To commemorate the 60th anniversary of the Surgeon General’s Report, Alan Blum, professor and Gerald Leon Wallace, MD, Endowed Chair in Family Medicine at the University of Alabama, as well as the director of the Center for the Study of Tobacco and Society, will serve as a guest editor for the Cancer History Project this January.
Blum is conducting a series of interviews with people who have been involved in the fight against tobacco since the report was published, and publishing a new online exhibit on the Center for the Study of Tobacco and Society website identifying the lost legacy of the Surgeon General’s Report on Smoking and Health.
Blum will be giving a presentation to commemorate the report at the University of Alabama Jan. 11, 12:15-1:15 p.m. CT. Guests can also attend virtually via Zoom.
Donald Shopland, an original member of the staff of the Advisory Committee to the Surgeon General upon its formation in 1962, will be giving a presentation on the Surgeon General’s Report Jan. 11, 5:30-7:00 p.m. CT. The presentation will be accessible via Zoom.
In 1964, the Office of the Surgeon General issued a report on smoking and health that ended a debate that had raged for decades—stating that cigarettes cause lung cancer and other diseases.
Sixty years later, Alan Blum, professor and Gerald Leon Wallace, MD, Endowed Chair in Family Medicine at the University of Alabama, as well as the director of the Center for the Study of Tobacco and Society, warns against celebrating the anniversary of the report.
“I should be clear that I would prefer to call this a commemoration,” Blum said in an interview with Donald S. Shopland, an original member of the staff of the Advisory Committee to the Surgeon General upon its formation in 1962. “A celebration would suggest everything is happy, because I think this is a more nuanced subject.”
This interview is available as a podcast through the Cancer History Project.
Since 1962, Shopland has served as an editor of 17 reports of the surgeon general on smoking and health, as interim director of the Office on Smoking and Health for two years in the 1980s, and as an advisor on smoking and health at NCI. He retired in 2014.
The process for choosing ten members who served on the Surgeon General’s Advisory Committee on Smoking and Health—who ultimately wrote and published the report—was quite complicated, Shopland said.
The Public Health Service, Federal Trade Commission, FDA, voluntaries, the American Medical Association—and two representatives from the tobacco industry—drew up the original criteria for the study.
“They said that they did not want anybody who really knew anything about the issue, or what they called taking a stand on the issue, which pretty much eliminated anybody who had done any work, any type of research on the [smoking and health,], because obviously that would’ve meant they had to take a stand,” Shopland said. “They also could not be part of any particular organization—this was the other criterion, nor could they have made any kind of a public statement either for or against smoking in health.”
The groups put together a list of 150 individuals, from which they selected 10 members to serve on the committee. Many of the final 10 committee members were cigarette smokers, he said.
“They weren’t familiar with the data, they weren’t experts, and here they had, sort of dumped in their lap, 7,000 studies that they now got to sift through,” he said. “And these guys didn’t know what to do with it. They actually spent the first two meetings trying to figure out what they were going to do.”
Members of the committee came in with a certain amount of bias, Shopland said.
“Like anybody else that was around at that time, if you were a smoker, you didn’t want to believe this stuff,” he said. “And they weren’t any different than the general public was, but it took them a good two months, or two committee meetings, before they actually got deep enough into some of the discussions about some of the data before they themselves decided that if they were going to answer this question, they were going to have to go a lot deeper than what the Public Health Services expected them to do, and come up with something a lot more detailed than something like the Royal College of Physicians.”
The committee’s goal was to issue a report that would end the controversy as to whether smoking was a health risk, Shopland said.
By this time, many studies had already demonstrated evidence that smoking was harmful, Shopland and Blum said. In fact, there was a long history of it.
In 1804, Benjamin Waterhouse gave a lecture to students at Harvard about the injurious effects of smoking.
“He was talking about cigar smoking and he was talking about stomach problems, but I think at least he was on the right track, but it took another 150 years or more for this committee to be established,” Blum said.
