444 Control 1999;8:444–445 Tob Control: first published as 10.1136/tc.8.4.444 on 1 December 1999. Downloaded from Obituary

Ernst L Wynder MD DrSc hc (mult) Dr med hc, 1922-1999

A man’s life of any worth is a continued allegory, and very few eyes, can see the mystery of his life— Keats, 1819

Ernst L Wynder, honorary life member of the smoking. He then methodically gathered American Association of Cancer Research, and information on the deceased by questioning president and founder of the American Health relatives about the occupation, lifestyle, and Foundation, passed away on July 14, 1999. His smoking habits of their loved ones. Thus, an fervour towards disease prevention, his inspira- epidemiologic investigation was born and it tion, and his networking eVorts in the cancer soon revealed a correlation between research community will be very much missed. smoking and the frequency of cases. He surely is among those whose epitaphs will In 1950, having collected 684 proven cases of be written over and over, as it is even at his lung cancer and their history, Wynder and Gra- death impossible to evaluate the full impact of ham published the seminal JAMA paper that his life’s work. was later declared a landmark research article in The legacy of Ernst Wynder as a disease 1985 and 1992. It preceded the first warnings prevention pioneer of the 20th century is a from the Royal College of Physicians in England seed that will reach its full harvest only as com- by 12 years and the first US surgeon general’s ing generations will report on smoking and mature. The allegori- health by 14 years. cal meanings of the During and after knowledge and wis- the gathering of the dom he has left us first epidemiologic will translate into evidence, Ernst Wyn- http://tobaccocontrol.bmj.com/ future generations der proceeded with a with healthier life- logical delineation of styles, especially bet- the causality of the ter nutrition, and correlation between higher self esteem, smoking and lung because these indi- cancer,1 and, impor- viduals will know at tantly, with investiga- an early age what their tions on the biology, parents and grandpar- chemistry, and bio- ents learned only late chemistry of smoking in life and were reluc- related - tant to accept: lifestyle esis. He invited col- and environment laborators with vari- on September 25, 2021 by guest. Protected copyright. when handled prop- ous expertises, erly, can lead us to a including Dietrich long, healthy, and HoVmann, a graduate productive life, even if of Professor Adolf our genetic predispo- Butenandt’s Max sition makes us high Planck Institute for risk candidates for Biochemistry in Mu- cancer, heart disease, stroke, and other nich, Germany, in 1957. Together, they and debilitating illness. their colleague Stephen S Hecht can be Born in Herford, Germany, in 1922, he credited with unravelling over a 40 year period arrived in the USA in 1938, earned a BA at New many of the processes involved in tumour York University, and toward the end of the sec- initiation and promotion, and also with the ond world war found himself back in Germany discovery of a tobacco alkaloid derived class of as a US Army intelligence oYcer. Upon nitrosamines that cause adenoma and completion of his tour of duty, he began the adenocarcinoma in the lungs of animals, and study of medicine at Washington University in likely also in the human lung. Some of these St Louis, Missouri, with the renowned thoracic have become the model carcino- surgeon Evarts A Graham. His keen observation gens against which chemopreventive eYcacy of of necropsy specimens led him to suspect that various classes of tumour inhibitors is now many of those diagnosed as having died from measured in laboratories throughout the lung cancer must have had a history of tobacco world. Obituary 445 Tob Control: first published as 10.1136/tc.8.4.444 on 1 December 1999. Downloaded from

