Chest

Chest

Volume 146, Issue 6, December 2014, Pages 1438-1443
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Commentary
Did We Finally Slay the Evil Dragon of Cigarette Smoking in the Late 20th Century?: Unfortunately, the Answer Is No—the Dragon Is Still Alive and Well in the 21st Century and Living in the Third World. Shame on Us!

https://doi.org/10.1378/chest.13-2804Get rights and content

Abstract

If cigarettes were introduced as a new consumer product today, it is unlikely they would receive government regulatory approval. Cigarettes have proven biologic toxicities (carcinogenesis, atherogenesis, teratogenesis) and well-established causal links to human disease. Things were very different in 1913 when the R. J. Reynolds Tobacco Company introduced the first modern cigarette, the iconic Camel. By the early 1950s, definitive scientific reports linked cigarettes and human disease, but it was more than a half century later (2006) that cigarette manufacturers were found guilty by a federal court of deceptive product marketing regarding the health hazards of tobacco use. In the United States, cigarette smoking remains a major but slowly declining problem. But in developing countries, cigarette use is expanding tremendously. In global terms, the epidemic of smoking-caused disease is projected to increase rapidly in coming decades, not decline. Society may have begun to slowly win the smoking battle in the developed world, but we are resoundingly losing the global war on smoking. All is not lost! There is some good news! The 2003 Framework Convention on Tobacco Control, supported strongly by the American College of Chest Physicians, is the first global public health treaty of the new millennium. Many developed societies have begun planning to rid their countries of cigarettes in what is called the Endgame Strategy, and now is the time for the international medical community to help change tobacco policy to a worldwide endgame approach to rid all humanity of smoking-related diseases.

Section snippets

A Modern Product That Is Legal Only by Historic Accident

There are two popular American myths about the cigarette, namely, that it is an ancient traditional product and a government-approved consumer product in the United States. Both are wrong! Tobacco leaf is indigenous to the Western Hemisphere but was unknown to the rest of the world until the 15th century.4 Indigenous Americans historically used tobacco (pipes, cigars, and chewing tobacco), but, importantly, did not smoke cigarettes. Cigar smoke and pipe tobacco smoke are alkaline and deliver a

Camel: The First Modern Cigarette

In 1913, the R. J. Reynolds Tobacco Company introduced a new cigarette, Camel, which was promoted with a novel and aggressive mass media advertising campaign, the likes of which had never before been seen; the success of Camel led to competing brands such as Lucky Strike and Chesterfield. In 1905, Americans smoked < 5 billion cigarettes per year, but by 1917 (only 4 years after “the year of the Camel”) consumption in the United States exceeded 16 billion cigarettes per year and spiraled upward

The Companies' Pledge to the American Public: The Frank Statement

By the early 1950s, definitive scientific reports of cigarettes causing diseases (lung cancer, emphysema) generated great concern in the public health community.9, 10, 11 The cigarette manufacturers responded with a cynical strategy that was widely publicized through the Frank Statement in full-page newspaper advertisements in > 400 leading newspapers across the United States.12 The Frank Statement represented tobacco companies' pledge to the American people with pronouncements such as the

US Department of Justice Lawsuit

The US Department of Justice legal suit resulted in the conviction of the cigarette manufacturers in 2006 for violating the racketeering statutes (Racketeer Influenced and Corrupt Organizations Act). Judge Gladys Kessler, the presiding judge, held the cigarette manufacturers accountable19 and ordered them to stop promotion of their “light” cigarettes as low-tar low-nicotine products and to publicly admit, for the first time, that they had deceived the public about the harmful nature and

Holding Ground in Developed Countries While Making Inroads in Developing Countries

Although good progress has been made in developed countries such as the United States, Ireland, United Kingdom, and Australia, the cigarette epidemic remains a major world problem. There are still 45 million active smokers in the United States and in 2008, the cigarette manufacturers spent $10 billion promoting and advertising their product in the United States, an increase of 46% compared with 1998.21 Despite the industry's denial of marketing to children, a major conclusion in the 2012

American Cigarette Companies

Intuitively, one would suspect that American cigarette companies should be in decline financially: Their sales are falling in the United States, tobacco advertising is severely restricted, cigarette taxes are at record levels, and the companies have made record financial settlements in the billions of dollars with state governments. But this conclusion is wrong—American cigarette companies are booming financially, predominantly from sales increases in export markets.25, 26, 27

World Health Organization Framework Convention on Tobacco Control

Developed in the first decade of the 21st century, the Framework Convention on Tobacco Control (FCTC) is the first global public health treaty.28 The cigarette industry fought hard to neutralize the FCTC, but, in the end, a strong international treaty was developed.29, 30 Importantly, it has been signed and ratified by > 170 countries, including all developed countries, with one notable exception—the United States.

The objective of the FCTC is “to protect present and future generations from the

Electronic Nicotine-Delivery Systems: Electronic Cigarettes

The latest innovation by the cigarette industry is the electronic cigarette (e-cigarette), an electronic device meant to simulate cigarette smoking using a heating element that vaporizes a liquid solution of nicotine and propylene glycol.31 e-Cigarettes are currently both unregulated in the United States and have minimal scientific evidence for their long-term safety. They are advocated as a potential therapy for tobacco dependence, but limited studies to date have shown no convincing

The Endgame Strategy

It can be argued that cigarettes are a legal product only by historic accident and early political intrigue, primarily by Buck Duke and his influence over the 1906 Pure Food and Drug Act. Had regulators known then what we currently know, it is unlikely that the public sale of cigarettes would have ever been approved. Cigarette smoking, unlike pipe smoking, is not a long-standing tradition; rather, cigarettes are a relatively new and highly sophisticated consumer product.

Countries such as

Bottom Line

The American College of Chest Physicians (CHEST) has a history as an early adopter of ardent antismoking recommendations, including an antismoking pledge by its membership. The initial conclusion of a 1982 report by the CHEST Subcommittee on Smoking in the Physician's Workshop, a project of the CHEST Project on Smoking and Health, stated “health hazards of tobacco smoking are not only individual hazards, but also public health issues.”50

We suggest that it is time to change tobacco policy from a

Acknowledgments

Financial/nonfinancial disclosures:The authors have reported toChestthe following conflicts of interest: Dr Hurt has received a medical education grant from Pfizer Medical Education Group 2010-2014. Drs Murphy and Dunn have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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