Ernst Wynder

Infobox Person
name = Ernst Wynder


caption =
birth_date = April 30, 1922
birth_place = Herford, Germany
death_date = July 14, 1999
death_place =
other_names =
known_for = Linking smoking and lung cancer
occupation = Physician, educator, health researcher
nationality = German, American

Ernst Wynder is an important figure in the history of epidemiology and public health in the United States, particularly in the study of risk factors for smoking disease. His 1950 coauthored publication of "Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of 684 Proved Cases" appeared in the Journal of the American Medical Association. It remains a landmark in the history of tobacco epidemiology, one of the first major scientific publications identifying smoking as a contributory cause of lung cancer. [Wynder, Ernst L., and Evarts A. Graham. 1950. Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of 684 Proved Cases. JAMA 143(4):334]

Biography

Wynder was born in Herford, Germany in 1922 to Jewish parents. In 1938 his family escaped Nazi rule and fled to the United States, where Wynder enrolled at New York University. During World War II, he attained citizenship and joined the U.S. Army, where, as a German-speaker, he was assigned to a psychological warfare unit to monitor German newscasts. After the war, he attended medical school at Washington University in St. Louis. In 1950, he received both a bachelor of science and a medical degree. Aside from his credentials as a physician, Wynder was a researcher, educator, and activist. He devoted his career to the study and prevention of cancer and chronic disease, including the publication of hundreds of scientific papers. Through the 1950s and 1960s, he worked at Sloan-Kettering Institute for Cancer Research. In 1969, he founded the American Health Foundation. In 1972, he founded the academic journal Preventive Medicine and served as the founding editor. Wynder died on July 14, 1999. [Brandt, Allan M. 2007. The Cigarette Century. New York: Basic Books, pages 133-134. Also see Wynder's obituary in Morbidity and Mortality Weekly Report 48(43), page 987, available at [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4843bx.htm MMWR] ]

Scholarship

Smoking and Lung Cancer Studies

Wynder began collaborating with his coauthor on the article, Evarts Ambrose Graham, as a medical student at Washington University in St. Louis in 1947. The previous summer he had conducted epidemiological studies of smoking behavior among 146 lung cancer patients in New York City. The project was funded by the American Cancer Society. Now, with Graham, Wynder collected extensive data on 604 patients with lung cancer at hospitals across the United States. Departing from a tradition of using anecdotal evidence (e.g., clinical interviews) to develop explanations of disease causation, Wynder and Graham applied rudimentary statistical methods to their study. They divided patients into crude categories of "moderate" or "heavy" smokers, based on retrospective interviews of each patient's smoking behavior over a twenty year period. They also measured and controlled for important confounding factors (e.g., age, types of tobacco use, inhalation level). Most importantly, with regard to an ability to demonstrate causation, Wynder and Graham also studied a control group of cancer-free individuals in hospitals. They used this control group to systematically compare their lung cancer patients. [Brandt, Allan M. 2007. The Cigarette Century. New York: Basic Books, pages 131-132.]

On May 27, 1950 the Journal of the American Medical Association published the resulting scientific report. Wynder and Graham found that lung cancer could develop among nonsmokers, such that smoking is not the single factor in the induction of disease. But they identified smoking's role as a significant risk factor for lung cancer, providing four reasons to support this argument: 1) Lung cancer prevalence was found to be rare in nonsmokers; 2) Among patients with lung cancer, cigarette use tended to be high; 3) Lung cancer prevalence among men and women matched patterns of smoking behavior in men and women; and, lastly, 4) "the enormous increase in the sale of cigarettes in this country approximately parallels the increase in [lung cancer] ." [Wynder EL, Graham E. Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma: a study of 684 proven cases. JAMA 1950;143:329-36. Also see Brandt, Allan M. 2007. The Cigarette Century. New York: Basic Books, pages 132-133.] As further scientific evidence of smoking's role in causing lung cancer began to mount in the United States and Great Britain, Wynder and Graham investigated the biological plausibility of the association between smoking and lung disease. In 1950, they initiated a study of the impact of tars from tobacco smoke on mice. After a year of exposure to tar, 44 percent of the mice developed cancers. Wynder also discovered specific carcinogens in tar (e.g., benzopyrenes, arsenic), but was unable to identify the contributions of these chemicals to cancer.

Wynder's studies of tobacco smoke were timely and important. Whereas laboratory studies of tobacco tar had been conducted elsewhere, Wynder's findings supported the growing epidemiological data. "The production of tumors in labor animals offered a powerful indicator that something in cigarette smoke could account for the epidemiological findings," writes Allan M. Brandt, a historian of medicine. [Brandt, Allan M. 2007. The Cigarette Century. New York: Basic Books, page 147.]

Other Research

Wynder published nearly 800 papers during his lifetime. [Hoffmann, I. The full bibliography of Ernst Ludwig Wynder. Prev Med. 2006;43:274–290; Stellman, Steven D. Ernst Wynder: The Citation Analysis. Prev Med. 2006; 43(4):268–270.] Wynder's work appeared in 139 periodicals and one book. More than half of his articles were published in ten prestigious mainline journals, such as Cancer, the flagship journal of the American Cancer Society. The dominant themes were lung and breast cancer, but there were also in-depth studies of the epidemiology of cancer of the bladder, larynx, colon and rectum, stomach, ovary, prostate, pancreas, and kidney, as well as numerous experimental studies. Many of these papers were the first or most comprehensive studies ever published, especially the massive 1960 coauthored study of the epidemiology of breast cancer. [Wynder EL, Bross IJ, Hirayama T. A study of the epidemiology of cancer of the breast. Cancer. 1960;13:559–601.]

ee Also

*Tobacco
*Public health
*Epidemiology
*Cigarette
*Nicotine
*Lung cancer
*Evarts Ambrose Graham
*Washington University in St. Louis

= References =

Notes

Further reading

* Brandt, Allan. "The Cigarette Century." Basic Books, 2007.
* Brandt, Allan. The cigarette, risk, and American culture. Daedalus 1990;119:155-76.
* Gately, Iain. "Tobacco: A Cultural History of How an Exotic Plant Seduced Civilization." Grove Press, 2003. ISBN 0-8021-3960-4.
* Kluger, Richard. "Ashes to ashes: America's hundred-year cigarette war, the public health, and the unabashed triumph of Philip Morris." New York: Knopf, 1996.
* Steinfeld JL. Smoking and lung cancer: a milestone in awareness. JAMA 1985;263:2995-7.
* Wynder EL. A corner of history: micro-epidemiology. Prev Med 1973;2:465-71.
* Wynder EL, Graham E. Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma: a study of 684 proven cases. JAMA 1950;143:329-36.