Ernst Wynder summarised his smoking and conditions that foster the development of health research in recent publications, disease or of unhealthful behaviour. In terms of including the American Association of Cancer children’s receptivity to health education mes- Research-American Cancer Society award lec- sages, he turned his attention in recent years to ture he gave in New Orleans in 1998.23 research on brain development and how it is Any evaluation of the impact that Dr positively and negatively aVected by the child’s Wynder’s research has had on the health of the physical and emotional environment. Similarly, nation and, in fact, on the health of the world he became very interested in reviewing what is population, must take into account his near known about the nocebo eVect versus positive genius entrepreneurship. He was a great attitudes in the prevention of illness and in the communicator and as such was never at a loss outcome of treatment. In this context, he also for words or enthusiasm when it came to moti- was very much concerned about the trends vating change. One fascinating account of his toward alternative (complementary) medicine attempts to change the industry can be found concepts and he felt that much could be in Richard Kluger’s Pulitzer award winning learned and gained from rigorous scientific “Ashes to ashes”.4 There is of course also the examination of such concepts. record of more than 770 publications in which Ernst Wynder clearly saw that 80–95% of Dr Wynder describes worldwide cancer epide- cancer and various other chronic diseases were miology as it relates to tobacco use, nutrition, in the end man made and, therefore, and other environmental influences, as well as preventable. This is why he established the his laboratory studies, his prevention American Health Foundation in New York strategies, and health policy and philosophical (Manhattan and Valhalla) as a free standing issues. disease prevention centre 30 years ago. He His interest in global led him strongly recommended that teaching preven- to state that the world was his laboratory. The tion skills should be given greater weight at comparative studies of cancer incidence and medical schools, and that physicians should be mortality rates, especially those between the given incentives to practise preventive USA and Japan, prompted his laboratory medicine. He was hopeful that the investigations into the aetiology of lifestyle and implementations of dietary changes to low fat, nutrition related cancers which he advanced high fibre nutrition which proved eVective in with John H Weisburger, Bandaru Reddy, Len model assays in the laboratory, would be Cohen, and David P Rose. proven to save women with breast cancer from In terms of health policy, Ernst Wynder developing a second primary breast cancer, regarded the prevention of the major chronic and that the results of chemoprevention assays illnesses, foremost tobacco and nutrition in the research laboratory would soon translate

related cancers, as public health priorities. He into clinical applications for the benefit of peo- http://tobaccocontrol.bmj.com/ would always seek sound reasoning as an ple at high risk for cancer. underlying concept for the causes and preven- He established the international journal Pre- tion of illness.5 ventive Medicine as a forum for the exchange of Then there was the creative impatience that ideas and concepts of disease prevention and would not allow him to await the outcome of health promotion, and served as its editor in tedious laboratory studies, but seek alternative chief to his last day. His eVorts and routes to a goal. For instance, while he achievements have been recognised by his acknowledged the need for molecular biology peers, by governments, and by medical schools studies, or for DNA adduct studies with here and abroad with numerous awards and reactive metabolites of tobacco carcinogens, he honorary degrees. He will be missed by his wife could not see that ultimately such research Sandra Miller Wynder, his sister Lore

would bear fruit in disease prevention in the Levinson, and his nephews, Robert and Martin on September 25, 2021 by guest. Protected copyright. way, and at the rate, child health education Levinson, both physicians. He will also be could. The magnitude and the social impact of dearly missed by all the children for whom he cancer and its relation to tobacco use and diet recreated the National Child Health Day, that as major causes, and the low rate of success of had first been instituted by Calvin Coolidge in many modes of intervention, convinced Ernst 1928. It was for them that he held high hopes Wynder that child health education is the only for a healthier tomorrow. way to avert the continuation of the tobacco DIETRICH AND ILSE HOFFMANN cancer epidemic. Thus, he conceived the idea New York, NY,USA for and implemented the creation of the [email protected] “Know your body program”. It is fair to say that the children of this world have now lost a 1 Wynder EL. Tobacco as a cause of lung cancer with special very good and caring friend. reference to the infrequency of lung cancer among non-smokers. Pennsylvania Medical Journal 1954;57:1073– Many call Ernst Wynder “the health 83. conscience of the nation” because of his inces- 2 Wynder EL. The past, present, and future of the prevention of lung cancer. Cancer Epidemiol Biomarkers Prev 1998; sant prodding of governmental authorities and 7:735–48. societal institutions to involve themselves in 3 Wynder EL. Tobacco as a cause of lung cancer: some reflec- issues of chronic disease prevention and health tions. Am J Epidemiol 1997;146:687–94. 4 Kluger R. Ashes to ashes. New York: Alfred Knopf, 1996. promotion. He gave much thought not only to 5 Wynder EL. Listen to nature: the challenge of lifestyle pathogenic agents but also to human medicine. Sozial Präv Med 1991;36:137–46.