Vol. 320 No. 24 



EDITORIALS 



IGI9 



The New England 

 Journal of Medicine 



Owned and Published by the 

 Massachusetts Medical Societ>- 



William G. Lavelle, M.D. 

 PrtsidaU 



William M. McDermctt.tr., M.D. 

 Exeaihve Vict Prtsidfnt 



Charles S. Amorosino, Jr. 

 Exeaitiu Stcrttaty 



The CoHurmE on Puvucationi 

 OF THE Massachusetts Medical Sootty 

 James F. McDonough, M.D., ChaifmoH 

 Henry H. Banks, M.D. Edward E. Jacobs, Jr., M.D. 



Frank E. Bixby, Jr., M.D. Brian J. McKinnon 



Howard M. Ecker, M.D. Daniel MUler, M.D. 



Howard Epstein, M.D. Percy W. Wadman, M.D. 



Arnold S. Relman, M.D., EorroR>tN-CHi£r 



Marda An^U, M.D., ExEciriTvi Ei>rTOR 



Edwin W, Salzman, M.D., DEPtrrv EorroR 



Gregory D. Curfman, M.D., DtTvn Editoii 



Edward W. Campion, M.D., Dturrv Eorroit 



Robert D. Uliger, M.D., DtFtnv Eorroii 



A990CUTZ EdITOM 



Jane F. Desforges, M.D. Norman K. Hollcnberg, M.D., Ph.D. 



Ronald A. Malt, M.D. Morton N. Swim, M.D. 



Franklin H. Epjtein, M.D. 



Frandj D. Moore, M.D., Boon Riview Editor 

 John C. Bailar, III, M.D., Walter WUlett, M.D., 



STATWnCAt CoNJUlTAWn 



Jo^ K. Iglehart, National Correspondint 



Marlene A. Thayer, EorroRiAL OmcE Manaoer 

 Stephen E. Cinto, Manaoer op Edftorial Production 

 Lorraine W. Loviglio, Manager op Manvicript Edttino 



EofTORiAL Board 



Eugene Braunwald, M.D. 

 Aram V. Chobuian, M.D. 

 Theodore Coltoo, ScO. 

 Richtni H. Egdaiil, MJ>. 

 John T. Hiniofton, M.D. 

 Hofnayoisi KiMiiu, M..D. 



Robert J. Mayer, M.D. 



Kenneth Mcintosh, M.D. 



David G. Nathan, MS). 



LawT<oa G. Rain, M.D. 



Kenneth J. Rothman, Dr.P.H. 



Thomas J. Ryan, M.D. 



EorroRiAL Oppics 



Nancy A. Bndy, Editorial Production Assistant; Helen Connors, 

 Research Assistant^ Karen M. Daly, Editorial Assistant; Brians 

 Doherry, Editorial Assistant; Kathleen Eagan, Manuscnpt Assist- 

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 Production Cooitlinator. ' 



Frederick Bowes, III, Director op PtntismNo Opkrations 

 Ann Reinke Strong, Dtpurr Dtaitn^a 



HEALTH AND PUBUC POLICY 



IMPLICATIONS OF THE "LOW YIELD" 



CIGARETTE 



Between 1955 and 1987 the average tar and nico- 

 tine yield of American cigarettes declined subsuntial- 

 ly. The average tar yield (weighted for the volume of 

 sales of the cigarette) fell from 34 to 13 mg, and the 

 average nicotine yield declined from 2 to 0.9 mg. Ad- 

 vertisements for "low yield" cigarettes often imply 

 that the health hazards associated with smoking these 

 cigarettes are less than the hazards associated with 

 higher-yield cigarettes. 



The case-control study by Palmer and coworkers 

 reported in this issue of the Journal shows that modem 

 low-yield cigarettes do not reduce the risk of nonfaul 

 myocardial infarction among women smokers under 

 65 years old.' Similar data have been reported for 

 men.' It seems clear that the hazards of coronary 

 heart disease are not reduced by smoking low-yield 

 rather than high-yield cigarettes. However, there is 

 evidence that smoking the low-yield cigarette may af- 

 fect the overall risks of adverse health effects in a pop- 

 ulation of smokers. The implications of these findings 

 for physicians and public policy makers are the subject 

 of this editorial. 



Yields are determined by analyzing the smoke 

 produced when a machine consumes a cigarette, 

 using spediic "puffing" characteristics. In the United 

 States, a 35-ml puff is taken over a period of two 

 seconds, and one puff is taken every minute until the 

 cigarette has burned to a specific length. Cigarette 

 testing was performed by the Federal Trade Commis- 

 sion between 1967 and 1987. The commission began 

 testing to deal with the competing advertising claims 

 of tobacco companies concerning tar yields. Govern- 

 mental testing was discontinued for economic and oth- 

 er reasons. Cigarette manufacturers, overseen by the 

 Federal Trade Commission, now undertake testing on 

 a voluntary basis. 



Historically, the first and most important step in 

 reducing tar and nicotine yields was the addition 

 to cigarettes of a filter tip that selectively removes 



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