US explores tobacco’s endgame, as report lists new known harms

Surgeon general marks 50th anniversary of landmark public-health study with new warning over smoking epidemic

A series of U.S. government regulations since 1964 has helped decrease the number of smokers.
Spencer Platt/Getty Images

Fifty years after Dr. Luther R. Terry first warned Americans about the dangers of smoking in his landmark surgeon general’s report in 1964, the federal government has made huge strides in persuading Americans to quit: Smoking rates among adults have plummeted to 18 percent, from 42 percent in 1964.

But this year’s surgeon general’s report about the health consequences of smoking emphasizes that the battle against smoking is far from over and issues a challenge to eliminate it altogether.

Surgeon General Boris Lushniak told reporters Friday that the nation must push even harder to eradicate smoking, with the goal of cutting the cigarette smoking rate down to 12 percent by 2020. "Enough is enough," he said.

The report, which was formally released by the White House on Friday morning, says, “For the United States, the epidemic of smoking-caused disease in the 20th century ranks among the greatest public health catastrophes of the century, while the decline of smoking consequent to tobacco control is surely one of public health’s greatest successes ... However, the current rate of progress in tobacco control is not fast enough, and much more needs to be done to end the tobacco epidemic.”

The report compiles the last 50 years of research on smoking and its effects on nearly every organ of the body. It describes the public-health efforts to curtail smoking, which have included bans on smoking indoors, the elimination of cigarette ads on television and heavily taxed cigarette purchases. 

The result is that “Americans’ collective view of smoking has been transformed from an accepted national pastime to a discouraged threat to individual and public health,” Department of Health and Human Services Secretary Kathleen Sebelius wrote in the report. “Strong policies have largely driven cigarette smoking out of public view and public air space.”

But more needs to be done, and the surgeon general vowed to accelerate polices aimed at making the U.S smoke-free.

“We will explore endgame strategies that support the goal of eliminating tobacco smoking, including greater restrictions on sales," the report stated.

The surgeon general’s office wrote that more than 20 million Americans have died from smoking-related illnesses in the last 50 years. 

Some 2.5 million of those people were nonsmokers who died from heart disease or lung cancer caused by secondhand smoke, the report said. And exposure to secondhand smoke increases the risk of stroke by 20 to 30 percent, the report found.

The epidemic of smoking-caused disease in the
20th century ranks among the greatest public health catastrophes of the century, while the decline of smoking consequent to tobacco control is surely one of public health’s greatest successes ... (but) progress in tobacco control is not fast enough.

Surgeon general’s report on smoking, 2014

Furthermore, smoking-related diseases will lead to the premature deaths of half a million adults in 2014 and rack up more than $289 billion in health care costs and lost productivity.

What’s more, the report accuses the tobacco industry of deliberately misleading the public about cigarettes and called them “highly engineered, addictive and deadly products” more lethal than they were 50 years ago. That’s because cigarettes are now designed to allow deeper inhalation, which has caused an increase in a type of lung cancer called adenocarcinoma. 

In addition, researchers newly confirmed smoking as a cause of more than a dozen types of cancer, including liver cancer and colorectal cancer, and a host of other health problems, including Type 2 diabetes, erectile dysfunction, rheumatoid arthritis and a variety of immune-system disorders.

Finally, the report said researchers recently found that nicotine itself is harmful to fetal growth and development. This is a blow for the in-vogue electronic cigarette, whose makers claim their products deliver nicotine without the harmful effects of tobacco smoke. It noted that major tobacco companies, including Altria Group, best known for its Marlboro brand; Reynolds American, maker of Camel cigarettes; and Lorillard, maker of Newport cigarettes, have invested in electronic cigarettes.

Cardiovascular disease

Public-health experts say it’s important for the public to know that cardiovascular disease kills more smokers over the age of 35 than lung cancer does, a key point made by the report.

“It’s heart disease that kills most of the smokers and a great majority of passive smokers,” Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California at San Francisco told Al Jazeera in a telephone interview. “Most people today, when you say ‘smoking,’ they think cancer. But one of the biggest differences between smoking and cancer and smoking and heart disease is that the cancer risk evolves slowly over a period of years.”

Smoking, on the other hand, has immediate effects on the cardiovascular system, he said, by causing the platelets in the blood to clot and compromising the functioning of the arteries. “If you’re even smoking a few cigarettes a day, you’re essentially getting the full cardiovascular risk,” said Glantz, who wrote portions of the latest report.

But quitting smoking also helps the cardiovascular system right away. And what’s more, research shows that passing clean indoor-air laws causes an immediate drop in hospital admissions for heart disease. “If you do something about smoking by implementing the policies they’re talking about here (in this report), you’ll see very rapid benefits,” he said.

‘Lack of political will’

Anti-smoking advocates said the report’s emphasis on social policy and the need for anti-smoking campaigns and higher cigarette taxes is a vast departure — and expansion — from where the surgeon general began back in 1964, when the focus was on the scientific evidence.

Still, they say there’s more work to be done.

“It’s more important than ever that our federal officials and those at the state and local levels enact the policies that have been proven to reduce tobacco use in the United States,” Erika Sward, assistant vice president for national advocacy at the American Lung Association, told Al Jazeera.

She said the Obama administration ought to define more clearly the benefits of not smoking in insurance plans through the Affordable Care Act so that smokers on Medicaid, for example, have access to every medication and type of counseling that would help them quit.

Sward added that the U.S. Food and Drug Administration should regulate electronic cigarettes and cigars in the same way they regulate tobacco cigarettes.

“What we have really seen over the last 50 years is the lack of political will from our policymakers to do what’s right, to do what we know will save lives,” she said.

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Key numbers:

  • Since the landmark surgeon general report in 1964, more than 20 million premature deaths are attributable to cigarette smoking, including 2 million from secondhand smoke exposure.
  • Adult smoking rates have fallen from 42% 50 years ago to about 18% today -- 40 million Americans are still dependent on tobacco. 
  • The CDC refers to U.S. cigarette addiction as the "tobacco epidemic," which it says has killed ten times as many Americans as have died in all foreign wars combined.
  • In 2014, one half-million adults will die prematurely from smoking-attributed conditions, and economic costs due to tobacco will exceed $289 billion.
  • Nearly 25 trillion cigarettes have been consumed in the last 50 years, peaking at 640 billion in 1981, and declining to 287 billion in 2012.

Key points:

  • Deliberately misleading the public about the risks of smoking, the tobacco industry's aggressive strategies caused and sustained the "tobacco epidemic."
  • Tobacco control programs have proven successful in limiting consumption, and progress will continue with full and expanded use of these same measures and regulations.
  • Smokefree laws have banned smoking on airplanes, and a growing number of restaurants, bars and government buildings.
  • Scientific research has linked cigarette smoking to diseases associated with almost all of the human body's organs, now known to include liver and colorectal cancer, in addition to type 2 diabetes, arthritis, ectopic pregnancy and erectile dysfunction. 
  • Secondhand smoke continues to cause cancer, respiratory and cardiovascular diseases -- now understood to include strokes -- and adversely impacts the health of children.
  • As articulated in past reports by Surgeons General, the harmful effects of tobacco are combated by eliminating all use of cigarettes and other combusted products.
  • Significant disparities exist in tobacco use across regions, as well as between racial and socioeconomic groups.
  • Important questions remain about the long-term effects of electronic cigarette consumption, and how much smoking risk is reduced with hundreds of new brands. 

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