There have been no major advances in the surgical or radiation therapy treatment of lung cancer. Multiple trials of neoadjuvant therapy of advanced stage lung cancer are in progress, and offer hope of some improvement in the treatment of these patients. Data from meta-analyses suggests that addition of chemotherapy programs to radiation therapy in patients with unresectable lung cancer offers a small but statistically significant improvement in survival. A curative chemotherapy approach continues to be elusive.
Although major strides have been made in the understanding of the molecular biology and genetics of cancer, less progress has been made with lung cancer than with other cancers e.g.breast and colon neoplasms. One reason for this is that no familial syndrome of increased risk of bronchogenic carcinoma has been described. A number of innovative therapeutics approaches based on disruption of molecular mechanisms in cancer cells, utilizing anti-sense constructs, ribozymes and gene therapy, are in the pipeline but offer no definite hope of a cure for lung cancer in the near future.
The evidence linking environmental tobacco smoke with lung cancer has strengthened.
No real advances have been made in effective screening for lung cancer. Although a number of recent studies from Japan have offered strong suggestive evidence that radiographic screening reduces mortality from lung cancer, the American Cancer Society insists that there is insufficient evidence to support a policy of nationwide screening by chest roentgenograms. I personally believe that this is a foolish decision, and that survival in a screened population can be as high as 35% rather than the 12% survival now achieved.
The only area in which progress has been made, is in the understanding of the minimally effective responses that our society and government have made to try to control the etiologic agent that causes the continuing holocaust which consumes 150,000+ lives each year in the U.S..
"If you want to beat malaria, you have to understand the malaria mosquitoes that spread malaria. If you want to prevent lung cancer, you have to study the tobacco industry to see how it spreads smoking."
Stanton Glantz
Lung cancer presents us with a strange and frustrating conundrum. Unlike the case with other types of cancer, lung cancer has a clear and obvious cause, cigarette smoking, which, if removed, would result in a reduction of more than 90% of deaths from lung cancer within three or four decades. Despite the fact that all reasonable people in the USA have clearly understood the etiology of the disease for more than 45 years, relatively minimal success has resulted from attempts by physicians and public health and government officials to control the disease. In 1995 there are still approximately 40-50 million smokers in the USA. We know exactly what must be done, but we are not doing it.
The Tobacco Policy Recommendations of the International Association for the Study of Lung Cancer (IASLC) are as follows:
In order to understand why efforts to implement these policies have been so limited and ineffective, one must follow the golden rule.
Golden leaf tobacco comes from the southeastern USA, where tobacco is grown with the help of subsidies, amounting to $42 million/yr., provided by the US government to tobacco farmers. Any attempt to abolish or reduce these subsidies is bitterly fought by the senators and representatives from the tobacco states, led by Jesse Helms, Republican senator from North Carolina.
After the tobacco has been processed into cigarettes and sold, a torrent of real gold, $42 billion, pours into the coffers of the major US tobacco companies. Philip Morris, ranked #1 in corporate profit in 1990, with $4.9 billion. The company is the 13th most valuable in the world, with an estimated net worth of $61 billion. It's Marlboro brand is second only to Coca Cola as the most valuable brand name in the world.
There has been an increasing recognition that cigarette smoking is a pediatric disease. Children and Tobacco The average smoker has his first cigarette at age 9 and is a regular smoker by age 12. 3000 children start smoking each day in the US, 1 million children each year. One in five teenagers is a smoker. Cigarette company advertising campaigns clearly have strong appeal to children, the most blatant being the infamous Joe the Camel logo, which carries name recognition in children equal to Mickey Mouse. Some black humor to help get this point across is at-
The D.O.A. Tobacco Companyand September/October 1994 -- Tobacco Sidebar: Unsmoky Joe's
Operation Storefront: Youth Against Tobacco Advertising and Promotion conducted a large survey of marketing practices in California that demonstrated how the tobacco industry spends $4 billion of it's advertising dollars on storefront ads. Among the more striking, statistically significant, findings were the following.
Faced with this immoral, drug-dealer type behavior, there are increasing efforts by Public health authorities in Canada to ban all tobacco advertising and promotions. The Clinton administration has proposed a ban on all vending machine sales, mail order and free sample cigarettes, outdoor advertising near schools, free products with tobacco industry logos, brand name sponsorship of sporting events and numerous other anti-smoking measures.
