Tobacco Institute
Current Digest of Scientific Papers Relating to Tobacco Use Vol. Viii No. 1
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- 1. Tobacco Industry Research Comm Recipient
- Affiliation:
Tobacco Industry Research Committee
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11.
MURPHY, Sh_sldon D., Ph.D., and PRINDLE, Richard A., M.D., Division of
Air Pol.Lution, U.S. Public Health Service, Washington, D.C.
"Effects oe automotive exhaust on pulmonary function."
"During the past year, studies of the effect of exhaust mixtures
on pulmonary function of guinea pigs have been continued as part of a
pilot investigation," the authors said. "Guinea pigs are placed in
body plethysmographs and exposed through face masks attached to a manifold
ventilated with air or exhaust mixtures.... Measurements of pulmonary
function w;~re made under two types of exposure conditions (While breathing
clean air Ebr two hours, and tests every 15 minutes during four hours of
exposure to exhaust-contaminated air)....
"...the first phase of the response consisted of increased
pulmonary E'low resistance and increased tidal volume and decreased
respiratoi=_T rates. Flow resistance remained high during the exposure
period, bub rapidly returned to air, pre-exposure, baseline values when
animals were returned to clean air. Respiratory rates and tidal volumes,
however, sliowed a biphasic response which had not been previously
observed (Ln earlier tests). Thus, during the last two hours of exposure,
respiratory rates rose, following an initial depression, to levels
considerabLy higher than air control baselines. Tidal volumes decreased
during the period of accelerated rates....
''This laboratory work is, as yet, far from providing the clinical
data that :)hysicians need in order to evaluate their patients' responses
to 'smog.' As it progresses, however, and is supplemented by new information
from epidemiological and environmental studies, it seems reasonable to hope
that the n=:eded answers will be forthcoming."
PHELPS, Lt. Col. Harvey W., MC, USA, SPOTNITZ, Maj. Murray, MC, USA,
REUSCH, Capt. Clifford S., MC, USAR, GELDERMAN, Capt. Gwynn, MC, USAR
and MtYri,EY, Hurley L., M.D., Professor of Medicine, University of
Southerii California, Los Angeles
"Tokyo-Yokohama asthma."
°'Over 3000 patients have now been evaluated in the pulmonary
function l~Lboratory at the U.S. Army Hospital, Zama. (Japan), during the
past two yoars," the authors said. "Of this 3000, 620 patients have been
diagnosed Ls having Tokyo-Yokohama asthma. All of these individuals
have a ne-;Ltive history of asthmaa prior to coming to Japan. All but 18
patients wore moderate-to-heavy cigarette smokers.
"Moderate-to-heavy cigarette smoking appears to be definitely
involved ia the contracting of this disease. Perhaps the irritating
effects of cigarette smoke makes the bronchial mucosa more suspectible
to the irr.tating and sensitizing effect of polluted atmosphere.... If
an individnal had this disease for many months or has had this disease on
more than one tour in this area, he runs the risk of developing permanent
lung -damag: !. "
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12.
REID, Prof. D. i_i., Director, Department of Epidemiology, London School of
Hygiene and Tropical Medicine, England
"Chronic bronchi.tis and air pollution."
"Mort=.lity from chronic bronchitis is highest in the congested
and heavily polluted industrial cities," the author said. "The British
excess in chron1c lung diseases mortality cannot... be attributed to
such variations in inherent susceptibility associated with'sex, or aging
or familial pretLisposition. Factors external to the individual are a
more likely somce of the adverse British experience. Cigarette smoking,
for example, ha:; been shown... to be related to the risk of subsequent
death from chronic bronchitis."
7. NATIONAL CONFERENCE ON AIR POLLUTION
Foll(yring are excerpts from papers presented at the National
Conference on A.r Pollution held at Washington, D.C., December 10-12, 1962.
DOHAN, F. Curti=a, M.D., Hospital of the University of Pennsylvania,
Philadelphia
'"The complexity of the relationship between air pollution and respiratory
health."
