SPEECH
WORLD CONFERENCE ON LUNG HEALTH
AMERICAN LUNG ASSOCIATION

(AMERICAN THORACIC SOCIETY)

. BOSTON, MA
Pew
MAY 21, 1990
RT +o
[1-1

C. EVERETT KOOP, MD

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GREETINGS, ETC.
"A THOUSAND AMERICANS WILL STOP SMOKING TODAY. ...

THEIR FUNERALS WILL BE HELD WITHIN THE NEXT THREE OR

FOUR DAYS."

THAT’S THE WAY I HAVE STARTED A NUMBER OF LECTURES ON

SMOKING.

IT GETS PEOPLE’S ATTENTION.
WHY DO I FEEL I HAVE TO SAY SOMETHING DRAMATIC TO GET
THEIR ATTENTION?

I SHOULDN’T HAVE TO.

WHAT IS IT ABOUT TOBACCO THAT NUMBS THE AMERICAN

PEOPLE?

IF ANYTHING ELSE KILLED 390,000 OF OUR FELLOW-CITIZENS
EACH YEAR, THE PUBLIC WOULD DEMAND ACTION FROM OUR

GOVERNMENT.
INSTEAD, TOBACCO HAS, FROM THE BEGINNING, BEEN CODDLED
BY OUR GOVERNMENT.

THIS DISTINGUISHED AUDIENCE KNOWS ABOUT THAT.

ASA PHYSICIAN AND FORMER PUBLIC HEALTH OFFICER, I DON’T
WANT TO RAISE YOUR BLOOD PRESSURE --OR MAKE YOUR
BLOOD BOIL-- BY REVIEWING THE SORRY STORY IN GREAT

DETAIL.
BUT IN A FEW WORDS, PLL REMIND YOU THAT TOBACCO HAS
BEEN ASSOCIATED NOT ONLY WITH DISEASE AND DEATH, BUT
ALSO WITH MONEY.

THAT, OF COURSE IS THE REASON FOR ITS SPECIAL TREATMENT
AND FOR ITS INTERNATIONAL POWER.

TOBACCO WAS THE CASH CROP THAT FINANCED THE AMERICAN
REVOLUTION --THOSE VIRGINIA PLANTERS FETCHED A GREATER
RETURN FOR TOBACCO LEAVES THAN DID THE HARDY NEW
ENGLANDERS WHO GREW PUMPKINS IN THE NEARBY FIELDS

AROUND BOSTON.
CONGRESS HAS BEEN HELD HOSTAGE EVER SINCE.

DESPITE THE SINISTER ASSOCIATIONS, FIRST WITH SLAVERY, AND
LATER WITH CANCER AND HEART DISEASE, AMERICAN TOBACCO
HAS ENJOYED GOVERNMENT PROTECTION.

TOBACCO MONEY EXPLAINS THE RELUCTANCE OF CONGRESS TO
TOLERATE ANY REGULATION OF TOBACCO, SO IT HAS BEEN
DECLARED TO BE NEITHER A FOOD, NOR A DRUG, NORA
COSMETIC:

A LOOSE CANNON ON THE DECK OF SPACESHIP EARTH.
ANY SPEECH ON SMOKING BECOMES A "GOOD NEWS/BAD NEWS"

STORY.

THE GOOD NEWS IS THAT WE ARE --AT LAST-- WINNING THE WAR

AGAINST TOBACCO.

THE BAD NEWS IS THAT THERE ARE MANY BATTLES STILL TO
FIGHT.

OF PRIMARY CONCERN TO US TODAY IS THAT --RIGHT NOW-- THE
TOBACCO INDUSTRY IS WINNING THOSE BATTLES OVERSEAS.

WE NEED TO COMBAT THEM BOTH AT HOME AND ABROAD.
IT IS A SPECIAL PLEASURE FOR ME TO BE WITH YOU TODAY,
BECAUSE IT BRINGS BACK THE MEMORY OF A VERY SPECIAL DAY
FOR ME. AND I HOPE IT HAS BECOME A SPECIAL DAY FOR ALL
WHO WORK TO BREAK THE DEATH-GRIP THAT THE TOBACCO

INDUSTRY HAS ON SO MANY LIVES AROUND THE WORLD.

