Surgeon General's Report on Smoking and Health

In 1963 annual cigarette consumption in the United States reached 4,345 per adult, up from 54 in 1900. The tobacco industry had spent more than a decade deflecting accumulating epidemiological evidence, partly by funding its own research and partly by casting the causal question as scientifically unresolved. The evidence was not, in fact, unresolved. Ernst Wynder and Evarts Graham had published a case-control study in 1950, Richard Doll and Austin Bradford Hill had produced prospective cohort data from British physicians, and in 1957 Surgeon General Leroy Burney declared that the evidence pointed to a causal link with lung cancer. In June 1961 the American Cancer Society, the American Heart Association, the National Tuberculosis Association and the American Public Health Association pressed the Kennedy administration for action.

Surgeon General Luther Terry announced a ten-member advisory committee in June 1962 and charged it with reviewing the literature comprehensively. Members qualified only if they had taken no previous stand on tobacco. Meeting at the National Library of Medicine from November 1962 to January 1964, they reviewed more than 7,000 articles with the help of more than 150 consultants. Terry released the report on Saturday, January 11, 1964, a day chosen to minimize the effect on the stock market and to maximize coverage in the Sunday papers.

The committee's findings were direct: cigarette smoking causes lung cancer in men and is the most important cause of chronic bronchitis. Average smokers had a nine- to tenfold risk of lung cancer, and heavy smokers at least a twentyfold risk. The report also linked smoking to emphysema and coronary heart disease and noted that smoking in pregnancy lowered birth weight. Those conclusions drew on multiple independent lines of evidence: animal experiments, autopsy pathology, epidemiological cohorts, and clinical series.

The political response followed. In 1965 Congress required a health warning on every cigarette package sold in the United States, and from 1970 the warning carried the Surgeon General's name. Broadcast advertising for cigarettes was banned from 1971. Smoking prevalence among U.S. adults, 42.4 percent in 1965, fell to 12.5 percent in 2020.

The report itself proposed no remedies. It called smoking a health hazard serious enough to warrant remedial action and left the choice of action to politicians. On one question the committee hedged: it described the tobacco habit as a habituation, not an addiction, partly because the addictive properties of nicotine were not yet fully understood and partly because its members disagreed over the meaning of addiction.