Remarks as prepared; not a transcript

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
United States Surgeon General
U.S. Department of Health and Human Services
U.S. Department of Health and Human Services

Launch of Report of the Surgeon General
National Press Club
Washington, D.C.
Thursday, May 27, 2004, 1:00 p.m.

"The Health Consequences of Smoking: A Report of the Surgeon General, 2004"

Thank you, Dr. Beato, for that terrific introduction. 

Ladies and gentlemen, thank you for joining us on this significant day in the history of Office of the Surgeon General.  As a scientist and a physician, it gives me great pleasure to release the 2004 Surgeon General’s Report on The Health Consequences of Smoking.

This Report is the result of collaborations between some of the leading scientists of our time.  I want to thank my colleagues at the Centers for Disease Control and Prevention, and the staff of the Office of the Surgeon General for their truly exceptional work on behalf of the American people. 

I especially want to acknowledge Dr. Jonathan Samet, Professor and Chairman of the Department of Epidemiology at the Bloomberg School of Public Health at John Hopkins University.  Dr. Samet served as the Senior Scientific editor of this Report.  He provided inspiring leadership for the large team of scientific experts, personally wrote much of the text, and helped ensure that all the data met the rigorous scientific standards of the Office of the Surgeon General.  Thank you, Dr. Samet.

I also want to thank one of the greatest advocates for health that our nation has ever known.  There is no greater leader in the battle against smoking than my boss Tommy Thompson.  As Secretary of Health and Human Services, he has played a critical role in alerting Americans about the health hazards of tobacco use. 

The Office of the Surgeon General has a long history in exposing the risks of tobacco use.  In 1964, Surgeon General Luther Terry issued the groundbreaking Report on smoking and health.  The key job of the Surgeon General is to protect and maintain the health of the American people, and Surgeon General Terry knew that to meet that obligation, he would have to call for a fundamental change in how our country viewed tobacco at the time.  Dr. Terry also knew that by issuing the results of the research available to him at the time — research that showed causality between smoking and three diseases — he was taking aim at one of the pervasive symbols of American life — the cigarette.

In 1964, more than 42% of Americans smoked.  As a matter of fact, until he started work on his smoking Report, the Surgeon General himself was a smoker. 

The circumstances surrounding the release of the 1964 Report on Smoking and Health are worth recalling today.  It was issued on a Saturday on a bitterly cold January morning.  Accredited members of the media — no members of the public — were admitted to an auditorium, and were locked in there with the Surgeon General and the scientific staff who had developed the Report.  What they came out of that room with was the revelation that smoking kills.

Today, 40 years later, the science is even more clear, as evidenced by the size of this Report compared to the 1964 Report.

But when this Report was issued 40 years ago, the contents were so drastically different from everything that Americans believed about smoking, that extraordinary measures were taken — simply because the Surgeon General knew that the reporters who first read the Report would see the findings as truly incredible.

At that time, there was sufficient research to conclude that smoking was a definite cause of three diseases: cancers of the lung and larynx in men, and chronic bronchitis.  Now, 40 years later, the 28^th Report on smoking and health documents that smoking causes disease in nearly every organ in the body, at every stage of life, here and around the world.  Everyone knows how bad smoking is, but it's actually worse.

The statistics are compelling.  Since the 1964 Surgeon General's Report, more than 12 million people have died from smoking-related illness.  These include 4.1 million deaths from cancer, 5.5 million deaths from cardiovascular diseases, 2.1 million deaths from respiratory diseases, and 94,000 perinatal deaths.  And, nearly 25 million Americans alive today are destined to die prematurely unless they quit smoking cigarettes.

We have known for decades that smoking is bad for your health.  In 1964, the findings were certain for three diseases, and the research that tied two of those diseases to smoking was conclusive only for men.  Now we know that the toxins in cigarette smoke go everywhere the blood flows. 

Key Findings
The Report has four major conclusions.

• First, it affirms that smoking harms nearly every major organ of the body, often in profound ways, causing many diseases and significantly diminishing the health of smokers in general.
• Second, quitting smoking has immediate as well as long-term benefits.  Within minutes and hours after smokers inhale that last cigarette, their bodies begin a series of changes that continue for years.  Among these health improvements are a drop in heart rate, improved circulation, and reduced risk of heart attack, lung cancer and stroke.  By quitting smoking today a smoker can have many healthier tomorrows.
• Third, smoking so-called low-tar and low-nicotine cigarettes provides no clear benefit to health.
• Finally, the list of diseases caused by smoking has been expanded to include abdominal aortic aneurysm; acute myeloid leukemia; cataract; periodontitus; pneumonia; and cancers of the cervix, kidney, pancreas, and stomach. 

Smoking even contributes to wound infections following surgery, and complications from diabetes.  For every premature death caused each year by smoking, there are at least 20 smokers with a serious smoking-related illness.  The costs in human life and in health costs to the nation are staggering.

Some of the major health problems this Report addresses are increased risk of cancer, cardiovascular disease, respiratory diseases, and reproductive problems.

