Address Presented to the Interagency Committee on Smoking and Health, Washington, DC
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15 (730,619 Bytes)
1985-10-01 (October 1, 1985)
Koop, C. Everett
This item is in the public domain. It may be used without permission.
Medical Subject Headings (MeSH):
Tobacco, Second-Hand Smoke, and the Campaign for a Smoke-Free America
Box Number: 14
Folder Number: Smoking and Health Notebook [First Meeting]
By C. Everett Koop, M.D.
Surgeon General, US Public Health Service and Deputy Assistant Secretary for Health
US Department of Health and Human Services
Presented to the Interagency Committee on Smoking and Health
October 1, 1985
(Greetings to hosts, guests, friends, etc.)
This past August, Americans and Japanese paused to reflect on the event, 40 years ago, that changed the history of this planet
forever. I'm not going to debate whether or not we should have dropped the atomic bombs on Hiroshima and Nagasaki. But
I am going to remind you -- as I was reminded just a few weeks ago -- the Hiroshima bomb killed some 340,000 people.
That number leaped off the pages of the newspapers as I read it. I'm sure you know where we've seen that figure before.
It's our best estimate -- and the conservative estimate, at that -- of the number of Americans who die prematurely each
year because they smoke.
In other words, cigarette smoking is killing as many people in this country each year is the first atomic bomb killed in Japan.
Most of the Japanese died in an instant; but all the Americans die in stages.
We dropped only those two bombs and then, thank goodness, the war ended. The dreadful statistics that all people of conscience
have quoted about Hiroshima are the statistics created on that single day in August 1945.
But we've been quoting that number, or similar numbers, every year for 20 years. If you allow for population growth and
cigarette composition and smoking patterns and so on, you might come up with a total of 10 million Americans -- 10 million
-- who have died prematurely over the past 20 years because they smoked cigarettes.
Year after year, our society has been, if you please, "atom-bombed" by cigarettes. But all the victims don't die
on just one horrendous day. A few die on the first day of the year . . . a few on the second . . . a few more on the third
. . . and so on right to the last day of the year.
We might not "commemorate" those victims, but we must never forget them.
I believe that this committee, above all else, must be bound to honor the memory of those wasteful deaths. They are the shadows
over our shoulders, urging us to do whatever we can so that eventually the number of such premature deaths will be zero.
That's the only goal worthy of this committee. And I would suggest it's a very logical goal of the law that brought
this committee into existence: "The Comprehensive Smoking Education Act of 1984."
We won't achieve such a goal overnight. We know that. But were working steadily toward such a goal:
We remain committed to reducing the proportion of adults who smoke to below 25 percent by the year 1990 but we won't stop
And I'm delighted to report that both government and the private sector are building momentum to make our society smoke-free
by the year 2000. That's a challenge I laid before the nation in May 1984 and I'm profoundly impressed at the degree
to which people are responding.
I think we'll reach our goals. And a key reason for my optimism is represented right here in this room today: the key
is the leadership of public officials and private citizens stepping forward from across the spectrum of American public life
and taking up these vital public health goals as their own responsibility.
That, my friends, is power.
Each of you, in your important work in academia, in research, and voluntary organizations, and government . . . each one of
you is here not only because of your own personal commitment to eliminate this intolerable danger to the public health, but
also because of the groundswell of support you enjoy in your parent organizations in your home communities.
Twenty years ago, a meeting such as this would have been unusual. Every person attending it would've been the subject
of intense public scrutiny. They would have earned criticism and -- yes -- even some harassment in their professional lives.
But the times have changed, thank goodness. As the coaches say, "We've got the horses." Our side now has a powerful
moral and material resources of the American Cancer Society, the American Heart Association, the American lung Association
. . . the three groups who are the foundation of the National Coalition on Smoking or Health.
And we have the Congress of the United States, which mandated four new and stronger warning labels for cigarettes and who
also established this committee.
With your permission, I want to take a moment to salute the three gentlemen of the Congress whose hard work, persistence,
and great legislative skills changed a visionary proposal into public law 98-474. They are . . .
Senator Orrin G. Hatch, chairman of the Senate Committee on Labor and Human Resources . . . a great legislator and a valued
friend of American public health.
Senator Bob Packwood of Oregon, chairman of the Senate Finance Committee . . . a strong and independent voice of good conscience
throughout the development of this law.
And Representative Henry A. Waxman of California, chairman of the House Committee on Health and the Environment, a tireless
and fair-minded strategist on behalf of the public health.
