Tobacco Documents Online

C MEDICAL TRIBUNE May 28', 1962 Coffin Nails C T 00 MUCH HEAT has been expended in debating whether cigarette smoking is a proved cause of bronchogenic carci- noma. Some of the liveliest minds among biostatisticians admit that the available data appear to suggest~ a statistical associ- ation between the two but have reserva- tions about'the experimental and sampling techniques employed and question the value of retrospective surveys. Above all, they demand the clinching biologic dem- onstration of the third of Koch's postu- lates: that exposure of an animal to cigarette smoke produce a bronchogenic carcinoma. The Scottish verdict of "not proven"' (which is rendered in the absence of a presumption of innocence)~ may apply,, but what of it? A more pertinent question is whether cigarette smoking is a detri- mental habit that should be actively dis- couraged ds a public health measure. The answer to that question, we believe, is an inescapable Yes. A campaign against cig- arette smoking ought to be actively pur- sued by physicians, individvally and through their organizations, and by all public health institutions, local~ state, and Federal. It ought to be as effectively sup- ported as is the campaign waged against obesity, in which all the avenues of public information, including the efforts of life insurance organizations, have been mobi- lized. Is the case ag:uinst obesity any better than that against cigarette smoking? Sta- tistics show that longevity is impaired byy obesity-statistics show the same associa- tion with cigarette smoking. Biologically we know that a glucose tolerance test may be abnormal in the obese and that success- ful weight reduction can improve it. Simi- larly we know that cigarette smoking is disastrous for thromboangiitis obliterans and thaG abstinence from smoking is ameliorative. If hypertension is associated'with obesi= ty, is there any doubt that arrhythmias can be precipitated by cigarette smoking? Who E;uestions the deleterious effects of cigar- ette smoking in chronic bronchitis? Are four-minute miles run by athletes on a pack or two of cigarettes a day? The Royal College of Physicians in Lngland takes as dim a view of cigarette l:moking as does the American Cancer Society. Both are convinced that the sta- iistical association with bronchogenic car- Einoma is not merely fortuitous. But even if that association is not~ beyond criticism, the measures recommended in the report of the Royal College ought to be sup- ~orted here too. The report does not favor pny laws against smoking; these would be both intolerable and ineffective. Instead, widespread educational efforts are urged (particularly directed towards young peo- ~le and children). In the earlier part of this century, cig- arettes were referred to as "coffin nails."' 'Yhey may well be so irn more than one 'sense: The role of the physician includes the practice of preventive medicine, and his responsibility here is clear and evident. •~.~ ,