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In response to your April 10 editorial titled “Misplaced priorities,” I ask that you read the Surgeon General’s latest report on secondhand smoke. I was privileged to watch him live when he discussed his report.
For those who have any doubts at all that secondhand smoke is harmful to everyone's health, including the smoker, our Surgeon General Richard Carmona said that “the debate is over” and “the scientific evidence indicates that there is no safe level of secondhand smoke.” . . .
You are misinforming your readers by stating that “in Pasadena, regulations against smoking are already some of the strictest in California.” On the contrary, Pasadena has a lot of catching up to do where indoor and outdoor air is concerned, compared with other cities. For instance, Beverly Hills and Santa Monica protect their outdoor diners, whereas we do not.
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‘There may be more famous surgeons general, but there was none more dedicated, tenacious or courageous’
Julius Richmond, who has died aged 91, was the US surgeon general who first warned the Carter administration that cigarette smoking was “slow-motion suicide”.
A pioneer of a vigorous anti-smoking campaign, he produced a report three decades ago citing “overwhelming proof” that tobacco causes lung cancer. . . .
Richmond’s 1979 report on the health risks of smoking persuaded congress to require new labels on cigarette packets stating “Surgeon General’s Warning” and outlining specific health risks related to smoking. He formally retired in 1988 but continued to research and write about the effects of smoking and he served as a key witness in legal actions against the tobacco industry. “We are in the midst of the largest man-made epidemic in history,” he declared.
General Julius B. Richmond, MD, FAAP, a pediatrician and pioneer in child development and anti-tobacco education, died Sunday, July 27, 2008, of cancer at his home near Boston. He was 91.
Dr. Richmond served as President Carter's Assistant Secretary for Health and as U.S. Surgeon General from 1977 to 1981. As Surgeon General, Dr. Richmond reinvigorated tobacco control efforts through the release of the 1979 Surgeon General's Report presenting for the first time overwhelming scientific evidence of the multiple harmful effects of smoking. The American Academy of Pediatrics Julius B. Richmond Center of Excellence - a program dedicated to eliminating children's exposure to tobacco and secondhand smoke - is named in honor of Dr. Richmond's lifelong commitment to the health of children and families.
"Dr. Richmond was one of the giants in our field," . . .
Although he officially retired in 1988, Dr. Richmond continued to teach, write and mentor students and colleagues. He served as an expert witness in several historic class-action litigations against the tobacco industry and served as founding chair of the Medical Advisory Board of the Flight Attendant Medical Research Institute (FAMRI). FAMRI, a not-for-profit medical research foundation, was established as a result of a class action suit brought against the tobacco industry on behalf of flight attendants exposed to secondhand tobacco smoke in airline cabins.
Dr. Julius Richmond, the pediatrician who helped create Project Head Start and later, as surgeon general, issued a 1979 report on the health risks of smoking that led to more informative warning labels on cigarette packs, died of cancer Sunday at his home near Boston. He was 91.
"Dr. Richmond was one of the giants in our field," said Dr. Renee R. Jenkins, president of the American Academy of Pediatrics. "He was a wonderful role model for pediatric leaders in the U.S. and throughout the world." . . .
He formally retired in 1988 but continued to teach, write and do research. He also served as an expert witness in several class-action suits against the tobacco industry, including one by flight attendants.
"We are in the midst of the largest man-made epidemic in history, and that is lung cancer," he later said.
Word just arrived that Julius B. Richmond, 91, the first director of Head Start and former U.S. Surgeon General who fought a career-long battle against cigarette smoking, died Sunday at his home in Brookline, Mass. He had cancer.
He was someone who had a big impact on public health in the U.S., especially in latter part of 20th century. We've started a full obit of him which I'll have late today. One interesting tidbit until then: at the announcement of his appointment as Surgeon General, here's what the Post reported:
One in eight babies - well over half a million a year - are born premature, a toll that's risen steadily for two decades with no sign of stopping.
The government this week begins an unprecedented push to figure out why, with special aim at preterm births that may be lowered: so-called late preemies, those born weeks, not months, early.
"The average woman should be thinking about this," says acting Surgeon General Steven Galson, who opened a two-day conference Monday on developing a national strategy to prevent premature birth. "We really need to redouble our efforts." . . .
Smoking and lack of prenatal care are the top preventable risks. To push health authorities to address those, the March of Dimes this fall will begin publicly grading states on their rates of preterm birth, pregnant women's access to smoking cessation programs, how many are uninsured and how many get a first-trimester ultrasound.
On Nov. 7, 2006, Ohio voters passed Issue 5, Ohio's smoking ban, which included exemptions for private clubs and family-owned businesses. Over a year later, no private clubs are exempt and no family-owned businesses are exempt as far as we know. Ohio citizens have serious concerns about Issue 5 and an apparent concerted effort by special-interests to mislead Ohio voters. . . .
