By Dawn Brazell
Public Relations

An encyclopedia of knowledge on anything you could ever want to know about the health effects of smoking and tobacco policy, K. Michael Cummings, Ph.D., knows how to tell it like it is.

Just ask the tobacco industry.

Cummings, who joined MUSC in October as a professor in the Department of Psychiatry & Behavioral Sciences, has authored landmark reports for the Office of the Surgeon General and the National Cancer Institute. In the late 1990s, Cummings scanned and posted online previously-secret tobacco industry documents detailing how product design influences smoking behavior and nicotine addiction. He has served as an expert witness against the tobacco industry in prominent legal proceedings, including cases that resulted in the Master Settlement Agreement.

He has a plaque "tobacco road" on top of a bookcase in his office in the Bioengineering Building, where he works as part of Hollings Cancer Center's Cancer Prevention and Control program, leading research on tobacco control, public policy and smoking cessation.

When asked what his vision is for South Carolina, he details an impassioned plan.

"We can't afford tobacco anymore. It's a luxury. The odds of dying from smoking — one out of two. Get a coin out and flip it. If you're a smoker, one out of two will die prematurely as a result from smoking — not good odds. Not good odds when you look at your parents or your sister or siblings, or co-workers who are addicted to cigarettes."

More than 440,000 Americans are going to die this year from smoking and that number can be multiplied by 20 to compute the number of people seriously ill from smoking in this country, he said.

As one of the world's leading authorities on tobacco policy, Cummings wants to start changing the statistics in this state, bending back the mortality curve. He brings to bear his 30-year experience from Roswell Park Cancer Institute in New York where he ran the New York state smokers' quitline, building it up to be the biggest quitline services in the world serving more than a million callers since opening in 2000. He's used to working with rural populations with high smoking rates and low access to health care.

"The opportunity here to grow a program brought me here. Tobacco remains a big problem in the South, even though most tobacco used in US cigarettes today is imported from overseas."

Cummings also is interested in the problem worldwide. He's involved in studies in 22 countries, tracking the beliefs and attitudes of smokers and non-smokers and the effectiveness of varying policies used to treat smokers. Cummings said the rising smoking rates internationally will have a huge impact on public health with serious economic repercussions.

"One-third of all cancers are due to smoking. Imagine if we had a vaccine that could prevent one-third of all cancers. The answer is we do — don't smoke. If we could reduce cigarette consumption by 10 percent we could prevent millions of deaths from cancer over the next two decades."

While biomedical research to improve detection and treatment of cancer is important to do, the most immediate benefits for cancer control will come by lowering smoking rates in the population, he said. It costs every South Carolina household about $1,000 per year to cover the health care costs from smoking-related illnesses.

"We can't afford to subsidize tobacco profits any longer."

Cummings said Hollings is already doing important research on tobacco and tobacco cessation. Most of his research at Roswell stemmed from what he learned about addiction from smokers who came to his cessation classes. He wanted to find out why they were having such a hard time quitting and develop effective treatment strategies. He's encouraged by the latest scientific advances that range from studying the effectiveness of combination therapies to the development of nicotine vaccines that could be used to help the body develop an antibody to nicotine.

Cummings' plans include establishing comprehensive smoking cessation services available to residents statewide and launching a large study combining smoking cessation with spiral CT scanning to screen heavy smokers and formerly-heavy smokers for lung cancer. MUSC was part of a large national study by the National Lung Cancer screening trial that found a 20 percent reduction in mortality from lung cancer because low-dose spiral CT screenings led to earlier detection and treatment.

"Here's the exact reason you do translational science. This is translating the science of imaging and biomarkers into something that will make a difference on a population-wide basis. About two-thirds of lung cancers are diagnosed in a late stage where treatments typically don't work well. We've got to make a bigger difference, and we've got to do it sooner."

Cummings' hope in the next decade in the state is to drop the late-stage detection rate of lung cancer from two-thirds to under a third. This will flip the survival curve around so that most of the lung cancers can be managed the way most breast cancers are today.

He'll continue to do what he does best — educate people about the dangers of tobacco use so they can make educated decisions. He has compassion for smokers.

"They get addicted to the product. The product has a high abuse liability. I think people ought to have free choice. This is about free choice," Cummings said, citing research that most smokers would quit if they could. He likes to educate smokers about what it's going to be like to quit, how to prepare for a relapse, and what it is about cigarettes that makes them so addictive and lethal.

Cummings believes smokers have a right to know cigarettes are engineered to be inhalable and highly addictive. That's why 85 percent of users today are addicted, persistent daily users. "You have 15 percent of people who use alcohol and have an abuse problem. With cigarettes, 85 percent get hooked and typically struggle for decades before they quit or get sick. That's why cigarettes are such a huge problem. There is no reason that cigarettes have to be designed to make them so hard to quit, except that tobacco companies have chosen to put their profits ahead of the health of their customers. This has to change, and it can be changed."

To see an interview with Cummings, visit http://www.youtube.com/user/prmusc?feature=mhee. To see MUSC's tobacco-free campus website, visit http://www.musc.edu/tobaccofree.