50 years later....

rick's picture

January 2014 marks the 50th anniversary of the U.S. Surgeon General’s first comprehensive report on the dangers of tobacco. That landmark document signaled the start of the nation's public health campaign against tobacco and its health consequences.

After five decades of anti-tobacco efforts, it’s fair to ask “How far have we come?”

“We’re fifty years down the line,” says Alan Woodward, M.D., chairman of Tobacco Free Mass, “and still these products are the number one cause of preventable death and chronic illness in this country.”

The effort continues, and that’s the subject of Smoking, Tobacco and Health, the latest edition of Physician Focus with the Massachusetts Medical Society.

Dr. Woodward, also a member of the Massachusetts Public Health Council, and Douglas Ziedonis, M.D., M.P.H., Professor and Chair of the Department of Psychiatry at the University of Massachusetts Medical School and UMass Memorial Health Care in Worcester, are the guests on the first episode of Physician Focus for 2014, examining the impact tobacco has had since the Surgeon General's first report in 1964.

Their discussion looks at the effects of tobacco use on personal and public health, what can be done to further reduce the use of cigarettes and other tobacco products, the challenges of new tobacco products, and ways for people to quit smoking. Hosting this edition is Hopkinton resident James Kenealy, M.D., a physician with ENT Associates in Framingham.

The physicians agree that we’ve made progress, severely cutting the smoking rates of both adults and youth. But nearly one in five Americans still smokes, and cigarette smoking is responsible for about one in five deaths in the U.S. every year, totaling more than 440,000 deaths. The problem is particularly acute with young people. Every day, more than 1,000 youth under 18 become daily cigarette smokers, and among high-school seniors, one out of four is a regular cigarette smoker. Ninety percent of smokers start before they’re 18 years of age, and 99 percent start before 26 – ages when the adolescent brain is much more susceptible to addiction.

As a result, current anti-tobacco efforts focus on the young, with such efforts as a move to make all colleges in the state smoke-free. “It’s time we redouble our efforts,” Dr. Woodward notes, “and try to prevent another generation from becoming tobacco and nicotine addicted.”

The dangers of tobacco use remain clear and convincing, says Dr. Ziedonis. The biggest health impact is on the heart, but smoking is also linked to many other conditions, such as emphysema, bronchitis, cancer, and diabetes. Such information has almost become common knowledge.

But the addictive effects are perhaps less well known. Dr. Ziedonis, an addiction specialist, views tobacco first as an addiction. “Nicotine affects the brain in certain areas,” he says, “and is clearly an addictive substance delivered in a very dangerous format with tobacco. You’re breathing it in, getting all the toxins and carcinogens.” And that’s a lot of harmful stuff: Cigarette smoke is estimated to contain some 700 different toxins and carcinogens, as well as additives put in by the cigarette manufacturers.

Cigarettes, however, are just one of the targets of physicians and public health officials. Smokeless tobacco and new products such as flavored cigars and electronic cigarettes are posing new challenges.

The physicians remain optimistic about anti-tobacco efforts. They point to the many successful actions already taken to curb tobacco – no smoking laws and regulations for public and private venues, higher tobacco taxes, and the various aids available to help people quit. Recent developments include cities and towns raising the age limit to buy tobacco products and local health boards prohibiting sales of products in health facilities such as pharmacies.

And though today’s target group may be youth, the physicians have not lost sight of others. “Even if you’re in your ‘60s or 70s’ and you quit,” Dr. Ziedonis says, “you’ll be able to lengthen your life and improve your health.”

“Fifty years ago we identified the problem,” he says, “but didn’t identify solutions. Since the Surgeon General’s report, we have developed a lot of treatments. Seven medications are now available, and there are a variety of ways people can quit. It’s never too late.”

Please join us in January for a reminder about the nation’s number one cause of preventable death and chronic disease – and how you can help people stop – or never start – smoking and using tobacco.

Caption: From left, James Kenealy, M.D., Douglas Ziedonis, M.D., M.P.H., Alan Woodward, M.D.