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The 1964 report, Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service (generally referred to as the Surgeon General's Report), has had lasting implications for clinical care and public health through its findings and methods (1). It is best known for the conclusion that smoking was a cause of lung cancer (in men), but it had other notable findings that anticipated conclusions of future reports (Table 1). Over time, many additional cancers were causally linked to smoking, as were cardiovascular diseases and diverse adverse effects of smoking on reproduction. Regarding respiratory diseases, the report found a causal association of smoking with "chronic bronchitis" and noted increased risk of death from influenza and pneumonia in smokers. Later reports concluded that passive smoking, a topic first considered in the 1972 report (2), caused diverse adverse respiratory effects for children and adults (Table 2).
Beyond these findings for smoking and health, the methodology used in the 1964 report was groundbreaking, becoming the foundation for evidence review, integration, and causal inference in subsequent reports of the Surgeon General (3). The approach of the 1964 report has also been widely used for evidence evaluation regarding causation in other domains (4). As described in the 2014 Surgeon General's report, the committee developed and applied a transparent methodology for finding and evaluating research results and interpreted the evidence within a framework for causal inference that is still widely referred to as "the Surgeon General's guidelines" or "criteria" (5). Surgeon General Luther Terry was not directly involved in the Advisory Committee's discussions, and the Advisory Committee was composed of individuals without strong prior opinions on smoking and health. The report represents an early application of what is now referred to as systematic review; a similar approach had been taken in the 1959 evaluation of the evidence on smoking and lung cancer by Cornfield and colleagues (6). Although systematic review had long played a role in the synthesis of scientific evidence in other fields, the 1964 report is one of the first instances of its use for integrating findings of biomedical research.
The reports of the Surgeon General on tobacco and health (including smokeless tobacco) have now been published for 50 years, a total of 33...