To the Editor:-I read with interest Dr. Koop's editorial regarding environmental tobacco smoke (ETS). [1]It was surprising to find within it references to “6,000 American teenagers try their first cigarette each day,”“Smokers tend to underestimate the number of cigarettes smoked per day,” and “the accepted and conservative number of nonsmokers who die each year from ETS exposure is more than 50,000,” without any citation of a scientific source for these statements. These important statements are striking and, if true, tragic. Yet, without proper documentation, their validity cannot be assessed.

Most health-care workers probably share Dr. Koop's view that any smoking is too much. And when we hear lay press reports of a large European study of environmental tobacco smoke in which no excess morbidity or mortality was found, we long for documentation to challenge that conclusion.

It is important that statements made in scientific publications be based on solid evidence and that the evidence be made accessible. It would be very helpful if Dr. Koop would provide appropriate references for these statements, and I ask that the Editor make a greater effort to ensure that such references are included in the future.

Theodore A. Noel II, M.D.

1404 Baldwin's Court; Maitland, Florida 32751

(Accepted for publication October 30, 1998.)

Koop CE: Adverse anesthesia events in children exposed to environmental tobacco smoke. Anesthesiology 1998; 88:1141-2