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October 23, 1972

Nonspecification of Tobacco Smokers

JAMA. 1972;222(4):487. doi:10.1001/jama.1972.03210040055020

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To the Editor.—  In the July 31 issue of The Journal (221:509, 1972), Dr. Daniell discussed the relationship between osteoporosis and smoking. The letter appeared to be well documented and convincing, but the theory is far from flawless. I am an exsmoker and, like Dr. Daniell, am always searching to connect disease processes with the deleterious effects of smoking.Nevertheless, smokers and nonsmokers are different people, so they cannot be used as comparable study groups. Those who do not smoke for reasons of healthy living habits, also carry these living habits into sports activities, proper diet, etc, all of which contribute to a positive calcium balance and less osteoporosis. Furthermore, heavy smokers as a group do not force themselves to do regular exercise to a like extent, and are less likely to be capable of equivalent physical exertion, due to a higher incidence of cardiovascular and respiratory disease in this