The Alton Ochsner Award Relating Smoking and Health

Guidelines

All agreed that the award should be presented annually, in the name of Alton Ochsner, to one or more scientists or physicians (with a maximum of three). Their research or clinical contributions should have been so important that they made a major impact on the overall scientific knowledge and medical practice that linked cigarette smoking to health. We further agreed that nominations for the award should be broadly solicited from the Departments of Medicine, Surgery, Pathology, Pediatrics, and Psychiatry of every medical school and Veterans Administration hospital in the United States and from leading scientists all over the world. Furthermore, we recommended that the sponsor of the award must commit its intention to maintain the award for at least 10 years. We all agreed that the amount of $15,000 would be awarded annually by a prestigious selection committee. The Lakeside organization rapidly agreed to these general guidelines. Later, when this company was purchased by Marion Laboratories and, then, when their interests were transferred to SmithKline Beacham Pharmaceuticals, the award was continued and has been maintained to this date.

Venue for the Award

It then was necessary to identify an important national or international scientific meeting where the Ochsner Award would be presented. One such organization, the American College of Chest Physicians, held its scientific meetings annually at different cities in the United States and Canada, and attracted among its attendees chest physicians, cardiologists, pediatricians, pathologists, surgeons, and basic scientists. All of us considered this organization to be ideal, and I contacted Dr. Alfred Sofer, then Executive Director of the College, who readily agreed to highlight the Award on the dias of their annual convocation when new Fellows of the College would be initiated. Having participated in these ceremonies in the past, I thought this would be an excellent place in their program since it would precede a voluntary anti-smoking oath taken by each new fellow (Tables 1). Dr. Porter and Lakeside accepted Dr. Sofer's offer.

Selection Committee

I then suggested the need to establish a Selection Committee. We agreed that among these individuals should be an internist, pulmonologist, cardiologist, oncologist, psychiatrist, epidemiologist, basic scientist, and representatives from the Alton Ochsner Medical Foundation.

Each person who was invited to participate on the committee immediately accepted. They included: Dr. Claude Lenfant, Director of the National Heart Lung and Blood Institute of the National Institutes of Health; Dr. Eugene Braunwald, Hersey Professor of Medicine and Physik, Harvard University; Dr. Shervert Frazier, Professor of Psychiatry, Harvard University and former Director of the National Institute of Mental Health; Dr. Michael DeBakey, Professor of Surgery and Chancellor of Baylor College of Medicine; Dr. William B. Kannel, Director of the Framingham Heart Study; and Rosalyn Yallow, PhD, Nobel Laureate and Senior Medical Investigator, Veterans Administration. Dr. Porter and I represented the Alton Ochsner Medical Foundation. The Committee held its first meeting in Washington, D.C. in July 1985, where it unanimously elected Dr, Lenfant as Chairman, accepted the above outlined guidelines (with some minor additions), and selected the first Alton Ochsner Award winner (Tables 2).

Over the subsequant 13 years, several members of the Selection Committee rotated from its membership and were replaced by other eminent and prestigious leaders in medicine. Thus, Drs. Braunwald and DeBakey were followed by Dr. Francois M. Abboud, Professor and Chairman of the Department of Medicine, University of Iowa, and a past President of the American Heart Association and David C. Sabiston, MD, James B. Duke Professor and Chairman of the Department of Surgery, Duke University. Dr. Kannel was replaced by Dr. H. Alfred Tyroler, Professor of Epidemiology, University of South Carolina, and later Dr. David A. Homberger, President, Carnegie Foundation; Dr. Kannel later returned to the Selection Committee. Dr. Frazier was succeeded by Dr. Samuel B. Guze, Professor of Psychiatry and former Chancellor and Chairman of the Department of Psychiatry, Washington University Medical Center. Drs. Harriet P. Dustan, Professor of Medicine Emeritus, University of Alabama, and Past President of the American Heart Association, and Frank A. Riddick, Jr, former Medical Director of Ochsner Clinic and Chief Executive Officer of the Alton Ochsner Medical Foundation later succeeded Drs. Abboud and Yallow. Throughout, Dr. Lenfant continued to serve the Committee exceedingly well as its Chairman. On behalf of the Committee and of the Alton Ochsner Medical Foundation, I express to each of these outstanding clinical and academic leaders our heartfelt gratitude and due appreciation for their outstanding and most responsible contributions.

