“Tobacco Heart!”

Cigarette Smoking and Cardiovascular Health

INTRODUCTION

Although most adults and adolescents know that smoking can cause lung cancer, only a minority recognizes that smoking takes an even greater toll on the heart. Heart disease is the leading cause of death for both men and women and across most racial and ethnic groups. It takes the lives of over 650,000 Americans each year–or one in every four deaths. 30% of these heart disease deaths are attributed to cigarette smoking. This does not include the toll taken by smoking on other parts of our circulatory system that can result in strokes and ruptured aortic aneurysms. 20% of deaths from heart attacks due to blocked coronary arteries, the most common form of heart disease, are in individuals under 65. One in 12 Americans over 20 has coronary artery disease. 75% of heart attacks in women under 50 are attributed to cigarette smoking, which depletes the estrogen that helps lower blood pressure and cholesterol. The risk of a heart attack is proportional to the number of cigarettes smoked. The near-universal adoption by smokers of filtered cigarettes since their introduction by tobacco companies in the 1950s (to allay consumer anxiety about getting lung cancer) has not reduced the risk for cancer or heart disease. Since the addiction is to nicotine, people who smoke filtered cigarettes inhale more frequently and more deeply, thus exposing the heart and lungs to a greater amount of carbon monoxide, formaldehyde, ammonia, and other poison gases.

The good news is that the benefits from stopping smoking can be demonstrated at all ages. The risk of sudden cardiac death drops immediately upon stopping smoking and the risk of a heart attack goes down within a few years of stopping to a level similar to that of a person who has never smoked.

As with lung cancer and emphysema, the dramatic rise in heart disease in the US paralleled the rise in cigarette smoking. Yet despite the early published evidence of the link between smoking and heart disease in the 1920s and 1930s, and the alarms raised by heart doctors and cardiovascular surgeons like Alton Ochnser, Michael DeBakey, Dwight Harkin, and Richard Overholt in the 1940s, the American Medical Association (AMA) and other health groups were reluctant to urge the public to give up their cigarettes. It didn’t help that well into the 1950s two-thirds of physicians still smoked. This exhibition looks at what organized medicine, medical schools, the mass media, voluntary health organizations, pharmaceutical companies, chain drugstores, and the federal government have done—and have not done—to reduce the devastating cardiovascular consequences of tobacco use.

Alan Blum, MD
Director, The University of Alabama Center for the Study of Tobacco and Society

Reference:
Centers for Disease Control and Prevention: Heart Disease Facts 2022.

“A TOBACCO HEART”
“NO-TO-BAC BRINGS ITS REWARD”

“DON’T TOBACCO SPIT AND SMOKE YOUR LIFE AWAY!
“TAKE THE NERVE-MAKER NO-TO-BAC GUARANTEED CURE
BRINGS SWEET REWARD
400,000 CURED. WHY NOT YOU?” (35 pages)

Promotional booklet by Sterling Remedy Company, Chicago, New York, Montreal for No-To-Bac,
“The original, only genuine guaranteed tobacco habit cure”
1894

Page 7:

A TOBACCO HEART

“Thousands of men cannot get life insurance because there’s ‘something wrong with the heart.’ It’s a tobacco or cigarette heart, a form of heart disease caused by tobacco. The continued depression of the heart’s action undermines its power, and in advanced life, or under exciting influences, the tobacco-enfeebled heart is liable to stop altogether. In a recent editorial the Chicago Ledger says: ‘Nearly every day the newspapers give an account of some eminent man falling suddenly dead at their desk from heart disease. As a rule, no middle-aged man in active business dies thus suddenly unless poisoned, and that poison in the majority of cases is tobacco. Meanwhile, the slaughter goes on…

“Many tobacco-users may escape the extreme consequences of the habit, but it can be truthfully stated that no man continues its use without inflicting on himself severe and permanent injury.

