Alton Ochsner, AMA, American Lung Association, American Medical Association, cigarette smoking, destroying the environment, Dr. Alton Ochsner Sr., EPA, epidemiology, health, insurance companies, lung cancer, media, Michael DeBakey, public health, smoking, tobacco companies
Book published almost 60 years ago, in 1954:
74 Years Ago, in 1939, Drs. Alton Ochsner, Sr. and Dr. Michael DeBakey wrote that they believed that smoking caused cancer:
“In our opinion the increase in smoke with the universal custom of inhaling is probably a responsible factor [in the increase in pulmonary carcinoma], as the inhaled smoke, constantly repeated over a long period of time, undoubtedly is a source of chronic irritation to the bronchial mucosa.” Ochsner A., DeBakey M. “Primary pulmonary malignancy“. Surg Gynecol Obstet. 1939;68:433–451.
Now, where’s the news here? Well, firstly some people still do not believe that smoking is bad for you. We don’t mean that they smoke anyway, we mean there are really people who think it is not bad for you. Secondly, it means that there should be no smokers below age 90, and yet there are. The story of Ochsner’s fight against smoking has many parallels today. The media would not let him explain his findings. He had the American Medical Association (AMA) calling his conclusions “extreme.” And, “Dr. Ochsner … endured considerable ridicule and derision … for his outspoken opinions about the hazards of smoking. His perennial reply: ‘Only two kinds of physicians do not accept the evidence of a causal relationship between cigarette smoking and cancer: employees of the tobacco industry and some addicted to cigarette smoking.” (See Blum, 1999, below, citing Ochsner, 1963).
Dr, Ochsner was one of the only voices, and perhaps the only voice, speaking out about the dangers of smoking for decades! In 1982, shortly after Dr. Ochsner died, the evidence was so overwhelming that some pathologists joked that they should promote smoking because it was good for business. Yet, 31 years later people still smoke and still impose their smoke upon others.
Currently, the US EPA and the American Lung Association http://www.lung.org are in court fighting to protect Americans from breathing mercury from coal-fired plants, mercury which can be filtered out, but industry mad-hatters, do not want this. Haven’t we known that mercury is bad for you for a very long time?
The constant roll-backs against knowledge regarding environment and public health; roll-backs where bad people are trying to convince good people that things which have been long proven bad for you are really ok, placed Dr. Ochsner in mind.
How many people have needlessly died because Dr. Ochsner was not listened to early on? How many will die, either from smoking or second hand smoke, because he continues to be ignored. How many died because Ignaz Semmelweis was ignored when he proposed that doctors should wash their hands when coming to deliver babies, after doing autopsies? Semmelweis was mocked and his career at the University of Vienna damaged, because he concluded, 166 years ago, that doctors should wash their hands in diluted chlorine solution, after dealing with corpses. http://en.wikipedia.org/wiki/Ignaz_Semmelweis Although he could not see germs, he could theorize them based on the evidence. Only 20 years later, with improved microscopes and Pasteur’s research was he proved correct. People are dying again in hospitals because health-care workers do not wash their hands.
In Victorian times “Mad as a Hatter” became a popular expression. The first known description of mercury poisoning in relation to hat makers (hatters) was made in St. Petersburg, Russia in 1829. In the US, in 1890, it was observed:
“The surprise is that men can be induced to work at all in such death producing enclosures. It is hard to believe that men of ordinary intelligence could be so indifferent to the ordinary laws of health… It does not seem to have occurred to them that all the efforts to keep up wages… [are] largely offset by the impairment of their health, due to neglect of proper hygienic regulations of their workshops… And when the fact of the workmen in the sizing room, who stand in water, was mentioned, and the simple and inexpensive means by which it could be largely avoided was spoken of, the reply was that it would cost money and hat manufacturers did not care to expend money for such purposes, if they could avoid it.” Bishop, Annual Report of the Bureau of Statistics of Labor and Industries of New Jersey (1890) http://en.wikipedia.org/wiki/Mad_hatter_disease (references at link; emphasis added)
Dr. Ochsner’s Courageous, Life-long Fight Against Smoking
“In 1939, Dr. Alton Ochsner, one of Ochsner’s founders, was one of the first to discover the link between tobacco use and lung cancer. He then dedicated the rest of his life to educating the world on the dangerous effects of smoking.
Alton Ochsner’s Legacy
“In our opinion the increase in smoke with the universal custom of inhaling is probably a responsible factor [in the increase in pulmonary carcinoma], as the inhaled smoke, constantly repeated over a long period of time, undoubtedly is a source of chronic irritation to the bronchial mucosa.”
