By Lauren A. Colby
- On July 13, 1994, an obituary in the Washington
Post reported the death, at age 60, of Richard Joshua Reynolds, III, an heir to the
founder of the R.J. Reynolds tobacco company. The headline and an accompanying photograph
showed the deceased smoking a cigarette and implied that Reynolds died from emphysema,
caused by smoking. Reading the obituary in detail, however, it turned out that he had quit
smoking eight years prior to his death; and that there was a family history of emphysema,
the deceased's own father having died from the disease at the age of 58. Furthermore, the
obituary disclosed that the deceased's own doctor was unable to state the "immediate
cause" of his death.
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- Medical opinion concerning emphysema has had an
interesting history. My 1973 edition of "Diagnosis and Treatment" (a standard
medical textbook), states that emphysema is a disease which involves destruction of the
alveolar (lung) tissue but that the cause is unknown, although "many doctors"
think it is caused by "cigarette smoking". In 1973, Chronic Pulmonary
Obstructive Disease (COPD) had not yet been invented. COPD, while now discussed at length
in modern medical textbooks, did not exist in 1973.
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- Some time subsequent to 1973, a genetic cause of
emphysema was discovered. In an article in the latest on-line edition of Grolier's
Encyclopedia, Howard Buechner, M.D., explains that a significant number of the people with
the disease lack a gene that controls the liver's production of a protein called alpha-1
antitrypsin (AAT). This protein controls or degrades an enzyme called neutrophil elastase,
produced by the white blood cells. When the enzyme is left unchecked, it destroys alveolar
tissue.
Evidently, the Reynolds, father and son, had
genetic cases of emphysema, which may or may not have killed the younger Reynolds, even
thought he had not smoked for eight years prior to his death. But this raises the
question: if there any proof that there is any cause of emphysema other than genetics?-
- The politically correct medical establishment
dances around that question with all of the skill of a lawyer. In the Merck Manual, 14th
Edition (1982), we are introduced to a new disease, Chronic Obstructive Pulmonary Disease,
or COPD, and, at page 629, we are shown a diagram, showing that the disease is combination
of emphysema and bronchitis, and that some patients may have one disease and some the
other, but many will have both. Smoking is said to "presumably" play a role in
COPD. At page 630, we told about AAT deficiency, but this is described as a "rare
condition"; it is not clear whether the authors mean that AAT is a "rare
condition" that causes emphysema, or that emphysema is rarely caused by AAT
deficiency. The language is, I think, deliberate vague.
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- By 1992, it becomes still more politically
imperative to blame smoking for COPD and emphysema. In the 16th Edition of the Manual
(1992), it is explained that, yes, emphysema is caused by destruction of lung tissue,
caused by an unchecked enzyme. We are told, however, that smoking lowers the body's
defenses to the enzyme. No evidence or authority is cited for that proposition.
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- Thus, we are left with confusing conclusions. We
have a new disease, COPD, the exact cause of which is unknown (indeed, the definition of
the disease is vague; it seems to be a case of "this patient has something wrong with
his lungs, but we don't know exactly what"). Smoking is thought to play a role; yet
the 16th Edition makes it clear that many cigarette smokers never develop the disease, and
the authors do not know why. I submit that the reason is very simple: smoking does not
cause emphysema.
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