Tobacco advertising money has, in turn, been effective in pressuring magazine editors into rejecting articles documenting the dangers of cigarette smoking in US publications. The Columbia Journalism Review, in 1978 found that it was
"unable to find a single article in 7 years of publication that would have given readers a clear notion of the nature and extent of the medical and social havoc being wreaked by the cigarette-smoking habit... one must conclude that advertising revenue can indeed silence the editors of American magazines."This problem is amplified by the diversification of tobacco companies into other sectors of the business world.
In some cases, buying into companies in the communications industry places the tobacco industry into a position to more directly smother anti-tobacco reports. Rupert Murdoch's New York Post has a deplorable record of factual reporting of tobacco related issues. Murdoch holds a position on the board of directors of Philip Morris.
A related problem occurs when companies have large amounts of money invested in tobacco companies. Prudential Insurance Co. which owns a number of HMOs in the U.S. has nearly $250 million in such investments. Will Prudential encourage it's medical companies to work to reduce the number of smokers, thus lowering the value of it's portfolio?
An interesting finding in the Brown and Williamson papers is a confidential letter from Sylvester Stallone agreeing to show Brown and Williamson products in five movies for $500,000.
On the flip side, diversification is also a source of weakness for tobacco
companies, in that anti-tobacco activists are advocating boycotts directed against
all products produced by any conglomerate which sells tobacco products. A list of
such companies and their products was published in California Physician.
"Members of Congress are as addicted to large campaign contributions as smokers are to nicotine."
Ann McBride
The gold that is contributed to politicians by the tobacco companies buys their votes against any legislation aimed at a regulation of tobacco products. The net result is that the federal government spends $100 million on control of tobacco, which is responsible for 400,000 deaths per year, and $12 billion on control of illicit drugs, which kill 10-20,000 yearly.
Stanton Glantz, a member of the Dept of Medicine of the University of California at San Francisco, who has been a most effective long term opponent of the tobacco companies, received a $600,000 National Cancer Institute grant to study the influence of political contributions from the tobacco industry on the voting record of politicians. He showed that the more money a politician had taken, the less likely he would be to vote for tobacco control legislation. On August 3, 1995 John Porter, chairman of the Republican controlled House Appropriations Committee, in a unique proceeding, recommended that NCI stop funding Glantz's research grant. The staff director of this committee is James Dyer, formerly a lobbyist for Philip Morris. Glantz was quoted
"This is not the first instance of lynch mob mentality directed at science, but I can't let this group of thugs shut the work down. I ain't going quietly."
Philip Morris is the leading soft money donor, $58,000, to the Republican National Committee. In the recent congressional elections, tobacco industry PACs gave $2,759,497. 79% of Representatives and Senators took tobacco PAC money.
A classic example of political gold was the California Proposition 99 political campaign, which the tobacco industry spent more than $11 million to try to defeat. Prop 99, called "
the most successful public health intervention since the invention of sewers", passed and has since reduced the number of smokers by one million with an estimated reduction of $385 million in health care costs to the state of California. The biggest recipient of tobacco gold in California was Willie Brown, Democrat, $470,000.
On June 21, 1995 the National Republican Congressional Committee "Salute to Newt Gingrich" collected $1.7 million. Co-chairmen for the event were the CEOs of Phillip Morris, RJR Nabisco and Brown and Williamson companies. 80 representatives were flown in for the banquet on corporate jets, including that of the US Tobacco Corporation. Gingrich was to receive $4.5 million in a book deal, from Rupert Murdoch, who is co-incidentally on the board of directors of Philip Morris, before public outcry forced Gingrich to back out of the deal..
On December 13, 1995 it was reported that Gov. Pete Wilson had suppressed an anti-smoking radio advertisement produced with Prop 99 money. Wilson had earlier attempted to divert moneys derived from Prop 99 away from anti-smoking activities. (For more information on this topic try-Expert says funds from tobacco tax misdirected) Wilson's aborted presidential campaign of 1995 was directed by Philip Morris Senior Vice President Craig Fuller.
When the Republicans recently took over the House Committee on
Commerce, anti-tobacco activist Henry Waxman was replaced as chairman of the
Subcommittee on Health and. Thomas Bliley the new chairman of the Commerce
Committee was quoted as saying
"As far as I'm concerned we have enough laws on the books regulating the sale of tobacco already."
