The Most Exhaustive Survey On Smoking & Disease

The first statistical studies of the re lationship between smoking and lung cancer had an understandable impact: there are 65 million cigarette smokers in the U.S. with an understandable in terest in their own health. But that twelve-year-old beginning left room for argument; even though the research continued, there were a few reputable medical men who were convinced that the case against cigarettes had not been proved. Late in 1959 the American Cancer Society enrolled 1,078,000 American volunteers in a project designed to produce enough statistics to convince anyone. Last week at the American Medical Association's clinical meetings in Portland, Ore., the Cancer Society's chief statistician, Dr. E. Cuyler Hammond, gave the first of a long series of reports on the million-subject study. The figures were indeed convincing.

Big Surprise. Because men under 40 were judged too young to show the effects of lifetime smoking, Dr. Hammond limited the first report to 422,094 of his volunteers--men aged 40 to 89. The findings went far beyond previous studies as they indicted smoking.

No one previously had gathered any data on the effect of deep inhaling upon health. The relationship had been assumed from the start, but this time all the subjects were specifically asked if they inhaled, and if so, how much. Among men aged 40 to 69, the death rate of those who said they did not inhale was 1.64 times as high as the rate for nonsmokers; but among those who said they inhaled deeply, it was 2.22 times as high. And the relative difference increased in the older age groups.

One big surprise was the importance of the age at which a smoker picks up the habit. In the 40-69 age bracket, the death rate of men who started smoking after 25 was 1.42 times that of nonsmokers; among those who had begun as striplings under 15, it was 2.29 times as high. The higher death rate can be traced, said Dr. Hammond, to three underlying factors: 1) precocious smokers tend to inhale more deeply, 2) they smoke more cigarettes a day, and 3) by the time they reach middle age, they have been smoking for many more years.

No Coincidence. In all areas, Dr. Hammond went out of his way to forestall argument. Earlier studies had classified subjects only as smokers or nonsmokers. Critics suggested that the apparent relationship between smoking and cancer might be largely coincidence, that other factors must be involved. What about race, heredity, occupation, nervousness, appetite for fried foods, use of tranquilizers, exercise--even circumcision and baldness?

Dr. Hammond divided his subjects aged 40 to 60 into groups, separating them according to 24 such factors. He discovered that it made virtually no difference whether the men were short or tall, black or white, native or foreign-born, married or single, gluttons for fried food or abstainers, bald or shockheaded, circumcised or not. The death rate ran consistently about twice as high among heavy smokers (a pack a day or more) as among nonsmokers.

Other Factors. The A.C.S. researchers pulled their neatest statistical trick to answer the critics who claimed that the association between heavy smoking and early death is a coincidental companion of some other factor. Hammond's computer wizards found 36,975 pairs of men who were matched in every conceivable respect except their smoking habits. The men in each pair were of the same race, within an inch of the same height, came from the same birthplace (U.S. or foreign), had the same occupational exposure to polluted air, had had the same amount of edu cation, were of the same religion and marital status, had the same drinking habits, took the same amount of exercise, had similar health records, and suffered--so far as anybody could judge --from about the same degree of nervous tension.

In the 34 months of the study, the members of these closely matched pairs had very different health experiences. Of the nonsmokers, 662 died. Only twelve died of lung cancer, one from emphysema, 304 of coronary artery disease and eight from aortic aneurysm--leaving 329 for other causes. But among the smokers, 1,385 died--110 of lung cancer, 15 of emphysema, 30 of aortic aneurysm and 654 of coronary disease.

Seeming Paradox. To cigarette addicts, the big question of the past few years has been: "Are filters safer?" Dr. Hammond gave a carefully qualified answer. Some filtertips pass as much nicotine and tar as old-fashioned "straights," or even more. So the key question becomes what brands are low in nicotine and tar. While nobody knows for certain that low-tar, low-nicotine cigarettes are safer, it is certain that smokers who use them cough less and have fewer day-today illnesses.

Dr. Hammond also dealt with a seeming paradox that had emerged from previous studies: among men who gave up smoking, the death rate was higher, within a year of their quitting, than among men who continued to smoke. The explanation, Hammond concluded, is easy: most men quit smoking only under doctor's orders. When they quit, they are already sick. And among such.men, it is natural that the death rate is high. The most encouraging note that Dr. Hammond struck was that men who give up smoking before they become desperately ill benefit noticeably. More of the tobacco damage is reversible than physicians once believed.

The A.M.A. was impressed. It has repeatedly provided Hammond with a platform and long ago dropped tobacco advertising from its publications, but last week was moved to unprecedented action. The doctors proposed long-range research to be financed partly by the

A.M.A., partly by contributions. "So many gaps exist in knowledge about the relationship of smoking to health," said the A.M.A. House of Delegates with extreme caution, that "a comprehensive program of research is needed."

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