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The link between smoking and ill health

This month in pharma: January 1964, and the publication of the US Surgeon General's 'Smoking and Health' report

Smoking and Health US Surgeon General report, 1964On January 11, 1964, the report 'Smoking and Health: Report of the Advisory Committee to the Surgeon General of the United States' made the link between smoking and ill health accepted widely among the general public.

Smoking tobacco is now responsible for the death of almost one in 10 of the world's adult population, according to the World Health Organisation (WHO). It is no surprise given the continued prevalence of cigarette smoking, particularly in the developed world, with over 36.5 per cent of the adult population a regular tobacco user in countries like the UK, Portugal, Russia and Poland according the WHO, with the likes of France, Germany and Spain not far behind.

It is also the 'the largest avoidable health risk in Europe, causing more problems than alcohol, drugs, high blood pressure, excess weight or high cholesterol', according to Ilze Bogdanovica writing in the British Medical Journal, with as many as 650,000 Europeans dying prematurely of tobacco-related causes each year in the EU with an economic impact of at least €100bn.

With its role in cardiovascular disease, chronic obstructive pulmonary disease (COPD) and other diseases where it can be the 'hidden cause', smoking negatively affects the health of millions leading to chronic conditions and death.

It is with cancer, though, in particular of the lung, that tobacco smoking is most strongly associated. Before the launch of mass-produced cigarettes at the beginning of the 20th century, however, it was something of a rarity.

In 1878, malignant lung tumours represented only 1 per cent of all cancers seen at autopsy in the Institute of Pathology of the University of Dresden in Germany, according to Hanspeter Witschi in 'A short history of lung cancer' published in Toxicology Science. By 1918, however, the percentage had risen to almost 10 per cent and by 1927 to more than 14 per cent.

The idea that smoking and lung cancer were linked was developed over the early- to mid-20th century, with early research by German doctors leading to a wide and relatively successful public health campaign in the country in the 1930s. This was continued by the Nazi regime with health reforms that saw an individual's average consumption rate of cigarettes drop from 1,022 per year in 1940 to 743 per year in 1944.

Despite the mounting evidence, many of these early research efforts were marred by their association with Nazism, and it took a long time for wider acceptance of the harmful consequences of smoking among the general public.

Indeed, it was January 14, 1964, before the US Surgeon General report 'Smoking and Health: Report of the Advisory Committee to the Surgeon General of the United States' was published, which saw the wider world accept the collated research that smoking was a major factor in chronic bronchitis, heart disease and was linked to an increase in the occurrence of lung cancer.

Published on a Saturday to ensure maximum coverage in the Sunday papers, the report gained widespread media attention, with the then Surgeon General, Dr Luther Terry, quoted by the US National Institutes of Health saying: "It was front page news and a lead story on every radio and television station in the United States and many abroad."

The coverage had a great impact on the public's perception of smoking. A survey conducted by Gallup in 1958 found that only 44 per cent of Americans believed the habit caused cancer, but by 1968, four years after the Surgeon General's report, this figure had increased to 78 per cent.

Governments' attitudes evolved across the world too, with the implementation of such laws as health warnings on cigarette packaging, bans on advertising in various media and the prohibition of smoking in public spaces.

Despite such efforts, smoking remains a huge health issue, with lung cancer the leading cause of cancer in males globally, accounting for 17 per cent of total new cancer cases and 23 per cent of total cancer deaths according to the 'Global cancer statistic' in CA: A Cancer Journal for Clinicians. It is also the third most common form of cancer in women in both developing and developed nations.

Treatment of lung cancer in both its forms, small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC), remains a key therapy area for many pharmaceutical companies.

Roche (Avastin, Tarceva), Bristol-Myers Squibb (Paraplatin, Taxol), Pfizer (Xalkori), AstraZeneca (Iressa) and Eli Lilly (Almta) all have branded drugs to treat variants of the illness, which is estimated to have a global market value of $13bn by 2020, according to a report published on MSN Money, with emerging market value expected to grow due to increasing use of tobacco products.

Tackling the cause rather than the disease is also a target for pharma companies and several have smoking cessation products.

To cut down the numbers of one of the world's biggest killers, however, is going to take more than products and greater education and awareness efforts are needed, especially in developing nations where lung cancer rates are increasing.

Some companies, such as Pfizer, have supported projects like World No Tobacco Day, and GlaxoSmithKline and Novartis have backed the WHO's attempts to educate about the effects of smoking and introduce smoking bans.

However, there is still a long way to go before this 'avoidable health risk' is avoided.


Tom Meek
The Author
Tom Meek
, web editor at PMLiVE

To comment on this article, please use the commenting feature below

19th January 2012

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