– Alton Ochsner, MD and Michael DeBakey, MD, 1939
When Drs. Alton Ochsner and Michael DeBakey published their groundbreaking paper linking smoking and lung cancer in 1939, even the idea that lung cancer cases were increasing was controversial. Plenty of physicians just didn’t accept or believe the mounting evidence that lung cancer was on the rise.
But Alton Ochsner was seeing more and more lung cancer patients in the operating room, and many of them were heavy smokers. Proving the link between smoking and lung cancer, treating the disease, and finding a cure became the focus of his research and put him at the center of a scientific controversy.
For years, physicians belittled his research and called his theories pure speculation. But he was right.
And that may be his greatest legacy-his efforts to warn the public about the dangers of smoking.” http://www.ochsner.org/programs/legacy_article_jan_18/ (emphasis added)
Dr. Alan Blum tells us in more detail the challenges which Dr. Ochsner faced in his mission:
“Alton Ochsner, MD, 1896-1981 Anti-Smoking Pioneer” By Alan Blum, MD
The story was told by a physician who had just heard Dr. Ochsner, at the age of 84, deliver one of the major scientific addresses at the annual meeting of the American Academy of Family Physicians in 1980; the listener had found his presentation on the same topic as dynamic and compelling as it was 30 years before. Even if Ochsner, who died on September 24, 1981, had not been among the first physicians to make the connection between smoking and lung cancer, he would still be remembered as one of the foremost thoracic surgeons and medical teachers in history. Named chairman of surgery at Tulane University at the age of 30, he went on to found the Ochsner Foundation Hospital (named after him as a sign of admiration by his physician-co-founders).
Alton Ochsner’s persistent belief that cigarette smoking was the principal cause of the growing epidemic of lung cancer—a theory he publicized throughout the 1940s in the face of ridicule and vituperative attacks even from within the medical profession—symbolized his energetic drive to improve public health. In 1919, lung cancer was such a rare disease that Ochsner’s entire junior medical school class at Washington University’s Barnes Hospital was asked to witness the autopsy of a man who had died from it. The professor, Dr. George Dock, believed that no one in the class would ever again see another such case. Seventeen years later, after having been a surgeon for more than a decade, Ochsner did see his next case of lung cancer—nine cases, in fact, in a period of just six months. Because all the patients were men who had taken up the newly mass-advertised practice of smoking while serving as soldiers in World War I…, he had the temerity to suggest that cigarette smoking was responsible.
By 1952 he and his colleagues, Drs. Michael DeBakey and Paul DeCamp, could write in the Journal of the American Medical Association, “There is a distinct parallelism between the sale of cigarettes and the incidence of bronchogenic carcinoma” (1). They accurately predicted that the death rate from lung cancer would escalate as long as smoking continued to exist and that lung cancer would be the leading cause of death from cancer. So controversial was Ochsner that prior to an appearance on Meet the Press in the mid-1950s, he was told he would not be permitted to mention on the air the possible causal relationship between cigarette smoking and lung cancer.
Barely a month following publication in January 1964 of the landmark report of the Surgeon General on smoking, the American Medical Association (AMA) became the only major health organization to join the industry in opposing the immediate implementation of warning labels on all cigarette packs and advertisements. At a symposium sponsored by the American Cancer Society, an angry Dr. Ochsner charged that the AMA was “derelict” in its duty as a leader in health matters to educate the public on the findings of the Surgeon General’s report. Moreover, he characterized the projected multi-million dollar long-term AMA research program on smoking, funded entirely by the tobacco industry, as “just delaying tactics” to prevent taking action to reduce demand for tobacco. The AMA countered that Dr. Ochsner’s viewpoint was “extreme.”
Indeed, for decades before the Surgeon General’s report, Dr. Ochsner had endured considerable ridicule and derision even from some doctors for his outspoken opinions about the hazards of smoking. His perennial reply: “Only two kinds of physicians do not accept the evidence of a causal relationship between cigarette smoking and cancer: employees of the tobacco industry and some addicted to cigarette smoking” (2).
Long after the AMA’s research program had begun, Ochsner vehemently opposed the premise that additional research studies were needed to prove that smoking caused lung cancer. In his essay “The Hazard of Bronchogenic Carcinoma” he wrote, “Until we find an animal which is foolish enough to smoke like human beings, it will probably not be possible to produce bronchogenic cancer in the experimental animal. However, with the proof in the human being, additional animal experimentation is not necessary” (2).
