Peter D. Jacobson

Every year, more than 400,000 Americans die prematurely because of tobacco use. Most began smoking during their teen years. Adolescent tobacco use remains our nation's most preventable threat to life and health. This public health crisis has generated widespread debate over how best to prevent young people from initiating smoking or using other tobacco products. Combating Teen Smoking is an invaluable guide for policymakers and communities on the front lines of this prevention effort.Synthesizing recent research regarding the prevention and control of adolescent smoking, this book offers the reader a convenient compendium of what is known about adolescents and tobacco use; it also highlights areas where additional research is needed. Based on their assessment of the considerable amount of information presented, the authors recommend various ways to help slow--or even reverse--the recent rise in teenage smoking. A comprehensive antitobacco program might include, for example, antismoking media campaigns based on social marketing strategies, clean indoor air laws, and the increase of cigarette prices.Combating Teen Smoking will appeal to a broad spectrum of readers concerned about the problem of adolescent tobacco use, including policymakers who are actively seeking ways to help reduce teen smoking.Peter D. Jacobson is Associate Professor, University of Michigan School of Public Health. Paula Lantz is Assistant Professor, University of Michigan School of Public Health. Kenneth Warner is Richard D. Remington Collegiate Professor of Public Health and Director, University of Michigan Tobacco Research Network. Jeffrey Wasserman is Consultant, the RAND Corporation and Senior Project Director, The MEDSTAT Group. Harold Pollack is Assistant Professor, University of Michigan School of Public Health. Alexis Ahlstrom is Research Associate, University of Michigan School of Public Health.

In the late 1980s, a promising new treatment for breast cancer emerged: high-dose chemotherapy with autologous bone marrow transplantation or HDC/ABMT. By the 1990s, it had burst upon the oncology scene and disseminated rapidly before having been carefully evaluated. By the time published studies showed that the procedure was ineffective, more than 30,000 women had received the treatment, shortening their lives and adding to their suffering. This book tells of the rise and demise of HDC/ABMT for metastatic and early stage breast cancer, and fully explores the story's implications, which go well beyond the immediate procedure, and beyond breast cancer, to how we evaluate other medical procedures, especially life-saving ones. It details how the factors that drove clinical use - patient demand, physician enthusiasm, media reporting, litigation, economic exploitation, and legislative and administrative mandates - converged to propel the procedure forward despite a lack of proven clinical effectiveness. It also analyses the failure of the technology assessments and randomised clinical trials that evaluated the procedure and the ramifications of this flawed system on healthcare today. Sections of the book consider the initial conditions surrounding the emergence of the new breast cancer treatment, the drivers of clinical use, and the struggle for evidence-based medicine. A concluding section considers the significance of the story for our healthcare system.