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SPECIAL NOTICE BECAUSE IT IIS S01 UNUSUAL for physici~ans to be exposed to any "controversy'r about the effects of smoking, the following from Medical World News of Nov. 17'is worth reading: Briitish renew smoking-cancer debate An old controversy flares in letters to the Times While tb Bntish governmenm steps up 'ta antismokivg :eam- paigq, a. fresh, debate hks esupled wi0hid the',biomedinle research com- usity in Englandd ov 'whether' amuYi:ng; reaBy eaosee- lung -. In the beatttad'ition of:such'',de- tiatea moat of the thrusn and parriees bave appear.ed is the letters mhvmoa d'.:Tlir Tswrea, Thua far, the refeetlesa battle haa pitted ProC Phililp R L Burct of Leede i Universityh depart-meet of inedidal phvsires againct Dr. 1likheel C.; P.' Stoker', direetor of:theImperisl Cancer Reseanch Fuadl tiabF aratoriea, Dr. Char4a. M~. FI'etcher'of' thi Royal P tg;raduate'. Medieai . B?Looi is Imndon,, and I Sir Richard I108, Regiua.pfnfeasor of:medieide'.aaqiford: Univeraity.' Dr. Burch,,a:phrysicut and bianutir' tlm'an, opened the', de.bate: by reiterat-, iag hia: b'elkf' that the moluttude', of ' .maile, timknglnng e.neer:.ith eig,v rette emokiog aree tlot atatistically' aal'Wr He added Insw fuel ta the hie Ay' stating that . while hee buys the mn- cept:thatt smokingmay ealme', chrnmia beonehitia,or pemiatent',mughioig,: he tLinks the: repoerte'relatidg smoking'.. to hexrt diaeax',are'.alln evspeet. Thephyaiuist said he waslinmm- ..,',/~: ~ pkte agrerment: with ~ the ~. late Sir: . Ronald. Pisberi s ~renowned: biostatis, tielan~who.prophesied.thau a'1997 re- port.by.theRoyal 0olleg;of Physb eians bllm~ing, cigarettes', would. ' ermWalli, bee regarded as' a'citr. . sttephie and maspieunus.howler." - A'rrovamokee who says ;he is inna w y' sssac ted with the'.tohacm in" •. duetryr Dr' Bundt poi>vtatn the:remrd -- ef' lung eancen nnong'g w . major fla.w in' the . accepted, dogpu. $tatiatiealt~; he'.says, thefz ioeidence'. -af Itlng raneer ha4w.en: lgpl ud; lY0 . `parall'eled that ofmeni, though it:waa . much kn. .But,rn. the 1g40a'.theumber'of:wumen, smeken'a began rta. inrrease'- noticeably, , he obeerves-a facter he..smrs is nnt reB'seted:in their hmg'eang nte The l.eedz physicist aldo maklrs the . pointt that while the death ente:from'e r of, the'.Iarynx,,pharyux, and'd teophagms-a11 mmsidered tn be smok- Ing; rel:ated-beg;an', tu dtup' fromabbuc:193D on, themosumption,of ta bem». by both sexea:was inveaeing.' Dr: Ba.e31 sayss behau.noa.heard . amy' m meingg deeviptlonofn the mechko im hy; whirth; smokiog u eupr pmed: to nuse'e lungra cn.He be. Bevea..