Dr Lowenfels proposes that the apparent protective effect of cigarette smoking on gallstone formation described in our study1 may be artifactual and a result of selecting control subjects from a trauma hospital. This is, indeed, a plausible hypothesis. Nevertheless, it should be pointed out that this control series of hospitalized patients, and others from the same institution, have been used in several, published case-control studies, including investigations of colorectal cancer, ovarian cancer, stomach cancer, and breast cancer.2-4 In none of these studies was cigarette smoking found to be in excess in the control series relative to the cases. Unless all of these cancers are positively associated with cigarette smoking, it is unlikely that the potential bias would limit itself to our present study. Additionally, our understanding of the biological role of smoking on estrogen concentration and on high-density lipoprotein cholesterol, as cited in our article, should
Pastides H. Smoking and the Risk of Gallstones-Reply. Arch Intern Med. 1991;151(2):398. doi:10.1001/archinte.1991.00400020134030
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