Public Health’s Answer to the
Cigarette Epidemic 1940-1966
Dr. Michael DeBakey
“It had become more frequent than cancer
of the stomach, that was very impressive,
from 1912 to 1939 a period of just a couple of
decades, lung cancer had now become from
the rarest of disease to one of the most
commons…”
By the end of the 1930’s the increasing number of lung cancer
diagnosis in their patience alarmed two American surgeons
Drs. Alton Oschner and Michael DeBakey.
In just a couple of decades lung cancer, one of the most rarest
diseases became one of the most common.
In 1940 Drs. Alton Oschner and Michael DeBakey an international
renown heart surgeon, unsettled with the fact that most of the
patience with lung cancer were smokers published
“Carcinoma of the Lung” in Archives of Surgery.
The Reader's Digest did not take tobacco advertising
money. In 1941 they published "Nicotine Knockout" by
prizefighter Gene Tunney.
Mr. Tunney wrote, “A great athlete and conditioner of
men indicts tobacco for poison and fraud.”
In the following year 1942 the Reader's Digest
publishes "Cigarette Advertising Fact and
Fiction," claiming that cigarettes were
essentially all the same, - deadly.
World War II
The second world war internationalized cigarettes,
everywhere the solider went the American cigarette
brands followed. By the end of WWII, 82% of British
men smoked. However the troops returned home to
find a newly emerging epidemic disease; Lung Cancer
in men had increased 5000 % in less than 40 years.
What was causing the increase in Lung Cancer?
• Motor traffic?
• Wood burning stoves?
The 1950’s were watershed years, there were 3
major publication released awakening the public
to the fact the smoking was connected to lung
cancer.
• Hill and Doll
• Graham and Wynder
• Morton Levin
In 1948 the First Report on Smoking and Lung Cancer
Smoking and Carcinoma of the Lung Preliminary Report by
Sir Richard Doll and Bradford Hill was published in
The British Medical journal.
“In other words, it must be
concluded that there is a real
association between
carcinoma of the lung and
smoking.”
Wynder Study
Ernst L. Wynder and Evarts A.
Graham (JAMA USA)
Tobacco Smoking as a Possible
Etiologic Factor in Bronchogenic
Carcinoma
“An elaborate, careful study of 687 lung cancer victims
and more than 700 ‘controls’ reveals cigarettes to be
“an important factor in the induction of
bronchogenic carcinoma.”
1952 The Reader‘s Digest: Cancer by The carton
Republishes Roy Norr's
"Cancer by the Carton" article
(December, 1952) from the
October, 1952 Christian
Herald. Norr was the
publisher of possibly the first
modern anti-smoking
periodical, the "Norr
Newsletter about Smoking
and Health" (NYC)
1953 Biological Evidence - Mouse Painting
June, 1953
Ernst L. Wynder, Evarts A. Graham
& Adele B. Croninger
Experimental Production of
Carcinoma with Cigarette Tar
Cancer Research 13:855-864
Of 81 tarred mice, 44 per cent developed
histologically proved carcinomas.
Of 62 mice alive at 12 months, 58 per cent developed
cancer.”
Wynder & Graham Study (1953) Life Magazine
1954 Prospective Epidemiological Studies
“Though the numbers of deaths at
present available are small the
resulting rates reveal a significant and
steadily rising mortality from deaths
due to cancer of the lung as the
amount of tobacco smoked increases.”
1954 E. Cuyler Hammond & Daniel Horn
(US)
The relationship between human smoking
habits and death rates; a follow-up study
of 187,766 men
JAMA 1954 Aug 7;155(15):1316-1328
“All of the evidence we have seen
seems to be consistent with the
hypothesis that the association
between smoking habits and death
rates from lung cancer and diseases of
the coronary arteries results from a
cause and effect relationship. We
know of no alternative hypothesis that
is consistent with all of the known
facts.”
1954 Richard Doll & A. Bradford Hill (BMJ UK)
The Mortality of Doctors in Relation to Their
Smoking Habits – A Preliminary Report
1954: Harpers Magazine
Leonard Engel, a popular
medical writer, stated in Harper's
Magazine article Get a Good
Scientist…and let him alone that
"the case against cigarettes is by
no means proved" and that
cigarettes may have "little or
nothing to do with cancer of the
lung."
Engel conceded that
cigarettes were "dirty, expensive,
and no contribution to physical
health," but he also believed
that the evidence made available
to him was not yet enough "for a
firm conclusion."
1955
Federal Trade Commission tells cigarette manufacturers
to make no health implications in there advertising.
The FTC publishes rules prohibiting health references in
cigarette advertising; references to the "throat, larynx, lungs,
nose, or other parts of the body" or to "digestion, energy,
nerves, or doctors."
1957 Pathologic Evidence
1957 Oscar Auerbach (NEJM USA) Changes in
the bronchial epithelium in relation to
smoking and cancer of the lung. A report of
progress.
