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Facts:
--The publications correctly note that secondhand smoke can be a public health hazard: children are particularly vulnerable. Parental smoking increases the risk of sudden infant death syndrome and middle-ear diseases including acute and recurrent otitis media and chronic middle-ear effusion. ETS can trigger asthma, coughing, and breathlessness in exposed kids and can retard lung growth and pulmonary function. There is evidence in adults that it can cause nasal irritation (not to mention be intensely annoying).
--The SG report is on target in that it systematically dismisses (or says there is insufficient evidence) for many of the oft-claimed hazards of ETS . . .
--The most significant and questionable conclusion of both reports is that ETS causes lung cancer and cardiovascular disease in nonsmokers. The SG argues that ETS increases a nonsmoker's risk of heart disease by 30%, causing 46,000 premature deaths annually. Similarly, ETS allegedly increases the risk of lung cancer 20-30%, causing 3,000 premature deaths from this cause. . . .
That brings us to the most important concepts of all: dose and length of exposure. Both the Surgeon General's and the CDC report completely omit any reference to these critical variables. The CDC motto here is "It hurts you; it doesn't take much; it doesn't take long," and they note that "even a little (ETS) can be dangerous." The SG goes even further, with this totally outrageous statement: "the scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke." This leaves us with the clear impression that if we merely walk through a smoke-filled room, we have put our health in irreversible jeopardy.
These statements violate the basic tenet of toxicology: "only the dose makes the poison." What is most alarming here is that the top doctor in the land is communicating a message that anything that is harmful at high dose can be lethal at low dose -- when that is simply not true.
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My views on nicotine addiction don't fit any known template. Except my own. And, oh, the facts. And to show how mainstream, how core, my views are, I‘ll refer in this post to only U.S. Government publications for data.
I. 1964 Surgeon General's Report - Smoking Not Addictive
I. 1964 Surgeon General's Report - Smoking Not Addictive . . .
II. 1988 SGR Nicotine Addiction - Addiction Changes!
A quarter century later, the people who brought you Smoking and Health were forced to come back with - dum-de-dum - Nicotine Addiction. It took these distinguished pharmacologists 600+ pages to explain that they were wrong in 1964 - smoking WAS addictive. . . .
But research has proven it's untrue that continuing smokers are more addicted than quitters. People can quit addictions at any point. And, even after decades of heavy marketing of smoking cessation aids, most smokers disregard the ads and still quit on their own.
The National Cancer Institute released a 2002 compendium report, Those Who Continue To Smoke, about smokers who hadn't quit since everyone learned that smoking causes cancer. NONE OF THE RESEARCHERS FOUND THAT CONTINUING SMOKERS WERE MORE ADDICTED. In fact, older smokers who were more dependent were more likely to quit! Why? Let's think. As you age, being a heavy smoker makes you reflect more on your mortality and you are more anxious to live.
This analysis presents a detailed defense of my epidemiologic research in the May 17, 2003 British Medical Journal that found no significant relationship between environmental tobacco smoke (ETS) and tobacco-related mortality. In order to defend the honesty and scientific integrity of my research, I have identified and addressed in a detailed manner several unethical and erroneous attacks on this research. Specifically, I have demonstrated that this research is not "fatally flawed," that I have not made "inappropriate use" of the underlying database, and that my findings agree with other United States results on this relationship. My research suggests, contrary to popular claims, that there is not a causal relationship between ETS and mortality in the U.S. responsible for 50,000 excess annual deaths, but rather there is a weak and inconsistent relationship. The popular claims tend to damage the credibility of epidemiology.
In addition, I address the omission of my research from the 2006 Surgeon General's Report on Involuntary Smoking and the inclusion of it in a massive U.S. Department of Justice racketeering lawsuit. I refute erroneous statements made by powerful U.S. epidemiologists and activists about me and my research and I defend the funding used to conduct this research. Finally, I compare many aspect of ETS epidemiology in the U.S. with pseudoscience in the Soviet Union during the period of Trofim Denisovich Lysenko. Overall, this paper is intended to defend legitimate research against illegitimate criticism by those who have attempted to suppress and discredit it because it does not support their ideological and political agendas. Hopefully, this defense will help other scientists defend their legitimate research and combat "Lysenko pseudoscience." . . .