- m likedy' expl 4om is:• theory <labamted th his :ml& i~agu0 6e~hu oeertheyeara that every dia-- eu< atta<khonly those with the appropriate . genetic . makeuppredir pmingthemt thlat ilinrv;.ndthan only'after'the' g nepattervs have. ehanged ua resudt.of'nnidommutar tions. He'e feelss itist the geneM1ie makeup of pot2ntial lung ance vio, tima th'ut.produees inn them iarv irre-. t ble rn.ing for tmb~a: H- ~viewe igarettea: an'd':rameer, to appear in hie fnrllwomiogb'ook; Biofngg.oJ Can-: ear:A. Ner..Lpprooak; will chalYeng,e medidal dog,ma un thee uueal link be-: tween emokiug and o cer beuose . "the', mnuloul simpl9, areM not war-.' nnted by,the evidenne" The physirist'd'.cFillenge in TAe. Tikles waa.qu ckl takem up: Dr Sto- kerwrot<'.augg ttnig:that ey: cettea themxlrea eause the'e cell mutations tn which Dr. Hurch'. refers. The L-d.sresenreher replied: that', surh,induced mu4tionswould. meam earlier onxtt of lung, nnrec id smoken: than'n in nsmokers,'m and.tlnis has noebeen the mae artau. Dr. Fletcher, .hn iaeh'airman of'a'f greup, ealkd Aetioni on Smokingg and'. Health,.said.in aletter that Proteseur have : far' higher riak of ~ long, eaneer:r tham those who dd not;" Dr Bareh reapomd¢d tu this sally byy ehkllengivg, thee referencesto Seventh Day Advevtistas and.Mormons asviolations af "dne'e of the must impor- tant,rudes ufslatiminl infere Suah groups; he says,:areself-seleded. rather than , rendumly: selected .. He alsos.ye'.th'at:S'irRichard "mak'ess rather' little:of the benefiEa~Bntishn ddctors:are suppoeed ta h'ave received . from,giaing'm up emoking." This: ul w ; he ad.vnts; peuuse the .evideolce n xthat' partimdar- group uimotrv" diktory,and Inmmpleta. )leanwhde,under a British Code ne' A'dvertising: amendment, e:igarettee advertisiagon', mo.iescreens ~u'.beinig: restriated', to. prognms of. X'-rat.edfilms Andd smokem ~:will! soon de able tosee exactly hhw much damage they, may orr may not bee doing to them selvea the tar mntene:uf~earA~efga- retee'.aold in.Englind.willl be dearlY , prinitedonthe.packagw a' BurrA ~"stands aLmost .alune!" berwuse' his "isttempte ov n several years to ientiste ofhis,snewppimt haee mmplet219, failed."' The .. physi- .msed: Dr. Burclr of, ignoring e. aem mmtrary'to his theories.'. In hiss reply', Dr. Burch: mmpiu tlled, . "1',eI not huttake oEfenee when they . eof:ignorin'gevidenm."!mto thefaet that:.sn many'aeienM1ista aruun d: the w or M blal aret tea. for' lung ; eanal physitart said, .'A A si®aar ma5d<roce: andd un n'imity. hkveprevloualy,b'eenmanifested:re- gp,rdimg theflatvne of:the.earth and'. ANO'.SM OKE RISfS'.ON THIS SIDE OF THE ATLANTIC th'erspeutiec efBcrey of' leechee, and: The BAmsn iprougonian.In the nmok:.. blloodletting." {og;-larrg cancen comroverry, hleve', To~deteth'e.strungestresponaeto tneir Am,ericancOuntarpartswha. Dr: Bmrch'a: atatements haa c so sit ¢qurrsiy o eitinaraWeof tha: frnmSirRidlard',whaheadi p te ro s o te'.nce Amang leose mmlvid ata gioua reae.r bgroup:at',17xford In aa firmly convinced of a causal velNiow longg letter Sir Ri.chandd said: Dr, ship:is:Dr. Wlham',Weiss', prntasaon Burch'a mmmentai'mntain no. faets. Ot medicime at Maknemann Medical and: no ideas that ha,ve'.not atneady College im Philadmlt>twi beem examised land ,found'wanting"' l.ung, wmcac in weman has nol In- Oaly' the'e prominenoee givenn thee de- ressed atma same rate m~eir smok-: batehy Tke T(,rw caueed him tn in-Ing:has:because the incutialion pe- tervene,Sir Richudlwrote..He then, rimd for, the diseasetakes'.JD