Saturday, September 29, 2007

A Chronology of Tobacco in the Civilized World

1492. After landing in the Caribbean, Columbus and his men notice the natives' fondness for chewing and smoking the dried leaves of an aromatic plant. The Indians inhale smoke through a Y-shaped pipe called a tobaga, thought by etymologists to be the origin of the name of the plant. While Columbus scolds his men for sinking to the level of the savages by mimicking their habit, he was reported to have said that, "it was not within their power to refrain."

1919. Alton Ochsner, a medical student at Washington University in St. Louis, attends a postmortem of a patient with a disease so rare the he was told he would never see another case...lung cancer.

1932. A paper in the American Journal of Cancer associates lung cancer with cigarettes.

1940. Hitler calls tobacco the "wrath of the red man against the white man for having been given hard liquor" and begins the world's first national anti-tobacco movement. He raises taxes on tobacco to 90% of the retail price, limits cigarette rations to the Wehrmacht, and bans smoking during pregnancy, in air raid shelters, on streets and on city trains and buses. German cigarette consumption drops by half between 1940 and 1950. During this time American consumption doubles.

1950. Lung cancer deaths quintuple in the United States from 5/100,00 in 1930 to 20/100,00 in 1950 (17,500/yr). JAMA publishes a landmark article by Graham and Wynder showing that almost all patients with lung cancer have been long-time cigarette smokers.

1954. Marlboro Man is introduced by Phillip Morris and its virile image takes the market by storm. Twenty-two years later the documentary "Death in the West," which juxtaposed years of Marlboro Man commercials with interviews of real cowboys dying of lung disease, is suppressed by a British court. This same year the AMA Board of Trustees votes to discontinue accepting advertisements for tobacco and alcohol-related products.

1962. President Kennedy, when pressured to give his opinion about smoking and health, indicates that he would not give an opinion because, "the matter is sensitive enough and the stock market is in sufficient difficulty without my giving you an answer which is not based on complete information, which I don't have..." Shortly thereafter he assigns Luther Terry, MD, the United States Surgeon General, to study the issue of smoking and health.

Two hundred thousand Americans will develop lung cancer this year; 180,000 of them will die. This is more American deaths than in World War One, Korea and Viet Nam combined. By the year 2000 more women than men will die of lung cancer. The cure rate is similar to that which was true in 1964 at the time of the first Surgeon General's report. Eighty-five percent of these cases could have been prevented, as many began habitual tobacco use after the Surgeon General's report in 1964. Although many individual physicians stand out in this public health struggle, the organized profession as a whole has been less than exemplary in the past. There are signs, though, that things may be improving.

Thomas E. Addison, MD / San Francisco Medicine Jul98

More: HERE