Ernst Wynder
Encyclopedia
Ernst Ludwig Wynder was an American epidemiology
and public health
researcher who studied the risk factors of smoking tobacco. His 1950 coauthored publication of "Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of 684 Proved Cases" appeared in the Journal of the American Medical Association
. It was one of the first major scientific publications identifying smoking as a contributory cause of lung cancer.
). In 1938 his family escaped Nazi rule and fled to the United States, where Wynder enrolled at New York University
. During World War II
, he attained citizenship and joined the U.S. Army, where, as a German-speaker, he was assigned to a psychological warfare unit to monitor German newscasts. After the war, he attended medical school at Washington University in St. Louis
. In 1950, he received both a bachelor of science and a medical degree. Aside from his credentials as a physician, Wynder was a researcher, educator, and activist. He devoted his career to the study and prevention of cancer and chronic disease, including the publication of hundreds of scientific papers. Through the 1950s and 1960s, he worked at Sloan-Kettering Institute for Cancer Research. In 1969, he founded the American Health Foundation. In 1972, he founded the academic journal Preventive Medicine and served as the founding editor. Wynder died on July 14, 1999.
, as a medical student at Washington University in St. Louis in 1947. The previous summer he had conducted epidemiological studies of smoking behavior among 146 lung cancer patients in New York City. The project was funded by the American Cancer Society
. Now, with Graham, Wynder collected extensive data on 604 patients with lung cancer at hospitals across the United States. Departing from a tradition of using anecdotal evidence (e.g., clinical interviews) to develop explanations of disease causation, Wynder and Graham applied rudimentary statistical methods to their study. They divided patients into crude categories of "moderate" or "heavy" smokers, based on retrospective interviews of each patient's smoking behavior over a twenty year period. They also measured and controlled for important confounding factors (e.g., age, types of tobacco use, inhalation level). Most importantly, with regard to an ability to demonstrate causation, Wynder and Graham also studied a control group of cancer-free individuals in hospitals. They used this control group to systematically compare their lung cancer patients.
On May 27, 1950 the Journal of the American Medical Association published the resulting scientific report. Wynder and Graham found that lung cancer could develop among nonsmokers, such that smoking is not the single factor in the induction of disease. But they identified smoking's role as a significant risk factor for lung cancer, providing four reasons to support this argument: 1) Lung cancer prevalence was found to be rare in nonsmokers; 2) Among patients with lung cancer, cigarette use tended to be high; 3) Lung cancer prevalence among men and women matched patterns of smoking behavior in men and women; and, lastly, 4) "the enormous increase in the sale of cigarettes in this country approximately parallels the increase in [lung cancer]." As further scientific evidence of smoking's role in causing lung cancer began to mount in the United States and Great Britain, Wynder and Graham investigated the biological plausibility
of the association between smoking and lung disease. In 1950, they initiated a study of the impact of tars from tobacco smoke on mice. After a year of exposure to tar, 44 percent of the mice developed cancers. Wynder also discovered specific carcinogens in tar (e.g., benzopyrenes, arsenic
), but was unable to identify the contributions of these chemicals to cancer.
Wynder's studies of tobacco smoke were timely and important. Whereas laboratory studies of tobacco tar had been conducted elsewhere, Wynder's findings supported the growing epidemiological data. "The production of tumors in lab animals offered a powerful indicator that something in cigarette smoke could account for the epidemiological findings," writes Allan M. Brandt, a historian of medicine.
. The dominant themes were lung and breast cancer, but there were also in-depth studies of the epidemiology of cancer of the bladder, larynx, colon and rectum, stomach, ovary, prostate, pancreas, and kidney, as well as numerous experimental studies. Many of these papers were the first or most comprehensive studies ever published, especially the massive 1960 coauthored study of the epidemiology of breast cancer.
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
and public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
researcher who studied the risk factors of smoking tobacco. His 1950 coauthored publication of "Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of 684 Proved Cases" appeared in the Journal of the American Medical Association
Journal of the American Medical Association
The Journal of the American Medical Association is a weekly, peer-reviewed, medical journal, published by the American Medical Association. Beginning in July 2011, the editor in chief will be Howard C. Bauchner, vice chairman of pediatrics at Boston University’s School of Medicine, replacing ...