“No-To-Bac will help you. Be sure you get the genuine.
LET NO-TO-BAC CURE IT, BEFORE IT’S TOO LATE”

Page 9:

“LACK THE NERVE TO MAKE HER HAPPY

“Tens of thousands of men bring home to their sweet-faced darling wives a tobacco-stinking breath and a nervous system irritated and debilitated by nicotine. Is it strange they are not greeted by that wonderful look of love-light in her eyes, by that tremble of delight which the magnetic touch of perfect manhood calls forth? In spite of all her love, nicotine debility, with its nasty accompaniments, fills her with disgust for the man who ought to make her happy…NO-TO-BAC will cure you, make you well, strong and vigorous…”

Page 18:

“HOW IT CURES

“NO-TO-BAC possesses powerful eliminating properties, and the poisonous nicotine in the tobacco user’s system is thrown off. It increases the flow of nervous fluid, restores to health and activity the diseased nerves, has absolutely no depressing influence; produces healthful and refreshing sleep, and leaves no injurious result, for it does not contain a particle of opium, morphine, or any drug that would be hurtful to the system…”

“A TOBACCO HEART?

“NO-TO-BAC KILLS THE TOBACCO HABIT IN EVERY MAN”

Magazine advertisement by The Sterling Remedy Company, Chicago, New York, and Montreal

1894

“Nearly every day the newspapers give an account of some eminent man falling suddenly dead at his desk of heart disease. As a rule no middleaged man in active business dies thus suddenly unless poisoned, and that poison, in a majority of cases, is tobacco. Meanwhile the slaughter goes on. The press and the pulpit seem muzzled, the majority being participants in the popular vice, and those who are not seem hypnotized and afraid to speak out.

“To the tobacco user, we say, investigate the merits of NO-TO-BAC. You run no physical or financial risk. We have over 100,000 recorded cures,and a CURE not only means the loss of desire for tobacco, but stronger nerves, better sleep, gain in weight, a vigorous vitality, a manly manhood, a ripe old age, and all that goes with it TO MAKE LIFE WORTH THE LIVING.

“OUR GUARANTEE IS PLAINAND TO THE POINT. One box, $1; three boxes, thirty days’ treatment, $2.50, IS GUARANTEED TO CURE THE TOBACCO HABIT in any form, or money refunded. We don’t claim to cure everyone, but the percentage is so large, we can better afford to have the good will of the occasional failure than his money. We have FAITH IN NO-TO-BAC. If you try No-To-Bac, you will find that it is to you WORTH ITS WEIGHT IN GOLD.

“Booklet called ‘Don’t Tobacco Spit and Smoke Your Life Away,’ and the Inter-Ocean Supplement entitled: “King No-To-Bac — His Work in America,” mailed for the asking. Buy No-To-Bac from druggists, or mailed for for price. Address THE STRERLING REMEDY CO., Chicago office, 45 Randolph St.; New York office, 10 Spruce St.; Montreal, Can., 274 St. Paul St.; Laboratory, Indiana Mineral Springs, Indiana.

“DRUGGIST

“Any druggist in the U.S. and Canada is authorized to sell No-To Bac under our

GUARANTEE”

When Did We Know?

“To realize that the first cause of death in the United States is a disease little known 50 years ago comes as a surprise to physicians and public alike. The dramatic form of coronary heart disease dates from 1912 when James B. Herrick first described the clinical manifestations of coronary thrombosis with cardiac infarction. The precipitative rise of the disease to the place it now occupies is unique…

“Heart disease in all forms superseded tuberculosis in 1912 as the leading cause of death in the United States and has maintained that position constantly since.”

David C. Miller, MD, Fredrick J. Stare, MD, Paul Dudley White, MD, and John E. Gordon, MD: The Community Problem in Coronary Heart Disease: A Challenge for Epidemiological Research, American Journal of Medical Science, Volume 232, Pages 329-359, 1956

“Does Not Affect the Heart or Throat”

Tobacco shop promotional sign for an assortment of pipe tobaccos by the National Tobacco Company (New Zealand)
Circa 1920

_____________________________________________________________________________________________

“Notwithstanding the social acceptability of the tobacco habit, the First World War saw the emergence of serious medical concern about the physical fitness of the troops and, in particular, that a condition known as ‘soldier’s heart’ was affecting the British fighting man. Some suggested a link between this unfitness and the ubiquity of the cigarette habit. The question was referred to the recently-formed (in 1911) Medical Research Committee for investigation. When its researchers published their findings in 1917 ‘excessive cigarette smoking’ was absolved of responsibility. Nevertheless, heavy smoking was linked with breathlessness and precordial pain. These results persuaded the Lancet of the dangers of excess and also that ‘the soldier should be warned against inhaling.’ As for the British Medical Journal, its interest in smoking during the First World war appears to have been utterly non-existent.”