"Chrouic bronchitis, one of the most important health problems
in England, has been statistically related to regional air pollution by
coal smoke, and to personal air pollution by cigarette smoke," the author
said. "Infection also plays a part.... (It) seems abundantly clear that
the relationshi) of respiratory health to air pollutants is a complex one;
that individual host response may vary; that pollutants and their
combinations va^y in kind, concentration and effect; that weather variables
are important; and, finally, that the effects of air pollution on bacteria
and viruses and their host's resistance must be considered."
GOLDSMITH, John R., M.D., Head, Air Pollution Medical Studies, California
Department oP Public Health, Berkeley
"Air pollution, morbidity, and mortality."
"The rates for chronic bronchitis and lung cancer are in general
lower in the UnLted States than in Great Britain, when comparable age
and sex groups a.re compared," the author said. "However, both these groups
of conditions are more common in urban that in rural areas and air pollution
has been thought of as the possible factor to account for these increases.
On the other hand, clear-cut relationships of cigarette smoking to both of
these conditions have been established in this country as well as in
Great Britain.
"Because different patterns of decisions are needed for reducing
the exposures, we may tend to separate the effects of cigarette smoking
on chronic lung disease from those of community air pollution on the same
conditions, but it is not reasonable to expect that the cells of the lung
will make such a distinction."
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13.
KOTIN, Paul, M.D., and FALK, Hans L., Ph.D., National Institutes of Health,
Bethesda, Md.
"Air pollution and lung cancer."
"The major emphasis of this presentation will be directed toward
exogenous factors including polluted urban atmosphere, cigarette smoke,
and viral iniections," the authors said. "It must be emphasized that
evidence for an exclusive environmental source or factor acting in the
pathogenesis of lung cancer is lacking. Therefore, a discussion of air
pollution and lung cancer, independent of its relation to other environmental
factors, is "nrealistic.
"Hcwever, sufficient epidemiological, clinical-pathological, and
experimental data exist to incriminate polluted urban atmosphere as an
environmental source pathogenetically related to the development of lung
cancer. Since the chemistry of polluted urban air and cigarette smoke are
remarkably similar, it is possible that much of what will be presented
as being pertinent to the former will also be applicable to the latter."
Discussing anti-carcinogenesis, they said, "Experimentally,
it has been possible to demonstrate that even the most potent carcinogens
can have their effect reduced or totally obliterated in the presence of
proper propoitions of inhibitors. This has immediate, practical significance
in that in all environmental sources of carcinogenic PAH industrial effluents,
automobile a:r-;d diesel exhaust, as well as cigarette smoke, a broad spectrum
of non-carcir.ogenic and weakly carcinogenic hydrocarbons are formed.
Experimenta7_1y these latter compounds unequivocally exert an inhibiting
effect, and ?inder actual environmental conditions they, in all probability,
exert a modi=ying or inhibiting effect on the total carcinogenic potency
of the milieu, in which they exist."
MITCHELL, Rou;er S., M.D., Webb Institute for Medical Research, Denver,
Colo.
"Concluding iemarks -- Panel C."
"I, _ is my opinion that polluted air (from both community and
individual scurces) is one of the causes of at least two major respiratory
diseases: brc-nchogenic carcinoma and the chronic bronchitis-emphysema
syndrome," tY.e author said. "One distinctly possible and happy dividend
of the abate,;.ent of community air pollution would be a probable decrease
in the hazard.s of cigarette smoking."
NELSON, Nortun, M.D., Director, Institute of Industrial Medicine,
New York University Medical Center, New York City
"Effects of motor vehicle pollutants."
In lung cancer, as in some other respiratory diseases, "the
factor of smt-iking is of definite importance and, therefore, adequate
allowance foi, the smoking history of individuals with lung cancer must
be made in any statistical study aimed at determining the role of air
pollution," !;he author said.
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14. MINNESOTA TOI3ACCO LIT.IC;-ATI()I1T
"A _n_-mmber of statistical studies have made correction for this
factor; these quite generally show higher lung cancer rates in cities
than in rural areas when comparisons are made on the basis of equal smoking
intensity or when the comparison is restricted to non-smokers....
