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January 24, 1996

The AMA, Tobacco, and the Public Health

Author Affiliations

Putnam Hospital Center Carmel, NY

JAMA. 1996;275(4):276. doi:10.1001/jama.1996.03530280028020

To the Editor.  —I congratulate you for your hard-hitting issue of July 19, 1995,1 exposing the tobacco industry's conspiracy to mislead and deceive the American public. As a practicing physician, I am frustrated when I care for a patient with chronic bronchitis, emphysema, or coronary artery disease (to name a few) and then am unable to use an ICD-9-CM2 to indicate that the illness was caused, in many cases, by tobacco. The only reference to tobacco in the ICD-9-CM is under the category for mental illness, as "tobacco addiction 301.5." A precedent exists for including causative agents in defining diseases, for example, "alcoholism 313.9," allowing the physician to diagnose "alcoholic cirrhosis of the liver 571.2," "alcoholic brain syndrome 231.2," or "alcoholic cardiomyopathy 225.5."The same latitude for coding tobacco-related organ damage does not exist in the current ICD-9-CM. Additions to ICD-9-CM could use additional decimals, such as adding