Article by Peter Bartrip
“Pushing the Weed: The Editorializing and Advertising of Tobacco in the Lancet and the British Medical Journal, 1880-1958”
Clio medica (Amsterdam, The Netherlands)
Volume 46, pages 100-126
1998

“Don’t wait until your heart trips your step to success because it is nicotine saturated.”

Advertisement for The Strongfort System
The National Police Gazette
May 19, 1917

“If Your Heart Starts Acting Like This —”

Magazine advertisement by Antonio Roig & Langdorf, Philadelphia, for Girard cigars
Circa 1920

“The tobacco heart has been named and is well known by its name, but its nature is not well known. We are very much in the dark as to its pathology.

“[To cite Sir Thomas Lewis, author of the textbook Diseases of the Heart Described for Practitioners and Students:] ‘It is suspected, but not proved that heavy tobacco smoking can lead to the degeneration of the arteries including the coronary vessels.’”

ES Cornwell, MD: The Tobacco Heart, Medical Times, Volume 62, Pages 209-211, 1934

Medical Times & Long Island Medical Journal with article “The Effects of Tobacco on the Heart and Blood Vessels”

Cover
July 1934

From Tobacco Record (tobacco industry trade weekly), June 7, 1944

“Tobacco’s Harmful Effect On The Heart Is Declared So Much Bunk
“Medical Critic and Guide Says That Smoking Is Not the Cause of Dread Angina Pectoris

“Another theory or notion concerning the use of tobacco has been exploded. The statement that the use of tobacco and alcohol is injurious to the heart has been declared so positively and so strenuously propagated and repeated so often that it has generally become accepted as a truism. It will come as a relief to the users of either that this is just more bunk.

“In a recent issue of The Medical Critics and Guide, the following appeared:

“‘…A careful analysis has been made by Dr. P.D. White and T. Sharber of Boston (J.A.M.A. Vol. 102, No. 9) of the past habits in the use of tobacco and alcohol of 750 consecutive private patients with angina pectoris and of 750 individuals without angina pectoris of exactly the same sex and age incidence and form the same walks of life. And this is the summary:

“…It appears from this study that neither the use of nor the abstinence from tobacco or alcohol plays an important role in the genesis of angina pectoris…”

“So tumbles another theory or notion.”

(Contributed by Joe Parker [1952-2018], historian of 19th century and early-20th century small tobacco companies.)

”

“The Tobacco Heart” (4 pages)

Article by Edward E. Cornwall, MD
Medical Times & Long Island Medical Journal
July 1934

From THE TOBACCO LEAF (tobacco industry trade weekly), December 28, 1946:

Tobacco Heart at 30,
Still Smokes at 91

Los Angeles, Dec. 20 — Charles Veeder of this city, was warned by his physician, at age 30, to quit smoking as he had tobacco heart. He is 91 now and averages nine cigars and a few pipe fulls of tobacco daily.

(Contributed by Joe Parker [1952-2018], historian of 19th century and early-20th century small tobacco companies.)

“After a man’s heart…
When smokers find out the good things Chesterfield gives them
Nothing else will do!”

Advertisement by Liggett & Meyers Tobacco Company
LIFE Magazine
1937

“After a man’s heart”

Front and back covers of the New York State Journal of Medicine
May 1, 1937

“Inhale to your heart’s content!”

Magazine advertisement for P. Lorillard Company’s Embassy cigarettes
1949

“Inhale to your heart’s content!”

Magazine advertisement for P. Lorillard Company’s Embassy cigarettes
1949

“Inhale to your heart’s content!”

Magazine advertisement for P. Lorillard Company’s Embassy cigarettes
1949

What Did We Know?

“The importance of cardiovascular disease, particularly coronary heart disease (CHD), to the health of the American public is evident. In 1980 cardiovascular disease accounted for approximately half of all U.S. deaths-980,000 out of 1,980,000 total deaths. Of these, slightly over 565,000 were due to coronary heart disease; that is, approximately 30 percent of all deaths and almost 60 percent of all cardiovascular deaths were due to coronary heart disease…

“In comparison, the total number of all cancer deaths was slightly over 416,000 in 1980. Thus, deaths from CHD exceeded all cancer deaths, and deaths from all cancers numbered less than one-half the total of all cardiovascular deaths.

