HIST 140 Lecture 17 Smoking, Lung Cancer, and Discovery of risk

Joe Camel Campaign by R.J. Reynolds, 1987-1997

-1991 San Francisco lawyer suit against RJR for targeting minors 1997 RJR out of court settlement: ended Joe Camel Campaign; paid $10 million to California cities and counties - Awareness of "Big Tobacco": 1994 documents from the Brown and Williamson Tobacco Corporation (B&W) to UCSF; 1995 the professor published 5 articles in JAMA -- Big companies always knew what they were doing, but always claimed that they had no idea that nicotine was addictive - 1998 Master Settlement Agreement: a. yearly payments to states; voluntary restriction on advertising and marketing tobacco products b. Funded American Legacy Foundation, anti-smoking advocacy group

Industry Reaction

1. 1954 Tobacco Industry Research Committee (TIRC): -- only "statistical" not laboratory -- only animals not humans -- aging population -- everyone dies of something

1980s Decline in "smoking as voluntary" argument

1. 1994 McDonalds, Chuck E. Cheese, Arbys, Taco Bells, and Dairy Queens banned smoking 2. 1994 Pro-Children Act: banned smoking in schools, day care centers, Head Start programs, and other places receiving federal funding for children's services

Safer smoking?

1. 1995 FDA: nicotine is a drug, cigarettes are "drug delivery devices" 2. pipes, filtered cigarettes, nicotine replacement therapy 3. E-cigarettes: less toxic, not tar, but high levels of nanoparticles, nicotine contraption depending on how deep the inhales are

1967-70 US Cigarette consumption declined

1. Celebrity lung cancer deaths 2. people were more uncomfortable with smoking

1964 Surgeon General's Report on Smoking and Health

1. In 1964 Surgeon General Luther Terry gave up smoking 2. 1965 Federal Cigarette Label and Advertising Act 3. "Caution: Cigarette smoking may be hazardous to Your Health" 4. Consumer Activism: a. ASH (Action on Smoking and Health) 1967 John Banzhaf III, Lawyer, forced FFC (Federal Communications Commission) to enforce Fairness Doctrine and show anti-smoking messages b. GASP (Group Against Smoking Pollution)- 1970 Clara Gouin (environmentalist whose father died of lung cancer) c. 1988 Americans for Nonsmokers Rights(ANR): Protests to get smoke-free meeting rooms, doctors' offices, hospitals, natural food stores

Population-based Research

1. New kind of epidemiology: disease with no "germ" a. Framingham Heart Study - 1948-present b. 1961 concept of risk factors in heart disease: high blood pressure, high cholesterol, possibly smoking - in 1948: 52-0 men and women between 30-62 had heart disease - Thomas Dawber, epidemiologist, Director 1949-66

Rise of chronic diseases and epidemiological transition

1. President Eisenhower's heart attack in 1955 a. Raised awareness of heart disease -- Doctors--does the disease have to do with the lifestyle, but not a specific germ? 2. Cardiologist Paul Dudley White, founder of preventive cardiology stressed importance of exercise.

Decline in deaths from infectious disease in 1950s and 1960s

1. Reasons Post WW2 background: a. Sanitary infrastructure: sewer system, water filtration b. public health infrastructure well established: clinics, education, labs for diagnoses and vaccinations c. More hospitals were built 2. Economic background: The living standard has risen: nutrition, housing, food, ability to pay for visit to doctor, buy private health insurgent to pay for hospital care 3. Behavioral: personal hygiene

Rise of Chronic Disease Epidemiology

1. Retrospective Studies: Interview lung cancer patients and other about their smoking habits a. Everts Graham and Ernest Wynder: Study in JAMA (1950): -- 605 men with lung cancer: 86% heavy smokers; 780 men with no lung cancer: almost all smoked but only 19% smoked a pack a day. -- Animal pathology: smoke produced skin cancer in 44% of the mice they had painted with tobacco tar condensed from cigarette smoke. 2. Prospective Study: Interview or send questionnaires to large group and then follow up their causes of death a. Edward Hammond and Daniel Horn: "The relationship between human smoking habits and death rates" JAMA 1954 -- studied smoking histories of 187.766 white man, aged 50-69, and then what killed them -- in 18 months 4854 men had died. 754 of them had smoked a pack of cigarettes or more a day; death rate almost twice as high as men who never smoked b. Richard Doll and Austin Bradford-Hill: British Doctors Study "Lung Cancer and Other Causes of Death in Relation to Smoking" British Medical Journal (1956) -- if you are a smoker, more likely to die ten years earlier than non-smokers -- Effect of stopping smoking at age 30: if stop smoking, can get the gap closer to non-smokers.

1969 the Public Health Cigarette Smoking Act

1. TV and Radio ban started 1971 2. new label "Warning: Cigarette smoking is dangerous to your health"

Continuing advertising on Marlboro Men and Virginia Slims(1968)

1. Targeting women: Slimmer than the fat cigarettes men smoke and women should feel right to smoke. 2. Rise in lung cancer among women: - 1987 lung cancer was the leading cause of death in women - Death rates for lung cancer and breast among women in US (1930-77) lung cancer exceeded breast cancer

Rising Concern in smoking and increase in lung cancer

1. US government saw cigarettes as a very crucial part in boosting morale of soldiers in both World Wars 2. Smoking was an integral part of medical culture because doctors used cigarettes Why increase in lung cancer? a. improved diagnoses so more cases were found b. genetic predisposition Why was it not linked to smoking? a. little rise in women's lung cancer cases b. lung cancer also occurred in non-smokers

Global Cigarette consumption

1. still promoting cigarette in less developed countries due to lack of regulations. 2. China now has 38% of world's smokers.

Rise of Harm Reduction

Clean needed exchanges use of naloxone reduced overdose deaths Opioid replacement therapy (ORT) replaced an illegal opioid like heroin with a longer acting but less euphoric opioid like methadone Safer sex education