ATLANTA (CNN) -- Before Dr. Luther L.
Terry, then the Surgeon General of the United States, issued his office's first
"Report on Smoking and Health" more than 30 years ago, thousands of articles had
already been written on the effects of tobacco use on the human body.
Tobacco companies had countered the reports --
which purported to show links between smoking and cancer and other serious diseases --
with denials and competing studies.
So in 1964, Terry and his Advisory Committee
on Smoking and Health knew they were stepping into a major pit of controversy when they
announced "cigarette smoking is a health hazard of sufficient importance in the
United States to warrant appropriate remedial action."
It was America's first widely publicized
acknowledgment that smoking cigarettes is a cause of serious diseases.
But the issue wasn't settled in 1964, nor is
it settled in 1997, despite literally thousands more studies -- and litigation that has
forced at least one tobacco company to admit what some activists say they knew all along:
cigarette smoke is hazardous to your health.
More than 30 years -- and more than 20 Surgeon
General reports -- later, the issue appears headed for settlement in the courtroom rather
than the laboratory.
So what are
Here's what tobacco's critics say:
The Centers for Disease Control and Prevention
says cigarette smoking is responsible for 151,322 cancer deaths annually in the United
States. Most of those -- 116,920 -- are from lung cancer. The CDC says men who smoke are
22 times more likely to die from lung cancer than non-smokers. Women who smoke are 12
times more likely to die from the disease.
Statistical studies have long shown that
people who don't smoke live longer than people who do, and scientists have seen
statistically the correlation between smoking and incidences of lung cancer since the
But a study earlier this year by Gerd Pfeifer
of the Beckman Research Institute pinpointed specific carcinogens in cigarette smoke that
target parts of a gene already known to be prominent in some cancers.
Pfeifer wrote in Science that cigarette smoke
causes changes in the gene p53, which protects against cancer when normal but promotes
cancer growth when mutated.
Another study, published by the American
Cancer Society, said that low-tar cigarettes offered no relief from the potential of
cancer, and in fact were responsible for a type of cancer that reaches deeper into lung
Other cancers are also
affected by cigarette smoke. An American Cancer Society researcher
reported earlier this year that smoking increased men's risk of
dying of prostate cancer, while other studies have linked tobacco
use to increased risk of other cancers, including throat, breast,
bowel, and mesothelioma cancer.
Adult Acute Leukemia
Adult Chronic Leukemia
Smoking also has been linked time and again to
cardiovascular diseases. Among these, the biggest killer is heart disease: according to
the CDC, smoking triples the risk of dying from heart disease among middle-aged men and
Studies also show an increased risk of death
from stroke, aneurysms, high blood pressure, and other cardiovascular illnesses.
Smoking is cited as a risk for dying of
pneumonia, chronic bronchitis, or emphysema. The CDC says people who smoke increase their
risk of death from bronchitis and emphysema by nearly 10 times.
A report recently published in the American
Journal of Epidemiology suggested that smoking increased the risk of developing
non-insulin-dependent diabetes mellitus (NIDDM) by more than three times.
Studies have pointed to smoking as a risk in
vision loss among older people, mental impairment later in life, Alzheimer's disease and
other forms of dementia.
EFFECT ON PREGNANCY
Pregnant women who smoke can pass nicotine and
carbon monoxide to their baby through the placenta. Research indicates this can prevent
the baby from getting the oxygen and nutrients it needs to grow -- potentially leading to
fetal injury, premature birth, or low birth weight. According to the American Lung
Association, smoking during pregnancy accounts for an estimated 20 to 30 percent of low
birthweight babies, up to 14 percent of premature deliveries, and about 10 percent of all
A mother who smokes can also pass nicotine to
her baby through her breast milk.
The studies didn't just point to the ill
effects of smoking on those who smoke -- non-smokers, too, are apparently affected by the
smoke from their friends, family members and strangers who light up in their presence.
A steady stream of reports documented the
statistical risks of contracting cancer or suffering from heart disease, even if you've
never put a cigarette to your lips.
The American Heart Association last fall
released a seven-year study showing that never-smoking spouses of smokers have more than a
20 percent greater chance of death from coronary heart disease than those who have never
smoked who live with non-smokers. That study gave more impetus to the drive to make
workplaces and other public areas smoke-free.
The effects of smoking are hard on the
children of smokers as well, the studies say. Dr. Claude Hanet of the St. Luc University
Hospital in Brussels, Belgium, said earlier this year that a baby born to a smoking mother
"should be considered an ex-smoker."
Hanet's study cautioned that cigarette smoke
was more detrimental with decreasing age.
And a University of Birmingham, England,
study, published in the British Journal of Cancer showed a possible link between fathers
who smoked and an increased incidence of cancers in their children, while studies in the
U.S. showed a possible link between smoking and DNA damage.
Of all the diseases associated with smoking,
addiction is perhaps the one that receives the least attention. But President Clinton
declared nicotine an addictive drug last August. In March, the Liggett Group, makers of
Chesterfield and Lark brand cigarettes, admitted that cigarettes were addictive and cause
cancer and agreed to pay about $750 million total to 22 states that had filed suit to
force tobacco companies to pay for Medicaid for smoking-related illnesses.
Scott Harshbarger, the Massachusetts attorney
general and president of the National Association of Attorneys General, told reporters
that the Liggett deal "will produce information that indicates major tobacco
companies were fully aware that the product they were selling is addictive, that the
product they were selling had great impact on public health."