IT WAS 6 YEARS AGO, IN 1984, AT THE MEETING OF THE
AMERICAN LUNG ASSOCIATION AND THE AMERICAN THORACIC
SOCIETY IN MIAMI THAT I FIRST CALLED FOR A SMOKE-FREE

SOCIETY IN AMERICA BY THE YEAR 2000.
AT THAT TIME I SAID VERY CLEARLY THAT I WASN’T PROPOSING

ANOTHER GOVERNMENT PROGRAM. THIS WAS NOT GOING TO BE

A PUBLIC HEALTH SERVICE INITIATIVE...NOR WAS THIS GOING TO

BE ANOTHER PET PROJECT OF THE U.S. SURGEON GENERAL.

INSTEAD, I RAISED THE IDEA AS A CALL...A CALL FROM THE

 

SURGEON GENERAL TO THE PEOPLE OF THIS COUNTRY.
YOU MAY RECALL THAT I DESIGNATED CERTAIN GROUPS TO DO
CERTAIN THINGS: THE BOY SCOUTS, THE CAMPFIRE GIRLS,
RESPIRATORY THERAPISTS, THE COALITION ON SMOKING OR

HEALTH.

IN THE YEARS SINCE, EACH GROUP HAS RESPONDED, AND

RESPONDED GENEROUSLY.

10
THE CALL FOR A SMOKE-FREE SOCIETY HAS BEEN
STRENGTHENED BY THE RECEPTION AFFORDED A NUMBER OF
SURGEON GENERAL’S REPORTS ON SMOKING.

IN PARTICULAR, THE SURGEON GENERAL’S REPORTS ON
INVOLUNTARY SMOKING, AND ON NICOTINE ADDICTION WORKED
TOGETHER TO GIVE THE MILITANT ANTI-SMOKERS NEW AND
POWERFUL WEAPONS.

THE NONSMOKER WAS MERELY IRRITATED AT FIRST...THEN

BECAME ANNOYED...AND THEN TURNED MILITANT.

11
STUDIES INDICATING THAT PASSIVE SMOKING LED TO 46,000
DEATHS ANNUALLY (3,000 FROM LUNG CANCER, 11,000 FROM

OTHER CANCERS, 32,000 FROM HEART DISEASE) MADE THE NON-

 

SMOKER MILITANT ...AND SUCCESSFUL IN ACHIEVING CHANGES

IN SOCIAL CUSTOMS AND IN LOCAL AND STATE LAW.

AS OF LAST YEAR MORE THAN 250 LOCAL COMMUNITIES HAD

ADOPTED REGULATIONS RESTRICTING SMOKING IN PUBLIC

PLACES, A THREE-FOLD INCREASE IN THREE YEARS.

12
A MOST SATISFYING VICTORY IS THE AIRLINE SMOKING BAN
THAT BECAME EFFECTIVE LAST WINTER.

OF THE 16,000 DAILY FLIGHTS IN THE USA, ONLY 28 SLIP
THROUGH THE BAN, ALLOWING SMOKERS TO FOUL THE AIR.
AND NORTHWEST AIRLINES VOLUNTARILY KEEPS THE CABIN AIR
SMOKE-FREE ALL THE WAY TO HAWAII. OTHER AIRLINES --
ALASKA, DELTA, EASTERN, AND U.S. AIR-- HAVE ALSO EXTENDED

THE BAN BEYOND THE REQUIREMENTS OF THE LAW.

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13
AND REMEMBER, LAST NOVEMBER A TOUGH LOCAL SMOKING
CONTROL ORDINANCE WAS APPROVED BY THE VOTERS IN
GREENSBORO, N.C, , IN SPITE OF HEAVY OPPOSITION BY

TOBACCO COMPANIES.

IF THE TOBACCO COMPANIES CAN BE BEATEN IN NORTH

CAROLINA, THEY CAN BE BEATEN ANYWHERE!

