The 50-year war on smoking

The 1964 U.S. Surgeon General’s report on smoking — the first official acknowledgment by the federal government that smoking kills — was an extraordinarily progressive document for its time. It swiftly led to a federal law that restricted tobacco advertising and required the now-familiar warning label on each pack of cigarettes.

Yet there was nothing truly surprising about the conclusion of the report. Throughout the 1950s, scientists had been discovering various ways in which smoking took a toll on people’s health. Britain issued its own report, with the same findings, two years before ours. Intense lobbying by the tobacco industry slowed the U.S. attack on smoking. And even when then-Surgeon General Luther Terry convened a panel before the report was issued to make sure its findings were unimpeachable, he felt compelled to allow tobacco companies to rule out any members of whom they disapproved.

Saturday marks the report’s 50th anniversary. The intervening decades have seen remarkable progress against smoking in the United States, despite the stubborn efforts of the tobacco industry, which lobbied, obfuscated and sometimes lied outright to the public about the dangers of its products. During those years, though, independent research tied smoking and secondhand smoke to an ever-wider range of ailments. According to the U.S. Centers for Disease Control and Prevention, smoking causes cancer of the lungs, larynx, bladder, bone marrow, blood, esophagus, kidneys and several other organs. It increases the risk of stroke, heart disease and cataracts. It can damage fetuses, weaken bones and harm teeth and gums. The list goes on.

The growing body of evidence bolstered important policies to combat tobacco use and the injury to nonsmokers barraged by the damaging effects of secondhand smoke. It can be hard for young Californians today to fathom that smoking was once practically ubiquitous throughout government buildings, restaurants and workplaces. In the 1970s, during hearings on legislation to curb smoking in public buildings, some legislators puffed away even as speakers described the asthma attacks they sometimes suffered from secondhand smoke. New restrictions helped smokers as well; if they could do without a cigarette for hours at a time at their jobs, many discovered, they could do without them entirely.

Limits on cigarette advertisements, rules that prevented sales to minors and new taxes on cigarettes helped bring smoking rates down.

In 1964, 42% of Americans smoked. Half the people on the panel that produced the surgeon general’s report smoked. Today, the U.S. smoking rate is 18%. Teen smoking rates fell to below 10% after the federal tax on cigarettes was increased by 62 cents a pack in 2009.

As smoking rates have declined, lung cancer rates have fallen as well. According to a report this week from the CDC, the rate among men ages 35 to 41 dropped by 6.5% per year from 2005 to 2009. One study just published in the Journal of the American Medical Assn. estimated that 8 million premature deaths from all smoking-related causes have been prevented since the surgeon general’s report was issued in 1964.

Despite the good news, smoking is still the No. 1 cause of preventable death in this country. Smoking-related disease costs $183 billion a year in medical expenses and lost productivity.

We know what works against this: research, education, limits on secondhand smoke and higher cigarette taxes. But the tactics of tobacco companies continue to hold the nation back.

Knowing how heedless of our well-being they have been all along, we should ignore their ads and their lobbyists and take the following steps:

• Raise tobacco taxes, preferably at the federal level to avoid black-market sales across state lines. According to a 2012 report by the U.S. Surgeon General, every 10% increase in the cost of smoking leads to a 4% drop in smoking rates.

President Obama has proposed increasing the federal excise tax by 94 cents a pack, nearly doubling it from the current $1.01, and using the resulting revenue stream — an estimated $78 billion over the next decade — to fund pre-kindergarten education. The tax is a good idea, but we have concerns about using the money for preschool. If smokers are paying the tax, the revenue ideally should go toward education, research, affordable cessation programs, enforcement of existing laws and healthcare costs related to tobacco use.

• Place increased emphasis on reducing teen smoking. If there’s one thing all Americans, including staunch defenders of the right to smoke, should agree on, it’s that minors should be protected from smoking. According to the American Lung Assn., more than two-thirds of adult smokers developed the habit as teenagers. Studies have shown that many retailers don’t check identification and sell even when the ID shows the buyer to be underage.

In addition, the U.S. Food and Drug Administration should immediately impose a ban on sales and marketing of e-cigarettes to minors, including Internet sales. E-cigarettes, which allow users to inhale nicotine-laced vapor rather than tobacco smoke, may turn out to be significantly more healthful than regular cigarettes, but studies are still underway about their long-term effects, and there’s no question that they encourage nicotine addiction. They have been heavily marketed to minors, who are allowed to buy them without restriction in most states. Further research is necessary as the e-cigarette market expands dramatically.

• Push for indoor-smoking restrictions in all states. It may surprise Californians, who now face smoking bans in parks, open eating areas and beaches, to learn that some states lack smoking bans even in workplaces, bars and restaurants. Kentucky, for example, restricts smoking only in government and university buildings.

Smoking is and should remain a personal choice among adults, but the nonsmokers around them have the right not to be sickened by the choices of others.