Further distracting from the actual content of the study and the legitimacy of the analysis, the press release added a number of out of context quotes from formerly confidential tobacco industry documents that had nothing to do with the conduct, analysis, or publication of the study. For the past several years these documents have been available online from the Legacy Tobacco Documents Library at UCSF [13], which was established by Glantz [14]. These documents are also available at other online tobacco document libraries [15]. As shown above, my tobacco industry funding and competing interests were clearly and accurately described in more than 200 words in the BMJ paper [1]. However, in order to raise doubts about my honesty and scientific integrity, the ACS made a great effort to locate and extract selective quotes from the professional correspondence I have had with the tobacco industry during my career. This ad hominem attack diverted attention from the paper itself and obscured its contribution to the body of epidemiologic evidence regarding the lethality of ETS.
As quoted from a recent report, “US Surgeon General Richard Carmona has concluded that there is no safe level of secondhand smoke exposure. The report, which reviewed 20 years of evidence on the health hazards of exposure to secondhand smoke, found that even trace levels of exposure have immediate, damaging effects on non-smokers.” Even though the evidence is overwhelming, and there are “no smoking” signs posted everywhere, as I walk through the City Center Mall, TheMall and Landmark Mall I am constantly assaulted by smoke mostly from men in national dress smoking openly, usually right under the posted “no smoking” signs while security guards and coffee shop employees blithely ignore both the health risk and disrespect to other shown by the smokers. Why bother posting signs that are ignored. Instead why not actually enforce the no smoking laws so that everyone can enjoy a healthier, smoke free environment.
President Obama's nominee for surgeon general, Dr. Regina M. Benjamin, is a woman of astonishing grit, selflessness and competence. If confirmed by the Senate, she would bring a perspective solidly rooted in the difficult reality so many Americans confront as they search for adequate, affordable health care. . . .
Despite its high-sounding title, the surgeon general is actually a mid-level federal health official whose primary powers are hortatory and educational. Some past surgeons general have reshaped thinking about the dangers of smoking and the urgency to combat AIDS, but many have disappeared into the bureaucracy.
Dr. Benjamin has said that she wants to act as a voice for patients and make sure that no one falls through the cracks as health care reform proceeds. And she has said she wants to focus on preventing disease, a crucial component of health care reform. To do all that, the soft-spoken, unassuming family doctor will also have to master the bully pulpit. But judging from her history, we are betting on her.
President Barack Obama has chosen a woman with an interesting and admirable story to be his surgeon general, but the nation would be better off if the position were abolished. . . .
The need for the position is gone. It was created by President Ulysses Grant to care for sailors and to monitor diseases coming into the country. Those duties have been assumed by other agencies.
The surgeon general is now a political position and a national nag.
The person in that position spends a great deal of time repeating advice Americans hear from their personal physicians and their loved ones. If Americans don't stop smoking or start exercising when their own doctors and their spouses tell them to, what makes the government think they will listen to a surgeon general? . . .
Other than repeating advice we already pay our own physicians to give us, the surgeon general is a mouthpiece for White House policy.
In 2007, three former surgeons general testified to Congress that their administrations had interfered in their jobs, telling them what policies to push.
It's fine for the White House to have its own ideas and policies about health and to lobby Americans to support them, but we shouldn't have to pay for unnecessary positions to echo the president's talking points.
Abolishing the position of surgeon general won't balance the federal budget. There's not that much money involved. But it can't hurt to save a few million here and there.
She has been a leader in both the Alabama and national medical associations, but she's also a doctor who drove long distances when sick patients could not get to her and who understands the ravages of smoking, poor diet and other unhealthy behaviors in the most intimate way, having lost members of her immediate family to easily preventable diseases.
If confirmed, Benjamin will take over a job known almost solely for the ubiquitous 1965 warning, later updated, that "The Surgeon General has determined that cigarettes may be dangerous to your health." The position, which is not responsible for such weighty policy matters as healthcare reform, nonetheless can wield tremendous influence when the person who holds it has a gift for communication and a reputation for passionate, science-based positions on public health. During the Reagan administration, Surgeon General C. Everett Koop advocated comprehensive sex education, produced an important paper on the effects of secondhand smoke and had information on AIDS mailed to every U.S. household.
