Tobacco Documents Online

T HROt'GHOt'T THE \VORLD millions of people smoke tobacco because it gives them solace and pleasure. Many find smoking a nuld tranquilizer and energizer. The public is no\i• the target of considerable propaganda from various volttntar.• and government agencies con- cerning the allegedly harmful effects of cigarette sa d r, ,,.i, ittg. t"nfortunatei\, the charges and claims have tended to obscure a number of scientific matters EDITOR'S \nTE Pharmacists across the nation are assuming an increasingly stringent anti-tubacco stance. At its annual convention last April, the American Phar- maceutical Association passed a resolution com- mending pharmacists who have stopped selling cigarettes, and urged others to initiate similar action. Against this background, The Council for To- bacco Research presents its case to pharmacists. The cigarette controversy is eslwcially impor- tant because pharmacists, as health professionals, exert considerable influence in their communities. The accompanying article, entitled "Smoking and Health : Many Unanswered Questions," was written by Sheldon C. Sommers, a1.I)., chairman of the Scientific Advisory Board to the Council for Tobacco Res,eareh,'and director of labora- tories, Lenox Hill Hospital, \.Y. of unquestionable validity. Because simple an- swers do not solve difficult problem~, of tlte human diseases to be discussed, and because s(~ many questions remain ttnanswerecl• I do no; believe it has been scientifically established that cigarette smoking causes human disea>c•. The Council for Tobacco Research-t•.`.A. was formecl in 1954 to hell) find answers to thi~: qttestiorts, partictttarh in regard w tutttg ewtinr-t^°, heart disease and chronic pulmonars• aiinrett:,. and to fill in the mant• gaps in knot;•lecl"e that still exist. al}• colleagues and I on The C<nincil'.~ Scientific Adt•isorv I3oard. xs•ho are respnnsil,le for funding the research program, are doing all v,•e can to aid the acquistion n of funclamen,,:il knowledge needed for the solution of these various major diseases. With reference to lung cancer, if smoking i, a causal factor, why is it that the di~,ease strikeN males five or six times more often than iemales: ha'~ adec7u,ttel~ No the~~rv ai causation known explained this striking seti difference. Unl\• aven• $ntall suhgrc~ull oi even hec"•~ smokers gets lttng cancer, and NOhW this is So is unknown. The great majority uf ci;*;+rette snwkers never deti•elop the di,,ease. :\,ortstrn.hers dci get `Itrng caneerV Tllli e 9111s'ezseqts ?n,pire prevalent in urban areas than in rural areas, sinoking Ai~ar~-- Trerd• . 82

IN DEFENSE OF CIGARETTES (Continued) habits notwithstanding. There is a marked difference in lung cancer rates in different countries, and the highest rates are in countries with less cigarette smoking than in the t'nited States. The recent press conference re- port of the induction of lung cancer in dogs exposed to cigarette smoke inhalation raised more questions than answers. In the experiment smoke entered through a tracheos- tomy, a traumatic method quite un- like the human custom : there were insufficient control animals de- scribed and inadequate control pro- cedures mentioned. The experi- ment. unpublished as of this date, also apparently failed to fulfill other important scientific criteria in work of this kind. In the last 30 years many cig- arette smoke inhalation experiments with different kinds of animals have failed to induce lung cancers of the most common type reported in humans. Further, there have been numerous tests on a varietv of animals and fowl in which cigarette "tars" were fed the animals or in- jected into their bloodstream or tis- sues. The results were negative. Of course, it is difficult to prove a negative, but if cigarette smoke is the cause of lung cancer that some claim, it is indeed surprising that none of these many experiments have succeeded in its repeated pro- ductian. A major drawback in experimen- tal work of this kind is the lack of a suitable test animal. The Council for Tobacco Research is devoting considerable time, monev and effort in research aimed at developing a better animal model that will be use- ful in research related to tobacco and in other fields of study.1'l'e con- sider this a most important area, as do others. As regards statistical studies in- volving the number of reported lung cancer deaths, experienced pathol- ogists would not include as valid scientific data the death certificate diagnoses that are not confirmed by study of tissues grossly or micro- scopically at surgery or autopsy. The overall autopsy rate in the t'nited States is below 10 per cent. and without supporting information there are too many death certificate errors in distingushing primar}- lung cancers (that orginate in the lung ) from secondary cancers (which spread to the lung from other organs). A recent report showed that death certificate noti- fications of lung cancer in one hos- pital, when checked bv autonsv. were more than half wrong. There are other difficulties in use of death certficates in scientific research, as a number of authors have pointed out. There are various pathologically classified types of lung cancer, and several have no implied relationship whatsoever to any environmental agent. It is a gross oversimplifica- tion to lttnnp together at least nine different tumor types and ascribe them all to any agent, including cigarettes. Medical fashions change, as do diagnostic methods, tools and even interest. For example, 30 years ago authorities considered tuberculosis the most common cause of lung cancer. There are still reports in- dicating that lung cancers may arise in or near the site of healed tuber- culous lesions. Other reports as- sociate lung cancer with previous lung damage as from influenza and other inflammations. It is important to note that under- standing the development of lung cancer is one of the most complex and difficult problems in all cancer research, not presently well under- stood and not vielding simple an- swers. More study is urgently needed to see what viruses, air pr+l- lutants, previous lung infections, hormones, constitutional factors, and others ma}• contribute to lung cancer development in animals and in man. Heart disease: There also are many unanswered questions about cardiovascular disease, the cause of about half the total deaths in the United States. It attacks men more often than women, for unknown reasons. With respect to smokinr as a possible cause or contrihutor% situation, newer multifactorial stud- ies point to a family history of heart disease, diet, blood cholesterol, bod., weight, and blood pressure as in- dependent, predictive factors which in various combinations are associ- ated with increased rates of heart disease. Each factor alone, includ- ing smoking, is not a cause. A num- ber of studies show no relation of smoking to heart disease. Aging and accompanying coronary arterioscle- rosis overshadow the other proces- ses that mav contribute to the most common type of heart disease. Another difficulty with coronan - heart disease concerns how accu- rately the diagnosis is made. When the most advanced clinical tests are employed, evidence for coronary disease is found in almost half of all men over 40 vtars of age By thi= age practically all the coronarN arteries show some pathologic le- sions. Since both coronarv disease and cigarette smoking are so com- mon in the L.S. male population. it is quite difficult to find adequcrte numbers of people for comparison who meet neither, or only one, of these conditions. A well-known statistical fallacy is likelv to exist when groups of such unequal size are compared. The factor of stress in cardiovascular disease seems to be important. Studies have shown such disease to be more prevalent among intense, hard-driving persons than among those who are more relaxed and easy-going. It would seem that con- stitutional factors may be strongly ' (Contin:rrd on PaPcll89) '', I 84 • Marketing irends AMERICAN DRUGGIST •$eptember 7, 1970