14
SMOKING HABITS HAVE CHANGED.

FIFTEEN YEARS AGO, AT MEDICAL MEETINGS, WHERE DOCTORS

SHOULD HAVE KNOWN BETTER, THE AIR WAS BLUE WITH SMOKE.

NOW YOU RARELY SEE A PHYSICIAN SMOKE;

THE ONLY SMOKE AT MEDICAL MEETINGS COMES FROM THE

SPOUSES.

IN 1964, BEFORE THE FIRST SURGEON GENERAL’S REPORT ON

SMOKING, OVER HALF OF ADULT AMERICANS SMOKED.

15
WHEN I BECAME SURGEON GENERAL IN 1981, THE NUMBER HAD
DECLINED TO 33 PERCENT.

WHEN I LEFT OFFICE 8 YEARS LATER, THE NUMBER OF AMERICAN
SMOKERS HAD SHRUNK EVEN MORE, TO 26 PERCENT.

FEW THINGS GIVE ME AS MUCH SATISFACTION AS THAT
DRAMATIC DECREASE, FROM 33 PERCENT TO 26 PERCENT.

AND IT NOW APPEARS THAT DURING MY LAST YEAR IN OFFICE,

SMOKING DROPPED ANOTHER ALMOST 5 PERCENT.

16
BETWEEN 1964 AND 1985 APPROXIMATELY THREE-QUARTERS OF A
MILLION SMOKING-RELATED DEATHS WERE AVOIDED OR

POSTPONED BY DECISIONS TO QUIT OR NOT TO START SMOKING.

EACH POSTPONED DEATH REPRESENTED AN AVERAGE GAIN OF 2
DECADES OF LIFE EXPECTANCY.
NEARLY HALF OF ALL LIVING ADULTS WHO HAVE EVER SMOKED

HAVE QUIT.

WITH THIS BACKGROUND, THE SMOKE-FREE SOCIETY THAT I
FIRST CALLED FOR AS I STOOD BEFORE YOU IN 1984 IS AN IDEA

’

WHOSE TIME HAS COME.

17
YOU'VE SEEN THE IMPACT.
HOSPITAL STAFFS ARE DEMANDING THAT THEIR FACILITIES BE
MADE SMOKE-FREE.

WORKING PEOPLE ARE ASKING FOR SMOKE-FREE
ENVIRONMENTS WHERE THEY WORK.

PROFESSIONAL PEOPLE ARE HANGING THOSE "THANK YOU FOR
NOT SMOKING SIGNS" IN THEIR WAITING ROOMS.

AND HOUSEHOLDERS ARE TACKING UP THE SAME SIGN OVER

THEIR FRONT DOORBELLS.

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I CANNOT NEGLECT THIS OPPORTUNITY TO SAY THAT THE
COOPERATIVE EFFORTS OF THE AMERICAN LUNG ASSOCIATION,
THE AMERICAN HEART ASSOCIATION, THE AMERICAN CANCER
SOCIETY IN WORKING TOWARD A CURRICULUM AGAINST
SMOKING THAT WOULD GRADUATE A HIGH SCHOOL CLASS IN
THE YEAR 2000 SMOKE-FREE HAS BEEN EXTRAORDINARILY
REWARDING.

I’VE PARTICIPATED IN THE PROGRAMS FOR THE FIRST AND
SECOND GRADES, AND I’M VERY ENCOURAGED ABOUT HOW
MUCH THESE YOUNGSTERS KNOW, AND HOW SERIOUSLY THEY
TAKE THEIR PLEDGE TO TURN THEIR BACKS ON ANYONE WHO

OFFERS THEM A CIGARETTE, NOW AND IN THE FUTURE.

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19
SO, I WANTED TO START OUT WITH THE GOOD NEWS, REMINDING
US OF HOW FAR WE HAVE COME, REMINDING US OF BATTLES

WON.
BUT THERE IS STILL A LONG WAY TO GO.

THERE ARE STILL BATTLES TO BE FOUGHT.