"It is very clear that the part played by place of residence
is small in comparison to the importance of smoking. However, as noted,
there is a cleai~ trend showing somewhat higher cancer rates in urban
dwellers after allowance for smoking.... Although an interpretation is
difficult, it wculd be a prudent assumption, still not proven,that
community air pcllution makes a significant, albeit, secondary contribution
to lung cancer cccurrence."
SPICER, William S. Jr., M.D., Head, Division for Pulmonary Diseases,
University oi Maryland School of Medicine, Baltimore
"The complexity of the relationship between air pollution and respiratory
health."
"Respiratory health, in itself, is not a simple concept and has
different meani=.gs for different investigators," the author said. "The
recording of tho symptoms of chronic bronchitis, e.g., cough, sputum,
wheeze, breathlr-ssness, etc., in a control population in relation to
either daily or long-term levels of air pollutants differs from the
recognition thatindividuals who have no clinical symptoms change in
relation to environmental factors when tested by complex pulmonary function
tests.... Uttei, confusion and misinterpretation will result unless we are
constantly clear as to which particular aspect of respiratory health is
being evaluated in any particular investigation."
"Health considerations."
"Both the products of industrial and automotive combustion and
of cigarette smoke can temporarily paralyze the cilia and depress the
self-cleansing mechanism of the respiratory tree, allowing the accumulation
or irritants, irLcluding carcinogens."
WYNDER, Ernest T,., M.D., and HOFFMANN, Dietrich, Ph.D., Sloan-Kettering
Division of Cornell University Medical College, New York City
"Air pollution =.nd lung cancer."
"We r~-:gard it as established that the urban population has a
somewhat higher rate of lung cancer than does the rural population as
shown by the stl_Ldy of Hammond & Horn (1958)," the authors said. "Other
evidence point-I=Lg to an 'urban factor' as recently presented by Haenszel
and his assoeial;es (Current Digest, June 1962, page 4) indicates that
individuals borfi in rural areas but who later lived in metropolitan areas
had a higher rai;e of lung cancer than those who lived in metropolitan
areas all their lives.... (This survey) also indicates that for non-smokers
the difference _n rates in urban and rural areas is 'trivial.'
"A major problem of the epidemiologist in evaluating the factor
of air pollutioji is that the correlation between cigarette smoking and
lung cancer is of such an order of magnitude as to overshadow other factors."
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8. CALIFORNIA AIft POLLUTION CONFERENCE (Part 2)
:?ollowing are excerpts from seven papers presented at the
Fifth AnnL=L1 Air Pollution Medical Research Conference, California State
Department of Public Health, at Los Angeles, December 4, 1961, published
in the Ame°ican Review of Respiratory Diseases, Official Journal of the
American T'~ioracic Society, Volume 86, December 1962.
REID, Dona_d, M.D., D.Sc., MRCP, Professor of Epidemiology and Director,
Departma-:nt of Medical Statistics and Epidemiology, London School of
Hygiene and Tropical Medicine, England
"Diagnosti~: standardization in geographic comparisons of morbidity."
(Pages 650-854)
"For epidemiological surveys designed to follow up the clues
provided b~~ the crude geographic comparisons of vital statistics, a greater
diagnostic precision is required," the author says, describing British
efforts to arrive at standard clinical diagnoses. Meanwhile, different
practices i,n Britain, the U.S.A. and other countries result in an "excess"
of chronic bronchitis in Britain.
'The question is whether the reported excess in the British
population in general, or the urban British in particular, is an artefact
due to difzerences between certifying physicians in habits of diagnosis
and classification of diseases, or whether there is a real disparity in
the disease level in the various populations concerned," he says.
Tn Tables 1 and 2 he shows the varying diagnostic allocations
of "standard" cases by some 30 hospital registrars in Boston, Mass., London,
England and Bergen, Norway, on the basis of clinical records of a random
sample of London hospital patients (Adapted excerpts):
Cause of death per cent: Boston London Bergen
Chronic broachitis 1 4 4
Chron. bron2h. and emphysema. 12 18 11
Emphys. (without ment. of bronch.) 5 1 6
Bronchiectasis 3 1 6
Other respj- ratory 4 1 2
Strokes 19 20 21
Cardiovasc»Lar 36 36 35
Renal 12 11 11
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16.
