Tobacco Documents Online

1 3 1 i ! 11 ... r Smo~ n~. ~n~ and :.eMIth by Dr. Frank G. Colby Ouestioro as to whether or not smoking• and toLaxo :n Qc7:rral. have any adverse effe:.ts on human heariR have been raised since the time tobacco first was introduced into Europe in the 16th century. The current contwiversy on smoking and health started more than a quarter of a century ago and gained notoriety with the Rrit US. Surgeon General's Report -Srnoking and Neatth' in 1964 (Terry Report). There can be little question that a large majority of the medical profession, the media, and the public - smokers and ron3mokers a6ke - believe that smoking 'causes' various chronic diseases, such as lung cancer and/or eardiovascular diseases. arxdbr chronic re- spiratory diseases. etc. The fact ls that smok- ing and health is a matter of controversy. This means that none of the many allegations which have been made against tobacco, and specifically against cigarette snwkinp as being a cause of kuq cancer and/or other oiseasesM have been proven on the other hand. it also means the corollary. and this also cannot be emphasized strongly enough. It also means that we cannot prove that cigarette smolonQ can be exonerated of suspicion as a possible health harsrd Sh+itarly, no cornponent or group of compo- nents as found in smoke has ever been pro- ven to be the tause of disease in man. For example, In 1M a co-worker of Doll made the following statement during a discussion at a scientific meeting near New York 'After 30 years of anaysis, still one has no clear Idea of what the carcinogenic components of tobacco smoke are' " Analogoushr. it is at this time trnpossible to exonerate unequivocaCy any of the smoke components singled out by the enti-tobacco forces of any involvement in tho human dis- eases afrsgedty linked to smoking. Most of the allegations against smoking are based on 'statisticsl associations' found in epiderniotogicaf studies. It is, however, axio- matic - IA other words there is no cor.tnOversy among scientlsts - that a statistical association does not establish causation and this applies, of course, to smoking and disease. Rather. Ik.indicates the need for further clinical and laboratory investigations to determine the nature of the relationship, Those who assert daims against smoking also Ignore the tact that the genetic or constitu- t'onal make up of the smoker, rather than SM,A.ng itselt, could well b4 a better exolana- tion for the reported statistical associations than the smoking causation hypothesis. This anemative is called the constitutional hypc- thesis. Phrased ditferentty, this ;neans that smoking may wep bo a'symptorn ; Mke fever, rather than a 'caese : h a very much oversimplified manner,twocon- dtions.are necessary to establish an unequi- vocal cause and effect relationship as mani- /ested by a disease,:.nd it is absuiuteyr impera- tive and axiomatic that DeM conditions are fut- f+ped: 1) There must be an unequivocal epi- demiological ink ie. asnociauon, Detween the alleged cause and the more or less wwe- spread occurrence of the disease; 2) what is equat.y knportant is to uncover the biological pathway or mechanism through which the alleged causa produces the disease, either in man or in a suitaWe anirmsl modeL No satis- factory mechanism has been described for any disease alleged to be associated with smoking. Nobody knows the causes of cancer or of heart disease, etc. This is one of the major reasons why ehe allegations against snwi3nQare controversial. In the past, tM,re have been many statistical associatwns which were fwmy, txst falsey, be- tieved by most medical scientists at that time. to be causal. For example. it was shown that scurvy occurred chiety fn people who ate meat satted for tho purpose of preservation. It was, theretors, believed that this was the eause of scurvy. Now we know better. Vlh knaw it was not the meat that these people ate that was the cause of scurvy, but a lack In their diet of fresh vegetables and fruit and other sources of vitamin C A second example - at one time it was 'sta- tisticaly proven: Mat .ralana eame from the so.alled 'n:ght ait of swampy areas. The very name of tladisease shows triat: mataria comes from-mal'arid ;two Italian woras wh tn mean bad air. Today we unequivocally know better. We know that malaria is caused by the presence of a parasite in tne red blood ceps transmitted to man by mosquitoes. A third example:,UMi about the end of the 1960s, neary all medical textbooks claimed that utcers were caused mainly by ths con- surnption of heavily spiced foods and recom- mended a bland diet heavy in dairy pro- ducts, for the rest of the sufferers lives. tiow- ever, new editions of these same textbooks published since the 1970s. 83 well as other new texttwoks, no loncer mnmw.n thle -rnn. ventional wisdom- causation hypothesis for uicets, aven though this concept Is stM hea by at least some physicians today. 