Benjamin should make the unhealthy fattening of America one of her keynote public health issues.She also can advocate for better primary-care coverage and encourage the brightest students in U.S. medical schools to consider careers in family medicine. Known for her unswerving determination and frank speech, Benjamin has the potential to be one of the strongest voices in public health in decades. Her confirmation should be swift.
he U.S. Surgeon General has been described as "the nation's doctor," a "national nanny" and the person who puts warning labels on cigarette packs. But lately, the position has been mostly called something else: invisible.
Once the government's leading voice on health issues, the surgeon general faded into relative obscurity in recent years. When asked to name a surgeon general, many people can only recall Dr. C. Everett Koop — the famous Reagan appointee with the look and bearing of a biblical prophet.
Some thought that would change under the Obama administration . . .
The job of surgeon general was created in 1870 to oversee the reorganization of a government network of hospitals for sailors, which was in shambles. The first surgeon general adopted a military model, creating a cadre of uniformed government physicians that could be sent anywhere they were needed.
Those uniformed doctors became medical heroes. They figured out that malnutrition was causing the pellagra illness that plagued the American South. They confined a dangerous plague outbreak in San Francisco. They coordinated care for millions of Americans sickened by the deadly Spanish flu.
Meanwhile, the surgeon general's power grew, with oversight of such agencies as the National Institutes of Health and the Centers for Disease Control and Prevention as they came into being. For decades, surgeons general were chosen from within the ranks of federal public health agencies.
Perhaps the surgeon general to have the biggest impact was Dr. Luther Terry, who in 1964 released a report that was seen as the government's official confirmation that smoking causes lung cancer. It influenced millions to stop smoking.
"It was one of the most important public health reports or public health pronouncements in medical history," said Dr. Otis Brawley, the American Cancer Society's chief medical officer.
However, by the mid-1960s, some political leaders had grown discontented with the surgeon general's troops, believing they had dragged their feet in implementing Great Society programs like Medicare. A government reorganization in 1968 stripped the post of administrative powers, and since then the surgeon general mainly has been a health educator and spokesman, reporting to an assistant secretary of health and human services. . . .
"She'll bring a front-line perspective you rarely hear in policy discussions," he said.
For her part, Benjamin told reporters at the press conference that becoming the Surgeon General would be "a physician's dream."
"Public health issues are very personal to me. My father died with diabetes and hypertension. My older brother and only sibling died at age 44 of HIV-related illness. My mother died of lung cancer because as a young girl she wanted to smoke, just like her twin brother could," Benjamin said.
"My family's not here with me today -- at least not in person -- because of preventable diseases," she added. "While I cannot change my family's past, I can be a voice in the movement to improve our nation's health care and our nation's health for the future."
My family's not here with me today -- at least not in person -- because of preventable diseases. While I cannot change my family's past, I can be a voice in the movement to improve our nation's health care and our nation's health for the future.Dr. Regina Benjamin, President Barack Obama's nomination for surgeon general.
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The President announced his nominee for the U.S. Surgeon General, Dr. Regina Benjamin, today at the White House. Dr. Benjamin has an extensive and distinguished career in medicine. She is the Founder and CEO of the Bayou La Batre Rural Health Clinic in Alabama, which aims to provide primary care to people of any age regardless of their financial situation. She previously served as Chair of the Federation of State Medical Boards of the United States, and as the Associate Dean for Rural Health at the University of South Alabama College of Medicine. Additionally, she was chosen as President of the Medical Association of Alabama in 2002, becoming the first African-American woman to be president of a state medical society. She was also the first African-American woman and physician under 40 to be elected to the American Medical Association Board of Trustees. She received the Nelson Mandela Award for Health and Human Rights in 1998, among other honors.
With that, let me introduce the next Surgeon General of the United States, Dr. Regina Benjamin.
DR. BENJAMIN: Thank you, Mr. President. And thank you, Secretary Sebelius, for being here with me.
I am honored and I am humbled to be nominated to serve as United States Surgeon General. This is a physician's dream. But for me, it's more than just a job.
