1/12/16: MEDICAL HISTORY: Marking Anniversary of 1964 Surgeon General’s Report and Remembering Luther Terry

220px-Luther_Terry_photo_portrait_as_surgeon_general

This morning I received a tweet from @Surgeon_General, commemorating a historic moment in medical history: “On this day [Jan. 11] in 1964,” it read, “Dr. Luther L. Terry released the first Surgeon General’s Rept. On Smoking & Health.”

The tweet came with a connection to a You Tube video of TV reporter Harry Reasoner’s “CBS News Extra” program about the report, in which the broadcaster calls smoking a “nonessential” habit and proclaims that 70 million people in the United States engage in it. The show’s title, “A Health Hazard of Sufficient Importance,” echoes a conclusion by Surgeon General Terry’s Advisory Committee on Smoking and Health:

Cigarette smoking “is a health hazard of sufficient importance . . . to warrant remedial action.”

I have not read this landmark Surgeon General’s report, but I think we all know that it did not establish a definitive causal relationship between cigarette smoking and lung cancer and other lung diseases, such as emphysema and chronic bronchitis. According to Dr. Terry in the video, the report announces “the strongest relationship” between smoking and lung cancer and disease (at least, among men, who were the subjects studied) and a “strong relationship and probably a causal relationship between heart disease [among men] and cigarette smoking.”

On the occasion of this anniversary, I’d like to go behind the scenes and share some reminiscences with you. My late father, Albert Sjoerdsma, M.D., Ph.D., knew Dr. Terry well in the 1950s and ’60s.

On July 1, 1951, Dad, newly commissioned in the U.S. Public Health Service (USPHS), reported to Dr. Luther Leonidas Terry (1912-85) in Baltimore. Terry was then chief of medical services at the Baltimore Marine Hospital and part-time director of the National Heart Institute’s General Medicine and Experimental Therapeutics branch.

After two years at the USPHS hospital in Baltimore, Dad joined Terry at the National Heart Institute in Bethesda, Md., where I grew up. One of only four institutes of the National Institutes of Health (NIH)—cancer, mental health, and dental disease were the others—the Heart Institute was created by Congress in 1948 to study cardiovascular disease, which was Terry’s and my father’s chief specialty. By the time Dad moved into the seventh floor of the NIH’s new Clinical Center, Bldg. 10, Luther Terry was full-time director of General Medicine and Experimental Therapeutics: He was clinical director of the National Heart Institute.

In my biography, “Starting with Serotonin: How a High-Rolling Father of Drug Discovery Repeatedly Beat the Odds,” my father recalls his good friend and boss, Luther Terry:

“Luther had a broad-base knowledge of medicine and was a damn nice guy. Everybody liked him. He never lost his temper. He was a guy you could always talk to. Luther was very conscious of honing his English, because he grew up in Red Level, Alabama. . . . He used to stop people when they used the word ‘irregardless.’” 

Al Sjoerdsma and his research team, whom Dad called a “wild bunch,” enjoyed exciting times in the 1950s and ’60s, being involved in breakthroughs in biochemistry and in medical knowledge and treatment, which I detail in my book. Naturally, in doing my research, I asked Dad and some of his younger clinical associates about the backdrop to the landmark Surgeon General’s Report. President Kennedy appointed Terry U.S. Surgeon General, effective March 2, 1961. The USPHS office then still wielded considerable independent clout.

As what would prove to be an ironic parting gift, Dad told me and others confirmed, he and his wild bunch gave Terry an elegantly engraved, silver cigarette box.

“No kidding. Everybody smoked then.” Walking into a medical meeting, he said, meant walking into a thick cloud of cigarette smoke.

According to Dr. J. Richard Crout, one of my father’s early clinical associates who went on to a distinguished career in academia and at the FDA, Luther Terry had tobacco-stained fingers when he presented his report to the nation. Another associate, Dr. Robert J. Levine, who has had a long association with Yale University, insisted, “His hand was yellow.”

“He was smoking four packs a day,” Levine told me. “He was smoking while he was on rounds seeing patients. . . . [When Terry attended important clinical meetings in Atlantic City,] he would post two of his boys at the door of the men’s room while he went in for a couple of cigarettes, John Oates and I were two of them. If we saw anyone coming whom we couldn’t trust or recognize, we would give a signal, and Luther would drop his cigarette in the toilet and come out.”

This was before Dr. Terry read a 1962 report by England’s Royal College of Physicians that linked cigarette smoking to lung cancer, bronchitis, and possibly cardiovascular disease. The British report convinced him to set up the Surgeon General’s Advisory Committee on Smoking and Health, which released its report after 14 months of study.

In 1965, Terry left the Surgeon General’s Office for the University of Pennsylvania medical school. That same year, Congress passed the Cigarette Labeling and Advertising Act, which put the Surgeon General’s warning about smoking on all cigarette packages. Although I do not know for a fact that Terry quit smoking, I have to assume he did. The one-time heavy smoker became a consultant to the American Cancer Society and was a strong force in the movement that led to the 1971 ban on U.S. radio and television cigarette advertising.

My father loved Luther Terry, who continued after his Surgeon General appointment to drop by Dad’s office in the National Heart Institute, whenever he got his hair cut at the NIH. This would be on a Saturday morning, when the Clinical Center’s seventh floor was quiet and Marceline Lee, the fiercely loyal secretary whom Dad “inherited” from Terry, was not posted sentry.

During one such visit, the Surgeon General confided his concerns about a polio outbreak in the Pacific Northwest related to Dr. Albert B. Sabin’s new oral polio vaccine. Sabin’s vaccine, a sugar cube that needle-fearing children could easily swallow, contained the live poliovirus. Dr. Jonas Salk’s vaccine, which was introduced in 1955, contained killed poliovirus and had to be injected. There was evidence that the Salk vaccine failed to completely immunize some patients, hence the interest in Sabin’s vaccine.

If you’d like to read about how Dr. Terry handled this potential crisis, I refer you to my book. I’ll say this much: My father did not allow my siblings or me to receive Sabin’s live-virus vaccine. And we have the faded injection marks to prove it.

Ann, 1/12/16

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