Industry Reaction To The 1964 Surgeon General's Report

At the same time that the tobacco industry was publicly claiming that there was no scientific proof that smoking is dangerous to health, official agencies in the United States and the United Kingdom produced two major reports on the health effects of smoking. The first was the 1962 report of the British Royal College of Physicians (RCP).

RCP Report, 1962

The RCP established a committee in 1959 to examine the data about smoking and health. The committee reviewed the scientific literature and considered all the various explanations that had been put forth about the rise in lung cancer cases and, in particular, about the more common occurrence of lung cancer among people who smoked. The committee also reviewed data pertaining to other conditions thought related to smoking. The Royal College issued its report on March 7, 1962, at a press conference headed by Sir Robert Platt, president of the college. The major conclusions were these:

The benefits of smoking are almost entirely psychological and social. It may help some people to avoid obesity. There is no reason to suppose that smoking prevents neurosis.

Cigarette smoking is a cause of lung cancer and bronchitis, and probably contributes to the development of coronary heart disease and various other less common diseases. It delays healing of gastric and duodenal ulcers.

The risks of smoking to the individual are calculated from death rates in relation to smoking habits among British doctors. The chance of dying in the next ten years for a man aged 35 who is a heavy cigarette smoker is 1 in 23, whereas the risk for a non-smoker is only 1 in 90. Only 15% (one in six) of men this age who are non-smokers but 33% (one in three) of heavy smokers will die before the age of 65. Not all this difference in expectation of life is attributable to smoking.

The number of deaths caused by diseases associated with smoking is large. (3, p. S7)

Thirty thousand copies of the report had been sold in the United States by May. Reader's Digest and Scientific American , among other publications, gave prominence to articles based on it (14, 15).

The tobacco industry's official statement in response to the RCP report avoided direct disagreement with it but called it "incomplete." The British Medical Journal reported,

On publication of the Royal College of Physicians' report the Tobacco Manufacturers' Standing Committee stated: 'The R.C.P. Committee was set up to consider the effects on health of both smoking and air pollution. By deferring to a separate report its consideration of air pollution the R.C.P. Committee has recognized the importance and complexity of this factor, but in so doing the Committee has, in T.M.S.C.'s view, produced an incomplete assessment of the problems involved.' The Tobacco Manufacturers' Standing Committee regards the three following approaches in research as 'both practical and essential': (a) 'A study of environment and personal characteristics, as well as past medical histories,' may throw important new light on the incidence of lung cancer and chronic bronchitis. (b) 'Much more research is undoubtedly needed into the constituents and effects of air pollution.' (c) 'Further investigation is needed into the chemistry and biological effects of tobacco smoke.' (16, p. 810)

The Tobacco Manufacturers' Standing Committee (TMSC), formed in 1956 by the British tobacco companies, was modeled on the American TIRC. TMSC, like TIRC, funded independent researchers to study issues related to smoking and health. Unlike TIRC, however, TMSC also conducted in-house research at a jointly sponsored industry laboratory in Harrogate, England, The Harrogate laboratory was opened in 1962. It conducted several large-scale studies on the effects of tobacco smoke

inhalation and skin painting in mice (to study cancer) and also did some work on nicotine (see chapters 3 and 4). Shortly after the Harrogate lab was opened, TMSC was renamed the Tobacco Research Council (TRC). The name was later changed again to the Tobacco Advisory Committee (TAC) {1014.01, pp. 11–12}.

Us Surgeon General's Report, 1964

Shortly after release of the RCP report, the US Surgeon General set up the Surgeon General's Advisory Committee on Smoking and Health to produce a similar report on the effects of smoking. The tobacco industry was allowed to veto any proposed member of the advisory committee that it deemed was not impartial on the issue of smoking and health. The committee therefore consisted entirely of scientists who had not yet publicly expressed any opinion about the health effects of smoking and who were willing to look impartially at the evidence. After working for fourteen months, the advisory committee released its report in 1964.

The major conclusions of the 1964 Surgeon General's report, Smoking and Health (4), were these:

The Effects of Smoking: Principal Findings

Cigarette smoking is associated with a 70 percent 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.

Lung Cancer

Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking far outweighs all other factors. The data for women, though less extensive, point in the same direction.

The risk of developing lung cancer increases with duration of smoking and the number of cigarettes smoked per day, and is diminished by discontinuing smoking. 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.

The risk of developing cancer of the lung for the combined group of pipe smokers, cigar smokers, and pipe and cigar smokers is greater than for non-smokers, but much less than for cigarette smokers.

Cigarette smoking is much more important than occupational exposures in the causation of lung cancer in the general population.

Chronic Bronchitis and Emphysema

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. A relationship exists between cigarette smoking and emphysema but it has not been established that the relationship is causal.

Studies demonstrate that fatalities from this illness are infrequent among non-smokers.

For the bulk of the population of the United States, the relative importance of cigarette smoking as a cause of chronic broncho-pulmonary disease is much greater than atmospheric pollution or occupational exposures.

Cardiovascular Diseases

It is established that male cigarette smokers have a higher death rate from coronary artery disease than non-smoking males. Although the causative role of cigarette smoking in deaths from coronary disease is not 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.

Although a causal relationship has not been established, higher mortality of cigarette smokers is associated with many other cardiovascular diseases, including miscellaneous circulatory diseases, other heart diseases, hypertensive heart disease, and general arteriosclerosis.

Other Cancer Sites

Pipe smoking appears to be causally related to lip cancer. Cigarette smoking is a significant factor in the causation of cancer of the larynx. The evidence supports the belief that an association exists between tobacco use and cancer of the esophagus, and between cigarette smoking and cancer of the urinary bladder in men, but the data are not adequate to decide whether these relationships are causal.

Data on an association between smoking and cancer of the stomach are contradictory and incomplete. (4, pp. 31–32)

After discussing the role of nicotine in tobacco use and recognizing that tobacco use is "reinforced and perpetuated by the pharmacological actions of nicotine" (p. 32), the committee offered the following summary conclusion:

On the basis of prolonged study and evaluation of many lines of converging evidence, the Committee makes the following judgment:

Cigaretter smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action [emphasis in original]. (4, p. 33)