Worse than you thought: New surgeon general report links smoking to more diseases

Diabetes, heart disease, colon cancer among those on list of diseases now associated with smoking tobacco
Health and Human Services Secretary Kathleen Sebelius
Health and Human Services Secretary Kathleen Sebelius speaks about the release of the US Centers for Disease Control and Prevention (CDC) report on "The Health Consequence of Smoking 50 Years of Progress" on Jan. 17, 2014. Pablo Martinez Monsivais / AP

It’s long been known that smoking causes lung cancer and heart disease, but a surgeon general’s report released Friday adds numerous other illnesses – including diabetes, colorectal and liver cancers, erectile dysfunction and ectopic pregnancy – to the growing list of smoking-related harms.

The report by acting surgeon general Dr. Boris D. Lushniak also names vision loss, rheumatoid arthritis, impaired immune function and cleft palates in fetuses of women who smoke. Additionally, it concludes that smokers have a much higher chance of developing lung cancer than they did in the past due to changes in the design of cigarettes.

The report comes just a week after the publication of a study in The Journal of the American Medical Association which estimates that 8 million lives have been saved in the U.S. by anti-smoking measures launched 50 years ago, when the surgeon general released a landmark report that launched national anti-smoking measures. Since then, various surgeon generals have issued more than 30 reports pointing to smoking’s potential to harm nearly every human organ.

“The conclusions from these reports have evolved from a few causal associations in 1964 to a robust body of evidence documenting health consequences both from active smoking and exposure to secondhand smoke across a range of diseases and organ systems,” Lushniak wrote.

“A half century after the release of the first report, we continue to add to the long list of diseases caused by tobacco and exposure.”

Dr. Jonathan Bricker, a psychologist in Fred Hutchinson Cancer Research Center’s Public Health Sciences Division, said the report affirms smoking’s connection to other illnesses that the scientific community has long known about. Bricker said while the report is useful as a tool for influencing research and policy, it creates “cognitive fatigue” by listing yet more illnesses that smoking causes without making recommendations on the need for new ways to further reduce smoking rates in the U.S.

“What’s needed is a bold call for innovative approaches – new technologies like smart phones and other mobile interventions to help people quit smoking,” he said. “You have to do something bold and new in order to make a breakthrough in the smoking rate.”

Public health efforts have sharply reduced smoking among adults, from 42 percent in 1965 to 18 percent in 2012. Still, more than 17.6 million Americans have died prematurely from smoking since 1964 and tobacco use remains the leading cause of preventable death in the U.S., killing more than 400,000 Americans annually, according to The Centers for Disease Control and Prevention.

The direct medical costs of smoking are more than $130 billion annually, according to Friday’s report, along with $150 billion a year in productivity losses from premature deaths.

Bricker said he would have like the report to have focused on groups of Americans among whom smoking-cessation efforts have been the least successful, including people with mental disorders, African-Americans, native Americans and youth. While smoking rates among the general population have decreased substantially, cessation levels in those groups have remained fairly flat, Bricker said.

Bricker, who has developed a smoking-cessation method that combines technology and psychology, commended the report for acknowledging the tremendous strides made in reducing smoking rates over the past 50 years. But he doesn’t expect the report will have much of an impact in further lowering those numbers. The most effective way for government to help drive down smoking, he said, is through more stringent controls on the sale and use of tobacco.

“Going forward, a report is not enough,” he said. “The times have changed and the norms have changed.

“What’s needed now are more effective tools that will bring us down toward a 0 percent smoking rate. A report won’t do that.” 

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