Twenty years ago, Surgeon General C. Everett Koop wrote, “The right of smokers to smoke ends where their behavior affects the health and well-being of others.”

Today, the current Surgeon General, Richard Carmona, MD, emphasized that statement and added evidence to the argument that secondhand smoke, or involuntary exposure to tobacco smoke, has severe health consequences. 

His report released this morning and titled “The Health Consequences of Involuntary Exposure to Tobacco Smoke” is thorough and hard hitting, with a clear message.

The evidence cannot be overlooked: secondhand smoke kills, secondhand smoke harms, and secondhand smoke has no safe limit of exposure.

And, according to the Surgeon General, the only effective strategy to reduce the adverse health effects of secondhand smoke is to remove it from our work, home, recreational and hospitality environments.  Anything less than a complete ban simply won’t work.

We have come a long way over the past four decades regarding our knowledge of the harms of cigarette smoking.  There likely aren’t many folks who aren’t aware of the dangers of smoking cigarettes, and for many who do smoke there are many who try repeatedly to quit.

We haven’t been as effective in convincing everyone that second hand smoke is also dangerous to our health, but we have made some progress over the past twenty years since the release of the last Surgeon General’s report which specifically addressed the harms of second hand smoke. 

We still have a long way to go, according to the evidence presented by Dr. Carmona.

Probably the most important messages from the Surgeon General’s report which was released today are what they call the “Major Conclusions.”

Here they are, with some of the points highlighted by me for emphasis:

• Second hand smoke causes premature death and disease in children and in adults who do not smoke

• Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma.  Smoking by parents causes respiratory symptoms and slows lung growth in their children.

• Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.

• The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.

• Many millions of Americans, both children and adults, are still exposed to secondhand smoke in their homes and workplaces despite substantial progress in tobacco control.

• Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke.  Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposures of nonsmokers to secondhand smoke.

If those are the only points you remember from the extensive scientific review and documentation contained in the report, then you understand enough to realize that this thorough analysis makes the exceptionally strong case for smoke-free environments essentially a no-brainer.

In addition, there are no rational arguments left to oppose smoke-free environments, or to speak against the legislation and regulation required to make them happen in communities across this nation.

Dr. Carmona talked about the fact that many people think that if they have only a little exposure there is no harm.

Not so, he pointed out. 

The Surgeon General was emphatic in his press conference this morning that secondhand smoke is harmful, and the effects are immediate. 

The effects on the cardiovascular system of secondhand smoke on non-smokers can be almost immediate.  If you have coronary artery disease, and you are a non-smoker (perhaps you are a former smoker) and you enter a smoke filled environment, the adverse effects of the second hand smoke in the environment can have an instantaneous effect on your body, your health and maybe even your life if it triggers a heart attack.

The report cites estimates that there about 46,000 excess deaths annually from cardiovascular disease and 3400 excess deaths each year from lung cancer related to secondhand smoke.

I think you will agree that these are not trivial numbers, and each life is a universe of its own, precious to those who know and love the people who die prematurely and unnecessarily (that, in plain English, is what the scientists mean when they say “excess deaths”).

The Surgeon General also takes on the tobacco companies and others who have used tactics that are, shall we say, less than open and honest.

Let me quote some interesting comments from the report:

“The evidence on secondhand smoke and disease risk, given the public health and public policy implications, has been reviewed extensively in the published peer-reviewed literature and in evaluations by a number of expert panels.  In addition, the evidence has been criticized repeatedly by the tobacco industry and its consultants in venues that have included the peer-reviewed literature, public meetings and hearings, and scientific symposia that included symposia sponsored by the industry.  Open criticism in the peer-reviewed literature can strengthen the credibility of scientific evidence by challenging researchers to consider the arguments proposed by critics and to rebut them.

“Industry documents indicate that the tobacco industry has engaged in widespread activities, however, that have gone beyond the bounds of accepted scientific practice.  Through a variety of organized tactics, the industry has attempted to undermine the credibility of the scientific evidence on secondhand smoke.  The industry has funded or carried out research that has been judged to be biased, supported scientists to generate letters to editors that criticized research publications, attempted to undermine the findings of key studies, assisted in establishing a scientific society with a journal, and attempted to sustain controversy even as the scientific community reached consensus.”

These are harsh words to be sure, but perhaps the circumstances demand that level of discourse.

We know secondhand smoke is bad.  60% of the citizens of this country have evidence in their bodies of exposure to secondhand smoke.  Our homes are becoming the primary places where this exposure occurs, and 126 million workers are still subject to secondhand smoke in their workplaces.

What more do we need to know? 

What more do our political leaders at the local, state, and national levels need to hear to understand the issue? 

Help me understand what more we can say, what more we can do, what more we can study to prove that smoking is bad not only for the smoker, but for everyone around them (including their spouse, who has a 25% greater chance of getting lung cancer than if they lived with someone who did not smoke)?

Let’s face the facts: even this administration, which is clearly pro-business, has produced a document which says the only way to produce a safe environment is to ban smoking from the building.

No fans, no ventilators, no separate rooms for smokers, no bars where kids can’t eat—NOTHING has been shown to reduce the levels of secondhand smoke to a safe level of zero except getting it out of the building completely.

That, to me, is the key message of the report and it is one that the Surgeon General emphasized clearly in his press conference this morning.

The science is overwhelming, the business case is overwhelming, and the human impact is overwhelming.

I guess I am perhaps a bit angry that it has taken us this long to get to where we are.  At the same time, we shouldn’t ignore the progress that has been made. 

But this stuff is bad, we know it’s bad, and I wonder how much more effort and time will have to expended to convince those that lead, and those that vote, that secondhand smoke is bad for everyone.

I suggest that we take a close look at the overwhelming evidence in the Surgeon General’s report, and make it very clear that the time for excuses is over, and the time for action is now.

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Aside from the many tobacco-related activities the American Cancer Society is engaged in, we also have a sister advocacy organization arm called the Cancer Action Network. 

Go to their website for more information, and send a letter to your elected officials about your concerns related to smoking and secondhand smoke in your local community.