3.7.7: British Doctor’s Study/Smoking
Smoking cigarettes had become a large part of American culture during the early 20th century. Cigarette advertising included cartoons and even children smoking, and many examples of physician endorsements, although lacking any support from scientific evidence. Smoking was concurrently portrayed as “manly” and “rugged” with characters like the Marlboro Man, and also as classy or even feminist with the Virginia Slims “you’ve come a long way, baby” campaign. At the same time, lung cancer deaths were increasing exponentially - a phenomenon revealed in two case-control studies published in 1950 which also correlated smoking to lung cancer. Two British doctors, Richard Doll and Austin Bradford Hill, had conducted one of these studies and found a significant dose-response relationship between smoking and lung cancer - the more cigarettes were smoked, the higher the risk. The next year they began a cohort study (see Chapter 5 for more on cohort studies) of British doctors to make this correlation even more clear.
Within just 10 years they had proven not only was smoking a strong risk factor for lung cancer, but also increased the risk of other lung disease and cancers as well - and that the risk was reduced when doctors quit smoking. Following up at each decade, this correlation continued, demonstrating that a smoker’s risk of dying was 2-3 fold higher than nonsmokers depending on their age and smoking habits (Di Cicco et al., 2016). This risk was recognized by the U.S. Surgeon General in 1957. Several private health associations including the American Cancer Society, American Heart Association, and American Public Health Association sent a letter to President Kennedy requesting he develop a commission on smoking. This commission was created in 1962 and reviewed over 7,000 research studies over the next two years.
In 1964 the U.S. Surgeon General produced a comprehensive report recognizing that the risks of developing lung cancer were 10-20 times higher for smokers than non-smokers, and smoking also increased the risk of several other chronic diseases. This hit the media like a bombshell. Subsequently, Congress created legislation to require health warning labels on cigarettes and banned cigarette advertising on TV. In the 1980s another Surgeon General report was published regarding secondhand smoke, which began a slew of smoking restrictions in public places (The 1964 Report on Smoking and Health, n.d.). For example, in the state of California, bans include smoking in workplaces, restaurants, and bars, near building entrances, around playgrounds, and in a car while driving with a minor. Several state beaches prohibit smoking and many cities have also banned smoking in public places (California Tobacco Laws That Reduce ETS Exposure, n.d.).