“[In 1982] this Department issued a report in which it was estimated that tobacco use, particularly cigarette smoking, was related to 30 percent of all cancer deaths in the United States-a projected 129,000 premature deaths. The findings of this year’s Report, however, should be considered even more alarming, in that the number of cardiovascular deaths that are reasonably estimated to be cigarette-related is even higher. A number of investigators have estimated that 30 percent or more of CHD deaths could be attributed to cigarette smoking because of the higher CHD death rates experienced by ever-smokers compared with never-smokers. If 30 percent of coronary heart disease deaths are attributed to cigarette smoking, 170,000 Americans will die prematurely of CHD each year. Smokers also experience increased death rates owing to other cardiovascular diseases such as stroke, peripheral vascular disease, aortic atherosclerosis, and other vascular problems.

“Each of the three major risk factors poses approximately the same increase in risk of CHD for the person with the risk factor, but cigarette smoking is far more prevalent as a risk factor for CHD in the American population than either hypertension or elevated serum cholesterol. Thus, the overall finding of this Report is clear: Cigarette smoking should be considered the most important of the known modifiable risk factors for coronary heart disease in the United States…

“The first major prospective study results were made public in 1954 in the United States by Hammond and Horn and found a strong association between cigarette use among men and coronary heart disease (CHD). Overall, smokers were found to carry a 70 percent greater risk of dying from CHD than nonsmokers; heavy smokers had CHD mortality rates almost two and one-half times greater than nonsmokers. Hammond and Horn also noted a consistent dose-response relationship with the number of cigarettes consumed per day….

“By 1979, the magnitude of the epidemiological, pathological, clinical, and experimental evidence had grown to the point that the Surgeon General’s Report concluded: “Smoking is causally related to coronary heart disease in the common sense of that idea and for the purposes of preventive medicine.”

The Health Consequences of Smoking–Cardiovascular Disease: A Report of the Surgeon General. United States Public Health Service, 1983

Special Supplement on Smoking and Health (4 pages)

Article: “Smoking and the Heart – The Basis for Action”
The Medical Journal of Australia
July 26, 1975

“The Grave Facts About Smoking” (3 pages)

Cover and editorial
The Medical Journal of Australia
July 26, 1975

“[A] new document, The Health Consequences of Smoking, 1974, has been released. This confirms the evidence in previous reports that cigarette smoking is a serious health hazard and contributes to the development of various forms of cancer, cardiovascular disease and respiratory disease…

“Arteriosclerotic cardiovascular disease is the leading cause or death in the United States, accounting for greater than 50% of annual deaths. Cigarette smoking is a major risk factor for the development of coronary heart disease (CHD), with male cigarette smokers running a twofold risk of dying from CHD compared to nonsmokers. There is a dose-response relationship, and cigarette smoking acts both independently of and synergistically with the other two major risk factors, hypercholesterolaemia, and hypertension, to produce these effects on morbidity and mortality. The relative importance of cigarette smoking in the development of CHD in young men (less than 50 years old) is greater than that for any other risk factor. Cigarette smoke, carbon monoxide and nicotine induce some of the biochemical, anatomical and pathophysiological changes seen in CHD, but prospective epidemiological studies document that cessation of cigarette smoking results in reduced mortality from CHD.”

Editorial “The Grave Facts About Smoking”, Medical Journal of Australia, July 26, 1975, Pages 120-121

What Did We Do About It?

“Physician, No Smoking Please” (3 pages)

Cover story by Douglas A. Geekie in the Canadian Medical Association Journal
January 24, 1976.

“Physician, no smoking, please!”

If you smoke, refrain from doing so during the conduct of your professional duties. Remember the importance of your personal smoking habits and behaviour as an example. Encourage your colleagues, employees and patients to refrain from smoking by signing the international no smoking prescription and displaying it prominently in your office.

