Special Report: Reflecting on the 1964 Surgeon General Report with Viet Le

Dr. Albert Rizzo:
Welcome to Lungcast, the monthly respiratory health podcast series from the American Lung Association and medical news site HCP Live. I'm your host, Dr. Albert Rizzo, chief medical officer of the American Lung Association.

Before today's episode, we'd like to remind you that you can subscribe to our YouTube channel at Lungcast to get updates on new episodes and interview segments. You can also find and subscribe to us on your favorite podcast platforms, and get more Lungcast-related content at HCP Live.com and Lung.org.

Today we're running a special episode outside of our regular programming. It has officially been 60 years since the 1964 Surgeon General report—an historic contribution not only to clinical research but also to our understanding of the impact of cigarette smoking on users, through increased risk and exacerbation of pulmonary and cardiovascular diseases.

To commemorate this landmark development in public health, I was invited by HCP Live to reflect on the Surgeon General report with Viet Le, an associate professor of research and preventive cardiology and physician assistant at Intermountain Heart and Vascular. Through our cross-specialty discussion, Mr. Le and I discussed the myriad of cascading effects delivered by the 60-year-old report, how it affected respiratory and cardiovascular care strategies, influenced modern public health efforts, and its resonance in current work to curb the impacts of vaping. We hope you enjoy this special episode.

Hello and welcome, I'm Dr. Albert Rizzo, pulmonologist and chief medical officer of the American Lung Association. I'm here today with Viet Le, a preventive cardiologist. Thank you for joining us.

We're here to take a deep dive into the nuanced intersections of healthcare research and the evolving landscape of public health. This January, we are celebrating the 60th anniversary of the 1964 Surgeon General report, which will be the topic of today's discussion. For those unfamiliar, the Surgeon General's report is among the most pivotal moments in U.S. public health history. It was delivered by Dr. Luther Terry and highlighted the dangers of smoking as a significant contributor to respiratory and cardiovascular disease.

No single issue has preoccupied the Surgeon General's office more over the past four decades than smoking. This report alerted the nation to the health risks of smoking and transformed it from an individual choice issue to a public health and epidemiology concern affecting both smokers and non-smokers.

Today's conversation will be broken into three parts, each unraveling layers of significance. We'll start with the impact on public health in the U.S. over the last 60 years. Viet, can you talk briefly about the impact of this report from a preventive cardiology standpoint?

Viet Le:
Since we've been tracking cardiovascular deaths, the velocity of rise in cardiovascular deaths in the early part of this past century has been astounding, and much of it can be directly attributed to smoking. It's fascinating, if not terrifying, to look at the statistics.

For those interested, the 2024 report “Heart Disease and Stroke Statistics” from the American Heart Association shows a meteoric rise up to 1960, followed by a significant decline after the Surgeon General's report. This societal awareness triggered a full offensive against smoking. By 1980, cardiovascular deaths dropped from about 1 million per year to 800,000—a 20% reduction, largely attributable to smoking prevention efforts.

Smoking still tops charts in terms of years of life lost due to disability and premature death. Between 1990 and 2019, smoking declined further by about 50%, but it remains a major public health concern.

Dr. Albert Rizzo:
Thank you, Viet. Now, moving to part two, let’s explore the successes of anti-smoking campaigns. Could you enlighten us on the strategies that made these campaigns effective?

Viet Le:
Sure. The push for the official report began in 1961, when organizations like the American Cancer Society, American Heart Association, and American Lung Association urged President Kennedy to form a national commission on smoking. They sought solutions that balanced industry freedom and public health.

The 1964 report declared cigarette smoking a significant health hazard but didn’t outline remedies. Public health organizations became advocates for law and policy changes. For example:

• In 1965, Congress required cigarette packages to carry a health warning.

• By 1970, cigarette advertising on TV and radio was banned.

These campaigns worked because they were science-based, trustworthy, and delivered by credible messengers. Addressing diverse populations and combating disinformation were critical. Public health advocacy extends beyond smoking to areas like vaccinations and environmental health.

Dr. Albert Rizzo:
Part three addresses vaping. Viet, what are your thoughts on this new era of e-cigarettes?

Viet Le:
Vaping presents unique challenges. Unlike combustible cigarettes, the long-term risks of vaping are unclear, as it’s been around only 10–15 years. Devices are unregulated, nicotine levels vary, and acute effects include airway inflammation and impaired aerobic capacity.

The EV-Vape incident showed acute hospitalizations related to contaminants like vitamin E acetate. While harm reduction is debated internationally, the American Lung Association advises quitting altogether. Counseling and FDA-approved medications exist to help smokers quit.

Dr. Albert Rizzo:
From a preventive cardiology perspective, harm reduction can be a tool to discuss quitting nicotine entirely. Cardiology guidelines incorporate cessation strategies, but education for colleagues is still needed. Full abstinence remains the goal, though switching from combustibles may reduce some risk temporarily.

Viet Le:
Absolutely. There’s more to discuss, but we’ll conclude here. Get involved in public health advocacy—it’s simple, such as signing up for emails to influence legislative votes.

Dr. Albert Rizzo:
Thank you for listening. For more information on pulmonology, cardiology, and public health, visit HCP Live.com. Thanks again to Viet Le for his insights. We’ll return to our regular Lungcast schedule in the next two weeks. For historical context, you can revisit our June 2021 episode on the health effects of e-cigarettes with Dr. Kevin Walton.

Until next time, I’m Dr. Albert Rizzo with the American Lung Association, reminding you: if you can’t breathe, nothing else matters.