Tobacco Documents Online

Dr. Milton Rosenblatt is associate professor of medicine at New York Medical College andco-author of the authoritative technical book, "Cancer Of The Lung. " ( ` JOURNAL OF THE ANERICAN MEDICAL ASSOCIATION April 71 1962 Quantophrenia, Lung Cancer, and Common Sense To the Editor:-In THE JOURNAL (175:997 [March 18] 1961), under the impressive title of "Some Thoughts on the Causation of Chronic Disease," Drs. Wynder and Day issued another blast in the lung cancer-smoking controversy. Their passionate communication paid great homage t'o statistical surveys, belittled the necessity for biological pa- rameters, and concluded with an appealo to common sense. The latter is an excellent suggestion and merits further eiaboration. During the past decade, epidemiologists havee applied a relatively new discipline, biometry, to establish the et'iology of lung cancer. In a remark- ably short period a problem which defied biological research for 150 years was readily solved by statis- tical data. The absence of unequivocal biological confirmation was embarrassing but inconsequential. The problem resolives itself into whether a statis- tical association bettiveen~ 2' variables, smoking and cancer, is sufficient to establish a causali relation- ship, particularly when the same data show a re- lationship between smoking and respiratory infec- tions, coronary disease, peptic ulcer, liver cirrhosis,, and prostatic cancer. Has: the etiology of disease been simplified into one universal, toxic agent? The allegation that bronchogenic carcinoma! was a rare disease before the era of widespread ciga- rette consumption is unfounded and based chiefly on paucity' of data. Metropolitan Life Insurance Company records show a 100% increase in the standardized annual death rate from lung cancer between 1917 and' 1926. RReview of t he national lung cancer deaths by l,,st-rums shows that the rate of increase is d'efinit'elydeclining. Between 1930 and 1935, the rate of increase was 79%, whereas ~ be- tween 1955 and 1960, the rate was only 33°!a. As bronchogenic carcinoma becomes progressively more accessible to diagnosis, the rate of increase will stabilize as it has for other cancers.. Obsession with statistical data on smoking has led to rejection of necropsy studies from European hospitals showing the same quantitative relation between lung cancer and total cancer in the 19th century as exists today. The increase in necropsy incidence of lung cancer has been but a small fraction of the increase in clinically diagnosed cases. The "pandemic" of lung cancer is a tribute to progress in diagnostic acumen. Exfoliative cytol- ogy, explorat'ory thoracotomy, and greater utiliza- tion of radiology,, bronchoscopy, and biopsy are the chief factors responsible. Lung cancer is predominantly a disease of males, and the attempts to attribute this sexual favoritism to smoking are amusing. The sex ratio favored males bef'ore cigarette smoking became popular and it has continued so, despite the prodigious in- crease of smoking among women. Lung cancer also occurs in areas where cigarette smoking is virtually unknown. The wide publicity given to the statisticali sur- veys has relegated to the background many basic observations on the histogenesis of lung cancer. A revival' of investigations in this field is warranted. MILTOIaB'. ROSE NBLATT, M.D. 1040 FiRh Ave., New York City 28