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50 Years After Landmark Warning, 8 Million Fewer Smoking Deaths

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50 Years After Landmark Warning, 8 Million Fewer Smoking Deaths

Public Health

50 Years After Landmark Warning, 8 Million Fewer Smoking Deaths

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
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This weekend marks 50 years since the surgeon general, Luther Terry, released his landmark report on smoking. Back in 1964, cigarettes were part of everyday life. Smoke clouded offices, restaurants, planes. Athletes and film stars advertised cigarettes on television. But Terry's authoritative report changed all that. He declared in no uncertain terms that smoking is dangerous.


LUTHER TERRY: The strongest relationship between cigarette smoking and health is in the field of lung cancer.

SIEGEL: Today, new research suggests that Terry's report may have had an even bigger impact than first thought, as NPR's Richard Knox reports.

RICHARD KNOX, BYLINE: Joanne Iuliucci started smoking when she was 12, 44 years ago. The surgeon general's report had come out six years earlier, but she says she had no idea smoking was dangerous.

JOANNE IULIUCCI: Absolutely not. Why would I? Because everybody was smoking, mother and father were smoking, doctors were smoking. You were able to smoke in the movie theater, food shopping with my mom. It was really, back then, nobody knew what we know today.

KNOX: In large part, that's because the tobacco industry maintained for years that experts still disagreed about the evidence, says Harvard historian Allan Brandt.

ALLAN BRANDT: Their campaign, their invented controversy, was actually enormously successful. If you asked people on the street: Do we know whether smoking causes lung cancer or not, many would say, well, you know, there's a very significant controversy about that.

KNOX: But in fact, Brandt says by 1964 there was very little controversy among scientists outside the tobacco industry. He says President Kennedy was not eager to take on the industry. Kennedy needed the support of tobacco-state Democrats to further his civil rights agenda.

BRANDT: So Kennedy was not happy about the idea of needing to take this on. But when asked about it publicly in a press conference, it became harder and harder for him to back away. And he punted, really and he said: This is what my surgeon-general will do.

KNOX: Now, it's important to understand that surgeons general had never been given such an assignment. In fact, public health rarely concerned itself back then with any hazards beyond infectious disease epidemics. And the American Medical Association wasn't keen on having government experts preach on the dangers of smoking.

BRANDT: There were some people in the profession who would say, you know, this is really between a patient and his or her doctor.

KNOX: So when Luther Terry put together his expert panel, it was carefully balanced.

BRANDT: The committee was made up of 10 scientists and physicians, five of whom were smokers, five of whom were not.

KNOX: During the meetings, there were ashtrays on the table and smoke filled the room. One Harvard statistician on the panel was a four-pack-a-day smoker. But the group didn't flinch when it came to declaring that smoking is deadly. And a new analysis, in this weeks' Journal of the American Medical Association, documents the enormous impact of that declaration.

Study author Theodore Holford of Yale says eight million Americans would have died if it hadn't been for the tobacco control efforts sparked by the report.

THEODORE HOLFORD: So this amounts to 157 million years of life that were saved as a result of the tobacco control effort.

KNOX: Much of that 42 million years of human experience was among people under 65. That kind of impact is hard to take in.

HOLFORD: It is a very large number, yes. And it's a rather staggering number in a way when we found it.

KNOX: Holford says tobacco control has increased U.S. life expectancy by 30 percent since 1964, more than any other public health or medical measure. But Brandt, the Harvard historian, says the impact of the 1964 report is even broader.

BRANDT: If we look at the history of public health - from the safety of cars and roads, other dangerous products, the environment, clean air, the workplace - all of these issues really have their origins in a moment 50 years ago around the first surgeon general's reports.

KNOX: And the benefits in reducing smoking deaths continue into the future. Joanne Iuliucci, whom we met earlier, eventually stopped smoking after her mother died of lung cancer.

IULIUCCI: I quit November 1, 2010. And a year later they told me I needed a lung transplant.

KNOX: The lung transplant was necessary because she had end-stage emphysema. By the way, that Harvard statistician on the surgeon general's panel who smoked four packs a day, within a year of the 1964 report he was diagnosed with lung cancer and later died of the disease.

Richard Knox, NPR News.

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