. It was one of the first major scientific publications identifying smoking as a contributory cause of lung cancer.
Biography
Wynder was born in Herford, Germany in 1922 to Jewish parents (a cousin of Robert WeinbergRobert Weinberg
Robert Allan Weinberg is a Daniel K. Ludwig Professor for Cancer Research at MIT and American Cancer Society Research Professor; his research is in the area of oncogenes and the genetic basis of human cancer. Weinberg is also affiliated with the Broad Institute and is a founding member of the...
). In 1938 his family escaped Nazi rule and fled to the United States, where Wynder enrolled at New York University
New York University
New York University is a private, nonsectarian research university based in New York City. NYU's main campus is situated in the Greenwich Village section of Manhattan...
. During World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
, he attained citizenship and joined the U.S. Army, where, as a German-speaker, he was assigned to a psychological warfare unit to monitor German newscasts. After the war, he attended medical school at Washington University in St. Louis
Washington University in St. Louis
Washington University in St. Louis is a private research university located in suburban St. Louis, Missouri. Founded in 1853, and named for George Washington, the university has students and faculty from all fifty U.S. states and more than 110 nations...
. In 1950, he received both a bachelor of science and a medical degree. Aside from his credentials as a physician, Wynder was a researcher, educator, and activist. He devoted his career to the study and prevention of cancer and chronic disease, including the publication of hundreds of scientific papers. Through the 1950s and 1960s, he worked at Sloan-Kettering Institute for Cancer Research. In 1969, he founded the American Health Foundation. In 1972, he founded the academic journal Preventive Medicine and served as the founding editor. Wynder died on July 14, 1999.
Smoking and Lung Cancer Studies
Wynder began collaborating with his coauthor on the article, Evarts Ambrose GrahamEvarts Ambrose Graham
Evarts Ambrose Graham was a professor and a physician.Born in Chicago, Illinois to a surgeon, Graham received his M.D. degree from Rush Medical College, in 1907. An expert thoracic surgeon, he was best known for collaborating with J. J. Singer on the successful removal of a lung to fight cancer....
, as a medical student at Washington University in St. Louis in 1947. The previous summer he had conducted epidemiological studies of smoking behavior among 146 lung cancer patients in New York City. The project was funded by the American Cancer Society
American Cancer Society
The American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...
. Now, with Graham, Wynder collected extensive data on 604 patients with lung cancer at hospitals across the United States. Departing from a tradition of using anecdotal evidence (e.g., clinical interviews) to develop explanations of disease causation, Wynder and Graham applied rudimentary statistical methods to their study. They divided patients into crude categories of "moderate" or "heavy" smokers, based on retrospective interviews of each patient's smoking behavior over a twenty year period. They also measured and controlled for important confounding factors (e.g., age, types of tobacco use, inhalation level). Most importantly, with regard to an ability to demonstrate causation, Wynder and Graham also studied a control group of cancer-free individuals in hospitals. They used this control group to systematically compare their lung cancer patients.
On May 27, 1950 the Journal of the American Medical Association published the resulting scientific report. Wynder and Graham found that lung cancer could develop among nonsmokers, such that smoking is not the single factor in the induction of disease. But they identified smoking's role as a significant risk factor for lung cancer, providing four reasons to support this argument: 1) Lung cancer prevalence was found to be rare in nonsmokers; 2) Among patients with lung cancer, cigarette use tended to be high; 3) Lung cancer prevalence among men and women matched patterns of smoking behavior in men and women; and, lastly, 4) "the enormous increase in the sale of cigarettes in this country approximately parallels the increase in [lung cancer]." As further scientific evidence of smoking's role in causing lung cancer began to mount in the United States and Great Britain, Wynder and Graham investigated the biological plausibility
Biological plausibility
In epidemiology and biomedicine, the term biological plausibility refers to the proposal of a causal association — a relationship between a putative cause and an outcome — that is consistent with existing biological and medical knowledge....
