January 8, 2014

Stanton A. Glantz, PhD

The tobacco companies were terrified of the 1964 Surgeon General report; will Obama finally realize their fears?

I have been getting many press calls for my assessment of the importance of the 1964 Surgeon General's report.  There is no question that the report was a landmark event that provided the weight of government behind the conclusion, already reached by the scientific community 10 years earlier, that smoking caused lung cancer.  The issuance of the report and the attendant public discussion did seem to stop the growth in per capita cigarette consumption (graph). 

While stopping the growth in smoking, it is worth considering what the tobacco companies were afraid would happen when the report came out.

Fortunately, we know, thanks to the millions of previously secret tobacco industry documents in the UCSF Legacy Tobacco Documents Library.  In a word, the companies were terrified.

In June 1963, the major tobacco companies and their public relations agency, Hill and Knowlton, held discussions about the then-anticipated Surgeon General's report.  Here is a summary of the meeting:

The consensus is that the Industry is in "grave crisis," and the philosophy is "to expect the worse and work for the best." Of course the greatest cause for alarm is the forthcoming Surgeon General's Report, which is expected to be detrimental to the industry. The only degree of hope is the possibility that, instead of singling out tobacco,  the report will two into account a list of other agents (environmental and otherwise) which are suspect. However, this is deemed a rather dim hope, because indications point to a strong Indictment of tobacco, with possible "root-shaking" consequences. [emphasis added]

And, while politicians and most health advocates, saw the companies as invincible, they themselves saw things quite differently; the memo continues:

Thus, an unmistakable note of pessimism sounded throughout the discussions. This was further evidenced by constant references to resolutions, programs, and statements against smoking by various organizations (American Cancer Society, Heart Association, State Medical Societies, etc.). Of real concern is the mounting organized opposition,. along with the extensive press coverage of anti-smoking reports and activities. This "stacking of the cards" against the industry is viewed with special alarm, since It conceivably can be conditioning the public to accept any detrimental aspect of the Surgeon General's Report.

It is felt that the Report will consist of two essential phases (1) the initial release of material on the Committee's findings, based on a review of scientific data and evaluation - this reporting is expected in the fall of We year. and (2) the recommendation for legislative or Government action, labeling, stricter FTC control, Pure Food and Drug involvement, etc. ). particularly state statutes inspired by the Report.

The companies were correct that there was supposed to be a second report on policy recommendations (which the Surgeon General's report mentions on page 8).  The second report was never written, and, aside from weak warning labels being enacted in 1965 together with preemption that shielded the tobacco industry from the state-level action they feared, the government did not follow up with any of the strong policies they so feared. 

Indeed, it was not until the grassroots nonsmokers' rights movement took hold around 1980 that per capita cigarette consumption started to drop.

The 50th anniversary Surgeon General's report will be released in Washington DC next week, on January 16.  It is expected to, appropriately celebrate the tremendous accomplishments made since 1964 despite "trench warfare" opposition from the tobacco companies.

The real question will be whether now, 50 years later, the Obama Administration will implement the kind of strong public health policies that the tobacco company executives were so afraid of 50 years ago.

I would start with:

  • Ban menthol in all tobacco products
  • Require large graphic warning labels on tobacco products (and, yes, that could be done even in the current legal environment)
  • Prohibit use of e-cigarettes anywhere that smoking conventional cigarettes is prohibited
  • Prohibit advertising of e-cigarettes on television and radio
  • Support Malaysia's proposal to "carve out" tobacco from the Trans Pacific Partnership Agreement to prevent the tobacco companies from using the TPP to fight tobacco control measures here and around the world
  • Drop the pressure for "fast tack" of the TPP so that there can be a full public discussion of these (and other) serious issues that the TPP raises
  • Publicly press the media companies to modernize their voluntary ratings system to award an "R" to movies with smoking to substantially reduce the number of kids who starts smoking because of onscreen smoking on the grounds that the Surgeon General concluded that smoking in the movies causes youth smoking



Stan - I am not sure how you can say that per capita consumption declined only after the non-smokers rights movement began in the 1980s.  This movement, while definitely beneficial, was not the only positive development.
Gary Giovino


... but it wasn't until about 1980 that the long sustained drop occurred.


Stan's recitation is consistent with how the industry responded internally to many of the reports of the Surgeon general – expressing fear internally and mounting massive resistance.
One small piece that Stan's note doesn't include.  Immediately after the 1964 Report, the FTC actually responded rapidly and with urgency and adopted a Regulation that would have required a warning stronger than Congress later authorized and indicated that it intended to monitor tobacco industry marketing.  What happened was all too typical.  Congress stepped in immediately and, first, threatened the FTC and then stripped the FTC of its legal authority for a period of five years.  This was an example of an agency that wanted to and tried to respond only to be shut down by tobacco interests in Congress.
Matt Myers


OK, I agree


A related point is to consider the international impact of the 1964 SG's report.  
Japan gives just one, but surely a prime example.  Within weeks, the US report sparked positive action for tobacco control regulations from high officials within the Japanese Ministry of Health.  After an initial smaller measure and a study group's rapid engagement, MOH's Public Health Section Chief, on February 6, 1964, issued MOH's second directive on smoking and health to all prefectural governors and to mayors of major cities declaring it to be "clear that long term and heavy tobacco consumption by adults detrimentally affect health" and stating a desire that measures be taken to widely disseminate information and guidance to the public concerning the health harms caused by smoking."
Regrettably, much of what Matt describes for the U.S. took place in Tokyo as well when the Ministry of Health was quickly and fully forced to back away from any further tobacco control policies.  MOH remained essentially out of the game for nearly 30 years.  Japan's Ministry of Finance, then the 100% owner of the nation's tobacco monopoly, presumably did the dirty work there.
Details of the story can be found in Levin, Stanford Law and Policy Review (1997, available at http://ssrn.com/abstract=1691348" title="http://ssrn.com/abstract=1691348";http://ssrn.com/abstract=1691348), beginning on page 19.
Mark Levin

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