Hazardous to Your Health

The year 1964 marked the last time that anyone in America relaxed with a cigarette. The date, to be exact, was January 10, 1964. On the next day, Surgeon General Luther L. Terry released his advisory panel’s report on smoking and health. After that, people could still smoke, of course, but never again in the hazy delusion that cigarettes were harmless.

The connection between smoking and disease had been noted early on. When European explorers brought tobacco home from the New World in the sixteenth century, smoking—that is to say, inhaling the smoke—was quickly recognized as a dangerous habit. Puffing on a long pipe was medically acceptable then, as were snorting snuff and working a chaw. For hundreds of years, though, smoking was something apart, something for “fiends,” deckhands, and exotic foreigners.

The idea of smoking was taken up again in the late 19th century, thanks in part to the development of one of the most lethal inventions of all time. It was a machine that could mass-produce cigarettes, making them cheap and easy to buy. Anyway, the turn of the century was a nervous age in America, ripe for a habit that was at once reckless and reassuring. People may have been calling cigarettes “coffin nails” and “cancer sticks,” but they were lighting them up all the same. The trick was never quite coming to admit that smoking was a slow form of suicide. That was possible because the evidence of tobacco’s relation to early death was entirely anecdotal. For every comment from some old nag about cigarettes giving Cousin Jo cancer, a person could take a long puff and then cite Great-uncle Lars, who smoked three packs a day and outlived his doctors.

Irrefutable evidence was wanting. Even if the incidence of lung cancer did rise in neat proportion to the number of smokers through the first half of the century, such figures didn’t actually establish a cause-and-effect relationship. Likewise, the fact that mice whose backs were smeared with nicotine developed tumors didn’t prove anything at all, except perhaps that, to be on the safe side, people oughtn’t smear their backs with nicotine.

While medical science continued to gather data in the 1950s, the nation’s six major cigarette companies introduced filter cigarettes. The smokers who did worry about their health made them bestsellers. The habit flourished as never before: More Americans took up smoking, and those who did smoked, on average, more cigarettes. The incidence of lung cancer, undistracted by the cunning of filter cigarettes, more than doubled between 1950 and 1960. It was an epidemic of willing comers.

The situation was untenable to health officials. They decided that, since American smokers had yet to be convinced of the risk of smoking, a kind of supreme court of medicine would have to convene and issue an official government statement on the issue. In June 1962, Surgeon General Terry announced the formation of an advisory panel of ten physicians and scientists representing a wide range of specialties. They examined previous studies, but didn’t conduct any new research. The single greatest contribution was the work of a Veterans Administration pathologist named Oscar Auerbach. Dr. Auerbach and a band of colleagues undertook to study actual tissue samples from the respiratory passages of 1500 deceased people. Correlating patient histories with analysis of the slides, Auerbach presented evidence that was anything but anecdotal. The slides revealed not only cancerous growths, but precancer conditions.

Abnormalities in the tissue were consistent across the statistical model, in relation to the amount of tobacco used. Medical science finally had irrefutable, human evidence of the danger of smoking.

The advisory panel released its findings in a book titled Smoking and Health: The Report of the Advisory Committee to the Surgeon General of the Public Health. Most of the 387 pages read like a biology textbook, but the panel was clever enough to put the conclusions up front.

The first conclusion was the most potent, with news value based not so much in what was said as in who said it. According to the Surgeon General, “Cigarette smoking is causally related to lung cancer… .” With that, a line was finally drawn.

Some people took the Surgeon General’s report very seriously. Emerson Foote, one of the nation’s top advertising men, responded by quitting his position as chairman of the McCannErickson agency, so that he would no longer have to handle tobacco company accounts. Meanwhile, cigarette sales dropped by as much as 25 percent in some parts of the country. The cigarette companies, which immediately refuted the report, did their best to throw the issue back into the gray area that had proved so congenial to them for so long. In the short run, they succeeded, as what became known as the “Great Forswearing” of January and February was followed by the “Great Relapse” of March. Cigarette sales in 1965 and 1966 set new records.

The Surgeon General’s report was one of those triumphs of science upon which the 60s built its hopes. Indeed, the report was eventually successful in reversing the trend. The percentage of American adult smokers dropped from about 40 percent in 1960 to about 20 percent today. The report is credited with extending the lives of more than two million people who either quit smoking or never took it up. The fact that everyone didn’t quit in the face of the Surgeon General’s report is even more intriguing, though, pointing up a fallacy in the panel’s 1964 viewpoint. The basic assumption was that all Americans wanted to live longer. That, apparently, just wasn’t true.

—Julie M. Fenster’s book Ether Day won the Anesthesia Foundation Award in 2004.