completeness andl validity. Following, the
publication of several notable retrospective studies in the years 11952-1'956,
the medical evidence tending to link cigarette smoking to cancer of the lung,
received particularly widespread attention. At this time, al'so, the criticali
counterattack upon retrospective studies and upon conclusions drawn from
them was launched by unconvinced individuals and groups. The same types
of criticism and skepticism have been, and are, marshalled against the meth-
ods, findings; and conclusions of the later prospective studies. They will be
discussed further in Chapter 3, Criteria for Judgment, and in other chapters,
especially ChapterII, Mortality, and Chapter 9, Cancer.
Durin- the decade 1950-1960, at various datesstatements based upon the
accumulated evidence were issued by a number of organizations. These
included the British Medical Research Council; the cancer societies of Den-
mark,'orway; Sweden, Finland, and the Netherlands; the American Cancer
Society; the American Heart Association; the Joint Tuberculosis Couneit of'
Great Britain; andlthe Canadian Nationall Department of' Health and~''Velfare.
The consensus, publicly declaned, was that smoking is an important health
hazard, particularly with respect to: lung cancer and! cardiovascular disease.
Early in 1954. the Tobacco Industry Research Committee (T:I.R.C.) was
established by representatives of tobacco manufacturers.. growers, and ware-
housemen to sponsor a program of research into questions of tobacco use
and health~ Sincethen, under a Scientific Director and a Scientific AdvisoryBoard composed of nine
scientists w,homaintain t'heirrespecthve institutional
affiliations, the Tobacco Industry Research Committee has conducted a
grants-in-aid program, collected information, and i'ssued reports.
The U.S. Public Health Service first became officially engaged in an
appraisal of the available data on smoking and health~ in~ June; 1956, when,
under the instfigation of the Surgeon General, a scientific Study Group on
6
the subject was established jointly by the National Cancer Instfitute;, the
National Heart Institute, the American Cancer Society, and the American
Heart Association. After appraising 16,independent studiesearried on in
five countries over aperiod'of 18 years, this group concluded that there is
al causal, relationship between excessive smokingoflcigarettesandilungcancer.
Impressed by the report of the Study Committee and by other new evi-
dence. Surgeon General Leroy E. Burney issued a statemea on July 12, 1957,
reviewing the matter and declaring, than "The Public Health Service feels
the wci_ht of the evidence is increasingly pointing, in one direct'2on;, that
Axcessive smoking is one of the causative factors in ltmg cancer." Again,
in a special article entitled "Smoking andlLung,Caneer A St'at'ement of the
Pi ublicHealthService;"published in the Journall of the American Medicall
1ssociation on November 20', 1959. Surgeon Generall Burnev referred too
his statement issued in 1957 and reiterated the belief of the Public HealthServ,ice that: "The
weight of evidence at present implicates smoking as the.
Eirincipal factor in the increased incidence of lung cancer," and that: "Ciga-
rette smoking particularly is associated with an increased chance of de-
Nelbpinn lung cancer." These quotations state the position of the Publfc.
Flealth Service taken in 1957 and 111959 ont'he question of smoking and
health. That position has not changed in the succeeding, years, dhring
«hichseveral units of the Service conducted extensive investigations on
t-moking and airpollution; and theService maintained a; constant scrutiny
'?freportsandlpublications in this field.
ESTABLISHi~-TENT OF THE COMMITTEE
The immediateantecedent's of the establishment of the Surgeon Gen-
eral's Advisory Committee on Smoking and Health: began in mid-1961.
On June t of that vear, a letter was sent to4hePresident' of the I:Tnited States:
qi;ned' bvt'he presidents of the American CancerSociety; the American
Public Health Association: the American Heart Association; and theNa-
tional Tuberculosis Association. It urged the formation of a Presidential'commission t~o~ study the
"widespread implications ofl the tobacco problem."'
On January 4, 11962, representatives of the various organizations met
with Surgeon General Luther L. Terry: who shortly thereafter proposed to
the Secretary of Health, Education, and Welfare the formation ofi an advi-
sorv committee composed of "outstanding experts who would assess avail-
able knowledgein this areai [smoking vs. health] and make appropriate rec-
ommendations, . . ."
On April! . 16. the Surgeon General sent a moredetail'ed' proposal t'o: theSecretarv for the
f'ormation of the advisory group, calling for re-evaluation
ofl thePublficHealth Service position taken by Dr. Burnev in the Journal
of the American Medical Association. Dr. Terry felt the need for a; new
look at the Service's position in the light of' a number of significant': develop-
ments since 1959 which emphasized the need f'or further action. He listed
t'heseas:
7
