An Uphill Battle Against Big Tobacco

CHEST through the years

August 25, 2023 | SUMMER 2023 ISSUE

1960s: Making the connection

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Beginning in the 1960s, the American College of Chest Physicians (CHEST) played an integral role in establishing the connection between smoking and lung cancer and making the public aware of these findings.


Statement on cancer of the lung

In response to the alarming increase in lung cancer cases, CHEST publishes a statement in the journal CHEST® (1960;37:248), the official journal of the college, emphasizing the need to find the causative agents of lung cancer. Smoking is cited as a probable cause.


Resolution relating cigarette smoking and cancer

After several years of studying the effect of cigarette smoking on the respiratory and cardiovascular systems, the CHEST Committee on Lung Cancer passes a resolution regarding the harmful effects of cigarette smoking. The US Surgeon General presents the resolution to a national advisory committee appointed to study the health aspects of smoking.

Prompted by CHEST and other medical society efforts to provide conclusive medical evidence on the harmful effects of cigarette smoking, the US Congress passes the bill in 1965 requiring the Surgeon General's warning label to be printed on all cigarette packages.


Worldwide smoking awareness campaign

CHEST develops smoking awareness signs for display in reception rooms of physician offices. The signs are distributed free of charge to physicians throughout the world and read: "Smoking can be a serious health hazard. Please do not smoke in the reception room—it may affect other patients."

1970s: Leading by example

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In the 1970s, CHEST attracted national attention by, first, segregating smoking to a certain area of the annual meeting and, then, instituting a nonsmoking pledge for all fellows of the college.


Special report on cigarette smoking

A two-part report, "Cigarette Smoking: Questions Patients Ask Doctors," is published in the journal CHEST (1970;58:147-151 and 1970;58:369-72). The report, written in response to the challenging inquiries patients are making about smoking cessation, outlines responses to commonly asked questions.


Symposium on cigarette smoking

CHEST holds a symposium, "Cigarette Smoking: The Physician's Role and Benefits of Cessation." The group discusses information regarding cigarette smoking and how physicians can use this information in guiding patients toward smoking cessation. The results, including a plan of action, are published in the journal CHEST (1971;59:414-417).


Adoption of "no smoking" policy

CHEST attracts the attention of the national media when it limits smoking to a specially designated area of the assembly hall at its annual meeting.


Nonsmoking pledge

CHEST adds a nonsmoking pledge requirement as a condition of obtaining Fellow of the American College of Chest Physicians (FCCP) designation.

1980s: Spreading awareness; creating obstacles

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In the 1980s, CHEST supported legislation to make the public aware of the hazards of smoking and played a role in increasing cigarette taxes.


Management of smoking in the physician's workshop project

Recognizing the importance of the physician assuming a leadership role in smoking cessation, CHEST’s Committee on Smoking and Health campaigns to eliminate smoking in physician offices. The committee publishes procedural guidelines for smoking management in the journal CHEST (1982;82:360-361).


The Smoking Prevention and Health Education Act of 1983

CHEST supports this bill, which would promote public awareness of the hazards of smoking through labeling and advertising.


Cigarette excise tax

CHEST joins with the Coalition on Smoking OR Health and 37 national organizations in the formation of the Ad Hoc Group to increase the cigarette excise tax from 16¢ to 32¢ a pack.

1990s: Supporting a smoke-free environment

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In the 1990s, CHEST played a key role to ban smoking on domestic flights.


Campaign for smoke-free society by 2000

The CHEST Government Liaison Committee develops a plan to achieve a smoke-free society by the year 2000. The plan focuses on:

  • Reducing or banning cigarette advertising
  • Raising taxes on cigarettes
  • Limiting tobacco sales throughout the nation

Smoking ban on domestic flights

CHEST plays a key role in the passage of federal legislation on February 25, 1990, banning smoking on domestic flights within the continental US, Puerto Rico, and the Virgin Islands. CHEST involvement includes:

  • Educating Congress during the deliberation of the original bill
  • Working with the US House members of the committee to support a stronger version of the bill
  • Working with other organizations, such as airline pilots, who also support the ban

International Committee on Smoking and Health

CHEST, the American Thoracic Society, the European Respiratory Society, the Asia-Pacific Respiratory Society, and the International Union Against Tuberculosis and Lung Disease join forces to form an international Committee on Smoking and Health. The committee begins work to produce a consensus statement, for release in 1995, representing an international agreement relating to:

  • The addictive nature of smoking
  • The relationship between smoking and disease
  • The role of physicians relating to smoking
  • The need to oppose expansion of the international tobacco market

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Delta Air Lines award

CHEST honors Delta Air Lines with a corporate award at the CHEST President's International Reception and Awards Ceremony for implementing an unprecedented smoking ban on transatlantic, intra-Europe, and New York/JFK to Mexico flights.