If you are interested in finding out whether your senator and representative have taken money from tobacco interests take this link and follow the instructions-The Center for Responsive Politics
Tobacco growth also displaces valuable farmland away from growing enough food to feed 20 million people, and results in deforestation, since one acre of timber is required to cure one acre's growth of tobacco.
cigarettes are the only legal product that is hazardous when used as intended".Yearly they cause more deaths than illicit drugs, accidents, homicide and suicide combined. Legal "dream teams" of high priced lawyers have been so successful that while
"tobacco companies have been held liable when their product contained human toes, mice, small snakes, nails, fishhooks, firecrackers, steel particles and worms,.... no tobacco company has ever been held responsible for a death, disability or disease caused by smoking". Lawyers advised Brown and Williamson and British American Tobacco how to hide research reports on the carcinogenicity of cigarettes, and how to use legal maneuvers to make damaging information non-discoverable in case of law suits. New product liability reform legislation introduced by Republican legislators will make it increasingly difficult for a cancer victim to bring a successful suit against a tobacco company. This absurd situation exists within a legal system that routinely grants large judgments against companies for trivial injuries to consumers.
Threats of legal action are also used as a potent weapon by the tobacco companies to intimidate opponents from airing the dirty linen of the industry. When "Mr. Butts", a pseudonym for a tobacco industry insider, gave 8000 pages of internal memoranda from the Brown and Williamson Co. to Stanton Glantz, the first window into the inner workings of the tobacco industry was opened wide. Legal firms working for the tobacco industry have been frantically trying to suppress this information, thus far unsuccessfully. This is not surprising, in view of the fact that the American Medical Association says that the papers show
"massive, detailed evidence of the tactics by which, for more than 30 years, the tobacco industry concealed evidence that nicotine is addictive and tobacco smoke causes cancer. The evidence is unequivocal- the US public has been duped."Glantz has subsequently turned the B+W papers over to the University of California at San Francisco. The papers are accessible through the internet at http://www.library.ucsf.edu/tobacco/bw.html/.
When Glantz and his associates tried to find a publisher for a book entitled
"The Cigarette Papers", they were turned down by 24 consecutive publishing
companies. Diane Wachtell of New Press stated "If you anger a tobacco company
and get into what amounts to a financial war with it--where the issue is who can
afford better attorneys for longer--you're going to lose."
Attorneys representing the Brown and Williamson Co. have also been in the
news recently as they were successful in quashing an interview on CBS television
with former employee, Jeffrey Wigand, who has charged "that the tobacco
company scrapped plans for a safer cigarette" and that it "knowingly used a pipe-
tobacco additive that causes cancer in laboratory animals". In the case of CBS,
the spiking of the critical interview on Sixty Minutes was probably facilitated by
the fact that the network is about to merge with Westinghouse Corp., whose
chairman, Lawrence Tisch, also heads a large tobacco company. B+W has also
gotten a Kentucky judge to issue a restraining order on Wigand, to stop
him from testifying in a lawsuit against the company.
The basis for tobacco gold is the powerful addictive nature of nicotine, the active ingredient in cigarettes. This addiction is so powerful that, although one- third of American smokers try to quit each year, only 7% are able to kick the habit long term. This is the reason why otherwise intelligent people continue to indulge in the self-destructive smoking habit. If this addiction is established during childhood, before the age of reason, it is doubly difficult to overcome.
Although cigarette companies deny it, they have know, at least since 1963, that nicotine was addictive. During the Rose Cipollone trial in New Jersey in 1983, attorneys for the Cipollone family, who were suing for wrongful injury (lung cancer) caused by cigarettes, lawyers representing her cited the addicting nature of nicotine as the reason that she had continued to smoke despite the Surgeon General's warning, printed on cigarette packs starting in 1966. It has recently been discovered that, at about the same time as this legal tactic was introduced, Philip Morris closed down the lab of research scientist Victor DeNoble, required him to withdraw articles submitted for publication, and ordered him not to discuss his research activities. DeNoble had successfully demonstrated the powerful addiction caused by nicotine in laboratory rats. This information was never revealed to the general public or to public health authorities. The molecular mechanism for nicotine addiction has recently been conclusively proven.
Other documents have suggested that the tobacco industry deliberately manipulates the amount of nicotine in cigarettes. This information has led the National Institute of Drug Abuse to conclude
"the cigarette is essentially the crack cocaine form of nicotine delivery".This raises a new issue in tobacco regulation, designation of cigarettes as a drug.
"The core issue affecting FDA movement toward regulation of cigarettes as "drugs" involves the intent of the vendor. If for example, there is an intention by the pertinent vendor to create an addiction, then cigarettes may properly be regulated."FDA Commissioner David Kessler wants to define nicotine as a drug, and considers smoking a "pediatric disease". Newt Gingrich has responded by calling Kessler a "thug and a bully".
"They don't realize the suffering that they're causing until it happens to them, and the suffering that they're causing is beyond words."
