Correspondence

The Human Costs of Tobacco Use

N Engl J Med 1994; 331:618September 1, 1994

Article

To the Editor:

The two-part article by Bartecchi and colleagues (March 31 and April 7 issues)1,2 describes different aspects of tobacco use. However, there is an important issue that was not discussed. Although cigarette smoking remains an important problem in the United States and other developed countries, the number of smokers in the Third World has increased dramatically over the past few years.

The annual number of deaths attributable to cigarettes will quadruple by 2030, and the bulk of these deaths will be in developing countries3. In China, 50 million of the children alive today will die from smoking4. In global terms, antismoking efforts in developed countries are neutralized by the increase in smoking in the Third World.

Knowledge of the harmfulness of smoking is often limited, or even nonexistent, in developing countries. The penetration of the transnational tobacco companies is another important factor5 that, along with the virtual absence of relevant laws and health-education programs, is responsible for the increased prevalence of smoking in developing countries.

Francisco Garcia-Rio, M.D.
Jose M. Pino, M.D.
Carlos Villasante, M.D.
La Paz Hospital, Madrid 28029, Spain

5 References

1. 1

   Bartecchi CE, MacKenzie TD, Schrier RW. The human costs of tobacco use. N Engl J Med 1994;330:907-912
   Full Text | Web of Science | Medline

2. 2

   MacKenzie TD, Bartecchi CE, Schrier RW. The human costs of tobacco use. N Engl J Med 1994;330:975-980
   Full Text | Web of Science | Medline

3. 3

   Mackay J. Tobacco: the Third World war. Thorax 1991;46:153-156
   CrossRef | Web of Science | Medline

4. 4

   Novotny TE, Peto R. Estimates of future adverse health effects of smoking in China. Public Health Rep 1988;103:552-553
   

5. 5

   Scull R. Bright future predicted for Asia Pacific. World Tobacco 1986;9:35-41
   

To the Editor:

Bartecchi et al. enumerate only the grave consequences of smoking, including cardiovascular disease, cancer, and lung disease. But there is another, less serious but nevertheless very important, consequence in men: impotence. The results of the Massachusetts Male Aging Study 1 show that the association of impotence with certain risk factors was greatly amplified in cigarette smokers. For men with treated heart disease, the probability of complete impotence was 56 percent for current smokers, as compared with 21 percent for current nonsmokers, to cite only one of six diseases and drug effects exacerbated by smoking.

Warning young men about this effect of tobacco use might perhaps impress them more than the threat of disease at older ages and might induce them to quit smoking.

Friedrich Katscher, Ph.D.
Mariahilfer Str. 133, Vienna A-1150, Austria

1 References

1. 1

   Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994;151:54-61
   Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: We certainly appreciate and sympathize with the plight of Third World countries. We can only hope that medical leaders in such countries will voice their concern to their people and their governments. U.S. citizens should also protest the exportation of potentially lethal products by tobacco companies to developing countries.

With regard to Dr. Katscher's comments: we fully expect that many more smoking-related problems are likely to be uncovered as researchers devote to smoking-related illnesses the amount of time and effort that a problem of this magnitude demands.

Carl E. Bartecchi, M.D.
Thomas D. MacKenzie, M.D.
Robert W. Schrier, M.D.
University of Colorado School of Medicine, Denver, CO 80262

Citing Articles (4)

Citing Articles

1. 1

   Carol A Derby, Beth A Mohr, Irwin Goldstein, Henry A Feldman, Catherine B Johannes, John B McKinlay. (2000) Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk?. Urology 56:2, 302-306
   CrossRef

2. 2

   Henry A. Feldman, Catherine B. Johannes, Carol A. Derby, Ken P. Kleinman, Beth A. Mohr, Andre B. Araujo, John B. McKinlay. (2000) Erectile Dysfunction and Coronary Risk Factors: Prospective Results from the Massachusetts Male Aging Study. Preventive Medicine 30:4, 328-338
   CrossRef

3. 3

   BEN J. BARNETT, DAVID S. STEPHENS. (1997) Urinary Tract Infection: An Overview. The American Journal of the Medical Sciences 314:4, 245-249
   CrossRef

4. 4

   Ronni Wolf, Adrian Shulmam. (1996) Erectile dysfunction and fertility related to cigarette smoking. Journal of the European Academy of Dermatology and Venereology 6:3, 209-216
   CrossRef