In 1900, early reports on the increase of lung cancer were reported, Blum said.
In 1928, a study by Herbert Lombard—published in the New England Journal of Medicine—pointed to an association between smoking and lung cancer.
In 1941, Michael DeBakey and Charles Ochsner reported several hundred case studies of lung cancer and smoking.
More research was done too.
In 1950, Richard Doll and Austin Bradford Hill published their findings, which stated that smoking was an important cause of lung cancer. Other groups worked to study the association between smoking and cancer.
Ernst Wynder and Evarts Graham studied the incidence of lung cancer in physicians. American Cancer Society scientists, E. Cuyler Hammond and Daniel Horn conducted a cohort study in 1952, recruiting approximately 188,000 American men ages 50-69, across 10 states.
After following the group for approximately 20 months, Hammond and Horn found that men with a history of regular cigarette smoking had a considerably higher death rate than those who had never smoked or who only smoked cigars or pipes.
The study also pointed to lung cancer and other diseases in men who smoked.
Still, organizations such as the American Medical Association would not weigh in on the subject.
“For 15 years, from 1964 to 1979, the AMA was virtually silent on this issue because they were taking, what it turned out to be, $18 million from the tobacco industry to do more research,” Blum said.
Tobacco industry groups argued that more research was needed before anyone could weigh in on the controversy.
“It led up to the industry reacting to every one of these studies by saying, we need more research.’” Blum said. “To the point where the medical community, two thirds of whom smoked, including my father, were just not buying into this association.”
The Surgeon General’s Report on smoking and health was no small task. The fate of public opinion on smoking depended on it.
While the committee evaluated some 7,000 studies that existed on smoking and health at the time—there was one small hangup: The cancer chapter.
“Of all things,” Shopland said.
Walter J. Burdette, a well-known thoracic surgeon and geneticist, was in charge of writing the chapter about cancer.
“A lot of the cancer chapter, as he was approaching it, unfortunately, put too much emphasis on genetic and constitutional factors as they related to cancer etiology, particularly lung cancer etiology,” Shopland said.
As the report’s deadline neared in the late summer of 1963, the cancer chapter was in disarray, Shopland said.
Leonard M. Schuman, an epidemiologist at the University of Minnesota and another member of the committee, took 30 days off from work to re-work the chapter, “emphasizing the epidemiology of lung cancer as it related to cigarette smoking.”
The report was released Jan. 11, 1964. Still, it stopped short of claiming that cigarette smoking was addictive.
One committee member, Maurice Seevers, who studied habit-forming drugs, followed World Health Organization criteria when it came to the question of addiction and smoking.
“[WHO] held at that time that it was not addictive, but it was habitual,” Shopland said. “That’s what he fell back on. That’s what he said the committee had to go to. That was the only criteria that they had at that time, was to use the WHO criteria. And they held that it was habituating and not addictive”
Sixty years later, Shopland said the report was the start of a series of Surgeon General’s Reports on smoking and health that have led to positive change.
“The real impact of those reports has been what I would call the constant drumbeat of more and more pronouncements that eventually, I think, more than anything else, undermine the behavior,” he said. “It undermined the social acceptability of smoking. And I think that particularly was true once we started documenting that it had an effect on the non-smoker.”
As of 2021,11.5% of U.S. adults (an estimated 28.3 million people) smoked cigarettes: 13.1% of men and 10.1% of women, according to CDC.
“But I’ll give the other side of that any day,” Blum said. “And that is, first of all, it took 60 years to do it.”
Subsquent Surgeon General’s Reports—those related to passive smoking, smoking addiction, and smoking in women, led to more significant change, he said.
“The passive smoking report led to a ban on smoking on airlines—the first federal effort on clean indoor air that I’m aware of,” Blum said. “There was not much federal legislation passed as a result of the Surgeon General’s Report.”
This column features the latest posts to the Cancer History Project by our growing list of contributors.
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