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merican Druggist •o~"of~ 1„1 ~~ ienn~Onil, er T~e w~~.f ...a N.n u iis wen 57th St, NTC 10019 - t212> >S7.SOt0 , ~. _ . •.N M .yH..•,N tN•N Eicti D `sUO- .r.'usMI-L" ^~~~i' ~iI ~e~~da-1+'~fLe~.:: T HROL'GHOL'T THE «'ORLD millions, of people smoke tobacco because it gives them solace and pleasure. Many find smoking a mild tranquilizer and energizer. The public is now the target of considerable propaganda from various voluntary and government agencies con- cerning the allegedly harmful effects of cigarette smoking. L'nfortunately. the charges and claims have tended to obscure a number of scientific matte» EDITOR'S XOTE Pharmacists acruss the nation are assuming an increasingly stringent anti-tobacco stance. At its annual conventiwt last April, the Amerinn Phar- ataceutical Association passed a resolution com- mending pharmaeists who have stopped sellin` ciAaretta, and urged others to initiate similar action. Against this background. The Council for To- bacco Research presents its case to pharnncists. The cigarette controversy is especially impur- tun because pharmacists, as health profasionals, exert con+iAcrabte inAuence in their cvmmunities. The accompan)ing anicle, entitled "Smoking and Health: Ntany l:nansw•ered Queationr," was written by Shrldun C. Sf,mmers, \I.1).. chairman of the Scientiiic Advisory }s.ard t/l the Council for Tobacco Rwarch, and director of lahora- tories, Lenox Hill Hofpital. \.Y. AMtlIGAN QlUGGISt • SfP'e-be• 7. 1970 of unquestionable validity. Because simple an- swers do not solve difficult problems of the human diseases to be discussed, and because so many questions remain unanswered, I do not believe it has been scientifically established that cigarette smoking causes huntan disease. The Council for Tobacco Research-U.S.A. ww fornted in 1954 to help find answers to these questions. particularly in regard to lung cancer, heart disease and chronic pulmonary ailntents, and to fill in the many gaps in knowledge that still exist. My colleagues and I on The Council's Scientific Advisory Board, who are responsible for funding the research program, are doing all we can to aid the acquistion of fundamental knowledge needed for the solution of these various nta jor diseases. With rttf.rance to lung cancer, if smoking is, a causal factor, why is it that the disease strikes males five or six times more often than females? No theory of causation known has adequately explained this striking sex dif[ercnce. Only a very small subgroup of even hea.•,rsntokers gets Iung cancer, and why this is so is unknown. The gre.u majority of cigarette smokers never develop the disease. \onsmokers do get lung cancer. The disease is more prevalent in urban areas than in rural areas, smoking Mark.1-.7 r,e.df • /3 CT i~ HN 014 96•r' 2 r.T ®

0 IN DEFENSE OF CIGARETTES (Continu.d) habits notwithstanding. There is a marked diR'erence in lung cancer rates in different countries, and the highest rates are in countries with less cigarette smoking than in the United States. The recent press conference re- port of the induction of lung cancer in dogs exposed to cigarette smoke inhalation raised ntore questions than answers. In the experiment smoke entered through a tracheos- tomy, a traumatic method quite un- like the hunun custom; there were insufficient control animals de- scribed attd inadequate control pro- cedttres mentioned. The experi- ment, unpttblished as of this date, also apparently failed to fulfill other important scientific criteria in work of this kind. In the last 30 years mam• 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 numerotas tests on a variety 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- duction. 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, money and effort in research ainted at developing- a better anitnal model that will be use- ful in research related to tobacco and in other fields of study. We 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 94 • Mor1.rnog rnadi United States is below 10 per cent, and without supporting information there are too many death certificate errors in distingushing primary 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 by autopsy, were more than half wrong. Thece 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 lump together at least nine different tumor types and ascribe them all to any agent, including ' cigarenes. 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- diating 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 inftamnutiotts. 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 stood and not yielding simple an- sw•ers. More study is urgentlv needed to see what viruses. air pol- lutants, previous lung infections. hormones, constitutional factors, and others may 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 L; nited States. It attacks men more often than women, for unknown reasons. With respect to smoking as a possible cause or contributnr.• situation, newer multifactorial stud• ies point to a family history of heart disease, diet, blood cholesterol, body w•eight, 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 stnoking, is not a cause. A num- ber of studies show no relation of smoking to hean disease. Aging and accompanying coronary arterioscle- rQsis overshadow the other proces- ses that may contribute to the most common type of heart disease. Another difficulty with coronary heart disease concerns how accu- rately the diagnosis is made. When the most advanced clinical tests are • eniployed, evidence for coronarN disease is found in almost half of all men over 40 years of age. By this age practically all the coronary arteries show some pathologic le- sions. Since both coronary disease and cigarette smoking are so com- mon in the U.S. male population. it is quite difficult to find adequate numbers of people for comparison who meet neither, or only one, of these conditions. A well-known statistical fallacy is likely 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 discase to be more prevalent among intense. hard-driving persons than atnong those who are more relaxed and easy-going. It would seent that con- stitutional factors may be strtmgly (Conf inucd on Page 89) AMerIcAW oRUccIsr • s.o#M"e., 7 . 1970 Z ta~ ~ l..r i 5 R i i N 014966

~ CIGARETTES (com.,,.ed) ~ ~. / pens. The cause of pulmonary ' „ emphysema, even antong ex- { intplicated in heart disease. Emphysema is now added to the list of diseases blamed on cigarette smoking. Recent reports eniphasize how difficult are the diagnnsis, clas- sification and grading of the severity unknown The admittedly is I L ! most common form develops ~ to some degree in every person ~ with age. and lumping several types together as if they com- Dr. S. C. Seminors prised an entity is unwarranted. Thus, death cenifi- cate diagnoses or a routine patho- logic diagnosis of emphysema at present are scientifically of little practical use except itt a few special- ixed research centers. In the current era of relative ignorance concerning how to define and recognize emphy- settta and other chronic lung dis- eases. no sweeping generalizations as to causation can be justified. In this brief review of a few se- lected discrepancies difficulties, shoncontings and DEolved prob• lenis in the field of stnoking and health, there is no wish to•denignte the cotuentrated efforts made by many workers to find answers. It is simply that the field' is too new, 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. Every- one wants better health for the public. Diseases such as ancer, heart disease and chronic pulnw- nary• ailments develop over long periods of time and do not have sim- ple cause-attd-effect relationships. Simple solutions to these complex ntedirtl problems may be hoped for but tltr%- are scarcely to be expected. The Council for Tobacco Re- search is deeply committed to the search for answers. Merlennp rre-df • I. CTR i i C ` 0149G9