Explanation and Argument for Issue 5 -- Surgeon General Carmona's Report: Those who could access the Secretary of State's website saw five bullet items in the Explanation and Argument for Issue 5 from the U.S. Surgeon General's Report. After the five bullet items, it then summarized "For these reasons...urge a YES vote on Issue 5." The fact is Issue 5 was based solely on Surgeon General Carmona's report. Issue 5 petition language was certified April 2005. The Surgeon General's Report wasn't issued until June 2006. FORCES, Inc., a non-profit educational corporation dedicated to scientific research integrity, has filed a complaint with the Health and Human Services, Office of Research Integrity against Surgeon General Carmona's report. . . .
Although Opponents of Ohio Bans believes that all private business owners should be allowed to make their own policies on smoking, several Ohio Senators have seen the devastating damage to family-owned businesses and private clubs and agree that at least they should be spared from this all too restrictive law. Senator Robert Schuler-R has introduced SB 346 to again exempt private clubs and family-owned businesses, as the law passed in November, 2006 stated by clearly defining "family-owned business." The bill is co-sponsored by 12 other senators.
To restate our points, the U.S. Surgeon General and others have stated that the best documented evidence is offered by the epidemiologic studies of lung cancer and involuntary exposure to environmental tobacco smoke (ETS). Thus, focusing on these studies provides the best evidence for our complaint.
It should be clear that prospective epidemiologic studies have been out of the question, leaving only the possibility of retrospective studies. Because lung cancer incidence peaks at ages beyond 55, by necessity the subjects of retrospective epidemiologic studies of lung cancer and ETS exposure are of advanced age. In fact, virtually all epidemiologic studies of lung cancer and ETS exposure have dealt with aged nonsmoking spouses of smoking husbands or wives.
The U.S. Surgeon General report in question notes that a legitimate risk assessment requires a summary measure of the infinitely variable momentary doses of ETS that were internalized over the prior lifetime of each study subject. It also recognizes that such summary measure is impossible to obtain.1 The logical corollary is that a legitimate risk assessment is not possible, but the U.S. Surgeon General report and all epidemiologic studies intentionally ignored this insurmountable obstacle, and arbitrarily decided that instead of dose, exposure alone is sufficient in assessing risk. In fact, however, the retrospective determination of lifetime exposures is also impossible, and for essentially the same reasons that have induced the Surgeon General to conclude that a summary determination of lifetime doses is impossible.
Even assuming the sufficiency of exposure alone in assessing risk, how would exposure be measured? . . .
the above considerations should be sufficient in their own right to qualify a plainly manifest and deplorable act of scientific misconduct on the part of the U.S. Surgeon General, and of the authors of all epidemiologic studies of ETS and lung cancer. Similar charges are equally valid for studies of ETS and cardiovascular and other diseases, which depend on identical sham “measurements” of ETS exposures.
Incidentally, we do not claim any discrepancy - as you suggest - between the epidemiologic studies and the U.S. Surgeon General report in question: they are all equally responsible of the identical misconduct. . . .
Our present complaint relates specifically to misconduct perpetrated by the Office of the Surgeon General, fully funded by the Public Health Service of the US Government. The misconduct we claim refers to the conscious use of fraudulent epidemiologic studies by that Office, with the intent of sustaining statements and policies that are just as fraudulent as the underlying epidemiologic studies adduced as justification.
Treating Tobacco Use and Dependence: 2008 Update, a Public Health Service- sponsored Clinical Practice Guideline, is a product of the Tobacco Use and Dependence Guideline Panel (“the Panel”), consortium representatives, consultants, and staff. These 37 individuals were charged with the responsibility of identifying effective, experimentally validated tobacco dependence treatments and practices. The updated Guideline was sponsored by a consortium of eight Federal Government and nonprofit organizations: the Agency for Healthcare Research and Quality (AHRQ); Centers for Disease Control and Prevention (CDC); National Cancer Institute (NCI); National Heart, Lung, and Blood Institute (NHLBI); National Institute on Drug Abuse (NIDA); American Legacy Foundation; Robert Wood Johnson Foundation (RWJF); and University of Wisconsin School of Medicine and Public Health’s Center for Tobacco Research and Intervention (UW-CTRI). This Guideline is an updated version of the 2000 Treating Tobacco Use and Dependence: Clinical Practice Guideline that was sponsored by the U.S. Public Health Service, U. S. Department of Health and Human Services. An impetus for this Guideline update was the expanding literature on tobacco dependence and its treatment. The original 1996 Guideline was based on some 3,000 articles on tobacco treatment published between 1975 and 1994. The 2000 Guideline entailed the collection and screening of an additional 3,000 articles published between 1995 and 1999. The 2008 Guideline update screened an additional 2,700 articles; thus, the present Guideline update reflects the distillation of a literature base of more than 8,700 research articles. Of course, this body of research was further reviewed to identify a much smaller group of articles that served as the basis for focused Guideline data analyses and review. This Guideline contains strategies and recommendations designed to assist clinicians; tobacco dependence treatment specialists; and health care administrators, insurers, and purchasers in delivering and supporting effective treatments for tobacco use and dependence. . . .