HAUSKNECH'P, Rit?,, Head, California Health Survey, Bureau of Chronic
Diseases, CaT.ifornia State Department of Public Health, Berkeley
"Experiences of a respiratory disease panel selected from a representative
sample of thr: adult population." (Pages 858-866)
Smok;_rLg histories and the effects of air pollution episodes
together with hi.stories of bronchitis were collected in 1956 for a sample
of 6939 persons aged 18 and over; an "original panel" of 1070 of those
aged 30 and ove:r- who reported bronchitis, asthma or chronic cough; and a
"residual panel" of 524- who were interviewed in four follow-ups from
1957 to 1959. !:n the general sample, 50% currently smoked cigarettes and
50% did not; in the "original panel" there were 62% smokers and 38% currently
not smoking, and in the "residual panel" the figures were 65% and 35%
respectively.
Air pol.lution effects reported were (in part) as follows:
Per cent: General
Sample "Original"
Panel "Residual"
Panel
Eye irritation 75 68 71
Nasal irritatio-a 35 50 62
Annoyance 15 14- 10
There were 41 circulatory, 5 respiratory and 9 other deaths in
the panel group: of these 55 deaths, 9 had reported bronchitis or asthma
without cough dzring the interviews, 15 bronchitis or asthma with cough,
and 31 cough only.
GOLDSMITH, John R., M.D., Head, Air Pollution Medical Studies Unit,
BECHTER, H. a., PERKINS, Norman and BORHANI, Nemat 0., M.D.,
Head, Heart Disease Control Program, Bureau of Chronic Diseases,
California State Department of Public Health, Berkeley
T'Pulmonary function and respiratory findings among longshoremen."
(Pages 86T-871+)
Cigarette smoking alone and the presence of cardiac symptoms
were found to hs.ve a slight effect (about 5 per cent in each case) on the
pulmonary function tests on 3311 members of the Longshoremen's Union in
the San Francisco Bay area, the authors say.
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They computed coefficients for three types of respiratory
measurements b-tised on 100 for those persons without respiratory conditions
who had never :;moked. Adapted excerpts from their Table 9 follow:
Including men with resp. cond. Excluding men with resp. cond.
Smoking pattera Puff- Forced Total Puff- Forced Total
meter exp.vol. vit.cap, meter exp.vol. vit.ca .
Never smoked 1.00 1.00 1.00 1.00 1.00 1.00
Ex-smokers o.96 0.97 0.99 0.96 0.97 1.00
Light smokers 0.95 093 0.94 0.97 0.93 0.96
Moderate smoke~~s 0.92 0.93 0.96 0.95 0.94 0.97
Heavy smokers 0.92 0.94 0.98 0.98 0.95 1.03
Pipe/cigar smohers 0.96 0.95 0.95 0.98 0.97 0.96
(Ed. note: Thi-; tabulation shows better scores among heavy smokers than among
light and mode~-ate smokers. The authors do not comment on this.)
"If ~Lo effect were exerted by smoking and/or respiratory conditions,
all of the peroentage values in table 13 would be distributed around 5 per cent
because of the definition of an 'abnormal' test," they say. "A notable
exception to t1his expectation is the 22.8 per cent of abnormal values among
the cigarette =smokers who had respiratory conditions without shortness of
breath. Cigar=:tte smoking in the absence of respiratory conditions had little
effect on the oroportion of abnormal values."