of the association between smoking and lung disease. In 1950, they initiated a study of the impact of tars from tobacco smoke on mice. After a year of exposure to tar, 44 percent of the mice developed cancers. Wynder also discovered specific carcinogens in tar (e.g., benzopyrenes, arsenic
Arsenic
Arsenic is a chemical element with the symbol As, atomic number 33 and relative atomic mass 74.92. Arsenic occurs in many minerals, usually in conjunction with sulfur and metals, and also as a pure elemental crystal. It was first documented by Albertus Magnus in 1250.Arsenic is a metalloid...
), but was unable to identify the contributions of these chemicals to cancer.
Wynder's studies of tobacco smoke were timely and important. Whereas laboratory studies of tobacco tar had been conducted elsewhere, Wynder's findings supported the growing epidemiological data. "The production of tumors in lab animals offered a powerful indicator that something in cigarette smoke could account for the epidemiological findings," writes Allan M. Brandt, a historian of medicine.
Other Research
Wynder published nearly 800 papers during his lifetime. Wynder's work appeared in 139 periodicals and one book. More than half of his articles were published in ten prestigious mainline journals, such as Cancer, the flagship journal of the American Cancer SocietyAmerican Cancer Society
The American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...
. The dominant themes were lung and breast cancer, but there were also in-depth studies of the epidemiology of cancer of the bladder, larynx, colon and rectum, stomach, ovary, prostate, pancreas, and kidney, as well as numerous experimental studies. Many of these papers were the first or most comprehensive studies ever published, especially the massive 1960 coauthored study of the epidemiology of breast cancer.
See also
- TobaccoTobaccoTobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...
- Public healthPublic healthPublic health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
- EpidemiologyEpidemiologyEpidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
- CigaretteCigaretteA cigarette is a small roll of finely cut tobacco leaves wrapped in a cylinder of thin paper for smoking. The cigarette is ignited at one end and allowed to smoulder; its smoke is inhaled from the other end, which is held in or to the mouth and in some cases a cigarette holder may be used as well...
- NicotineNicotineNicotine is an alkaloid found in the nightshade family of plants that constitutes approximately 0.6–3.0% of the dry weight of tobacco, with biosynthesis taking place in the roots and accumulation occurring in the leaves...
- Lung cancerLung cancerLung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
- Evarts Ambrose GrahamEvarts Ambrose GrahamEvarts Ambrose Graham was a professor and a physician.Born in Chicago, Illinois to a surgeon, Graham received his M.D. degree from Rush Medical College, in 1907. An expert thoracic surgeon, he was best known for collaborating with J. J. Singer on the successful removal of a lung to fight cancer....
- Washington University in St. LouisWashington University in St. LouisWashington University in St. Louis is a private research university located in suburban St. Louis, Missouri. Founded in 1853, and named for George Washington, the university has students and faculty from all fifty U.S. states and more than 110 nations...
Further reading
- Brandt, Allan. The Cigarette Century. Basic Books, 2007.
- Brandt, Allan. The cigarette, risk, and American culture. Daedalus 1990;119:155-76.
- Gately, Iain. Tobacco: A Cultural History of How an Exotic Plant Seduced Civilization. Grove Press, 2003. ISBN 0-8021-3960-4.
- Kluger, Richard. Ashes to ashes: America's hundred-year cigarette war, the public health, and the unabashed triumph of Philip Morris. New York: Knopf, 1996.
- Simmons, John Galbraith. Doctors and discoveries: lives that created today's medicine: from Hippocrates to the present. pp. 307-311. Houghton Mifflin, 2002. ISBN 0-618-15276-8.
- Steinfeld JL. Smoking and lung cancer: a milestone in awareness. JAMA 1985;263:2995-7.
- Wynder EL. A corner of history: micro-epidemiology. Prev Med 1973;2:465-71.
- Wynder EL, Graham E. Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma: a study of 684 proven cases. JAMA 1950;143:329-36.