Three U.S. surgeons general have played the biggest roles in alerting the public to the dangers of tobacco.
In 1964, Dr. Luther Terry issued the first Surgeon General's Report on Smoking and Health, irrefutably linking smoking with lung disease and other illnesses. The report led to a sharp drop in smoking and to the first warning labels on cigarette packages.
Seven years later, Dr. Jesse L. Steinfeld issued a second report focused on the dangers of secondhand smoke. He proposed what he called the Non-Smoker's Bill of Rights, which said that the country must free non-smokers from the hazards and annoyance of other people's addictions. He strengthened the warning on packages and issued the first ban on smoking in certain government buildings.
In the 1980s, Dr. C. Everett Koop accelerated the war against tobacco, producing the first ban on smoking in airplanes.
The tobacco industry considered Steinfeld's actions so egregious that he was labeled the "worst surgeon general ever." The industry lobbied vigorously for his removal and he became the first surgeon general ever forced out by the president.
Steinfeld died Tuesday at a nursing home in Pomona from the aftereffects of a stroke, according to his family. He was 87.
He "was at the leading edge of the social changes we are all benefitting from today," said UC San Francisco tobacco expert Stanton A. Glantz. "He started people thinking about the issue [of non-smoker's rights] differently. Even getting partial smoking restrictions was a major accomplishment at the time."
Terry's report and other activities during the 1960s led Republicans — and some Democrats — to argue that surgeons general were intruding inappropriately into private life. They viewed Richard Nixon's election to the White House in 1968 as an opportunity to defang the position.
That effort had already begun in 1968 with a reorganization of the Department of Health, Education, and Welfare that removed a large part of the organization from the surgeon general's purview.
Steinfeld taught at the USC School of Medicine during the 1960s and lived in Orange County, where he met Nixon campaign organizer Bob Finch. In 1968, he moved to the National Cancer Institute and became deputy director the following year. In 1969, he planned to return to USC, his wife and family having already packed and left for the coast.
But Finch, by then Nixon's HEW secretary, promised to appoint him surgeon general if he would stay in the capital. Nixon and his aides really didn't know Steinfeld but thought he was a personable man who could be a good spokesman for their conservative social views. That proved to be a mistake.
When Steinfeld took office in December 1969, he noticed at least 13 ashtrays scattered around the suite. He immediately had them all removed and posted signs saying "Thank you for not smoking." He also refused to meet with tobacco industry lobbyists.
Although much of the office's bureaucratic power had been stripped, Steinfeld used it as a bully pulpit to promote what he considered good health policies. The new surgeon general's report, released in 1972, was already in preparation, but he adopted it and made it his own. That report's central point was that there is "no disagreement" that cigarette smoking is lethal. The report was the first to discuss the health issues of secondhand smoke.
Steinfeld called for a ban on smoking in virtually all public places, including restaurants, theaters, planes and trains. It took another 25 years for that to begin to be accomplished, however.
He also changed the warning labels on cigarette packages. After Terry's report, the labels bore a warning that tobacco use "might" be connected to health problems. Steinfeld successfully changed the labels so that they read "The surgeon general has determined that smoking is hazardous to your health." The warning label was also made larger, and tobacco advertising on television and radio was banned.
In fairness, some critics have argued that tobacco companies favored the warnings because they feared that each of the states would impose their own requirements and they didn't want to deal with 50 different labels. They also hoped the warning would indemnify them against lawsuits, but Steinfeld and Congress made clear that was not the case.
Shortly after Nixon declared his famous "War on Drugs," Steinfeld told a Los Angeles convention that the real No. 1 problem was smoking, lacing his speech with statistics about the epidemic of lung cancer and other smoking-related disease.
He took on other issues as well. He argued successfully for the government to take a larger role in promoting the fluoridation of water, banning the pesticide DDT and banning cyclamate, an artificial sweetener thought to cause cancer.
He also argued that violence on television had a disturbing effect on the social development of children, and called for networks to impose some type of self-censorship or to, at least, label programs that contain violence to alert parents.
His superiors ordered him not to testify before Congress on the issue, but he was subpoenaed and decided to testify without clearing his testimony first. That further frayed his relationship with the administration.
Nixon and HEW came under tremendous pressure from the tobacco industry to get rid of Steinfeld. When Nixon was reelected in 1972, he asked all members of his administration to submit letters of resignation. After he had been forced to rewrite it twice to weaken it, Steinfeld's letter was accepted. The office of the surgeon general then remained vacant until Jimmy Carter appointed Dr. Julius Richmond in 1977.
The only other surgeon general forced out of office was Dr. Joycelyn Elders, who was fired in 1994 by Bill Clinton after she made a speech during the AIDS epidemic that was interpreted as meaning that children should be instructed in how to masturbate.
Jesse Leonard Steinfeld was born Jan. 6, 1927, in the Pittsburgh suburb of West Aliquippa, also the home of musician Henry Mancini. Steinfeld rode the school bus with Mancini and fondly recalled standing outside the Mancini house while Mrs. Mancini yelled, "Henry, sit down at that piano and practice!"
Teenage boys in West Aliquippa were routinely placed in the vocational track with the prospect of working in mines or other local industry, but Steinfeld persuaded his counselor to place him on the academic track. He graduated high school at 16 and 19 months later, in 1945, received his bachelor's degree from the University of Pittsburgh. He received his medical degree in 1949 from what is now Case Western Reserve University.
He did his residency at Cedars of Lebanon Hospital (now Cedars-Sinai Medical Center) in Los Angeles and had residencies at the VA Hospital in Long Beach and UC San Francisco. His residency was interrupted so he could serve as a physician on a Coast Guard cutter in the North Atlantic during the Korean War.
He was director of the radioisotope laboratory at the National Cancer Institute from 1954 to 1958, then taught at USC until he rejoined NCI in 1968.
After being forced out of his job as surgeon general, Steinfeld spent a year at the Mayo Clinic and two years at UC Irvine. From 1976 to 1983, he served as dean at the School of Medicine at the Medical College of Virginia. In 1983, he became president of the Medical College of Georgia.
At Georgia, he created a master plan for the future of the school and oversaw the construction of new facilities and an ambulatory care center. "He was truly a visionary leader whose time here, unfortunately, was short," said his successor, Dr. Francis J. Tedesco. "He laid the groundwork for future development."
Steinfeld retired in 1987 after he developed debilitating osteoarthritis with spinal stenosis.
Even after he left government, Steinfeld was a passionate advocate for non-smokers' rights. He testified in several trials, including one filed by flight attendants against the major airlines. He and Terry also petitioned the Food and Drug Administration to regulate tobacco as a drug.
According to his daughter Susan, "He was a voracious reader, loved classical music, a good joke and home cooking ... and he was immensely proud to have accomplished everything he did as the son of Jewish immigrants."
Steinfeld is survived by his wife of 61 years, the former Gen M. Stokes; three daughters, Dr. Mary Beth Steinfeld of Sacramento, Jody Stefansson of Pasadena and Susan Steinfeld of La Cañada Flintridge; and two grandchildren.