January 11, 1964: The Surgeon General's Warning On Smoking

 

January 11, 1964: Luther Terry, the Surgeon General of the United States, issues Smoking and Health: Report of the Advisory Committee to the Surgeon General. For America's addiction to smoking cigarettes, to borrow a saying of Winston Churchill, it was not the end, it was not even the beginning of the end; but it was, perhaps, the end of the beginning.

Evidence of the ill effects of smoking accumulated during the 1930s, 1940s, and 1950s. Epidemiologists used statistics and large-scale, long-term, case-control surveys to link the increase in lung cancer mortality to smoking. Pathologists and laboratory scientists confirmed the statistical relationship of smoking to lung cancer as well as to other serious diseases, such as bronchitis, emphysema, and coronary heart disease.

Smoking, these studies suggested, and not air pollution, asbestos contamination, or radioactive materials, was the chief cause of the epidemic rise of lung cancer in the twentieth century. On June 12, 1957, Surgeon General Leroy E. Burney declared it the official position of the U.S. Public Health Service that the evidence pointed to a causal relationship between smoking and lung cancer.

The impulse for an official report on smoking and health, however, came from an alliance of prominent private health organizations. In June 1961, the American Cancer Society, the American Heart Association, the National Tuberculosis Association, and the American Public Health Association addressed a letter to President John F. Kennedy, in which they called for a national commission on smoking, dedicated to "seeking a solution to this health problem that would interfere least with the freedom of industry or the happiness of individuals."

The Kennedy Administration responded the following year, after prompting from a widely circulated critical study on cigarette smoking by the Royal College of Physicians of London. On June 7, 1962, recently appointed Surgeon General Luther L. Terry announced that he would convene a committee of experts to conduct a comprehensive review of the scientific literature on the smoking question.

Terry invited representatives of the four voluntary medical organizations who had first proposed the commission, as well as the Food and Drug Administration, the Federal Trade Commission, the American Medical Association, and the Tobacco Institute (the lobbying arm of the tobacco industry) to nominate commission members. Ten were finally chosen, representing a wide swath of disciplines in medicine, surgery, pharmacology, and statistics, though none in psychology or the social sciences. Candidates qualified only if they had taken no previous stand on tobacco use.

Meeting at the National Library of Medicine on the campus of the National Institutes of Health in the Washington suburb of Bethesda, Maryland, from November 1962 through January 1964, the committee reviewed more than 7,000 scientific articles with the help of over 150 consultants.

Terry issued the commission's report on January 11, 1964, choosing a Saturday to minimize the effect on the stock market, and to maximize coverage in the Sunday papers. As Terry remembered the event, two decades later, the report "hit the country like a bombshell. It was front page news and a lead story on every radio and television station in the United States and many abroad."

The report highlighted the deleterious health consequences of tobacco use. It held cigarette smoking responsible for a 70 percent increase in the mortality rate of smokers over non-smokers. The report estimated that average smokers had a nine- to ten-fold risk of developing lung cancer compared to non-smokers: heavy smokers had at least a twenty-fold risk. The risk rose with the duration of smoking and diminished with the cessation of smoking.

The report also named smoking as the most important cause of chronic bronchitis, and pointed to a correlation between smoking and emphysema, and smoking and coronary heart disease. It noted that smoking during pregnancy reduced the average weight of newborns.

On one issue, the committee hedged: Nicotine addiction. It insisted that the "tobacco habit should be characterized as an habituation rather than an addiction," in part because the addictive properties of nicotine were not yet fully understood, in part because of differences over the meaning of addiction.

The 1964 report on smoking and health had an impact on public attitudes and policy. A Gallup Survey conducted in 1958 found that only 44 percent of Americans believed smoking caused cancer, while 78 percent believed so by 1968. In the course of a decade, it had become common knowledge that smoking damaged health, and mounting evidence of health risks gave Terry's 1964 report public resonance.

Yet, while the report proclaimed that "cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action," it remained silent on concrete remedies. That challenge fell to politicians. In 1965, Congress required all cigarette packages distributed in the United States to carry a health warning, and since 1970 this warning is made in the name of the Surgeon General: "SURGEON GENERAL'S WARNING: Smoking can be hazardous to your health."

In 1969, cigarette advertising on television and radio was banned, effective December 31, 1970. The last such ad aired that New Year's Eve, during NBC's broadcast of The Tonight Show Starring Johnny Carson. It was an all-female commercial, for Virginia Slims, which turned to print advertising to keep its "You've come a long way, baby" campaign aimed at women.

By the end of the 1980s, print advertising had also eliminated smoking ads. By the turn of the 21st Century, most American public places, including sports stadiums and arenas, were officially smoke-free.

The percentage of Americans who smoke dropped from 42 percent in 1964, the peak year for smoking, to 18 percent by 2022. A new report in JAMA estimates that the decline in smoking prevented 8 million deaths since 1964, more than half of them among people under age 65.

When people cite JFK's accomplishments, Terry's report is almost never mentioned. It may have been released after he died, but it was commissioned under his leadership. If going to the Moon can be counted as a Kennedy accomplishment, so, too, can the decline in smoking.

Born in Alabama in 1911, Luther Terry served as Surgeon General of the United States from March 2, 1961 to October 1, 1965. He died in 1985, from a heart attack, not as a result of anything connected to smoking.

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January 11, 1964 was, as stated, a Saturday. Baseball was out of season. Football season had just ended. There were 3 games played in the NBA:

* The New York Knicks beat the Los Angeles Lakers, 118-108 at the Los Angeles Memorial Sports Arena.

* The Philadelphia 76ers beat the Boston Celtics, 115-108 at the Philadelphia Civic Center.

* And the St. Louis Hawks beat the Detroit Pistons, 112-107 at Cobo Hall (now Huntington Place) in Detroit. Bob Pettit scored 37 points.

And 2 games were played in the NHL. The Toronto Maple Leafs beat the Boston Bruins, 3-1 at Maple Leaf Gardens in Toronto. And the Chicago Black Hawks beat the Detroit Red Wings, 6-3 at the Chicago Stadium. The New York Rangers and the Montreal Canadiens were not scheduled.