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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.
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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 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 June, 2006, then Surgeon General Carmona released his report titled "The Health Consequences of Involuntary Exposure to Tobacco Smoke". Since that date, his report has drawn criticism from Scientists and Epidemiologists worldwide.
Four separate groups have filed complaints with the Office of Research Integrity, Health and Human Services against Ex-Surgeon General Carmona's 2006 Report.
Opponents of Ohio Bans filed a complaint against the scientific misconduct (manipulation of research) of the economic assessment/impact of smoking bans. According to Carmona's report, smokefree policies do not harm business. Two thirds of the studies in Carmona's report were either authored or co-authored by Stanton Glantz, Director of the Center for Tobacco Control Research and Education at the University of California San Francisco School of Medicine, who is not an economist. He and his university have profited heavily by anti-tobacco funding and grants. Absolutely no studies or reports conducted by economists or trade organizations were cited in Carmona's report, although many sources were available at the time.
For example, the highly regarded Deloitte and Touche reported a study for the National Restaurant Association study (2004), the Ridgeway Economic Associates New York Nightlife Association/Empire State Restaurant and Tavern Association Study (05/12/2004) . . .
Dr. Michael Siegel is a prominent doctor specializing in Preventative Medicine and Public Health. . . .
Other articles such as "Science and Secondhand Smoke: the Need for a Good Puff of Skepticism" by Sidney Zion (Skeptic, Volume 13, Number 3, 2007), "Where's the Consensus on Second Hand Smoke?" by Joseph Bast of Heartland Institute, and "Did Carmona Read His Own Report?" by Jacob Scullum with Reason Magazine 06/29/2006 http://www.reason.com/blog/show/114497.html are but a small representation of the articles that give a glimpse of how damaging the epidemic of anti-smoking is.
1878: Eighty-six years before the U.S. surgeon general issues a report confirming the dangers of smoking tobacco, a letter from English physician Charles R. Drysdale condemning its use appears in The Times of London.
Drysdale, the senior physician to the Metropolitan Free Hospital in London, had already published a book on the subject, Tobacco and the Diseases It Produces, when he wrote the letter that described smoking as "the most evident of all the retrograde influences of our time."
Drysdale had been on an anti-smoking crusade since at least 1864, the year he published a study documenting the effects on young men of consuming ¾ ounce of tobacco daily. That study reported cases of jaundice, and at least one subject having "most distressing palpitations of the heart." . . .
He also warned against exposure to second-hand smoke: "Women who wait in public bar-rooms and smoking-saloons, though not themselves smoking, cannot avoid the poisoning caused by inhaling smoke continually. Surely gallantry, if not common honesty, should suggest the practical inference from this fact." . . .
Though physicians and scientists understood there were numerous health hazards associated with the practice, the number of smokers increased dramatically in the first half of the 20th century. Thank you, Madison Avenue. Thank you, Hollywood.
The turning point probably came in 1957, when then-Surgeon General Leroy Burney reported a causal link between smoking and lung cancer. It was left to Burney's successor, Luther Terry, to lower the boom. . .
And to think it only took 86 years.
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.
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."
Columbia City Council, buoyed by a state Supreme Court decision Monday, will press ahead this week on activating a dormant 2006 ordinance that would prohibit smoking in public buildings.
Mayor Bob Coble said he asked the city's attorney to brief the seven-member panel Wednesday on a ruling that upholds a municipal ordinance that bans smoking in Greenville's restaurants and bars.
The Supreme Court reversed a lower-court decision that initially sided with business owners who claimed the city of Greenville enacted a local law that exceeded the authority of state law.
Winning attorney Ron McKinney said the case is significant because it is the first time the S.C. Supreme Court has had before it the issue of second-hand smoke being a health threat, and no one questioned that assertion.
"Ten years ago, this would not have happened," McKinney said, explaining that in recent years overwhelming scientific evidence has confirmed the threat.
In a guest editorial on Jan. 26, Carson Taylor attacks "anti-smoking zealots" who rely on "junk science" to press for laws protecting the public from secondhand smoke. He doesn't identify these zealots, but I will. They include the surgeon general, EPA, Center for Disease Control, National Institute of Health, WHO and virtually every other public health organization on the planet.
Even Phillip Morris USA officially admits the risk. . . .
Now they indirectly fund outside groups such as "Citizens Against Government Interference" and "My Smokers' Rights," to do the dirty work for them.
Internal tobacco industry documents, made public by a lawsuit, reveal the strategy. "Our overriding objective is to discredit the EPA report. . . .
The Internet is full of sites claiming the moon landing was a hoax, Elvis is still alive and there is a conspiracy, hatched by public health officials around the world, to attack secondhand smoke with "junk science." As for me, I'm siding with the surgeon general
FORCES International has presented an official complaint based on rigorous scientific analysis of the 2006 Surgeon General's (SG) Report on Passive Smoking to the Office of Research Integrity (ORI) of the United States in Washington, DC, and the complaint has been forwarded to the Inspector General of the Department of Health and Human Services.
FORCES's complaint concerns several worrisome aspects of the SG Report, including deficient data-gathering methodology, data cherry-picking, and misrepresentation of flimsy evidence, which reveal not simply bias, but a clear determination to reach or reinforce predetermined political conclusions.
Based on such sham scientific bases, smoking bans are implemented in the United States and abroad, and have severe negative impacts on both the economies and the social fabric. . . .
Maryetta Ables, President of the organization, stated: "Innocent smoking citizens have become target practice for discrimination and social hatred. They are accused of anything from being killers to child abusers, all based on junk science, propagated with an appalling blindness to scientific and social ethics."
The complaint has been presented also on behalf of several foreign branches of FORCES (such as FORCES Germany and FORCES Italy), as well as affiliate organizations such as the UK's Freedom to Choose, and other independent organizations.
Innocent smoking citizens have become target practice for discrimination and social hatred. They are accused of anything from being killers to child abusers, all based on junk science, propagated with an appalling blindness to scientific and social ethics.Maryetta Ables, President of FORCES, on the Surgeon General's Report; a complaint has been filed with the Office of Research Integrity (ORI).
In 1998, I issued the first Surgeon General's report on tobacco use among racial and ethnic groups in the United States. . . .
This year, Congress has an opportunity to do something truly important to improve the health of America's families. The Family Smoking Prevention and Tobacco Control Act (S.625/H.R.1108) is bipartisan legislation that will finally give the U.S. Food and Drug Administration authority over tobacco products and their marketing. . . .
There is no better example of the powerful impact of tobacco marketing on African-American children than the popularity of Lorillard's Newport cigarettes. . . .
Recently, tobacco companies have increased marketing to the Hispanic community with ads in magazines popular with Latino youth. . . .