Actual Causes of Death in the United States

Jetson E. Lincoln
JAMA. 1994;271(9):660. doi:10.1001/jama.1994.03510330037020.
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To the Editor.  —If cigarette smoking is as lethal as authorities continue to say it is,1 why have the experimental outcomes of randomized intervention trials2-5 failed to date to indicate (by generating greater mortality rate reductions among baseline-defined smokers than among baseline-defined nonsmokers) that successful smoking cessation guidance prolongs survival? How can the outstanding longevity of Japanese men be reconciled with a smoking prevalence among them that is higher than for most other countries? Why is the approximate 4.6:1 ratio of male-to-female cigarette smoking prevalence for Japan, vs only about 1.3:1 for the United States, not reflected in a wider gap between men's and women's life expectancy for the Japanese than for the Americans?

Financial Disclosure.  —Mr Lincoln has about 20% of his pension under the control of Philip Morris, and about 15% of his net worth is in tobacco company securities.


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