Ochsner Awardees

Since establishment of the Ochsner Award in 1985, 19 honorees have been chosen by the Selection Committee. In addition, four other outstanding individuals were named to receive Special Awards of Recognition presented by the Alton Ochsner Medical Foundation at the same time the annual honorees received their awards (Tables 2).

The first Award was presented to Oscar Auerbach, MD, of the Veterans Administration Hospital (East Orange, NJ), in 1986, for his series of studies extending over a lifetime that demonstrated in patients, as well as experimentally in beagle dogs, that long-standing smoking produced early lesions of bronchogenic carcinoma. Moreover, he demonstrated that these early lesions were reversible with cessation of smoking. In 1986, the Award was conferred upon Aaron Janoff, PhD, a psychiatrist at the State University of New York at Stony Brook, whose interest in addictive behavior demonstrated that prolonged cigarette smoking was addictive and that the addictive behavior associated with cigarette smoking was related to its nicotine content. The third Award, presented in 1987, was conferred on three men who had confirmed the original clinical observation of DeBakey and Ochsner reported in 1939. The association between cigarette smoking and lung cancer was true, and a statistically significant relationship, in fact, existed. Thus, independently, Ernst L. Wynder, MD (American Health Foundation, New York); and Sir Richard Doll, MD (Imperial Cancer Research Fund's Cancer Epidemiology Program and Clinical Trials Research Unit, England); and A. Bradford Hill, PhD (London School of Hygiene and Tropical Medicine), demonstrated epidemiologically as well as clinically that the association was a very real clinical problem. Their findings confirmed Ochsner and DeBakey's original observations.

In 1989, the Award was conferred upon Frank Speizer, MD, of Harvard Medical School, who demonstrated that prolonged cigarette smoking progressively impaired ventilatory lung function eventually resulting in emphysema. Emphasizing the further role of prolonged cigarette smoking on the development of emphysema, the 1990 Award was presented jointly to two independent clinical scientists, Gordon L. Snider, MD, of Boston University, and Ronald G. Crystal, MD, of the National Heart Lung and Blood Institute, for their studies that clearly showed the relationship between cigarette smoking and specific enzymatic changes that promoted emphysema.

The Award shifted its focus in 1991 from cigarette smoking's pulmonary target organ involvement to the cardiovascular system. Studying young individuals dying of sudden trauma, Jack Strong, MD, of Louisiana State University, New Orleans, showed that long-standing cigarette smokers had more severe atherosclerotic changes of the aorta and blood vessels than non-smokers.

Attention once again was focused on the addictive properties of nicotine in long-standing cigarette smokers in 1992 when the Award was conferred on Murray E. Jarvik, MD, PhD, of the Veterans Administration Medical Center, Los Angeles, and Theodore A. Slotkin, PhD, of Duke University. These workers demonstrated that not only did prolonged smoking produce nicotine-induced tobacco addiction, but the lung lesions were also associated with fetal malformations in babies born to mothers who had been addicted to smoking.

In 1993, the Award was presented to Curtis C. Harris, MD, of the National Cancer Institute (NIH), for his fundamental genetic studies which demonstrated that prolonged cigarette smoking was associated with the induction of specific oncogenes that preceded the development of bronchogenic carcinoma. On the following year, 1994, Hildegard Schuller, DVM, PhD, of the University of Tennessee, Chattanooga, received the Award for her work which demonstrated that certain chemicals in tobacco smoke, the nitrosoamines, were responsible for the development of lung cancer. Moreover, there was a potential reversibility of the early developmental lesions by certain pharmacological agents (i.e., calcium antagonists).