These three legislators led the way for a majority of both houses of Congress to enact the four new warnings.
The cigarette companies have bought full-page newspaper ads to tell their version of the health story. But, thanks to the
U.S. Congress, the truth doesn't require a full-page of newsprint. It just needs a little rectangle with room enough to
warn the public . . .
That " . . . Smoking causes lung cancer, heart disease, emphysema, and may complicate pregnancy."
That " . . . Pregnant women who smoke risk fetal injury and premature birth."
That " . . . Cigarette smoke contains carbon monoxide."
And that " . . . Quitting smoking now greatly reduces serious health risks."
All four warnings will begin appearing on cigarette packages and cigarette advertising as of October 12th. But you and I know,
from our experience of the past 20 years, that such scientific conclusions, by themselves, are not enough.
We need to alert the American people that such information is available . . . that it is accurate . . . that it can be trusted
. . . and that this information is vital to their health and to the health of their friends and families.
That's why Congress put the word "education" right up in the title of this law and why public information and
education programs are mandated.
The act of smoking is, by itself, not an illegal act. It's unhealthy and risky . . . but it's not illegal. Some state
and local laws prohibit smoking in certain places or under certain circumstances. And more of those laws are being enacted.
But the mere act of "lighting up" is not, by itself, illegal.
Therefore, our task is to find ways to get people to understand and to agree, on their own, that smoking is a bad idea. They
need to decide, on their own, to give it up if they do smoke, or not start if they don't smoke.
That's an educational challenge . . . that's the key challenge for this committee.
We can take some comfort in the fact that cigarette sales are beginning to decline, that the latest surveys of teenagers indicate
they've been turned off from the cigarette habit, and that women are starting to resist the heavy tobacco ad campaigns
aimed right at them.
Those are all good signs. And yet . . . and yet . . .
We still have a little more than 50 million men and women who smoke. The burden they place upon the health care system, upon
their families, and upon themselves is enormous. It is a painful and costly burden.
So, while we can take comfort in the statistics or that survey, this is not the time to relax our anti-smoking efforts. Quite
the contrary. Now, more than ever, we need the ideas and energies of leaders such as yourselves to keep building the case
against smoking . . . to win back the smokers -- 50 million of them -- to get them to quit, and to help all non-smokers stay
In your efforts to have the support of the Congress. You have the support of this department. Secretary Heckler, I can assure
you, is totally committed to the national anti-smoking campaign.
And, as has been the case for the past 21 years, you have the complete support of the Surgeon General of the US Public Health
Service . . . whoever that person may be.
Currently, I am proud to say, that person is C. Everett Koop. But before I came along, three other physicians -- Julius Richmond,
Jesse Steinfeld, and William Stewart -- were all equally dedicated Surgeons General.
The four of us, however, have had to measure up to a model set by a physician who will always represent excellence in medicine
and in public service. That person was the courageous and dedicated Surgeon General who began his fight against smoking: Dr.
Dr. Terry died earlier this year, a genuine hero of the Public Health Service. He lies in a hero's grave in Arlington
Luther Terry went for the big one. He attacked a health problem that has affected hundreds of millions of people, in our country
and around the world.
He attacked one of the major power centers of international business: the tobacco industry. And the industry has never forgiven
him, nor his successors either. But I must tell you that its enmity is a badge we have all worn with much honor.
Dr. Terry swallowed hard and told various congressmen and senators from tobacco-growing states that they needed to do some
serious thinking down the road . . .
They had to see that agriculture and public health to not collide over the cigarette issue . . .
They had to get us all working together on a solution that would advance the public welfare, however the chips might fall.
Dr. Terry also challenged his own colleagues in medicine and public health. He challenged them to believe the results of research,
to stop smoking, and to get others to stop smoking, too.
But physicians are a stubborn bunch. For many years they did not respond well to Dr. Terry's message. They are now beginning
to do so, and that's good. I don't think it's ever too late for redemption.
Luther Terry was a modest man. He always said he had helped start something. He never claimed to have done it all. He left
plenty of room for the rest of us to make our contributions to the elimination of cigarettes.
The Congress has asked each of you to do just that: to contribute your best effort as a member of this important committee.
Now, let me close with a little quotation that might be of some help.
When I was having a difficult time a few years ago, a friend wrote me a note with a line from Goethe. And I'm going to
pass it on to you this morning. It goes like this:
"Our friends show us what we can do; our enemies teach us what we must do."
My friends, smoking is our enemy. Let's get on with what we must do.