When the CVS Caremark drugstore chain recently announced it would stop selling tobacco products in an effort to shift the chain’s focus from retail to health, Jonathan Samet saw this as a sign that America may be in for a healthier future after years of a smoke-filled haze.
Samet, professor and chair of preventive medicine at the Keck School of Medicine of USC, is a pulmonary physician and epidemiologist and one of the nation’s most widely respected experts on the health risks of active smoking and second-hand smoke, tobacco control and air pollution.
As the senior scientific editor of the recently published The Health Consequences of Smoking — 50 Years of Progress: A Report of the Surgeon General, 2014, Samet believes the news is both good and bad.
The report follows up on America’s relationship with tobacco since the first Surgeon General report on smoking published in 1964. The report’s conclusions show that after more than 50 years, cigarette smoking has declined, but the number of diseases linked to tobacco has risen sharply. With the CVS announcement, Samet believes a national retail chain’s decision to “kick the habit” of tobacco sales indicates real progress.
“The decision by CVS is precedent-setting and engages a major U.S. business sector in the pursuit of a healthier America,” said Samet, whose leadership includes serving as chair of the U.S. Food and Drug Administration (FDA)’s Tobacco Products Scientific Advisory Committee and membership on the National Cancer Advisory Board. “The issue of whether pharmacies should sell cigarettes has been discussed for a long time. CVS says their future is in advancing health — a goal shared with Keck Medicine of USC. I applaud the CVS decision.”
Samet was a key participant in a mid-January launch of the new Surgeon General report with national health leaders Kathleen Sebelius, U.S. secretary of health and human services; Thomas Frieden, director of the Centers for Disease Control and Prevention; and Howard Koh, U.S. assistant secretary for health. As senior scientific editor of the report, Samet got a close look at what has been effective in tobacco prevention and the work that remains to be done to intervene against the marketing messages, especially for younger Americans, that cigarettes are “cool.”
“Young children, most influenced by media accounts of celebrity smokers, continue to start to smoke even though they know the facts,” Samet said. “The tobacco industry is not allowed, by law, to directly market to youth. But the aura of smoking as a rite of passage into adulthood reaches our youth. Once started, nicotine is very addictive. It becomes an involuntary matter.”
Other sobering facts from the Surgeon General’s report:
• Cigarette smoking is causally linked to diseases of more than just the lungs. There are connections to diabetes mellitus, rheumatoid arthritis, colorectal cancer, macular degeneration and numerous cancers, including liver, bladder, stomach and leukemia.
• Exposure to secondhand tobacco smoke has been causally linked to cancer, respiratory and cardiovascular diseases, as well as negative effects on the health of infants and children.
• Disease risks for women have risen dramatically since 1964 and are now equal to men. Women age 35 and older now have more relative risk of death from coronary heart disease, which is causally related to smoking.
• Although cigarette smoking has declined since 1964, there remain considerable disparities in race, ethnicity, educational level and socioeconomic status.
Still, Samet is encouraged by recent corporate responsibility decisions, such as that made by CVS, as well as the advances in tobacco prevention, including warnings on cigarette packs, as well as higher taxes and prices in some states (although Samet stated, “They’re still cheap in California”). He sees the report as a strong plea to policymakers to shake off 1960s thinking about smoking cessation models and help promote healthier lifestyles for the nation’s future generations.
Despite the statistics on smoking-related health risks, the tobacco industry isn’t idle. The emergence of e-cigarettes, promoted by celebrities, has presented fresh challenges, including uncertainty about how to regulate the product.
In late 2013, Keck Medicine of USC became one of 14 academic institutions to establish a National Institutes of Health-funded Tobacco Center of Regulatory Science, intended to help create the scientific base for decision-making by the FDA on tobacco products. Samet and Mary Ann Pentz, professor of preventive medicine and director of the Institute for Prevention Research at the Keck School, are co-principal investigators.
As Samet continues to fight the good fight, the Surgeon General report marks a moment to celebrate the freedom from the smoke-choked rooms of the past and get back to work.
“I was in college in 1964 when the first report came out,” he said. “My roommates all smoked, our parents smoked. Since then, there’s been a tremendous change in social norms, and most environments today are smoke-free. We’ve made progress in ways that I couldn’t imagine.”