Cancer
Cancer was among the first diseases linked to smoking. Early studies focused on lung cancer, which by the mid-twentieth century was rising in epidemic proportions.

Now we know that smoking causes the vast majority of lung cancers, along with cancers of the mouth, throat, larynx, esophagus, pancreas, kidney, bladder, stomach, and acute myeloid leukemia. The risks for these cancers increase with the number of cigarettes smoked and the number of years an individual smokes. The risks decrease after smokers quit cigarettes completely.

Cardiovascular Disease
The link between smoking and cardiovascular disease was noted in the 1964 Surgeon General’s Report, and subsequent Reports have revealed a much stronger connection. In fact, the Reports concluded that smoking is one of the major independent causes of coronary disease. This new Report adds even more evidence. Smoking causes atherosclerosis, strokes, and abdominal aortic aneurysm. It accelerates the progressive hardening and narrowing of the arteries. Cigarette smoke damages the cells lining the blood vessels and heart.

Perhaps most importantly, smoking can increase the body’s tendency to form blood clots, both through the process of inflammation and by stimulating platelets to clump together.

Respiratory Disease
More than 90% of emphysema deaths are caused by smoking. Smokers have more upper and lower respiratory tract infections and other respiratory diseases than nonsmokers.

At any age, smoking damages your lungs. The more cigarettes you smoke, the faster this happens. The effects of smoking on lung development can begin before birth. When mothers smoke during pregnancy, it damages their infants' developing lungs. Children and teens who smoke are less physically fit and have more breathing problems. When teenagers smoke, their lung functions begin to decline years earlier than nonsmokers.

By quitting, former smokers can return to a normal rate of lung function decline over time.

Reproductive Problems
The damage that cigarette smoking causes to mothers and their unborn children is heartbreaking. As this Report documents, smoking harms every phase of reproduction. Women who smoke have more difficulty becoming pregnant and have a higher risk of never becoming pregnant. Smoking increases the risk of complications during pregnancy, it raises the risk of premature birth, low birthweight infants, stillbirth, and infant mortality.

Infants exposed to secondhand smoke after birth have double the risk of sudden infant death syndrome, or SIDS. Infants whose mothers smoke before and after birth are three to four times more likely to die from SIDS.

Other Health Effects
In addition to cancer, cardiovascular and respiratory diseases, and reproductive effects, the 2004 Report documents many other damaging effects of smoking, including increased risk for eye diseases, loss of bone mass, and peptic ulcers.

Smokers are generally less healthy than nonsmokers.  Smoking affects the immune system.  Illnesses in smokers last longer and smokers are more likely to be absent from work.  Smokers also use more medical services, both outpatient services and hospitalizations — about 25% more than nonsmokers. 

All in all, smoking low-tar and low-nicotine cigarettes does not make smoking safer.  It does not offer a health benefit over smoking regular cigarettes.  This conclusion supports and adds to the findings of a scientific monograph on low-tar cigarettes that the National Cancer Institute issued in 2001.  Unfortunately, many smokers still view low-tar cigarettes as a safer alternative.  So we need to keep getting out the message that the only way to avoid the health hazards of smoking is to quit completely.

In fact, where the health hazards of smoking are concerned, there are still many areas where we need to improve public awareness and understanding.  Even though virtually everyone knows generally that smoking is bad for health, many fewer people truly believe how bad smoking is. 

The findings I have just presented provide just an overview of the devastating health consequences of smoking.  But our job of communicating these messages to the American people is not finished just because we've published a 960-page Report and called this press conference.  We need to work over the coming days, weeks, months, and years to ensure that we reach as many people with this critical health information as possible, in ways they find interesting and easy to understand.

So, along with the technical Report, we've also produced this colorful, easy-to-understand "people's piece" — a consumer version that can be used by community organizations, in doctors' offices, in churches and schools, and by individual smokers and their families.  This Report for the public explains the major diseases caused by smoking, discusses the immediate and long-term benefits of quitting, and offers a variety of tips and advice on stopping smoking.  It is also available on my web site. 

Another educational tool that we developed and are issuing today is an interactive web site that takes an animated look at the human body, allowing the user to see the heart beating, the lungs breathing, and even a fetus moving in the womb. The user will be able to rotate the body to see the internal organs from different views.  Our goal is to use graphics and animation to help bring the medical content of the Report to life, and again, to highlight the benefits of quitting.  Let's lower the lights for a few moments to see a piece of this web site.

(show web site demo)

Health Literacy
We are in the process of packaging the people's piece and the animated web site with lesson plans for teachers who want to present smoking and health information in the classroom using technology that students will find interesting and engaging. We will promote this classroom package both on the web and as a CD ROM to some 100,000 elementary, middle, and high schools later this summer in time for the fall 2004 semester.

The first-of-its-kind people's piece, the web site, and the school lesson plans are a direct result of my personal commitment to make the information in Surgeon General's Reports meaningful and personal to every American. By getting the best available science into the hands of all Americans, we can improve the health literacy of our population, and equip them with the knowledge and tools they need to make good, healthy decisions for themselves and their families.