8ut most irnportantty. In addition, tJrore ara many studies wfreh an inconsistent vwth the smoking causation hypotheses. and almost every day papers are published In prestigious medicat Ourr>ab which contain data which support the concept of controversy with re- ference to one or another allegedly .rnoldnp related disease. On the other hand, it b un- deniable that a much targer number of stuwes aaege that smoking and certain •iiseases are associated The foUowing comments can men- tion ony a/ew of the findings which are tnoons~stent with tne arrstong caus=tiG.r hy- potAeses. • for examoie, :he •nost publicized of the sta- tisticat studws alleging a Fnk between snwldnq 3nd Wnp cancer. hean disease. eta, Is the on.~Mlion9kes persons study of tha AmerF can Canca Society or Hammond study. This sludy anows, among other tttinqs that the mortality of their tthen) cwrent male smo!aers, even of one pack a day or nwre, was below that of U.S. white males tbr the same time period. The same holds true for ae the other nwja `Prospect;v.' statistical studies re- vfewed in the 1964 t1.5. Surgeon Generars Report, and is so acknowledged in the Report Zhe persons exanNnsd in that ACS study are also non.epessntative in many other re- apects compared to tAe u.& poptAatton at farge. A conviction heid equally as strongty by the medical estabistrnent as the aftspa- tion tMt smokinp -causes' various dneas4M Is the daim that high fat consumption ahor- Wns fife. taorwvef the Hammond study shotvs both for men who newr smoked, as we1 as for men who smoked more than a padc of cigarettes per day. death rates deereased as consumption of tried foods lndeased Arwther epidentiolo9ical study often dted against smoarq is a study by poo on British docton, where he found consistently - con- trary to the Fiartrnond sfudy, and contnry, to -bW' - that the incidence of fung cancer was 1ov+er among ciparette smokers wAo inhaled 1i-.an among non+nhalera: this apoliea esoecl- sii'l to heavy smok7~s. Sim*kardaia have twe;o kwnd by otner 8ritish aund French studiei AAany investigators - ir><Jud'eq Gotl In a study other than the one mentioned cbove - have found that cigarette corwu•nptan data In va- rious counales do not corrobte with tung un- cer, death rates M ttwse countries. A very important actor which at kast In paR aupports the controversial nature of tM ctakn- ed assocl.tion atween arnokino and tunp eancer ta 1M problem of diagnosis. even by Nadinp medical estaWisfr+n.nts in the VMestern world. Forexampte,a paperfrom ths University

11 I 4 I a% 4X flftx puDfl{hed of)iy about 10 yeara aQO. ed a diagnostic enor of about 50 per cent for king cancer. A more wcent itudy from YYla l.'nlveisity found that tM amount of lunp c.noer dia0nosla wa! t'uacty r.lated to Me physioans' knowledge of the amokin0 habits of tnrn.ir patients. For nomsmokers mis- diapnoses of almost 40 per cent were fantd, however, even for heavy smokers misdia0- nosas were atxwt 10 pa cant In other words, 1Ms meana that the claimed rNativa knaease of km0 cancer as a cause of death it, at Isast in part, anributabie to Imprwed dhpnoaea. How- aver, other tactors such as the radippy kr crsased aQe of the populations In the deve- bped countrles iave an even more knpoAant tnpact Rw4ted to thesa two factors Is the *equent tbtdktp that during the time deaths attnbuted to cancer of the lung have allegedly proportbnay k+creased, deaths seeped to be dW to tNberCulosO of UP1e kln.- heva plopor- ttorntty decreased Further, though enormous etforts have been made and many stud',es have been made, not a sinple experiment was abts to ktduce lonp cancer resembling human krnp cmncer h taboratory animals through amoke inMte- tiorL evan though such studias hava been auuCessA,lwith subsVatesotherthen clpanane artscice. Similar cornmsnb apply to anYnat ex- pertments Lwotvinp other diswses alleged to be associated wtth amokkig. This holds true. even though in many cases the smoking conditions wero unFeasonabiy dnutlc, nroNinq artwwtts oomparativeiy many times the Gfe- tkrte Mtake of even the heaviest of human amoken. A few yaars aoo the then President of the Memorial Sloan Kettering Cancer Center In New Ykxk City made the toilowiq statement: 'Bmnchltis, emphysema and chronic pukno- nary obstructiw disease am still unsolved etio- b0ic probiems. Oiparette smoking and air pol- lution ara suspected as causes. but the actual mechanisrns underfykr0 the ktJury to kinfl tlswe remain unknown'. This statement still holds true today. Wry recently (t983), the resutts of a muitF- nwron dollar US study (MRFTT) on heart d'u- sase wena ptalMstied The aim of the study wa to show that those persons wtto through intenslve medicai intervention couid be Indu- ted to decrease their so-called •risk factors- - a statbticalfy associated characterlstic - such as tat coruumptior, smoking, etc., would have a substantially decreased cardiovascular mor- tafAy rste. However, even though the medical Interventan was Quite sutcesstul In reducing risk factors compared to the group which had no such intervention and was quantitatively most successful with reference to smoking, there was no significant difference In cardio- vascular morta4ty In general. (For cancers In general there was even a very sfi0ht ad- vantape tor those not subject to interventlon.) Several of the other •intervention• studies Mvw produced similar results. On the other h.nd. still different papers have made con- trary ciairy A 11979 stuey of cardiovascutar disease amonp women In Switrariand found thatt while Swiss women have incpeased their smoking In the last 25 years, tnere has been a significant decrease in cardiovascular disease during the oame perbd. Mora knportanty. smoking does not asem to be ev.n a risk factor for heart diaa.se, unless other risk factors are simultaneously prsent, afpeeiaiy hyperNpidemia or abow •nonnar blood levels of fatty substances such aa ohoiesterok etc. This opinion is aJso.Mid by scientists who otherwise anf very much op• posad to srnokk+p. Several scientists havr reported that about hJi or more of card,ovaacuiu deaths c,ccw In persons without any risk factors. 