Doctors Aren’t Advising Most Smokers to Quit

Though tobacco has long been identified as the most fatal, dangerous and dependency-inducing of harmful drugs, a new survey finds that doctors advise fewer than half the smokers they see to quit.

And that rate (44% of smokers seen as patients) doesn’t vary much even when the patients in question are overweight or have high blood pressure or are women who smoked and took birth control pills. Men 18 to 34 who smoked were least often advised to stop--just 30% of the time. Blacks were generally told even less often than whites to quit--though smoking rates among blacks are higher. A report of the research appeared last week in the Journal of the American Medical Assn.

The findings--produced by a team led by researchers from the Michigan Department of Public Health--focused on nearly 6,000 men and women. The low rates of quit-smoking advice were at odds with the position of the AMA, which since 1980 has advised physicians to routinely counsel all smokers to stop.

Doctors did advise three-quarters of smokers who had survived a heart attack to quit, but the Michigan team found that, in general, physicians got very low marks in their attempts to get people to stop using tobacco. Doctors told 43% of white men and 47% of white women to quit, but gave the advice to just 32% of black men and 37% of black women. A total of 58% of men with diabetes--but just 39% of women--were told to quit, as well as 40% of overweight men and 41% of overweight women.

Even though experts agree that women taking oral contraceptives should not smoke, only 41% of those taking the Pill got that advice from their doctors.

The research team suggested that insurers consider paying doctors a fee to provide smoking cessation and other prevention advice. The researchers concluded that “physicians need to increase their efforts in counseling smokers to quit before smoking-related diseases result.” Osteoporosis Myths

Promotion of centers purporting to predict development of osteoporosis--and sale of calcium supplements to prevent it--may have given women the disquieting impression they face the almost unavoidable prospect of broken bones in old age. But marketing efforts that imply that half--or more--of women will sustain fractures seriously overstate the actual risks, a geriatrics specialist says.

Despite the 50%-or-greater risk touted by some osteoporosis treatment and prevention entrepreneurs, the overall chance of having an osteoporosis-related broken bone is 25% or less--with many of those being minor wrist fractures that heal comparatively readily. Moreover, concluded Dr. John Meuleman, of the Gainesville (Fla.) Veterans Administration Medical Center’s geriatrics center, a review of dozens of osteoporosis studies finds that the most dreaded of osteoporosis-related old age broken bones--fractured hips--occurs in only 15% of women at some time in their lives.

In a telephone interview, Meuleman noted that even a 25% fracture incidence could be considered high, but he said promotion of screening programs and calcium supplements--two issues of growing concern in geriatric medicine--may have instilled an undue sense of panic in older women. Meuleman published an article in the journal Archives of Internal Medicine summarizing three major misconceptions about osteoporosis.

He found there may also be a 5% to 10% chance of having a fractured vertebra for a woman between ages 70 and 80. But only 25% of women will ever have a broken bone related to osteoporosis, with many of those involving the wrist, he concluded.

Meuleman identified two other myths about the disease: the notion that most white women (who have a greater incidence of osteoporosis than blacks) should undergo X-ray screening to predict whether they will have the disorder, and the idea that women should routinely take calcium supplements to maintain bone mass. Meuleman said only women who consume less than 800 milligrams a day of calcium, recommended for a normal diet, should consider calcium supplements.

Aspirin-Reye’s Link

For the fifth time since 1980, U.S. Public Health Service researchers have found clear evidence linking the taking of aspirin by children with incidence of potentially fatal Reye’s syndrome. And at this point, a Cleveland expert said, the relationship is “definitive.” Reye’s syndrome is a viral infection often characterized by nausea and vomiting.

The researcher, Dr. Edward Mortimer of the Case Western Reserve University School of Medicine, criticized the aspirin industry as “irresponsible” for continuing to dispute the findings. But in Washington, the Aspirin Foundation of America Inc., a trade group, said the aspirin-Reye’s relationship remains unproven and that Mortimer’s comments were “disappointing.”

The report, published last week in the Journal of the American Medical Assn., is the latest in a series of studies that have found aspirin capable of triggering Reye’s. In 1986, after several years of resistance by aspirin companies, the government started requiring a warning label advising against use of aspirin by children. The aspirin industry is the only major holdout in acceptance of the link.

In the newest study, Centers for Disease Control researchers found a clear relationship between aspirin use and Reye’s, concluding that the drug is responsible for “a majority” of such cases. In an editorial accompanying the study, Mortimer lambasted aspirin companies for their continuing refusal to accept the findings, saying, “I consider these actions to be irresponsible.”

However, Dr. Joseph White, head of the Aspirin Foundation of America, said the industry continues to find fault with CDC research and that aspirin makers still refuse to accept the relationship between use of their product by children and Reye’s syndrome. White said the industry is awaiting results of a study it is funding before drawing final conclusions. “We deny just about everything that’s in the (study) and the editorial,” White said.

Tobacco, Big Leagues

As if major league baseball didn’t have enough trouble with allegations of racism and drug use, a Wisconsin public health officer reports disturbing results from a review of emphasis on chewing tobacco in last year’s World Series.

Rhys Jones of the Wisconsin Division of Health in Madison reported that when he took a stopwatch to the television broadcast of the fifth game of the World Series (between the New York Mets and the Boston Red Sox), he found 23 minutes and 55 seconds of “perceptible use of tobacco,” mostly by players and managers. (Boston won, 4-2.) Jones calculated that this focus on tobacco use--mostly in the form of chewing tobacco used by players--gave tobacco companies the equivalent of $36 million worth of free advertising.

Jones was especially irate about one episode in which announcer Vin Scully, commenting on Mets manager Davey Johnson filling his mouth with Red Man, exclaimed: “Davey goes to the chew and pulls the pitcher!” Noting that major leaguers are not permitted to smoke in the dugout or on the field, Jones contended in a letter to the editor in the New England Journal of Medicine that tobacco companies may be switching to a chewing tobacco focus to have their products identified with sports events. Cigarettes cannot be advertised on TV but chewing tobacco can--though it is linked to mouth, tongue, lip and other cancers.

Concluded Jones: “Further attempts should be made to sever the relation between tobacco and sports.” Spokesmen for major league baseball could not be reached for comment.

Drinks and Pregnancy

Drinking during pregnancy has attracted the attention of a wide variety of public health experts, who advise pregnant women that alcohol consumption’s potential risks to their fetuses are so great they should not drink at all.

But to the consternation of the federal government’s National Institute on Alcohol Abuse and Alcoholism, a research team in Finland has concluded that while alcohol consumption must be restricted in pregnancy, consuming less than two drinks a week poses no significant risk. The study was published in the journal Obstetrics and Gynecology.

The Finnish study surveyed drinking behavior among 530 pregnant women, of whom 55% continued to drink. Beer was the most popular beverage, followed by wine and liquor. Researchers found women tended to moderate their drinking during pregnancy but that no discernible risks could be found among women who averaged less than two drinks a week.

In Washington, a spokesman for the institute noted that American health officials, including Surgeon General C. Everett Koop, still think abstinence is the only safe approach. The agency noted it is often difficult for people to agree on what quantity constitutes a “drink” and that still-incomplete research in the field has convinced top U.S. health officials that women must remain “very much on the cautious side.”