Ochsner would drive home this point with the story of a cavalry officer who suspected his wife of being unfaithful. After telling his wife he was departing for a military campaign, the officer hid across the street and witnessed a soldier from another regiment arriving at his house and being warmly welcomed by his wife. He watched through the window as they kissed, embraced, disrobed, ran upstairs, embraced again, and leaped into bed. Then the lights were turned off and the officer exclaimed, “Damn, if I only had proof!”
He sardonically contrasted the Food and Drug Administration’s quick removal of thalidomide from the market with governmental inaction on cigarettes. “If there were one tenth the evidence that the Brooklyn Bridge was unsafe for traffic as there is that cancer of the lung is caused by cigarette smoking, the Brooklyn Bridge would be closed to traffic within 24 hours until it could be determined whether it was safe” (3). It was all about money: “Our complacency about this much greater health hazard is undoubtedly due to the economic significance of tobacco” (3).
In the 1960s and 1970s Ochsner pointed out that as tragic as is the fatality rate from lung cancer due to smoking, it pales in comparison to cigarette-related deaths from heart attack and emphysema. After the widespread publicity accorded the breast cancer experiences of First Lady Betty Ford and the wife of the Vice President, Happy Rockefeller, Ochsner castigated the mass media for ignoring lung cancer—a more preventable problem and soon to become a greater cause of death among women. Noting the absurdity of women who continued to smoke as a means of keeping their weight down, Ochsner wondered aloud, “Who wants to be a svelte corpse?”
He also criticized insurance companies, having tried for years to get them to give preferential rates to non-smokers. “The companies’ own statistics show that heavy smokers live about eight years less,” he said, “but premiums appear to be set according to death rates for smokers. Company profits are thus boosted at the expense of nonsmokers who do not only pay extra but live longer.” He surmised-correctly-that insurance companies have tobacco stocks in their portfolios.
Among the first to debunk the government’s $40 million research effort to develop a “safe cigarette,” Ochsner, whenever he was asked if filtered cigarettes had any value, would reply, “Yes, for the tobacco industry. They help sell more cigarettes.”
Dr. John Ochsner, emeritus professor of surgery at the Ochsner Clinic, recalls that all teenagers took up smoking for a time, and the Ochsner children were no exception. “Not only did we get the lecture from Dad,” he said in a recent interview, “but when he found out my sister was smoking he put an article on her bed every night—and if he didn’t have an article, he wrote one.” Nor were colleagues immune to his wrath. Dr. Minis Gage, his closest friend, once told John Ochsner, “I burn more holes in my pockets stuffing cigarettes when your dad comes around!”
Although pleased that his father’s work has been cited as the cornerstone of legislative actions to punish, restrict, and regulate the tobacco industry, Dr. John Ochsner does not believe that his father would have approved of the efforts by some plaintiffs’ attorneys to profit from the issue: “Dad had no love for people who would capitalize off the suffering of others.”
Obituaries of Ochsner depicted him as a foe of smoking and a nemesis of the tobacco industry. It would be more accurate to depict him as a forceful advocate for good health. Although a surgeon, he preferred to speak out about measures that could prevent the need for the knife. “Even though relief of symptoms and prolongation of life can be obtained by surgery and other therapeutic measures,” he wrote in 1966, “only through prevention, mainly abstinence from smoking, can one hope to attain better results in the treatment of lung cancer” (4).
There is little on the horizon to challenge that statement.
Ochsner J. 1999 July; 1(3): 102–105.
Alan Blum, MD
Gerald Leon Wallace Professor of Family Medicine, Department of Family Medicine, College of Community Health Sciences, University of Alabama School of Medicine; Director, University of Alabama Center for the Study of Tobacco and Society; Founder, Doctors Ought to Care
Copyright Academic Division of Ochsner Clinic Foundation
Articles from The Ochsner Journal are provided here courtesy of Ochsner Clinic Foundation
1. Ochsner A, DeBakey ME, DeCamp PT. et al. Bronchogenic carcinoma, its frequency diagnosis and early treatment. JAMA. 1952;148:681–697. [PubMed]
2. Ochsner A. The hazard of bronchogenic carcinoma. Milit Med. 1963;128:1167–1172. [PubMed]
3. Ochsner A. The increasing menace of bronchogenic cancer. N Physician. 1964;13:29–36. [PubMed]
4. Ochsner A. Bronchogenic carcinoma stages III and IV: palliation by surgery JAMA 1966. 196: 852. [PubMed]”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145444/ (bold was added for emphasis) See also: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096386/
It is worth noting that cigarette companies paid for many TV advertisements in the period when he was forbidden from speaking out against smoking on TV. Also, those more rare cases of lung cancer were probably among miners.