Before I say more, it is my understanding that the Marlboro man later got lung cancer and did television commercials to stop people from smoking.

This is a clip from a one hour primetime television documentary that I made in the 1980s on smoking. The narrator was my friend and colleague, the great Peter Thomas. At the time, about 30+ percentage of Americans smoked cigarettes even though it was clear starting with the 1964 Surgeon General's report, that smoking provoked a variety of illnesses and in fact, was killing Americans.

The debate over smoking had divided physicians, scientists, governments, smokers, and non-smokers since Tobacco was first imported to Europe from its native soil in the Americas. A dramatic increase in cigarette smoking in the United States in the early 20th century provoked anti-smoking movements. Reformers, hygienists, and public health officials argued that smoking brought about general malaise, physiological malfunction, and a decline in mental and physical efficiency. Evidence of the ill effects of smoking accumulated during the 1930s, 1940s, and 1950s.

The impulse for an official report on smoking and health came from an alliance of prominent private health organizations. In June 1961, the American Cancer Society, the American Heart Association, the National Tuberculosis Association, and the American Public Health Association addressed a letter to President John F. Kennedy in which they called for a national commission on smoking, dedicated to "seeking a solution to this health problem that would interfere least with the freedom of industry or the happiness of individuals."

The Kennedy administration responded and Surgeon General Luther Terry announced that he would convene a committee of experts to conduct a comprehensive review of the scientific literature on the smoking question.

Meeting on the campus of the National Institutes of Health in Bethesda, Maryland from November 1962 through January 1964, a committee of top experts including scientists, physicians, and tobacco industry representatives reviewed more than 7,000 scientific articles with the help of over 150 consultants. Terry issued the commission's report on January 11, 1964, choosing a Saturday to minimize the effect on the stock market and to maximize coverage in the Sunday papers. As Terry remembered the event, two decades later, the report "hit the country like a bombshell. It was front page news and a lead story on every radio and television station in the United States and many abroad.

What did the 1964 Surgeon General's report find?
The report highlighted the deleterious health consequences of tobacco use.  It held cigarette smoking responsible for a 70 percent increase in the mortality rate of smokers over non-smokers. The report estimated that average smokers had a nine- to ten-fold risk of developing lung cancer compared to non-smokers: heavy smokers had at least a twenty-fold risk. The risk rose with the duration of smoking and diminished with the cessation of smoking. The report also named smoking as the most important cause of chronic bronchitis and pointed to a correlation between smoking and emphysema, and smoking and coronary heart disease. It noted that smoking during pregnancy reduced the average weight of newborns. On one issue the committee hedged: nicotine addiction. It insisted that the "tobacco habit should be characterized as an habituation rather than an addiction," in part because the addictive properties of nicotine were not yet fully understood.

The 1964 report on smoking and health had an impact on public attitudes and policy. A Gallup Survey conducted in 1958 found that only 44 percent of Americans believed smoking caused cancer, while 78 percent believed so by 1968. In the course of a decade, it had become common knowledge that smoking damaged health, and mounting evidence of health risks gave Terry's 1964 report public resonance. Yet, while the report proclaimed that "cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action," it remained silent on concrete remedies. That challenge fell to politicians.

In 1965 Congress required all cigarette packages distributed in the United States to carry a health warning, and since 1970 this warning is made in the name of the Surgeon General. In 1969, cigarette advertising on television and radio was banned, effective September 1970.

In 1969 Congress passed the Public Health Cigarette Smoking Act which prohibited cigarette advertising on television and radio and required that each cigarette package contain the label “Warning: The Surgeon General Has Determined That Cigarette Smoking Is Dangerous to Your Health.”

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David Hoffman filmmaker

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