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CIGARETTES (continued) implicated in heart disease. Emphysema is now added to the list of diseases blamed on cigarette smoking. Recent reports emphasize how difficult are the diagnosis, clas- sification and grading of the severity of pulmonary emphysema. even among ex- perts. The cause admittedly is unknown. The most common form develops to some degree in every person with age, and lumping several types together as if the~- com- prised an entity Dr. S. C. Sommers is unwarranted. Thus, death certifi- cate diagnoses or a routine patho- logi:- diagnosis of emph}•sema at present are scientifically of little practical use except in a few special- ized research centers. In the current era of relative ignorance concerning how to define and recognize empd~~~-- sema and other chronic lung dis- ease;, no sweeping generalizations as tr, causation can be justified. In this brief review of a few se- lected discrepancies, difficulties, shortcomings and unsolved prob- lems in the field of smoking and health, there is no wish to denigrate the concentrated efforts made bv mam• workers to find answers. It is simply that the field is too rbe%. the techniques are still being devel- oped, and the conclusive proofs are not in. It is less than 40 years since lung surgery began, for example. The needs for research are great, perhaps exceeding the pres- ent number of qualified investiga- tors and their available time. E.•en - one wants better health for the public. Diseases such as cancer, heart disease and chronic pulmo- narv ailments develop over long periods of time and do not have sim- ple cause-and-effect relationships. Simple solutions to these complex medical problems may be hoped for but they are scarcely to be expected. The Council for Tobacco Re- searcli is dee,ply committed to the search for answers. Morkehnp Trends 0 119 -xs. . . ;-=CUTIiTE CHMGES: At Ilizabe-th Arden : ..4a'bn ~. Yalcom to v._Xw.~'tirag for the : 1T. S.' aProducsta tliv, .: t~esebrouAh-Pond' s: -George E. ?,aursen to diroator of U. S. manufaeturing, a new poat..:lioxell: George --E. 16. 'Parbee to new product wgr and Roger ~-Yeager to product mgr/Noxzema and Therma Blem. a ' Stripe patterns are being used for Coty's fragrance packaging this Christmas. Emeraude collections are wreathed in green and white; 1' Aimant is decked in rose and white ; and L'Origan gets a taupe and white toned stripe. • Yardley goes in for fruit, candy, and flowers on its Christmas packaging this year. Their lip polishes are wrapped in a fruit and candy-colored Slicker Bon Bon Box and their floral fragrances are wrapped in floral patterned boxes.  Reusable containers are a feature of Elizabeth Arden's Christmas packaging. The Arden for Men collection includes an ice bucket holding Sandalwood grooming essentials and a black leather-like chest studded with nailheads holding Sandalwood cologne, after-shave, deodorant, talc, shave cream, and soap. Blue Grass holiday gifts include a wicker basket containing all the necessary ingredients for a beauty bath and a straw, 4-compartment basket containing preparations necessary for skin care. "Shadow Blossoms" is what Max Factor calls one of its Christmas gift ideas. A blue flower pot holds 8 shades of creme eye shadow sticks, each secured in a flower-like holder. • Parfums Corday is capitalizing on the popularity of lockets and pendants this year by including a locket holding a sachet waf er in its Christmas line. Also available are creme perfume compacts in various designs. Solid perfume compacts being offered by Helena Rubinstein this year include a purse ... an owl with "Jewel eyes"... and a shell design. Heaven Sent is the fragrance inside •