Table 13 (Adap,;ed) Per cent of subjects with "abnormal" pulmonary finction tests
------Never smoked------ ---Cigarette smokers---
Respiratory st-etus No.of
erp son.s No.ab-
normal % ab-
normal No.of
persons No.ab- % ab-
normal normal
No respiratory conditions 156 8 5.1 390 27 6.9
Resp.cond.without short. of breath 45 3 6.7 136 31 22.8
Resp.cond.with short. of breath 7 4 57.1 26 9 34.6
HECHTER, H. H., Bureau of Chronic Diseases, California State Department of
Public Heal;th
"Notes on a me;;hod for ascertaining the influence of smoking." (Pages 875-877)
This is a biostatistical discussion of data compiled in the
preceding pape.,. Among other things, it indicates a high ratio of
2.32 for resp-f ~~a.tory conditions in smokers aged 35-44 compa.red to those
who never smok.:d, and a low ratio of 1.22 for such conditions in smokers
aged 65 and ov=~r compared to the non-smokers.
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SCHOETTLIN, Cha^les E., M.D., Medical Director, Rocketdyne Corporation,
Canoga Park, Calif.
"The health eff,:ct of air pollution on elderly males." (Pages 878-897)
Resid~~nts of the Veterans Administration domiciliary and
chronic disease hospital of Los Angeles, with a high prevalence of chronic
respiratory disz~ase, were examined in June 1958. Five occupational
exposure categocies -- cooking fats, gasoline and oils, coal dust, road
dust, and wel_di.-1g fumes -- had significantly higher prevalences of selected
criteria of chronic respiratory illness among exposed persons than among
the remainder oE' the population, the author says.
"Thoszs men who had smoked 10 years or more had significantly
higher prevalen;e of the criteria of chronic respiratory illness than persons
who had smoked Less than 10 years," he says. "Increasing prevalence of
illness paralleLed increasing duration of smoking."
MARTIN, C. J., -4.D., Director, Institute of Respiratory Physiology,
Firland Sanatorium, Seattle, Wash., and HALLEZT, Wilbur Y., M.D.,
Pulmonary PhYsiology Laboratory, City of Hope Medical Center, Duarte,
Calif.
"The diffuse obstructive pulmonary syndrome: A factor in tuberculosis
treatment failures." (Pages 898-901)
The history of smoking was of no significance in this study,
regardless of tze amount smoked or duration of the habit, the authors
say. Evidence Df the diffuse obstructive pulmonary syndrome was found
in 91% of 45 tuoerculous patients considered treatment failures. "This
incidence was uarelated to age, sex, or smoking habits," they say.
REVOTSKIE, Nich:)las, M.D., KA.NNELL, William, M.D., GOLDSMITH, John R., M.D.,
and DAWBER, 'P. Royle, M.D., U.S. Public Health Service, Framingham (Mass.)
Heart Diseas-s Epidemiology Program (Except Goldsmith: California
Department oE' Public Health)
"Pulmonary function in. a community sample." (Pages 907-909)
The authors tabulated the ratios of "observed" to "predicted"
pulmonary function test values by smoking patterns and respiratory findings,
in the manner raported for California longshoremen by Goldsmith et al.
(supra), for mea and women in the Framingham study. Wide differences
between the sex-as and between the classes of smokers and non-smokers are
shown in the table. Not all of the subjects had all the respiratory
tests, and the aumbers of subjects therefore are not suitable for estimating
rates, a footnote says.
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9. MEDICAL OPINIONS
BAIRD, K. A., M.D., Lancaster, New Brunswick, Canada
"Chronic iespiratory disease in the aged." (Journal of the American
Geriatiics Society, Volume 10, pages 1062-1071, December 1962)
One type of irritation in the respiratory tract is mechanical,
the author says: "Examples would include house dust, road dust, and
smoke -- whether from wood fires or burning tobacco leaves:" He also
cites Garston (Current Digest, December 1961, page 12) on the association
between cigarette smoking and air pollution and chronic respiratory
diseases.
BRITISH NiwDICAL JOURNAL, London, England
"Effect of tobacco smoke on lungs." (Editorial; December 1, 1962, page 1457)
The Journal reviews several 1961 and 1962 reports by Auerbach,
Stout, H?mmond and Garfinkel, concluding: "Broadly, then, the frequency
of atypicaL cells shows a direct correlation to the dose of tobacco smoke,
being virtually nil in non-smokers. Commenting on the 1962 paper by
Bock et al, on filter and regular cigarette smoke condensate tests on
mice, it s-Lys: "This is further evidence that if moderation were the
mark of smoking habits in Britain the death roll from lung cancer would
not be so grim."
