U.S. asks doctors to combat tobacco New guidelines urge physicians to pressure patients to quit


CHICAGO -- Doctors should routinely ask patients about their tobacco use and actively work to get those who smoke, chew or sniff tobacco to quit, according to new guidelines released yesterday by the U.S. Agency for Health Care Policy and Research, an arm of the Department of Health and Human Services.

The guidelines will be published today in a special issue of the weekly Journal of the American Medical Association. "I wouldn't say it's malpractice not to inquire about tobacco, but it is now a standard of care doctors should meet," said Dr. Randolph Smoak, secretary-treasurer of the medical association. "It's a whole cultural change for someone to quit smoking, and doctors should try to help."

The Robert Wood Johnson Foundation, which is active in anti-smoking programs, announced a grant to the medical organization yesterday to print the new practice guidelines and distribute them to 200,000 doctors. Although 70 percent of the nation's 46 million adult smokers say they want to quit, only 50 percent have ever been urged to do so by their doctors, according to Dr. Michael K. Fiore, a professor at the University of Wisconsin Medical School who led the panel that developed the guidelines.

In the medical journal, the doctors' group also calls on investors to stop investing directly in tobacco companies or in mutual funds that have such companies in their portfolios. In the mid-1980s, the medical association divested itself of all stock in tobacco.

The journal issue, the second devoted entirely to tobacco in less than a year, comes as the industry continues to fight investigations by the Justice Department, lawsuits trying to recover money spent on health care for smokers, and efforts by the Food and Drug Administration to regulate tobacco as a drug. This week tobacco companies have been hit with a new spate of negative news.

On Monday, a Washington state court upheld a state regulation banning smoking in private workplaces. On Sunday, scientists at an American Association for Cancer Research meeting in the nation's capital presented new research linking smoking to cervical cancer in women.

Also on Monday, the CBS Evening News reported on a 1974 research memorandum from the R. J. Reynolds Tobacco Co. that tobacco critics say suggests that the company believed that advertising influences teen-age smokers. The company has consistently denied that advertising plays any role in the decision by teen-agers to smoke.

Wall Street was undisturbed by the new attacks on the industry. Shares in Philip Morris, the industry leader, were off 12.5 cents, at $87.875, in trading on the New York Stock Exchange. Those of RJR Nabisco Holdings, R. J. Reynolds' parent, rose 25 cents to $29.75.

"There's been so much noise, investors are not paying any attention," said Alan Kaplan, who follows the industry for Merrill Lynch.

It would take a loss in one of the many lawsuits against the industry to shake investors, he said.

Articles in the new issue of the medical journal run the gamut from politics to medical practice. One calls on local governments to move more aggressively to ban cigarette billboard advertising. Another recommends that doctors routinely prescribe nicotine patches to help patients in programs to halt smoking and concludes that it would be cost-effective for the insurance industry to pay for such therapy.

Pub Date: 4/24/96

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