Other tobacco companies are clearly none too
keen on the Liggett deal. For them, nicotine remains what they call a harmless flavor
Despite the weight of the data about the ills
of tobacco smoke, research also shows some occasional benefit from smoking. Researchers at
the Brookhaven National Laboratory in Upton, New York, reported that something in
cigarette smoke lowers the levels of an enzyme known as MAO B.
This coincides with an increase in dopamine,
known for years to be the brain chemical responsible for part of nicotine's pleasure.
Smokers, say the researchers, may have a lower
risk of Parkinson's disease, because the nerve disease is aggravated by shortages of
And while smoking may be a cause of dementia,
it also could be sharpening the mind. University of California-San Diego researchers
presented a study to the Society for Neuroscience earlier this year showing that smoking
cigarettes sharpens short-term learning and memory among young people.
Researchers in the study, however, cautioned
that such benefits don't outweigh the risks of more serious ailments.
ASHES TO ASHES
According to the CDC, 400,000 Americans die
each year because they smoke cigarettes, making it the single most preventable cause of
premature death in the United States.
Quitting doesn't necessarily help, according
to another University of Birmingham study -- at least not if the smoker waits too long.
Stroke risk is high for up to 20 years after a smoker quits, according to that study,
published in the Journal of Epidemiology and Community Health.
The CDC says that on average, if you smoke,
you will die seven years earlier than if you don't.
What is the human
toll of smoking?
Number of deaths per year attributed to tobacco in the
United States: 400,000 *.
Number of deaths per hour: 45.
Number of deaths due to:
Cardiovascular disease: Almost 180,000. *
Obstructive lung disease (chronic bronchitis and emphysema: 65,000 *.
Risk for a smoker dying of lung cancer, compared to a
Male: 22 times
Female: 12 times
Number of scientific studies on the health effects of tobacco, approximate: 50,000.
Percentage of United States adults who smoked in 1993: 25 *
Percentage in 1965: 42 *
Number of years of life smoking costs the average smoker: 7
Number of identified carcinogens in tobacco smoke: 43
Estimated 1993 health care costs due to smoking, according
to Centers for Disease Control and Prevention: total $50 billion. This figure includes:
$26.9 billion for hospital costs
$15.5 billion for doctors
$4.9 billion in nursing home costs
$1.8 billion for prescription drugs
$900 million for home-health care expenditures
Number of times "addiction" is listed on
compulsory cigarette warnings (in United States): 0.
Marketing and promotional budget of tobacco companies,
(1993): $6 billion.
Number of cigarette advertisements this money bought that
mention addiction, habituation, dependence or the difficulty most smokers experience in
Revenues of the U.S. tobacco companies, 1991: $32 billion
Percentage of adult smokers who had tried cigarettes by
18th birthday: 80.
Percentage of smokers age 12 to 17, according to a 1992
Gallup poll, who want to quit: 66.
Percentage of NCAA baseball athletes who use
"smokeless tobacco": 57 (source: "The marketing of nicotine addiction).
* American Cancer Society fact sheet "Questions About Smoking, Tobacco, and Health
... and the Answers.
Smoking is a
greater cause of death and disability that any single disease, says the World Health
According to their figures, it is responsible
for approximately 3.5 million deaths worldwide every year - or about 7% of all deaths.
Tobacco smoking is a known or probable cause of approximately 25 diseases, and even the
WHO says that its impact on world health is not fully assessed.
Heart attack and stroke
UK studies show that smokers in their 30s and
40s are five times more likely to have a heart attack than non-smokers. Tobacco
contributes to the hardening of the arteries, which can then become blocked and starve the
heart of bloodflow, causing the attack. Often, smokers who develop this will require
complex and risky heart bypass surgery. If you smoke for a lifetime, there is a 50% chance
that your eventual death will be smoking-related - half of all these deaths will be in
middle age. Smoking also increases the risk of having a stroke.
Another primary health risk associated with
smoking are lung cancer, which kills more than 20,000 people in the UK every year. US
studies have shown that men who smoke increase their chances of dying from the disease by
more than 22 times. Women who smoke increase this risk by nearly 12 times. Lung cancer is
a difficult cancer to treat - long term survival rates are poor. Smoking also increases
the risk of oral, uterine, liver, kidney, bladder, stomach, and cervical cancers, and
leukaemia. Another health problem associated with tobacco is emphysema, which, when
combined with chronic bronchitis, produces chronic obstructive pulmonary disease. The lung
damage which causes emphysema is irreversible, and makes it extremely difficult to
Harm to children
Smoking in pregnancy greatly increases the risk
of miscarriage, is associated with lower birthweight babies, and inhibited child
development. Smoking by parents following the birth is linked to sudden infant death
syndrome, or cot death, and higher rates of infant respiratory illness, such as
bronchitis, colds, and pneumonia. Nicotine, an ingredient of tobacco, is listed as an
addictive substance by the US authorities. Although the health risks of smoking are
culmulative, giving up can yield health benefits regardless of the age of the patient, or
the length of time they have been smoking.
By 2020, the WHO expects the worldwide death
toll to reach 10 million, causing 17.7% of all deaths in developed countries. There are
believed to be 1.1 billion smokers in the world, 800,000 of them in developing countries.