These three requests form the quintessence of an appeal letter sent to all Canadian physicians by the minister of national health and welfare and the president of the Canadian Medical Association. For over 3 decades, and as late as Nov. 22, 1975, with the publication of the editorial entitled “Cigarette smoking, coronary heart disease and sudden death” (Can Med Assoc J 113: 919, 1975), this Journal has recorded the proven and potential hazards of smoking-related to pulmonary carcinoma, chronic bronchitis, and emphysema – to the smoker. Only recently, however, has medical science come to appreciate the health hazards to nonsmokers of cigarette smoke. As the appeal letter says, “physicians especially cannot ignore the large number of their patients with asthma, chronic bronchitis and emphysema who suffer respiratory, psychogenic or other distress when exposed to smoke”. The influence of the physician’s personal example on the smoking habits of patients cannot be denied: how credible is the physician who, while “lighting up”, advises a patient with emphysema or one who has had a myocardial infarction that he should stop smoking? And though the term hypocrite may not be entirely appropriate, that ever-declining, but a still sizable, group within the profession who smoke have reason to be uncomfortable when the subject of smoking and health is discussed.

Douglas A. Geekie, Communications Director, Canadian Medical Association, Canadian Medical Association Journal, Volume 114, Page 96, January 24, 1976

In 1964, rather than joining with virtually all major health organizations around the world to endorse the landmark Surgeon General’s Report on Smoking and Health released by Dr. Luther Terry and to get behind his call for immediate remedial actions to curb cigarette consumption, the American Medical Association instead signed a $10 million contract with six cigarette manufacturers to support “independent research” that it claimed was needed for the “identification and removal of the harmful components in tobacco.” The tobacco industry had been using this exact language since the first large studies linking smoking and lung cancer were published in the early 1950s. In 1978, after taking a total of $18 million from tobacco companies and doing nothing to fight smoking for 14 years, the AMA confirmed that cigarette smoking did indeed lead to the same heart and lung diseases that Dr. Terry’s report had described in 1964. In the introduction to the AMA Education and Research Foundation report, Tobacco and Health, AMA Executive Vice President James H. Sammons, MD expressed “gratitude to the Tobacco Industry for its financial support.”

“AMA: CIGARETS DAMAGE HEART
Tobacco Firms Financed Study” (2 pages)

Front page, New York Daily News
August 6, 1978.

“The 365-page book includes a summary of the sponsored research projects…” (2 pages)

AMA news release about the publication of its report entitled Tobacco and Health
July 17, 1978

Tobacco and Health

Book, front cover and preface
Published by the American Medical Association Education and Research Foundation (report on research funded by a tobacco industry grant)
1978

The Half-Hearted Media

“The risk of myocardial infarction is proportional to the number of cigarettes smoked. The trend toward the use of filter cigarettes does not appear to have reduced the risk of coronary heart disease…Since the addiction is to nicotine, people who smoke low-nicotine cigarettes undergo compensatory smoking, in which they inhale more frequently and more deeply…

“Benefits from stopping smoking can be demonstrated at all ages… The risk of sudden {cardiac] death decreases immediately upon stopping smoking and the risk of myocardial infarction decreases within a few years of stopping to a level similar to that of men who have never smoked…Three fourths of myocardial infarctions in women below the age of 50 have been attributed to smoking.”

Robert Rakel, MD and Alan Blum, MD: Nicotine Addiction, In Rakel’s Textbook of Family Practice, 1990.

“Filter for Better Taste the Tareyton Way with Activated Charcoal“/ The Tragic Record of Heart Transplants

Front and back covers of LIFE Magazine
September 17, 1971

NYT Magazine Coronary Artery x Marlboro 1973 Edit

“Marlboro”/ Coronary artery: Closing in on life

Front and back covers of The New York Times Magazine
March 25, 1973

“Camel Mellow Turkish Blends”/ Women & Heart Disease

Front and back covers of TIME Magazine
April 25, 2003

“Vantage. Taste of Success”/ Replacing the Heart

Front and back covers of Discover
February, 1983

“Marlboro”/ How To Reverse Heart Disease

Front and back covers of U.S. News & World Report
August 6, 1990

“Marlboro”/ Cut Risk of Heart Death in Half

Front and back covers of National Enquirer
April 9, 1985

“Winston America’s Best”/ Bill Schroeder’s Artificial Heart

Front and back covers of LIFE Magazine
May, 1985

“Move to Malibu”/ What You Should Know About Heart Attacks

Front and back covers of Newsweek
February 8, 1988.