GP, Published by the American Academy of General Practice, Chicago, Ill.
"Welfare al~d the weed." (Editorial; Volume 26, page 79, December 1962)
Discussing a recent statement by Secretary Celebrezze of the
Department of Health, Education and Welfare, the journal says, "we
tend to agiee with an expert who recently said, 'I don't know why
cigarettes are harmful -- but I'm pretty sure they are.' The weight
of evidence seems to confirm his conclusion. There is certainly enough
evidence, in our opinion, to justify prompt HEW action. But the department,
we suppose, is as human as a department can be. Think what would happen
if Mr. Celebrezze slapped a ban on the sale of all tobacco products....
We humbly suggest that Mr. Celebrezze's boss would lose 40 million votes.
The facts remain: Tobacco is apparently detrimental to human health --
and no one's doing much about it."
JONES, HardLn Blair, Ph.D., Donner La boratory, Division of Medical Physics,
University of California, Berkeley
"Premature old age, major effect of smoking." (Science News Letter, Volume 82,
page 288, November 3, 1962)
T'ae author told a symposium on aging in San Francisco sponsored
by the Kais=:r Foundation Hospitals that smoking brings on a shift toward
old age ear,'_ier in life, and that the smoker of a package of cigarettes
daily can e::pect his life to be shortened by seven years. The life-shortening
process is n direct proportion to the amount smoked, he said; the extra-aging
_stops whene-er the person stops smoking.
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LAWTON, M. Powell, Ph.D., Norristown State Hospital, Pennsylvania
"A group therapeutic approach to giving up smoking." (Applied Therapeutics,
Volume 4, pages 1025-1028, November 1962)
This is a study of a tobacco addiction cure which is based on
the same principles as the cure for alcoholics as set up by the Alcoholics
Anonymous. Several individuals from the American Cancer Society, the
author, and others met to plan a group therapeutic approach to help
confirmed adult smokers quit -- a program which would rely wholly upon
psychological an_3 social treatment, the author says. "Considerable
validity for the approach is attested to by the fact that some inveterate
smokers did stop," he says.
MEDICAL TRIBUNE, New York City
"Smoking and the government." (Editorial; December 17, 1962, page 15)
Taking Secretary A. J. Celebrezze to task for his "prohibition
did not work" attitude on the smoking and health issue, the journal
says, "It is unlikely that those who recognize the noxious effects of
cigarette smoking advocate -- or will in the future advocate --
prohibition by ls.w of the manufacture, sale or smoking of cigarettes.
What is strongly recommended is an educational program to tell the public
of the hazards and to influence our youth not to acquire the habit. Isn't
it the role of the government to do more than inform the citizen? If the
day comes when scientifically irrefutable evidence links cigarette smoking
with cancer of the lung, will it not be the duty of the government to
educate the citizen to the hazards of an action that may be fatal for him."
NIESS, Oliver K., Major General, MC, Surgeon General, United States Air Force
"A united front against common killers." (Proceedings, 69th Annual Meeting,
Association of Military Surgeons, Washington, D.C., November 12, 1962)
"The relationship between cigarette smoking and lung cancer,
pulmonary diseases, and cardiovascular diseases has been established by
many studies over the past few years," the author says. "Our health
education progrP m acquaints our personnel with the dangers of smoking in
relation to these diseases."
PUBLIC HEALTH S~:ftVICE, Washington, D.C.
"Cancer cause and prevention." (Public Health Service Publication
No. 959, pages 3-14, 1962)
In a x=eview of information on various aspects of cancer cause
and prevention, the publication says: "The question whether smoking
causes cancer cannot be answered in a simple manner. But the Public
Health Service, on the basis of research, has concluded that the weight
of evidence at present shows that smoking -- particularly cigarette
smoking -- is a principal reason for the rising death rate from lung
cancer in the p?st 30 years.
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