Intended for healthcare professionals

Rapid response to:


Emerging tobacco hazards in China: 2. Early mortality results from a prospective study

BMJ 1998; 317 doi: (Published 21 November 1998) Cite this as: BMJ 1998;317:1423

Rapid Response:

Stop Smoking Carol AS Thompson!

Even for a traditional medical journal as the BMJ, the Internet
allows a lively discussion and obviously attracts also readers outside the
medical community. The editorial registrar qualified the unusually harsh
electronic responses by Carol AS Thompson (1) as "a combination of
aggression, intolerance, stupidity and fanatism"(2). Furthermore, the
combination of these attributes reminded him of Nazi propaganda. As an
Austrian he has to be sensitive by nature for early signs of this

The reaction by Carol AS Thompson may, however, also be seen from a
different perspective. Carol AS Thompson is not a physician and therefore
not used to behave properly in the framework of a highly ranked medical
journal. Nevertheless, she was brave enough to post her opinion in an
unaccustomed environment. In addition, Carol AS Thompson is supposed to be
cigarette smoking dependent and therefore her view of the real problem may
be blurred.

Nicotine dependent cigarette smokers have shown to exhibit increased
lifetime rates of major depression and anxiety disorders (3). Smokers with
more than 20 cigarettes per day were more likely to exhibit cognitive
dissonance over smoking-related health beliefs than were lighter smokers
In contrast, offensive behaviour is not due to smoking. Smoking of
nicotine containing cigarettes has been found to suppress human aggressive
behaviour (5). Nicotine, administered with experimental cigarettes also
showed to produce a dose-dependent decrease of aggressive behaviour in
humans. (6).

The burden of disease caused by smoking is too obvious to be denied
without contradiction.
Carol AS Thompson, you have demonstrated interest in this field otherwise
you would not have found this article in the Internet. You also have shown
courage to post your viewpoint in one of the most traditional medical
journals. The data on smoking related diseases are all true. Smoking is a
deadly disease. Fill up with new courage, stop smoking and throw your last
butt in a tar pit where it belongs.


1. C. Thompson. Throw Peto in a tar pit. eBMJ, 13 Dec, 1998

2 M. Muellner. Thank you Carol AS Thompson. eBMJ, 15 Dec 1998

3. N. Breslau, M. M. Kilbey, and P. Andreski. Vulnerability to
psychopathology in nicotine-dependent smokers: an epidemiologic study of
young adults. Am.J.Psychiatry 150 (6):941-946, 1993.

4. M. T. Halpern. Effect of smoking characteristics on cognitive
dissonance in current and former smokers. Addict.Behav. 19 (2):209-217,

5. D. R. Cherek. Effects of cigarette smoking on human aggressive
behavior. Prog.Clin.Biol.Res. 169:333-344, 1984.

6. D. R. Cherek. Effects of cigarette smoking of nicotine on human
aggressive behaviour Psychopharmacology. 75(4):339-345, 1981.

Michael Binder, MD
Decision Systems Group
Brigham and Woman´s Hospital
Boston, MA 02115

Competing interests: No competing interests

17 December 1998
Michael Binder
Reearch fellow in medical informatics
Decision Systems Group, Brigham & Woman's Hospital, Boston, MA