Public health issues are very personal to me. My father died with diabetes and hypertension. My older brother, and only sibling, died at age 44 of HIV-related illness. My mother died of lung cancer, because as a young girl, she wanted to smoke just like her twin brother could. My Uncle Buddy, my mother's twin, who's one of the few surviving black World War II prisoners of war, is at home right now, on oxygen, struggling for each breath because of the years of smoking.
My family is not here with me today, at least not in person, because of preventable diseases. While I can't -- or I cannot change my family's past, I can be a voice in the movement to improve our nation's health care and our nation's health for the future.
My mother died of lung cancer, because as a young girl, she wanted to smoke just like her twin brother could. My Uncle Buddy, my mother's twin, who's one of the few surviving black World War II prisoners of war, is at home right now, on oxygen, struggling for each breath because of the years of smoking. My family is not here with me today, at least not in person, because of preventable diseases. While I can't -- or I cannot change my family's past, I can be a voice in the movement to improve our nation's health care and our nation's health for the future.President Obama's nominee for Surgeon General of the United States, Dr. Regina Benjamin, in the Rose Garden.
President Obama will name a new surgeon general at 11:40 a.m. in the Rose Garden. According to the Associated Press, his pick is Regina Benjamin, a family physician from Alabama.
Benjamin made headlines after Hurricane Katrina for her efforts to rebuild her Bayou La Batre, Ala., health clinic, which serves 4,400 people who would have a hard time finding health care elsewhere, the AP says.
Last fall, she received a MacArthur Foundation "genuis grant," and she is a recipient of the Nelson Mandela Award for Health and Human Rights.
Noon ET: Update: Calling the surgeon general's post "a physician's dream," Benjamin pledged to be "America's doctor" and to help guide the nation through whatever health care changes are approved by Congress and the White House.
"Public health issues are very personal to me," she said, recounting how her father died of diabetes and hypertension, her mother from smoking-related lung cancer and her brother and only sibling from HIV-related complications. In each case, she said, her family members died from preventable diseases.
President Obama announced Monday his choice for surgeon general -- Dr. Regina Benjamin, a 52-year-old family practice doctor who has spent most of her career tending to the needs of poor patients in a Gulf Coast clinic in Alabama. . . .
Benjamin cited the toll of preventable illness as the reason her family was not with her at the announcement: Her father died with diabetes and high blood pressure; her older brother and only sibling died at age 44 of an HIV-related illness; her mother died of lung cancer after taking up smoking as a girl; her mother's twin brother could not attend because he is at home "struggling for each breath" after a lifetime of smoking.
In "Aiming Wide in City War on Smoking" (NYC column, June 30), Clyde Haberman reports that the city's Department of Health and Mental Hygiene wants to post photos of diseased lungs next to cash registers where cigarettes are purchased.
My mother had a better idea. When the surgeon general issued his report "Smoking and Health" in 1964, she got hold of a copy, wrote on the cover, "To my children and their friends, because I love them," and left it on the pillow each time we had an overnight guest.
It's been 45 years since I quit smoking cigarettes, two weeks before the surgeon general's report on smoking came out.
I thought you should be smart enough to figure out that cigarettes were bad for you without the government telling you After all, they didn't call them "coffin nails" for nothing.
I'd been quitting smoking for almost as long as I'd been smoking, about 12 years. . . .
My environment didn't help. I worked in a newsroom, where pretty much everyone smoked. . . .
That was the thing about cigarettes, they were cool. And if you wanted to be cool, too -- and who didn't? -- you had to smoke them. Edward R. Murrow, the coolest of postwar TV journalists, held his cigarette like a scepter while interviewing the rich and famous, his head wreathed in smoke.
James Dean, the coolest of young actors not named Brando, appeared in "Rebel Without A Cause" with a filtered cigarette lightly clenched in his front teeth. Until then we hadn't realized that filtered cigarettes could be cool. (Such was the power of movies in the good old days.)
But, always, we knew it was bad for us. We could feel it. We just didn't know how bad. The surgeon general's report told us. Very bad. . . .
The report, initiated under President John Kennedy, was easily the greatest public health initiative of my time. And now we have another step on the way to sanity, and it promises to be the next great public health measure. . . .
I'll admit that even today it looks kind of cool when you see people smoking in, for example, a French movie (smoking has all but disappeared from American movies). Seeing someone in a hospital bed, tubes attached, gasping into an oxygen mask? Not so cool.