Task Force on Women, Smoking, and Lung Cancer

Chaired by Carolyn Dresler, MD, FCCP, and Diane Stover, MD, FCCP, the CHEST task force unveils a new speaker's kit on Women and Girls, Smoking, and Lung Cancer.

This task force program involves numerous presentations of the speakerʻs kit to some 3,000 middle school-aged girls, and the kit was later adapted for use in India, Latin America, China, and other Asian countries.


Presenting congressional testimony on tobacco

D. Robert McCaffree, MD, Master FCCP, CHEST President, testifies before the House Commerce Committee Subcommittee on Health and Environment regarding the tobacco settlement and its importance to the public health community.

Discussions with the World Health Organization

CHEST delegation meets with the World Health Organization in Geneva, Switzerland, to discuss worldwide tobacco education programs.

2000s: Advocating for regulation

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Throughout the 2000s, CHEST fought against tobacco through regulatory channels, issuing formal letters and connecting with policymakers.


Framework Convention on Tobacco Control

D. Robert McCaffree, MD, Master FCCP, submits written testimony on behalf of the college to the Framework Convention on Tobacco Control in October 2000. The testimony includes important initiatives to be considered.


Developed Lung LessonsSM: Making Smart Decisions About Lung Health

A program is designed to educate children, grades three through six, about lung health and the dangers of tobacco, helping them to make smart decisions about not using tobacco. It is developed through a partnership with the Congressional Caucus for Women's Issues (Women's Caucus), the college, and the CHEST Foundation—the philanthropic arm of CHEST. Women's Caucus/CHEST physician teams visit schools and community youth groups to present Lung LessonsSM.

Participates in development of and testifies at Senator Durbin's hearing on tobacco marketing

On May 14, 2002, the Senate Subcommittee on Oversight of Government Management, chaired by Senator Richard Durbin, with the help of CHEST and the CHEST Foundation, holds a hearing entitled, "Tobacco's Deadly Secret: The Impact of Tobacco Marketing on Women and Girls." The focus of the hearing is to examine the impact of tobacco industry marketing on smoking rates among women and girls in the US and overseas and review the steps that the US government is taking and should take to address this epidemic of smoking-related disease among women.

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FDA control over tobacco products

CHEST works closely with both the Republican and Democratic Senators and the Campaign for Tobacco-Free Kids to grant the US Food and Drug Administration (FDA) authority over tobacco products.

Smoking cessation codes established

Works with the Centers for Medicare & Medicaid Services (CMS) to establish two new Healthcare Common Procedure Coding System (HCPCS) codes, G0375 and G0376, to compensate the time physicians spend in counseling their patients to quit smoking. Effective March 22, 2005, this coverage is added for smoking and other tobacco use cessation services to help patients quit. The final Medicare coverage decision is available on the CMS website at www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=130.

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Tobacco Dependence Treatment Toolkit

The Treatment of Tobacco Dependence: American College of Chest Physicians Toolkit is developed to assist physicians, nurses, and cessation counselors to help their patients quit smoking. Last updated in 2021, the toolkit includes new treatments, clinical issues, and additional tools, including a new section geared specifically to the pediatrician or pediatric pulmonologist.


Lung cancer screening

A Screening for Lung Cancer guideline is published to the journal CHEST and updated in 2021 with 16 evidence-based recommendations and an update of the evidence base for the benefits, harms, and implementation of low-dose chest computed tomography screening.


CHEST appeals to FDA

CHEST issues a letter to Robert Califf, MD, newly appointed Commissioner of the US FDA, and to Brian King, PhD, MPH, newly appointed Director of the Center for Tobacco Products, to share the priorities of the college.

CHEST representative, Frank Leone, MD, FCCP, later hosts an open conversation with Dr. King to discuss regulation, progress, and potential for tobacco control.


Cancer Moonshot Smoking Cessation Forum

CHEST representative, Frank Leone, MD, FCCP, is invited to the White House to participate in the Cancer Moonshot Smoking Cessation Forum to support President Joe Biden’s initiative to accelerate the rate of progress against cancer.