80 other findings stww thet It Is •healthier to snwke 10 or less cigarettes daiy rather than be a non-smoker. In this context it Is Important to be fully aware that the aiSeOed overall higher mortality of smoken compared to non-smokera prsdo- minantly refers to heart dissases, whid t arr by far the most knponant ceuses of death in the developed counHlss for nonsmoksrs and smokers alike. In other wonxs, these pur- ported CTarences are not mainly due to king cancer and other chronic respiratory o"uas as b popularly believed. Some studies craim that by and large smoktrip mothers, as compared to nonsmolong mo- thers, give birth to infants which have ahGhliy, but significantly lower birth weights, However. it has tFso been foLnd that the inctdenee of kiw-birlh.mei0ht infants born to futun smokaa during the period before they started to srtwka b as high as the Incidencr for Infants of mo- thers aN of whose pre0nancies occurred dunnq periods of smoking. The ktcidsnce of bw- - birtfrweipht for kttants born to this group was also sipni0cantty higher than that of kMants of mothers who never smoked. Ste'Jbnp a;so was the finding that past smokers dwk+p the period before they Quit smoldrq gave birth to relatively lew kow-bktMwsipnt tnfants. The tncidence was siprdficanty lower than for in- s ihnb whose mothers anaked during all the pregnancies. Therefow, even while they smoked, women who subsequently quit smoking differed in their rsproductivd expert- ence fromcontirxrous smoksrs. These M+OmQa of course, " support the constrtutionel hypo- thesis. For this reasor% the chief Investigator of this study has stated Vut these data indi- cate that •it is the smoker, not the smoidn0 ; Other studies have found that iovwbirthwsipht babies born to smoking mothers have a better survivai rate than similarly kow-blrth-wei0ht In- fants born to nonsmokinp mothers. But here a9ain, wlat has been said many times must be repeated that as for nearly all smoking and health related scientific papen, these da/ms are controversial in tiwt other studies disagree with the findings just descrUbsd. In recent years. studies have been published and statements have been made which ane0e that sidestream tobacco smoke and that from exhalations of smokers, cause disease in non- smokers. This has been catleG pess+ve ernoidn0, public smokinp. Involuntary smokinp, ambient smoke, atmospheric smoke, etc. However, this b one area where there Is no scientiflcally valid controversy. AU the studies alleging a disease-causing effect from akiestream smoke In adult nonsmokers am seriously glawed. However, it is ciearthat heevily smoke- iN e atmospheres have a distinct annoying effect on some, or, In extreme cases, even r.. !itFrank O.Coby la Aaaodaee tDir..:.taof Salentlrte L.u.e in the ReseaRh and Or Maiopm.nt Oepartrn.nt of R.l R•ynolds Tobaooo Gompany in Y1r•.wton-Salar. tiorth Carorrs.lle did hb uerdu4radu+ta *nd praduate work at the tlMverslty of Gewev~ inSlwttaaAand.obta.l-irp his OSc. sn Wpan/c cMn+Mtry U 1C41. ANw a stsy h Qisa, and eTvtoyrn.nt In the cl-enresl hduetry In tha Unltea Statee, he pirrd (ttJ. Reyrwlds Tobacco Co+nparry tr t:St. IM meb, ari.rsss k,chde acientJ/lo Mror- a+atlon on at aepecb of the tobaoco ht- dustry ana, more r.oentfy, aepedaQy aw+oktrq and Aatdtl. 1 most nonsmohers, and often avenon snwksrs In those situatioru it behoves the smokers and others to be OouReous and retieva such conditions through venblatior, etc. Wb have discussed above some of the contro- varsies regarding the WMned positive ssso- thtions wtween srnoibnp and various chronic diseases. What is much less weU known is that there artl 't;ontroversiaP atudia% fwp- tkshed In major medieat lournab, showirq for some conditions that smokers we apeyedty kis afrected than non-smokers, They inchde colon cancer In mdes. breast cancer in wo- men, maybe Over uncer, hypartension, utce- rative coGtis. ParWnson's doease, survNai of k*,binr.,weqht babies, etc, However, It would be as unJustiSed to el.hn an advantage for these diseases for amokers, as it is to alleQa that smoking Causes the vsrious other Ca- eases mentansd. such as ktn0 cancer,urdlo- nscular diseases, etc. In summary. M can be stated that an un- emoUOnal and unprejudiced examination of the relationships between srtwlort0 and health cleariy reveals that they an a maner of oon- troversy; put very succinctly - smoking an neither be Incriminated nor exonar.ted. It is eQuaGy impoAant to remsrnber that there b an aitemative explanation to the causation hypothesis; this is the conftttutlonal or penetk: hypothesa which states that spttokars ana non-smokers ara constitutionab diflerenC , •