How a pharmaceutical company helped TIME promote healthy hearts… and cigarettes

In 2001, Monarch Pharmaceuticals, which markets the blood pressure-lowering drug Altace (ramipril), sponsored a four-page cover wrap-around advertisement in several issues of TIME Magazine, with the theme, “I Love protecting my health.” The drug, the 2022 retail cost of which is $300 a month, was promoted as a way to prevent heart attack and stroke. Just a few pages away were advertisements for cigarettes, such as this two-page ad for Philip Morris’ Parliament. The magazine was sent free and unsolicited to physicians for their office waiting room.

Michael DeBakey, MD: Pioneer in the Treatment–-and Prevention–-of Heart Disease

Renowned worldwide for having revolutionized the treatment of coronary artery disease and vascular repair during a medical career of over 75 years, Dr. Michael DeBakey (1908-2008) was also an early ardent opponent of cigarette smoking.

“We have the facts. We know that smoking is a very important factor in the development of very significant disease–heart disease and cancer–which kills two-thirds of the people in this country…”

– Michael E. DeBakey, MD, 1992

“Big Change in Tempo!”/ Surgeon Michael DeBakey: Toward an Artificial Heart

Front and back covers and article in TIME Magazine
May 28, 1965

“…heart disease and cancer, which kills two-thirds of the people in this country.” (00:19)

Comment by Micael E. DeBakey, MD
Medicine Vs. Madison Avenue
Video by Alan Blum, MD and Eric Solberg
Doctors Ought to Care (DOC)
1992

Photograph, Dr. DeBakey and Dr. Blum at Baylor College of Medicine, 1992.

Dr. DeBakey, who served on the faculty of Baylor College of Medicine for 60 years, presided at the ceremony marking Baylor’s becoming a smoke-free campus on January 1, 1991.

Photograph, Alan Blum, MD, October 9, 1990.

Pfaint of Heart

“In the 1990s Pfizer pharmaceutical company was a leading sponsor of continuing medical education courses and symposia on cardiovascular disease, in an effort to encourage the prescribing of its antihypertensive medication Norvasc and its cholesterol-lowing drug Lipitor. In 1995, at a Pfizer-sponsored dinner in Anaheim held during the American Academy of Family Physicians Annual Scientific Assembly I was one of three speakers each addressing one of the major risks factors for heart disease: smoking, hypertension, and high cholesterol. I noted that the leading preventable cause of heart disease wasn’t hypertension, hyperlipidemia, or cigarette smoking, but Marlboro, the nation’s top cigarette brand. The following year, Pfizer offered me the opportunity to create an educational poster for physicians on cardiovascular disease and smoking for display at the 1996 AAFP Scientific Assembly in New Orleans. But when I arrived at the conference I saw that my poster had been changed by Pfizer. The brand names Marlboro and Camel had been replaced by the word ‘Smoking’ because the company feared a lawsuit by the tobacco companies.”

-AB

[Footnote: In the 1980s Pfizer still owned one of the world’s leading cigarette flavorings companies, Camille, Albert & Laloue, which advertised in tobacco trade publications. See: Richards JW, Blum A: Pharmacists who dispense cigarettes–with reference to drug store chains and pharmaceutical companies. New York State Journal of Medicine 1985; 85:350-353.]

“Smoking and the Patient With Cardiovascular Disease”

Poster by Alan Blum, MD, commissioned by Pfizer Pharmaceuticals, for display at the Pfizer booth at the American Academy of Family Physicians conference, New Orleans, 1996.
(Digital Version Here)

Only at the conference did Dr. Blum discover changes made by Pfizer in violation of the agreement of full editorial freedom.

Original: Marlboro’s Myocardial Mayhem
Pfizer: Smoking’s Myocardial Mayhem

Original: Camel’s Coronary Consequences
Pfizer: Smoking’s Coronary Consequences

What Didn’t We Do About It?

For many years, February has been designated “American Heart Month” by the Centers for Diseases Control and Prevention (CDC), the American Heart Association, and major corporations to promote heart disease research as well as public education about the modifiable risk factors for heart disease: high blood pressure, high cholesterol, and cigarette smoking.

But what message does American Heart Month partner Walgreens send when it still sells cigarettes in its 9000 drugstores or Walmart in its 4,743 stores, Dollar General in its 17,266 stores, Pilot Flying J in its 650 truck stops, Albertson’s in its 2,254 supermarkets, Publix (1294), Kroger (2300), Safeway (900), Winn-Dixie (529), and Piggly Wiggly (500)?

