If successful, President Clinton's election-inspired proposals to curb tobacco smoking by teenagers will help reduce the most preventable cause of ill health in America (an estimated 450,000 smoking-related deaths occur in the United States each year), as well as save more than $100 billion annually in federal, state, and private expenditures for health care and lost work. But recent revelations by the Liggett Group, Inc.--makers cigarettes--make it clear that much more action is needed.
In its March 20, 1997, legal settlement with the attorneys general of twenty two states seeking to recoup health care costs of treating smokers, Liggett admitted that it and other tobacco giants had known for decades that cigarettes cause cancer, they are addictive, and the tobacco industry had deliberately marketed them to teenagers to make up for slumping sales to adults.
It is thus time for the nation to adopt a comprehensive plan to dramatically reduce smoking and thereby improve general health. While those who still wish to smoke should be allowed to do so, the majority who desire neither this habit nor its high social costs are entitled to some relief. I believe my forty odd years of experience in the trenches of the tobacco war have given me the necessary long range perspective to offer a set of workable, constructive changes for the future.
In the late 1940s, as a youth in suburban New York, I joined several other neighborhood kids in taking my first furtive cigarette puffs in a nearby, empty wooded lot. This rite, kept secret from our (smoker) parents (and followed by Sen-Sen and cloves), seemed to us to be an exciting way to assert our prepubescent independence. Ubiquitous cigarette ads in papers and magazines at the time heralded smoking doctors touting "safe" cigarettes, lauded the salubrious effect of smoke on your "T-zone" (throat), assured you that "L.S.M.F.T.--Lucky Strike Means Fine Tobacco," and, through celebrity testimonials, promised youth, glamour, vigor, and good looks to smokers.
In the 1950s, as a high school student serving the summer as an orderly at White Plains Hospital in downstate New York, I first encountered unfiltered the deadly ravages of smoking. After I wheeled the bodies of dead lung cancer victims to the morgue and watched as the pathologist sliced white golf ball or melon sized tumors out of blackened lungs, I reviewed the patients' charts. The conclusion was crystal clear even then: all the lung cancer victims had a previous history of heavy smoking for many years. I gave up cigarettes then and there. However, as a magazine editor at Amherst College in the late 1950s, I was only too happy to accept a small subsidy for including preprinted, color back covers that proclaimed: "Join the men [ranch hands] who know: nothing satisfies like the big clean taste of top tobacco-Chesterfield Kings" or "Live Modern: Change to Modern L&M."
But as a medical student at the University of Rochester, New York, in the 1960s, I learned that the components of tobacco smoke's 4,000 chemicals include at least forty three different proven car cinogens (in humans and other animals) and more than 200 poisons, such as aromatic hydrocarbons and nitrosamines. I also learned that nicotine is addictive in the particulate phase and the gas phase de livers many more poisons--carbon monoxide (which displaces needed oxygen from red blood cells), formaldehyde, ammonia, nitrogen oxides, benzene, acrolein, pyridine, and hydrogen cyanide, to name a few--directly into the lungs' bronchial airways and alveoli (air sacs) and, thence, directly and quickly into the bloodstream.
Later, as an internal medical resident and fellow in pulmonary medicine at Boston City General, Boston Veterans Ad ministration, and Massachusetts General hospitals, I tried to help long term smokers, gasping from their smoking induced emphysema, bronchitis, and heart disease. Many passed their final days in the intensive care unit, hooked up with tubes from a tracheostomy (incision in their wind pipe) to a ventilator machine. …