The Battle to Decrease Tobacco Use

Skull with a lit cigarette by Vincent Van Gogh (1853-1890). Oil on canvas on display in the Van Gogh Museum in Amsterdam. It was painted in 1886 while Van Gogh was taking a course on the baroque artist Pieter Paul Rubens at the Antwerp Art School. There is no evidence it was a statement about the effects of tobacco. He was a very heavy pipe smoker. Nevertheless, it would make a suitable illustration for a cancer society or a pulmonary disease society to highlight the relationship of smoking to premature death.

It is estimated that there are over one billion people who use tobacco products worldwide. Approximately eight million die each year from tobacco-related causes of which approximately 15 percent do so from second-hand smoke. An estimated two-hundred million have disability-adjusted life-years lost. Tobacco smoke contains several thousand derivative chemicals of which 70 are established carcinogens.

The Center for Disease Control and Prevention (CDC) has recently reported that approximately 31 million Americans over age 17 years continue to inhale combusted tobacco, established by the World Health Organization to be a proximate cause (increases the incidence) of 13 cancers. These sites include the lung, mouth, throat, larynx, esophagus, bladder, kidney, liver, stomach, pancreas, colon, rectum, and uterine cervix. Acute myeloid leukemia is very likely a 14th type. Tobacco use also contributes to other consequential health hazards, including chronic lung and cardiovascular disease.

Although used ceremonially by natives in the Americas for centuries, beginning in the 17th century tobacco was brought to the American colonies by Iberian explorers. The invention of the “cigarette”, so named by the French as a diminutive cigar, fueled a dramatic rise in tobacco consumption and cigarette smoking quickly outpaced cigars, pipes, snuff and other form of tobacco use. The first patented cigarette-making machine was invented in Mexico in 1847. Production increased when a better cigarette-making machine was developed in the U.S. in the 1880s, increasing the productivity of cigarette companies. Their output went from about 40,000 hand-rolled cigarettes daily to around 4 million. Cigarette smoking increased dramatically from the late 1800s to the mid-1960s when over 40% of Americans were smokers. The encouragement of American troops to use cigarettes to avoid boredom and relieve stress during World War I and World War II, abetted by the Armed Services who included cigarettes in rations, resulted in an exponential growth of cigarette use among all Americans.

The ferocious battle to have cigarette smoking recognized as a cause of cancer, especially of the lung, the first cancer incontrovertibly shown to be caused by inhaling combusted tobacco smoke, has a very long and sordid history. Tobacco interests fought vigorously to deny the connection and used all means possible to seduce men, women and young people to smoke. The movie industry and advertising heightened the image of the sophistication and pleasure of cigarette smoking.

Warnings of the ill-effects of using tobacco products date back at least to the proclamation of James I of England (James VI of Scotland) (1566–1625) in 1604. The year he commissioned the King James version of the Bible he described tobacco use as ‘A custome lothsome to the eye, hatefull to the Nose, harmefull to the braine, dangerous to the Lungs, and in the blacke stinking fume thereof, nearest resembling the horrible Stigian smoke of the pit that is bottomlesse’. The King also required Thomas Earle of Dorset, High Treasurer of England, to collect a tax on each pound of tobacco imported. When the royal exchequer grew from the tobacco tax imposed on imports from the Virginia colony, James’s criticism of using tobacco products became muted.

Although, physicians linked smoking to lung cancer in the late 18th, the 19th and very early 20th century, their views were attacked by a powerful tobacco lobby. In the 1950’s and early 1960’s, studies of the role of tobacco smoking as the cause of lung, other cancers and heart and lung disease were too compelling to be pushed aside. In 1964, the Surgeon General of the United States, Luther Terry, published extensive and compelling evidence that established the effect of combusted tobacco inhalation as a carcinogen. His first public announcement was made on Saturday to avoid roiling the stock market. Tobacco was a dominant industry at that time. Among the external carcinogens, inhalation of combusted tobacco is the most consequential. The antismoking campaigns in the U.S. have been productive, despite the recalcitrant. Smoking in the U.S., now, is highly inversely correlated with income and educational level. The push by tobacco companies to entrap the unwary, especially the young, into the several varieties of other nicotine-based products carries significant health risks including addiction, altered brain development, damage to the fetus and more. Nicotine is a significant toxin and health-hazard for its users.