This Guideline concludes that tobacco use presents a rare confluence of circumstances: (1) a highly significant health threat;4 (2) a disinclination among clinicians to intervene consistently;5 and (3) the presence of effective interventions. This last point is buttressed by evidence that tobacco dependence interventions, if delivered in a timely and effective manner, significantly reduce the smoker’s risk of suffering from smoking-related disease.6-13 Indeed, it is difficult to identify any other condition that presents such a mix of lethality, prevalence, and neglect, despite effective and readily available interventions. Although tobacco use still is an enormous threat, the story of tobacco control efforts during the last half century is one of remarkable progress and promise. In 1965, current smokers outnumbered former smokers three to one.14 During the past 40 years, the rate of quitting has so outstripped the rate of initiation that, today, there are more former smokers than current smokers.15 Moreover, 40 years ago smoking was viewed as a habit rather than a chronic disease. No scientifically validated treatments were available for the treatment of tobacco use and dependence, and it had little place in health care delivery. Today, numerous effective treatments exist, and tobacco use assessment and intervention are considered to be requisite duties of clinicians and health care delivery entities. Finally, every state now has a telephone quitline, increasing access to effective treatment.
The scant dozen years following the publication of the first Guideline have ushered in similarly impressive changes. . . .
The overarching goal of these recommendations is that clinicians strongly recommend the use of effective tobacco dependence counseling and medication treatments to their patients who use tobacco, and that health care systems, insurers, and purchasers assist clinicians in making such effective treatments available. 1. Tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit. Effective treatments exist, however, that can significantly increase rates of long-term abstinence.
2. It is essential that clinicians and health care delivery systems consistently identify and document tobacco use status and treat every tobacco user seen in a health care setting. 3. Tobacco dependence treatments are effective across a broad range of populations. Clinicians should encourage every patient willing to make a quit attempt to use the counseling treatments and medications recommended in this Guideline. 4. Brief tobacco dependence treatment is effective. Clinicians should offer every patient who uses tobacco at least the brief treatments shown to be effective in this Guideline. 5. Individual, group, and telephone counseling are effective, and their effectiveness increases with treatment intensity. Two components of counseling are especially effective, and clinicians should use these when counseling patients making a quit attempt: • Practical counseling (problemsolving/skills training) • Social support delivered as part of treatment 6. Numerous effective medications are available for tobacco dependence, and clinicians should encourage their use by all patients attempting to quit smoking—except when medically contraindicated or with specific populations for which there is insufficient evidence of effectiveness (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents). • Seven first-line medications (5 nicotine and 2 non-nicotine) reliably increase long-term smoking abstinence rates:
– Bupropion SR – Nicotine gum – Nicotine inhaler – Nicotine lozenge – Nicotine nasal spray – Nicotine patch – Varenicline
8 • Clinicians also should consider the use of certain combinations of medications identified as effective in this Guideline. 7. Counseling and medication are effective when used by themselves for treating tobacco dependence. The combination of counseling and medication, however, is more effective than either alone. Thus, clinicians should encourage all individuals making a quit attempt to use both counseling and medication. 8. Telephone quitline counseling is effective with diverse populations and has broad reach. Therefore, clinicians and health care delivery systems should both ensure patient access to quitlines and promote quitline use. 9. If a tobacco user currently is unwilling to make a quit attempt, clinicians should use the motivational treatments shown in this Guideline to be effective in increasing future quit attempts. 10. Tobacco dependence treatments are both clinically effective and highly cost-effective relative to interventions for other clinical disorders. Providing coverage for these treatments increases quit rates. Insurers and purchasers should ensure that all insurance plans include the counseling and medication identified as effective in this Guideline as covered benefits.
The guidelines for smoking cessation released today by the U.S. Public Health Service provide an important reminder to the nation's 45 million smokers that they have more scientifically proven tools available to help them quit smoking and protect their health than ever before, including safe and effective medications, counseling and telephone quitlines. Combining counseling and medication is especially effective in helping smokers quit. These findings are based on a thorough review of the evidence and have critical implications for policymakers as well as medical providers.
Unfortunately, while most smokers want to quit, and millions try each year, most do not avail themselves of the evidence-based treatments that improve success rates. While the guidelines address actions clinicians can take, policy makers at all levels, as well as employers, also need to take action to prevent kids from smoking in the first place, encourage smokers to quit, enhance awareness of the treatments available and provide affordable access to these live-saving interventions. As the guidelines emphasize, providing insurance coverage for these evidence-based treatments increases both the rates that smokers use these treatments and the rates that smokers quit.
