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September 8, 1975

Hard Put For A Silver Lining

JAMA. 1975;233(10):1090. doi:10.1001/jama.1975.03260100060024

Tobacco is an enemy whose crimes are admitted even by its devotees. Its only defense is the claim that the alternatives to smoking—depression, excessive appetite, and nervous tension—may outweigh its dangers.

There are, however, circumstances under which smoking may be beneficial. In a study of risk factors for deep vein thrombosis complicating myocardial infarction, Handley and Teather1 found, to their surprise, that this complication occurred more often in nonsmokers than in cigarette smokers. Deep vein thrombosis was diagnosed by125I-labelled fibrinogen scanning in 17 (28%) of the 61 cigarette-smoking patients seen in the coronary care unit of Queen Mary's Hospital, Roehampton, England, as compared with 19 (51%) of their 37 nonsmoking counterparts.

The difference became even more significant after high-risk cases, ie, patients aged 70 years or more and those with varicose veins or a history of previous thromboembolism, had been excluded. In the narrowed sample, 9 (41%)