to50 dismieaedtheprofineois'.refere'noetnd years',he:otlserves'."Sinceemok{ng Ihetheory'oftinduced mutationsas.a, among women liecmne:really.wide-."typiealred:herringfanduldaherin~ spreadaraumdwormMmrll,it'a'onryfa<t; the theory suppurta the . c o.w that wa canlxgin to:see: eistsep . agfi.neteigarettes.Healso~poin6edtut riseirntneirnnc.erranee.rtheSe,enthlDly'Adventistsand:Mnr- Thereiisr'naahned:aleclbn'timc! eu. mens as graups who benefit from,nut~ een r: - 'lo: suppomD, Buochn com- sma4fnlg: flil 9. nal hiypoth n; the i Phila- Whde adrvttl g. Dt Bueehh eelph I. - nico an2sTniso.ly1 f d some pp renl' paradA " way to prve ,E nyy cauaat Sqr'Rrchard ins'nted that thuse-ndi- Ineouy, n saya, wou/d bete lak viduals "'who regularly.apply thin Iabl 1,00,000 cnMkfren. maka ithenn ameke oratotry eu<ieogqn to their lungs: IOraO; years, and: buen compare tnam witn 100.000 :coneron .who.had been prohrbiled from smoking', foi years.. A co:rrnpari-oflmng cancerrateer omg tme hvo groupse woudd', bs con clbsive, he says: Fsvrer.than' 1% of men who', de- velopp uL g' '.er ara nOnsmmkbn, Dr ~ Weiss'e reports'. In' Onro: study, Of 6,000 o Wer men in ~PniladeNphia, he.' found miat 121 of tnem got lung can- cer ddning; a1D-ypan periodway Ome a amoker-wnnei g30 wno'nevM sm:oked neMer gpt lung:canaer. "Theevidence:in lavoro1'the. arnoMng-lung: , Cancer nypolRelra r3. everwnalm,g,Drt. We~aa'. wrate in the Sepllember American Journal o/. vu04a Hawlrnl "NO m~atter, whlere we umx. me a oanon is sutent 5trqng,: and specifio,: smokingg pre- cedes leng c r, ana;comerancs betwee m. Caua lihas, of evl- denaei of .n-ghordar," oppositioncomes hom Da: HlramTl.tangston, prolessor'ol,surgery.at: theUnlvermrry ot, Illinols,' wnm hnds' Dr. BunctYS',cOnstitunonal h'ypotnasrss a. "veryy inlnrestmg" comcept tnat'auppnrn hinown v,ews.' "I unnot aacept :this'snog9mous nogen'as:a czuae', ol~lu.ng.cam- cerCl" nei daoEareo.°Tnl! chnical - h'avlor of inei dlbease ini mry panenn raises a numiber 011q:ueshons that h'uvein0beanng,onsmoiking Fore.r a le; m~ lumg can¢er n3 prrn¢ipally'ap di ase o1 men-even mouqn woman me smotlmg muon more'. "l.pmg aanOerdoesnft occur.bllao- ariSlly,:- h : t ues.' M . r; the trache0 rarely affecteda dsurely I11nnaIW ~. srmoas can cause lung can- eril c0uld also d3mage the Iracnaa: Ahotherfo'rmi of malignancry.' lar=ynqaal k•ancer„yi.nllayndlYreared Iln tigarett okng But' nave iseen no: lno- ua'mcrease'. n larfmgeal I wnaer.° an.Weiedrespands'. mat hiureral I lumg cancer'ia.so: inlrle0uent because "MOu; people who:do'.develop orw. gross lung; cancen will pi!a napdly be- fora.the.reia.adaquate:Ome for olner' milv7mant :Cn'amg;es: rm the ibro.nanlial muoou tm becoma gnoss ca-ers." Sofar as thetrachae rsco:neevned: 'when you dAaw vn' a poR na --el 10 quieklypasaef'.down li Irecnea', spreading out ClffUsell' into 1ne smae b'romchi, where:it fwrrn: arownd But the ~ nacneaa is a' atraighl -md:- down tubb: s tn e 'rt ry chanaei ror me.wmoke.to. swrl around:Tne me.tM 1g. g 1'. tM 1 t: I n- yns, wme' [h o . lasler sitvas Inanitd 9einnnesn a bronci "