Federal government: Congress and the Administration should implement the National Action Plan for Tobacco Cessation
An updated clinical practice guideline released today by the U.S. Public Health Service has identified new counseling and medication treatments that are effective for helping people quit smoking. In addition, the May 7 issue of JAMA includes a commentary that urges clinicians to use the updated guideline to accelerate progress in reducing the use of tobacco.
Treating Tobacco Use and Dependence: 2008 Update was developed by a 24-member, private-sector panel of leading national tobacco treatment experts that reviewed more than 8,700 research articles published between 1975 and 2007. The review found that there are now seven medications approved by the Food and Drug Administration as smoking cessation treatments that dramatically increase the success of quitting. The medications are: bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline.
. . .
The 2008 PHS guideline update and its companion products, which include a consumer guide and a pocket guide for clinicians, are available online at http://www.surgeongeneral.gov/tobacco/default.htm. Copies of the 2008 PHS guideline update products are also available by calling 1-800-358-9295.
"Caution - Cigarette Smoking May Be Hazardous to Your Health." By today's explicit and bloodcurdling standards the warning that appeared for the first time on cigarette packs in the United States in 1966 was quaint in its understatement. But with those words William Stewart helped turn smoking - in the West at least - from emblem of cool into, almost literally, a deadly social sin.
Stewart was Surgeon General of the United States, the country's most senior public health official, between 1965 and 1969. In recent years, under the dominance of the conservative doctrine of "small government," the post has lost much of its former importance. But in that era, as President Lyndon Johnson pushed through his groundbreaking civil rights and public health legislation, the Surgeon General was a power in the land. . . .
Today the cigarette packet health warnings he helped pioneer in the US are positively tame by international standards. Across the EU, packets proclaim that "Smoking Kills", while many countries either have already, or are about to have, packets carry pictures of body organs damaged by smoking. In America, by contrast, there are merely rotating warnings printed on the side of the packet only, and in colours that do not clash with those of the product - with no updating since 1984.
Contrary to the obituary in today's New York Times, former Surgeon General Dr. William H. Stewart did not "put the first health warnings on cigarette packs," notes the public interest law professor who caused the first decline in US smoking by getting free time for antismoking messages on radio and TV.
"Although Dr. Stewart urged health warnings, he had no authority to order them," notes law professor John Banzhaf of George Washington University. In fact, the story is somewhat more complicated, he explains. . . .
Unfortunately, something that Stewart could not have anticipated -- but which Congress should have foreseen -- occurred. Years later the major tobacco companies were successful in defending themselves from law suits claiming that they failed to adequately disclose the dangers of smoking by arguing that they put on their packs exactly the warning Congress had required.
None of this should detract from Stewart's legacy, however, says Banzhaf.
eneral in the Johnson administration who put the first health warnings on cigarette packs and integrated the United States Public Health Service and many Southern hospitals, died on April 23 in New Orleans. He was 86.
His death was announced by the L.S.U. Health Sciences Center, including the Louisiana State University School of Medicine, which he directed from 1969 to 1974. . . .
Dr. Stewart also prepared an influential three-part report, "Health Consequences of Smoking," released from 1967 to 1969, as the second salvo in a series of surgeon generals' reports that helped change smoking from social norm to social stigma.
Dr. Luther L. Terry, Dr. Stewart's predecessor, began the campaign with the 1964 report that the death rate from lung cancer for men who smoked cigarettes was almost 1,000 percent higher than it was for nonsmokers.
William H. Stewart, 86, who as U.S. surgeon general from 1965 to 1969 led the federal anti-smoking crusade and called for warning labels on cigarette advertising and who used the introduction of Medicare to desegregate hospitals throughout the country, died April 23 of kidney failure at Ochsner Medical Center in New Orleans.
Dr. Stewart was a career Public Health Service officer who became surgeon general one year after his predecessor, Luther L. Terry, released a landmark report that drew an explicit link between smoking and lung cancer and other diseases.
Expanding on the 1964 report, Dr. Stewart commissioned studies that hammered the tobacco industry by spelling out the toll that cigarettes exacted in lost productivity, disease and early death. Many of his recommendations, including stricter warning labels on cigarette packages and advertising, were adopted despite fierce opposition. . . .
He fought to toughen the Cigarette Labeling and Advertising Act of 1965, which affixed a warning on cigarette packages saying that smoking could be "hazardous to your health."
He maintained that it was "indefensible" for the tobacco industry to advertise cigarettes "in a context of happiness, vigor, success and well-being without even a hint appearing anywhere that the product may also lead to disease and death."