Focusing on a different line of investigation, Robert M. Senior, MD, of Washington University, St. Louis, was presented the Award in 1995 for his research work demonstrating that smoking stimulates the attraction of inflammatory cells in the lung by elastin peptides which, in turn, enhances the development of emphysema. In 1996, the Award was given to three clinical scientists, Neal L. Benowitz, MD, of the University of California San Francisco; Jack E. Henningfield, PhD, of the National Cancer Institute (NIH); and Professor Michael Russell of the Institute of Psychiatry, University of London, for their independent studies demonstrating the pharmacological interaction of nicotine and its metabolites which result in tobacco addiction and, eventually, lung cancer.

Refocusing on tobacco-induced lung injury, the Award was presented to James C. Hogg, MD, of the University of British Columbia in 1997, for his long-term research studies that revealed the role of tobacco-induced lung injury and the development of alveolar cell wall injury by viral and other noxious agents.

Shifting from biochemical, pathological, and physiological evidence of prolonged tobacco consumption and bronchogenic carcinoma to the new clinical discipline of diagnostic genetics, the Ochsner Award was presented to David Sidransky, MD, of The Johns Hopkins University in 1998 for his research studies. This young clinical scientist demonstrated that the sputum of patients who smoke contains cells that have undergone genetic changes, permitting the diagnosis of lung cancer, even before the disease is otherwise shown clinically.

Special Awards of Recognition

In addition to the foregoing annual Awards, on occasion the Selection Committee saw fit to recommend to the Alton Ochsner Medical Foundation that it should confer Special Awards of Recognition to certain individuals for their important roles in relating cigarette smoking to the development of disease. Thus, in 1993, the Alton Ochsner Medical Foundation honored Michael DeBakey, MD, for his initial clinical report co-authored with his mentor and associate Alton Ochsner. Thus, Dr. DeBakey was recognized for the seminal observation that smoking is, indeed, associated with the development of lung cancer.

Another Special Award was presented to Stanton A. Glantz, PhD, in 1997 for his ongoing research relating nicotine and smoking to heart disease and for his extraordinary advocacy efforts dealing with the interface between medical science and health policy.

The Honorable Mike Moore, Attorney General of the State of Mississippi, and Lonnie R. Bristow, MD, former President of the American Medical Association, were each presented a Special Award in 1997 for their individual and important roles in focusing the attention of the public, the government, and the legislative process on the necessity for the tobacco industry to compensate the state governments for health care costs attributable to chronic cigarette smoking and disease. These two recipients were also instrumental in raising general awareness of the need to initiate educational programs on the dangers of smoking and to cease promotion of tobacco products to our nation's youth. It was their efforts that eventually led to individual financial and legal settlements between the tobacco industry and certain states as well in 1997 and 1998.

Concluding Remarks

The foregoing discussion, and the recognition of outstanding scientists and public leaders, make it very clear that the abundant scientific data amassed over the past 60 years clearly demonstrate and clarify the association of cigarette smoking and the eventual development of disease. The data are now amply clear that, through its chronic consumption of nicotine, cigarette smoking promotes tobacco addiction. This, in turn, reinforces the drive of tobacco abusers to remain as tobacco consumers leading to the eventual potential patients of smoking-induced disease. Among these diseases are lung cancer, emphysema, bronchiectasis, chronic lung infections and bronchitis, atherosclerosis, myocardial infarction, stroke, fetal abnormalities, and other pathological entities. Not yet identified for Ochsner Awards are those individuals who have shown that smoking is related to other diseases which are obviously of major concern. Included among these other diseases are peptic ulcer, bladder cancer, bone diseases, and others. Their turns at recognition will no doubt occur, but we of the Ochsner Medical Institutions are honored to have been permitted to highlight many research achievements that have lead to the presentation of our Ochsner Award.