Would we even need an American Heart Month if these companies put their ethics where their mouth is by ending cigarette sales? CVS, Aldi, Trader Joe’s, Wegman’s, and Fresh Market are just a few examples of successful companies that either stopped selling tobacco products or never sold them to begin with.

-AB

Advocating for Tobacco-Free Pharmacies: Past and Current Efforts

Poster by Vinayak M. Jha, MD, George Washington University School of Medicine, and Alan Blum, MD, University of Alabama School of Medicine, presented at the World Conference on Tobacco or Health, Singapore, 2012.

“TobaccofreeRx is concerned that the American Heart Association is contributing to tobacco use by continuing its relationship with Walgreens.”

Letter from Vinayak Jha, MD to Nancy Brown Chief Executive Officer of the American Heart Association May 30, 2012.

“We have an obligation to engage those who can help us reach consumers with lifesaving health information and resources.”

Response from Nancy Brown, Chief Executive Officer of the American Heart Association to Vinayak Jha, MD, June 11, 2012.

“Take Heart and Give”

Walgreens advertisement soliciting donations for the American Heart Association, circa 2008.

“Walgreen to Toughen Policies on Tobacco”

Article from Bloomberg News, The Los Angeles Times, February 14, 2002.

“Walgreen to Toughen Policies on Tobacco”

Article from Bloomberg News, The Los Angeles Times, February 14, 2002.

Walgreens Smoke Buster Center and Marlboro display rack in Houston pharmacy.

Photograph, Alan Blum, MD, circa 1990.

“Fit heart health into your life”

Walgreens Sunday newspaper advertising insert, February 2012.

FDA Targets Walgreens as Biggest Youth Tobacco Sale Violator

Article in The Los Angeles Times, February 7, 2019.

From Cradle to the Grave

Note: On February 5, 2014, CVS announced that it would phase out the sale of cigarettes in its 7,866 pharmacies by October 1, 2014.

Unpublished cartoon, The Marlboro Journal of Medicine, by Ted Rall and Alan Blum, MD, 2013. (Rejected by The New York Times)

Walgreens to Implement New Tobacco 21 Policy to Further Prevent Youth Access to Tobacco Products

Press Release from Walgreens, April 23, 2019.

What More Should the Government and Health Associations Do?

Although many billions of dollars have been spent on heart disease research since the first Surgeon General’s Report on smoking and health in 1964, resulting in great advances in cardiovascular surgery such as heart transplants and repair of aortic aneurysms, these treatments are what is known as tertiary care — heroically fixing something that should never have been broken in the first place. Promoting primary prevention of heart disease — such as never taking up cigarettes — through paid ad campaigns in print, broadcast, and social media has amounted to less than a penny for every thousand dollars spent by tobacco companies to promote their products.

Public service advertisements (PSAs) are broadcast free of charge by TV and radio stations to promote causes of non-profit organizations, including the American Heart Association and the American Cancer Society. Because they are unpaid, PSAs are most often shown at off-hours, which led Tony Schwartz, author of Media: The Second God, to comment wryly in the 1980s that “Public service ads are the ones played at three a.m. telling kids not to take rides with strangers, when the only people up at that time of night are the strangers.” Only in 2012 did the Centers for Disease Control and Prevention begin purchasing advertising space for compelling messages in its “TIPS from Former Smokers” campaign– but for just 18 weeks a year and at a budget that was the equivalent of three days of the tobacco industry’s annual advertising expenditures.

-AB

Reference: Media briefing on Tips from Former Smokers Campaign, June 26, 2014

“Ed Smith’s Lifestyle,” “Smoking Machine,” “Like Father, Like Son, “All the Cigarettes in the World”

Public service announcements by the American Heart Association, 1960s.

“Fatty Cigarette”

Advertisement from the British Heart Foundation, 2004.

“TIPS From Former Smokers – Roosevelt S.’s Tip Ad”

Advertisement from the Center for Disease Control, 2012.

What More Should Physicians Do?

