Social Disease


Washington. -- At Barnes Hospital in St. Louis in 1919 a docto summoned some medical students to an autopsy, saying the patient's disease was so rare that most of the students would never see it again. It was lung cancer.

That story, from John A. Meyer's article "Cigarette Century" in the December American Heritage, illuminates like a lightning flash this fact: Much -- probably most -- of America's hideously costly health-care crisis is caused by unwise behavior associated with eating, drinking, driving, sex, alcohol, drugs, violence and, especially, smoking. Therefore, focusing on wellness -- on preventing rather than curing illness -- will reduce the waste inherent in disease-oriented, hospital-centered, high-tech medicine. The history of the connection between cigarettes and lung cancer illustrates the fallacy of associating health with the delivery of medicine.

One of those 1919 medical students later wrote that he did not see another case of lung cancer until 1936. Then in six months he saw nine cases. By the 1930s advances in immunology and public-health measures (sanitation, food handling, etc.) were reducing the incidence of infectious diseases. But the nation was about to experience an epidemic of behaviorally driven disease.

The lung-cancer epidemic can be said to have sprung from the 1881 invention of a cigarette-making ma- chine. Prior to that, commercial manufacturing of cigarettes was, Dr. Meyer says, a cottage industry. But by 1888 North Carolina's James Buchanan Duke (whose fortune endowed the university) was selling nearly a billion cigarettes annually. Next, war, the shaper of our century, worked its transforming force. Duke's company and the National Cigarette Service Committee distributed cigarettes free to soldiers in France during World War I. So important were cigarettes thought to be to morale, General Pershing demanded priority shipment for them.

Between 1910 and 1919 U.S. cigarette production increased 633 percent, from 10 billion to almost 70 billion annually. Dr. Meyer notes that O. Henry's meticulously observed short stories, written at the turn of the century, almost never mention cigarettes, but the expatriates -- men and women -- in Hemingway's "The Sun Also Rises" smoke constantly. By the 1930s physicians were struggling with the consequences of the new, "emancipated" behavior.

In 1930 the lung-cancer death rate among men was less than five per 100,000 per year. By the 1950s, after another war, in which cigarettes were sold for a nickel a pack and were distributed free in forward areas and were included with K rations, the death rate among men was more than 20 per 100,000. Today it is more than 70 per 100,000, women's lung cancer rates are soaring and lung cancer is by far America's leading cause of cancer death.

We have come a long way from the early days of television, when the sponsor of anchorman John Cameron Swayze's "The Camel News Caravan" required him to have a lighted cigarette constantly visible. The aggressiveness of today's anti-smoking campaigns is attested, paradoxically, by a "smokers' rights" movement trying to protect from employment discrimination those persons who only smoke away from the job.

The American Cancer Society is testing the tolerance of the magazine industry, which last year got $264.4 million -- 4 percent of its revenue -- from tobacco advertising. Some magazines may flinch from running advertisements that say "Smoking promotes zoo breath" or "More Americans die each year from illness related to smoking than from heroin, crack, homicide, car accidents, fires and AIDS combined." (A current idi- ocy: the loud, abrasive entertainer Denis Leary, who harangues MTV's young viewers about the dangers of crack, smokes while haranguing.)

The social disaster of the smoking addiction illustrates why behavior modification is the key to cost-containment re-garding health. Journalism can help. The Washington Post's Jay Matthews reported on the Liggett company's campaign to revive the Chesterfield brand of cigarettes. Launched 80 years ago, the brand has not been advertised for decades. It flourished when smoking was most glamorous, from the '30s into the '50s, when the "Chesterfield Girl" was a TV fixture.

Today 50 million addicted Americans pay $26 billion for almost half a trillion cigarettes each year, so if Chesterfield wins one-half 1 percent of the market (2.4 billion cigarettes), it will be a success. To achieve that, Liggett is merchandising Chesterfields with a $50 million advertising campaign featuring soft, 1930s-style photography.

Mr. Matthews reported:

"Janet Sackman, who was the Chesterfield Girl on 'The Perry Como Show' in the late 1940s, said she was not impressed. She speaks with difficulty because of surgery for both throat and lung cancer, which she blames on 33 years of smoking urged by a Chesterfield executive who thought she would look more authentic. 'People who smoke ought to take a look at me,' she said."

George F. Will is a syndicated columnist.


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