Historic Public Health Report Marks 60th Anniversary
Smoking and Health: Report of the Advisory Committee to the Surgeon General, published 60 years ago in January 1964, reshaped the way Americans viewed smoking. As the scientific foundation of a highly effective public health campaign, it provided a new model for changing individual behavior.
Smoking had become wildly popular in the first half of the 20th century, even as epidemiologists and pathologists demonstrated its connections with lung cancer and other deadly diseases. The scientific results were taken up by nonprofit advocates such as the American Cancer Society, American Heart Association and the National Tuberculosis Association, precursor to the American Lung Association. But tobacco companies publicly dismissed the then-novel research as inconclusive and, as more American households bought televisions, the industry stepped up its pro-smoking advertising campaigns.
In 1956, Surgeon General (SG) Leroy Burney convened a year-long study group to review the available research. That review confirmed the causal relationship between smoking and lung cancer, which Burney then announced as the official opinion of the U.S. Public Health Service (PHS).
The tobacco industry aggressively questioned PHS’s interpretation of the data, and Burney issued a still-stronger statement in 1959.
Yet U.S. smoking rates continued to rise: By 1960, more than 40% of adult Americans reported actively smoking. The public health challenge was thus to convince Americans to make decisions about whether to smoke—or quit—in light of sound scientific evidence.
Photo: Credit NLM
Burney’s successor, SG Luther Terry, convened a second study group in November 1962. This time, members were asked to prepare a formal report for publication.
Terry’s committee worked for just over a year, without fanfare, meeting mostly in offices in the basement of NIH’s brand-new National Library of Medicine (NLM) building (see sidebar).
NLM staff helped compile more than 7,000 publications, including many studies conducted at or funded by NIH.
In the five years since Burney’s press conference, new research had directly linked smoking tobacco with several other deadly diseases that were already rising health concerns.
Taken together, the effects of smoking produced a 70% increase in mortality over nonsmokers, and smokers had been found to face a 10- to 20-fold increase in the risk of death from lung cancer—although quitting was shown to substantially improve the odds. Scientists had also determined that women who smoked while pregnant had babies with significantly lower birth weights.
Photo: courtesy don shopland
Terry presented the report’s highlights in a press conference on Jan. 11, 1964, prompting shocked stories in newspapers and TV programs across the U.S. and abroad. Catchy public service announcements soon followed.
In 1965, Congress stepped in with the Federal Cigarette Labeling and Advertising Act, compelling U.S. tobacco companies to print health warnings directly on cigarette packets and requiring the SG’s office to produce annual reports on smoking and health, thereby ensuring attention to emerging questions such as health consequences for women (1980), nicotine addiction (1988), effects by race and ethnicity (1998), effects of secondhand smoke (1986, 2006, 2010) and risks of e-cigarettes (2018). In 1969, legislators passed the Public Health Cigarette Smoking Act to prohibit cigarette advertising via television and radio.
The 1964 Report on Smoking and Health thus left an admirable legacy. While smoking is still a leading cause of preventable death, U.S. rates now hover at an all-time low of about 11%. Youth smoking, which peaked at 36.4% in the late 1990s, is currently less than 2%.
Read more about the historic report online at https://go.nih.gov/QZJbehf.
Location, Location, Location
NIH Site of Committee Deliberations Humble
Photo: courtesy don shopland
For all of its momentous responsibility and undertaking, the 10-member group tasked with advising the U.S. surgeon general on the health effects of smoking held forth in somewhat humble surroundings—a super-subbasement of the National Library of Medicine (NLM) building newly constructed on NIH’s Bethesda campus.
“The staff was housed on C level in NLM, far away from the madding crowd,” said Donald Shopland, who was still a teenager when he was assigned a job supporting the committee. “C level back then only contained journals published prior to 1946 that were in significantly less demand than the more current journals on A level. As a result, few people were on the floor, except for the occasional library tech who retrieved journals from that era. C level is three floors below ground.”
Immediately after the committee was formed, the Public Health Service constructed short-term offices for the staff, Shopland recalled. In addition, a temporary enclosure was erected next to the offices.
“The staff affectionately called it the ‘bullpen,’” Shopland said, “and that is where the full committee met to discuss the evidence and put their final report together.”
Accommodations were far from lavish. The enclosure stood less than 6 feet tall, was completely open at top and bottom and had no doors. And, being cast far from the public eye perhaps offered the group more freedom of expression.
Photo: Credit courtesy don shopland
“It wasn’t unusual to hear a few ugly words being said as the committee ‘debated’ the evidence,” Shopland remembered. “More than a few shouting matches occurred too.”
Since committee members maintained their full-time academic positions back home, they always met on weekends—usually beginning on Friday and going through Saturday. Later, meetings extended into Sunday and even Monday.
“Obviously that meant the staff worked weekends too,” Shopland lamented. “In fact, certain members of the staff worked most weekends. It wasn’t unusual for some of the core staff to turn in timecards with as many hours of overtime as regular time.”
Now set to become an octogenarian this fall, Shopland, who eventually served as coordinator of the National Cancer Institute’s Smoking and Tobacco Control Program, may be the sole surviving person to have worked on the groundbreaking report.
A book, Clearing the Air. The Untold Story of the 1964 Report on Smoking and Health, which he and two fellow staffers wrote with two committee members gives the inside scoop on “just what went into putting that landmark report together.” It's now available for free download at https://uchealthhumanitiespress.com/books/clearing-the-air/.