Lawrence Garfinkel

Oscar Auerbach, M.D.

Oscar Auerbach, who did important research linking cigarette smoking to lung carcinoma, died on January 15, 1997 at the age of 92. He was a respected scientist with an outstanding career in the field of tuberculosis pathology when he started his investigations into the effects of cigarette smoking on changes in the tracheobronchial epithelium in 1954, after noting at autopsy that many patients who died of lung carcinoma were heavy smokers. After completing preliminary studies, he was joined in his investigations by colleagues from the American Cancer Society who helped in the design of the studies and analysis of the data, and continued his investigations with financial support from the Society’s research program. In a major study of 402 autopsied cases at the Veterans Administration Hospital in East Orange, New Jersey, using as many as 50 slides per case, he found that precancerous changes, (including basal cell hyperplasia, stratification, and cells with atypical nuclei) were minimal in men who never smoked, and increased in direct proportion to the number of cigarettes the subject had smoked during his lifetime. The greatest number of such changes were in those individuals who died of lung carcinoma. His next study of tracheobronchial changes in autopsied cases included women as well as men; smokers of cigars and pipes; urban and rural cases; and both young and elderly men. The findings in these comparisons agreed very well with results of epidemiologic studies. Included in this large study of 758 subjects with a total of 41,690 slides were 72 for men smokers who had quit smoking at least 5 years earlier. Examination of the slides from these subjects showed a decrease in the number of sections with basal cell hyperplasia and atypical cells compared with those who smoked up to the time of death, and in some of the slides Dr. Auerbach found cells with disintegrating nuclei, a sign of a healing process in the bronchial epithelium. Dr. Auerbach subsequently reported on cellular changes in the larynx, esophagus, and pancreas in relation to smoking. As in the lung, he found that the changes in these organs increased in proportion to the number of cigarettes smoked, again confirming the epidemiologic evidence of the relationship between cigarette smoking and cancer of these sites. In addition to reporting changes in epithelial cells, Dr. Auerbach also investigated the development of emphysema, and thickening of vascular walls in the coronary arteries, as well as in the arteries and arterioles of other organ sites, in relation to smoking. He joined with others investigating the role of uranium dust and

Research methodology: What the clinician should know

Many clinicians find it difficult to fully evaluate the findings of research papers published in medical journals. Theoret ically, the journals review board has se lected studies that are well designed and well carried out and rejected the poorer ones. This may not, however, be neces sarily true. Some reviewers who are fa miliar with the literature and techniques employed in their specialties, but not with research methodology, may accept a manuscript with methodologic or sta tistical flaws. This paper is not concerned with case reports, descriptions of techniques, re view articles or those which reflect opin ions of the author, but rather with the basic elements of good research design, particularly as they pertain to experi mental and epidemiologic studies. The following should be kept in mind when evaluating a research study: (1) statement of the problem and formulation of the hypothesis; (2) review of the literature; (3) pretesting; (4) design of the study; (5) analysis of the data; (6) interpretation of results.