Dose-Response Relationship
“This histological study shows that among people who
died of causes other than lung cancer, basal-cell
hyperplasia, stratification, squamous metaplasia and
carcinoma-in-situ were least frequent in the group that
never smoked regularly, with a progressive increase in
the moderate and heavy smokers. The same but more
extensive changes were observed in those who died of
carcinoma of the lung.
The findings are also fully consistent with the theory
that cigarette smoking is an important factor in the
causation of bronchogenic carcinoma.”
1957
President Dwight D. Eisenhower talks at a
press conference about his battle to quit
smoking after suffering a heart attack.
"I'm a little like the fellow who said I don't
know whether I'll start again, but I'll never
stop again."
1957
July Surgeon General Burney says
''It is clear that there is an increasing
and consistent body of evidence that
excessive cigarette smoking is one of
the causative factors in lung cancer.'‘
Senator Bennett (Utah)
introduces bill requiring cigarette
packs carry label, “warning: prolonged
use of this product may result in
cancer, in lung, heart and circulatory
ailments and in other diseases.”
1957 The Blatnik Hearings
The Blatnik hearings were the first testimony
presented to Congress on smoking and health.
The hearings center on whether the FTC should
regulate advertising claims of filtered cigarettes.
John A. Blatnik was chairman of the Legal and
Monetary Affairs Subcommittee of the House
Government Operations Committee.
After hearing that filtered cigarettes deliver
about as much tar and nicotine as unfiltered
due to the stronger tobaccos used, the
subcommittee moves to grant the FTC injunctive
powers over deceptive cigarette advertising.
The Blatnik Report concludes, "The cigarette
manufacturers have deceived the American
public through their advertising of cigarettes."
Shortly after the report is issued, Blatnik is
stripped of his chairmanship and his
subcommittee is dissolved.
1958 Blatnik Commission report
February 20, 1958 Blatnik Commission report is
delivered to Congress.
“The cigarette manufacturers have deceived the
American public through their advertising of filter-tip
cigarettes . . . Without specifically claiming that the filter tip
removes the agents alleged to contribute to heart disease or
lung cancer, the advertising has emphasized such claims as
'clean smoking,' 'snowy white,' 'pure,' 'miracle tip,' '20,000
filter traps,' 'gives you more of what you changed to a filter
for' and other phrases implying health protection, when
actually most filter cigarettes produce as much or more
nicotine and tar as cigarettes without filters. . . The Federal
Trade Commission has failed in its statutory duty to
'prevent deceptive acts or practices' in filter-cigarette
advertising."
False And Misleading Advertising (Filter-tip
Cigarettes). Twentieth Report By The Committee On
Government Operations
Very shortly afterwards, Blatnik's commission was unceremoniously dissolved
1958
Senator Maurine
Neuberger proposes bill
providing state grants,
educating school
children on “harmful
effects of tobacco,
alcohol and other
potentially deleterious
consumables.”
The 1960’s
American Cancer Society and other fundraising groups
request president Eisenhower to establish commission to
study tobacco and health questions.
With no answer within the Eisenhower administration,
on June 1, 1961 the presidents of the American Cancer
Society, the American Heart Association, the National
Tuberculosis Association, and the American Public Health
Association submitted a joint letter to President Kennedy,
pointing out the increasing evidence of the health hazards of
smoking and urging the President to establish a commission.
The result will be the landmark 1964 SG report.
In 1962 the British royal college of physicians released
the First report on Smoking and Health.
1962
Surgeon General Luther Terry Announces
formation of Advisory Committee on Smoking
and Health.
1963
Sen. Moss (Utah) introduces measure
to five FDA same power to police content,
advertising, and labeling of cigarettes as
FDA has over food, drugs and cosmetics.
Surgeon General Luther Terry and his Advisory Committee
The members for the Surgeon General’s advisory Committee were announced on October 27,
1962. Dr. Peter Hamill was medical coordinator and pulled together this team of experts.
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Dr. Walter J. Burdette, head of the Department of Surgery, University of Utah
Dr. Stanhope Bayne-Jones, former dean, Yale School of Medicine
William G. Cochran, professor of Statistics, Harvard University
Dr. Emmanuel Farber, chairman, Department of Pathology, University of Pittsburgh
Louis F. Fieser, professor of Organic Chemistry, Harvard University
Liggett consultant
Dr. Jacob Furth, professor of Pathology, Columbia University
Dr. John B. Hickam, chairman, Department of Internal Medicine, Indiana University
Dr. Charles LeMaistre, professor of Internal Medicine, the University of Texas
Southwestern Medical School CONSULTANT FOR BW???”
Dr. Leonard M. Schuman, professor of Epidemiology, University of Minnesota
Dr. Maurice H. Seevers, chairman, Pharmacology, University of Michigan
Industry consultant
Peter Hamill picture needed
January 11, 1964
The Surgeon General releases report linking cigarettes to lung cancer
U.S. Surgeon General,
Luther Terry, M.D.