The American Heart Association, the American College of Cardiology, and the American Association of Medical Colleges are not putting the most preventable cause of heart disease and high medical costs –- cigarette smoking–- among their highest priorities. It is ironic that personalized, engaging educational approaches, which patients so appreciate in their physician, take a backseat to expensive technology and medications. Medical schools have paid little attention to smoking prevention and cessation and relapse prevention. One-third to one-half of patients who smoke say they have not even been advised by their physicians to stop. Merely providing a prescription for a modestly effective, costly medication for smoking cessation is woefully inadequate What’s urgently needed and long overdue are continuity-of-care experiences in lifestyle education and behavior modification of patients by medical students beginning in their first year and continuing in each year of medical school and residency training. Sadly, such a curriculum does not yet exist at a single medical school. The result is that residents and medical students study even the rarest cardiovascular conditions but know little about enhancing their patients’ ability to lose weight, to exercise, to relax, or to give up cigarette smoking–the leading avoidable cause of heart disease.

-AB

Addressing Tobacco Addiction A Neglected Cornerstone Of Preventative Cardiology

Article by Alan Blum, MD in Atlanta Medicine, Spring, 2011.

Cardiologists With A Heart

“Our arteries carry blood from the heart throughout the body, delivering oxygen to keep all of our cells alive. Four arteries feed the heart itself, and a heart attack occurs when these coronary arteries fail to get oxygen-rich blood to the heart muscle. Smoking can cause this in three different ways.

First, the chemicals in cigarette smoke (“tar’) damage the delicate inner lining of our arteries (the intima), making us more susceptible to other harmful conditions such as hypertension and high cholesterol. This in turn leads to overdrive of the body’s attempt to repair the damage by producing plaque along the artery wall. Plaque build-up of any one of our coronary arteries can be disastrous if it progresses to a full-fledged blockage. Lacking oxygen, the part of the heart muscle fed by the artery dies. The resulting myocardial infarction, or heart attack, can be fatal.

Second, nicotine narrows our coronary arteries by causing them to spasm, decreasing blood flow and increasing the chance of a blood clot (thrombus). A thrombus is found in 90% of heart attacks.

Third, when a person lights up a cigarette and inhales the smoke, carbon monoxide replaces oxygen in the blood and deprives the heart of life-sustaining oxygen. Carbon monoxide also causes direct damage to the heart muscle. Because it is odorless and colorless, carbon monoxide is known as the invisible killer.”

Margaret M. Beahrs, MD
Cardiologist, United Heart and Vascular Clinic, St. Paul, Minnesota

*****

“I say to patients who smoke, ‘I know it can be difficult it is to stop, and I know you receive a certain pleasure from smoking. But what about all the other pleasures you’ll lose when smoking extinguishes your life?’ Patients say they know about the dangers, and I review the list with them with them every time–progressive heart disease, emphysema, and cancer of the lungs and throat–but I also throw in a few things they might not have thought of: a shorter life span, decreased exercise ability, problems with sexual function, and the harm that their smoke can cause to all their loved ones especially children. And I emphasize that I will help them stop smoking not just with medications but with my emotional support.”

Barry Silverman, MD
Recent past director of cardiology, Kaiser Health Plan of Georgia; former director of the Department of Cardiology and internal medicine education, Northside Hospital, Atlanta, Georgia

“Tobacco Heart!”

Cigarette Smoking and Cardiovascular Health

Curated by Alan Blum, MD

Professor and Endowed Chair in Family Medicine
Department of Family Medicine
Director, Center for the Study of Tobacco and Society
The University of Alabama School of Medicine, Tuscaloosa

“Tobacco Heart!” is Copyrighted 2022

ALL ITEMS IN THE EXHIBITION ARE FROM THE CENTER’S COLLECTION UNLESS OTHERWISE INDICATED.

Designed by Kevin Bailey, MA

Collections Manager and Digital Archivist
Center for the Study of Tobacco and Society
The University of Alabama

“Tobacco Heart!”

INTRODUCTION

When Did We Know?

What Did We Know?

What Did We Do About It?

The Half-Hearted Media

How a pharmaceutical company helped TIME promote healthy hearts… and cigarettes

Pfaint of Heart

What Didn’t We Do About It?

What More Should the Government and Health Associations Do?

What More Should Physicians Do?

Cardiologists With A Heart

“Tobacco Heart!”

Curated by Alan Blum, MD

Designed by Kevin Bailey, MA

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