I would again like to thank the staff of the CDC, and my staff, for making this a reality.

For the medical and scientific community, we also are working to improve the maintenance and updating of the Surgeon General's Report series. Today, I am pleased to announce a new scientific database that will make the 1,600 key articles cited in this Report available online. People can search the database and find detailed information on specific health effects, as well as develop customized analyses, tables, and figures.

This database will be continually updated as new important studies are published, allowing us to determine on a regular basis whether the weight of evidence supports a new definitive conclusion about smoking and disease. By monitoring new information and studies, we can alert the American people on a timely basis as we learn of other serious hazards of smoking.

But perhaps the single most important solution that we can bring to bear on the problem of smoking is to energize individuals and communities across the country. We need to capitalize on the unique assets of all different sectors of society to help lift the burden of tobacco use from the backs of American families.

Now, please allow me to introduce to you three very special guests from our audience today. These individuals represent just three of the many sectors we need to help us carry on with our work.

First, representing the business community, is Marcy Zauha, Director of Health Services at Union Pacific Railroad. Marcy, could you please stand? Union Pacific has implemented a successful company-based smoking cessation program, called "Butt Out and Breathe." Thanks to this program, Union Pacific has cut the smoking rates of its employees by one-third, from 40% in 1992 to 27% in 2003. Employees receive counseling, support materials, and pharmacotherapy at no charge as part of their health benefits package. Plus, the company has a comprehensive policy to ensure a smoke-free environment in all company facilities, vehicles, and meetings. Union Pacific understands this simple win-win equation: helping employees quit smoking translates into healthier, more productive workers while at the same time it cuts health care costs. Thank you for being with us, Marcy.

I would also like to recognize Miss Rachi Govil, a founding member of the New Jersey REBEL program, one of the most dynamic youth-led anti tobacco movements in our country. Rachi, could you please stand? REBEL stands for Reaching Everyone By Exposing Lies. REBEL students use their energy and imagination to create new and effective ways to educate their peers that smoking is harmful and not "cool," and to help their friends who smoke to quit. Created in 2000, REBEL now includes more than 12,000 young people between the ages of 14 and 17 who are involved in community-based and high school programs in all 21 New Jersey Counties — and the movement is still growing.

Because the vast majority of smokers start as young people, it's absolutely critical for us to continue doing all we can to prevent our nation’s youth from ever starting to smoke. And who better to lead the charge than young people themselves. Rachi is active in promoting the college component of REBEL at Rutgers University, where she now attends. Plus, she is on the speakers' bureau of the American Legacy Foundation, traveling across the country motivating and equipping teens to take local action to prevent tobacco use. Thanks for joining us today, Rachi, and keep up the good work.

Closing
Before I introduce our third special guest, let me remind all of us what we are aiming for: To make a real dent in the numbers of deaths and illnesses caused by smoking, the public health community has set two ambitious goals for the year 2010. First, to reduce high school smoking rates to no more than 16%, down from the current level of about 22%. And second, as Secretary Thompson noted in the statement that Dr. Beato read to us earlier, to cut adult smoking rates to no more than 12%, from the current level of 22.5%.

If we can meet these goals, we can prevent about 7.1 million Americans from dying prematurely after the end of this decade. On average, smokers lose more than 13 years of life. Those are years that could have been productive, years that could have been spent enjoying children and grandchildren. Those lost years are not just numbers; they are tragic losses. Unfortunately, unless we accelerate our progress in smoking cessation, deaths related to smoking are not expected to decline substantially for many years to come.

As important as the facts and figures in the 2004 Surgeon General's Report are, they take on much more meaning when we see them with a human face. The victims of smoking are people we know. They live in our neighborhoods, we work and worship alongside them, they are members of our own families.

I personally understand something about what that means. I grew up poor, and both my parents were at times almost chain smokers. Both of them died before their time, and smoking was a big reason for their early deaths and for considerable suffering. It is a terrible thing to lose a parent when you are young and need them so much. I know firsthand that cigarette smoking steals precious time away from families.

Now, I would like to introduce the last of our special guests, Ann Schnur and David Hudson of Atlanta, Georgia. Here's a glimpse of their personal story about how much cigarette smoking has cost their family.

(show segment of video)

I would now like you to meet Ann. Ann and David have been married for 30 years and as you saw in the clip, they have two children, daughter Drue, who is 18, and son Jamie, who is 16. Ann smoked cigarettes since she was 12. She stopped smoking on February 14, 2002 — the day she was diagnosed with stage 4 lung cancer, which thankfully is in remission.

(Ann Schnur speaks)

Thank you, Ann. Thanks for your courage in joining us today and your commitment to spreading the word about the human costs of smoking. Stories like Ann's remind us all of why this Report matters so much and why our collective action is so critical.

I hope this Report will inform, galvanize, and inspire our nation, states, and communities to reduce the terrible toll of smoking and to secure a healthy future for America.

What I hope more than I can even express is that this new information will help motivate people to quit smoking and will convince young people to not start.

Thank you. I'll be happy to take any questions you may have.

###

Last revised: January 9, 2007