50th Anniversary: Surgeon General's Report on Smoking

In 1964, the U.S. Surgeon General released a groundbreaking report on Smoking and Health that for the first time linked cigarettes to many health dangers, such as heart disease and cancer. The report validated much of what pulmonologists and other doctors already suspected, and it launched many anti-smoking efforts and campaigns. Just one year later, the Federal Cigarette Labeling and Advertising Act went into effect, requiring warning labels on cigarette packages. The report, and those that followed, have influenced social norms and policies throughout the years. Notable smoking-related victories in more recent years include tax increases, restricting flavored tobacco and smoke-free workplaces.

Dr. Cugell
 Dr. Cugell

Dr. David W. Cugell, who established the Pulmonary Function Laboratory at Northwestern Memorial Hospital in 1959, joins others in calling the report "the most significant health report ever." At the time of the report, he was practicing medicine at Northwestern and was on the Board of Directors of the Tuberculosis Institute of Chicago and Cook County (now Respiratory Health Association). In honor of the 50th anniversary of the U.S. Surgeon General's Report on Smoking and Health, Respiratory Health Association interviewed Dr. Cugell. He recounted the importance of the report on public health and what can be done to ensure that future lung health initiatives succeed.

Respiratory Health Association (RHA): Prior to the report did the public suspect or believe there were health risks associated with smoking?
Dr. Cugell: I don't believe so, but physicians generally did.

RHA: To what level before the report had doctors already suspected/communicated the health risks of smoking?
Dr. Cugell: Many thought it contributed a great deal to the frequency of heart attacks. Emphysema and COPD were not yet household words.

RHA: At the time the report was issued, to the best of your knowledge, what percentage of your patients smoked? (The national rate was 42 percent, with more than 50 percent of men smoking.)
Dr. Cugell: Approximately 80 to 90 percent, but the percentage was high because of my medical specialty.

RHA: How did people in the medical field react to the report? Did they incorporate the messaging into everyday practice?
Dr. Cugell: It took a while, I know not how long, before talking with patients about smoking came into vogue. People began counting ashtray contents and cigarette butts at the end of meetings. The counts declined markedly at meetings of internists in general, especially American Thoracic Society members. At meetings of surgeons the butt counts declined much less rapidly.

RHA: Did you personally witness a decline in smoking after the report was issued?
Dr. Cugell: No, not until "no smoking" campaigns became widespread - except for myself. I quit smoking within a year or two after the first report was issued.

RHA: What did the tobacco industry do in response to the report?
Dr. Cugell: They launched a massive public relations campaign, in print and on the TV networks, denying any adverse health effects from tobacco. I participated in several round table-type discussions with tobacco industry spokespersons who denied the report was scientifically valid.

RHA: In your opinion, is tobacco use still a major health challenge and do you still think more measures need to be taken to protect the public from the health risks associated with smoking?
Dr. Cugell: We need more of what has been successful so far - tax, education, to limit tobacco advertising and, most importantly, make tobacco use less "cool".

Respiratory Health Association continues to support public health victories

To continue the fight against tobacco, Respiratory Health Association supports many current anti-tobacco legislation and policies. The Chicago City Council is considering an ordinance to treat electronic cigarettes like tobacco. By defining e-cigarettes as tobacco products, the City of Chicago can utilize its licensing and enforcement tools to restrict sales to youth. This ordinance would also eliminate the risk of exposure to the chemicals emitted from e-cigarettes. Please click here tell your Alderman that you want e-cigarettes to be treated as tobacco and have them included in Chicago's clean indoor air law.