THERE IS STILL PLENTY OF BAD NEWS.

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EVEN IN THE UNITED STATES, EVEN WITH ALL THE PROGRESS WE
HAVE MADE,SMOKING IS STILL THE SINGLE MOST DEADLY
"HABIT" ... ASSOCIATED WITH HIGHER MORTALITY AND ILLNESS
THAN DRUGS, AUTOMOBILES, AND AIDS COMBINED.

ALL THE AIDS PATIENTS WHO HAVE DIED SINCE WE KNEW ABOUT
THE DISEASE, 9 YEARS, EQUALS THE SMOKING DEATHS OF ONLY

4 MONTHS.

THE NUMBERS OF DEATHS ANNUALLY ATTRIBUTABLE TO

SMOKING HAVE RISEN WITH EACH SURGEON GENERAL’S REPORT.

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SO, EVEN THOUGH WE’VE MADE PROGRESS, AS A SOCIETY WE’RE
STILL BURDENED WITH THE TREMENDOUS AMOUNT OF
SUFFERING AND HARDSHIP THAT GOES ALONG WITH ALL THESE
DEATHS...

THE PEOPLE OF AMERICA ARE STILL BURDENED WITH THE

ECONOMICS OF SMOKING.

WE STILL HAVE TO COME UP WITH THE MONEY TO PAY THE

ANNUAL SMOKING-AND-HEALTH BILL OF $39 BILLION.

22
THAT’S FOR PERSONNEL AND MEDICAL TECHNOLOGY AND
INSURANCE AND LOST WAGES...ALL THE REAL, BASIC COSTS
LEVELLED AGAINST US ALL BY DISEASE AND DISABILITY.

{2
SOME 49 MILLION AMERICANS STILL SMOKE, SO OUR EDUCATION
CAMPAIGNS AND OUR SELF-HELP GROUPS MUST CONTINUE
THEIR GOOD WORK.
WE MUST GUARD AGAINST COMPLACENCY, AND INTEN SIFY OUR
EFFORTS TO ELIMINATE THE GREATEST CAUSE OF PREVENTABLE

DISEASE AND DEATH AFFLICTING OUR SOCIETY. °

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AND THE TOBACCO INDUSTRY HAS NOT GIVEN UP.

I DOUBT THAT YOU CAN FIND A MORE HEAVY-HANDED, OBTUSE,
IMPOLITIC, AND UNTRUTHFUL GROUP OF CORPORATIONS
ANYWHERE IN THE GREAT PANOPLY OF AMERICAN PRIVATE

ENTERPRISE.

TO BE PERFECTLY HONEST, I DID NOT ASSUME THE POSITION OF
SURGEON GENERAL WITH THE CLEAR INTENTION OF BEING SO
PRO-ACTIVE AN OPPONENT OF TOBACCO AS I HAVE BEEN. BUT
THEN I BEGAN TO STUDY IN SOME DEPTH THE
INCONTROVERTIBLE TRUTHS ABOUT THE HEALTH HAZARDS OF

SMOKING.

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/AND I MUST TELL YOU THAT I WAS AT FIRST DUMBFOUNDED AND
THEN PLAINLY FURIOUS AT THE TOBACCO INDUSTRY FOR
ATTEMPTING TO OBFUSCATE AND TRIVIALIZE THIS

< EXTRAORDINARILY IMPORTANT PUBLIC HEALTH INFORMATION.
HOW COULD THE TOBACCO INDUSTRY DARE TO DISMISS AS
UNFOUNDED AND UNPROVEN THE ABSOLUTELY CLEAR
CONNECTION BETWEEN SMOKING AND HEART DISEASE ...
BETWEEN SMOKING AND DEATHS FROM STROKE ... BETWEEN
SMOKING AND CANCER OF THE LUNG, THE MOUTH, THE
ESOPHAGUS, AND OF THE STOMACH ... AND BETWEEN SMOKING
AND A DOZEN OR MORE SERIOUS, DEBILITATING, EXHAUSTING,

EXPENSIVE, AND HUMILIATING DISEASES?

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