Health
The Surgeon General's report of 1964 which outlined, for the first time, the effects of smoking on health, along with the tobacco control efforts that followed, are responsible for adding nearly 20 years of life to eight million people, according to a study in the Jan. 8 issue of JAMA.
“The report and subsequent tobacco control efforts represent the most dramatic and successful public health campaign in modern history, in terms of benefit to the entire population,” said the study's senior author, David T. Levy, PhD, a population scientist at Georgetown Lombardi Comprehensive Cancer Center.
“In 1964, more than 40 percent Americans adults smoked, and now, 50 years later, less than 20 percent use cigarettes. Our research suggests that this dramatic reduction is due to the 1964 Surgeon General's report and the tobacco control activity that followed, “ he said. “While this is a significant public health achievement, we have much more to do – smoking continues to be the leading contributor to the nation's death toll.”
The researchers also estimated that, over the past 50 years, 17.6 million deaths in the United States were related to smoking.
Of these deaths, 6.6 million occurred in individuals below the age of 65, implying a large productivity loss due to illness and death during the working ages, Levy says.
The study was conducted by a group of researchers who are part of the Cancer Intervention and Surveillance Modeling Network or CISNET, funded by the National Cancer Institute. CISNET uses statistical modeling to improve understanding of cancer control interventions.
The lead investigator of the study is Theodore Holford, PhD, from Yale School of Public Health, and researchers from the University of Michigan and Fred Hutchinson Cancer Research Center also participated.
The research team examined smoking patterns up through 1964 and then modeled mortality rates based on what would likely have happened in the absence of tobacco control.
They then compared actual death rates. This resulted in an estimated 157 million years of life saved – 19.6 additional years for each smoker who quit.
Tobacco control policies had an impact on John Hilburn of San Antonio. He gave up his two pack-a-day 20-year habit 30 years ago due to two factors – the Surgeon General's warning on his cigarette pack and an increase in price for a pack of cigarettes.
“I thought smoking might be unhealthy, but when I read the warning, I knew it was. I just decided I didn't want to pay $1 a pack to ruin my health,” Hilburn said.
He threw his carton of cigarettes away, and hasn't smoked since.
“I'm 67 years old and I attribute the health I have to giving up cigarettes,” he said.
Levy's research mirrors Hilburn's experience. “Higher taxes on cigarettes have had the most impact on cessation, and smoke-free air laws – prohibiting smoking indoors – have also been very effective.”
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The United States' global share of biomedical research spending fell from 51 percent in 2007 to 45 percent in 2012, while Japan and China saw dramatic increases in research spending.
The research and development spending in the United States dropped from $131 billion to $119 billion, when adjusted for inflation, from 2007-2012, while Japan increased spending by $9 billion and China increased by $6.4 billion.
Overall, Asia's share of spending grew from 18 percent to 24 percent. Europe held steady at 29 percent.
Prior analyses have suggested the United States' share of global expenditures were once as high as 80 percent.
Results of this new analysis, conducted by researchers from industry and academia, including both medical researchers and economists, appear in the Jan. 2 New England Journal of Medicine.
“The United States has long been a world leader in driving research and development in the biomedical science. It's important to maintain that leadership role because biomedical research has a number of long term downstream economic benefits, especially around job creation,” said study author Reshma Jagsi, M.D., D.Phil., associate professor of radiation oncology at the University of Michigan Health System.
Despite reductions in funding from the National Institutes of Health, including a 20 percent drop in purchasing power since 2003, the researchers discovered that the United States' decline was driven almost entirely by reduced investment from industry, not the public sector. This includes support for clinical trials testing potential new therapies.
Jagsi suggests that this may boil down to fewer regulations and less expense to conduct research in Asia – labor costs less, government may be offering subsidies and the research infrastructure is not as bureaucratic as it is in the United States.
“We were surprised the impact of industry funding was that dramatic, but it's key to note that government funding is equally important to maintain or grow. Research funded through the National Institutes of Health helps scientists understand how diseases work – this will happen slower as NIH funding continues to be cut,” says study author Justin Chakma, a venture capital investor with Thomas, McNerney & Partners in La Jolla, Calif.
Historically, about half of drugs approved by the U.S. Food and Drug Administration had some federal government funding during the course of the research and development.
The authors note the critical need for increased NIH funding coupled with incentives to industry for investing in biomedical research and development here. They call the lack of a coordinated national biomedical R&D strategy “disappointing.”
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