The epidemiological analysis, published online in BMC Cancer, linked smoking to more than 70 percent of the cancer death burden among Massachusetts men in 2003. This percentage is much higher than the previous estimate of 34 percent in 2001.

"This study provides support for the growing understanding among researchers that smoking is a cause of many more cancer deaths besides lung cancer," said lead author Bruce Leistikow, a UC Davis associate adjunct professor of public health sciences. "The full impacts of tobacco smoke, including secondhand smoke, have been overlooked in the rush to examine such potential cancer factors as diet and environmental contaminants. As it turns out, much of the answer was probably smoking all along."

Leistikow used National Center for Health Statistics data to compare death rates from lung cancer to death rates from all other cancers among Massachusetts males. The assessment revealed that the two rates changed in tandem year-by-year from 1979 to 2003, with the strongest association among males aged 30-to-74 years.

Smoking is a known cause of most lung cancers, and the study authors concluded that the very close relationship over twenty-five years between lung and other cancer death rates suggests a single cause for both: tobacco smoke.

Leistikow, whose research is dedicated to uncovering the causes of premature mortality, said, "The fact that lung and non-lung cancer death rates are almost perfectly associated means that smokers and nonsmokers alike should do what they can to avoid tobacco smoke. It also suggests that increased attention should be paid to smoking prevention in health care reforms and health promotion campaigns."

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In the second case, a 38 year-old man tested positive for amphetamines after an occupational urine screening test and was suspended from work. Both fenproporex and fluoxetine were detected in his imported pills. While he was taking the pills he also experienced insomnia and palpitations, symptoms which disappeared after he stopped taking the pills. In both cases, not all the substances detected in the pills matched the ingredients on the vial labels.

Because of the ease of availability of these diet pills over the Internet amongst others, the health and economic consequences of diet pill use are likely to be widespread within certain communities in the US, according to Dr Cohen. He recommends that physicians be made aware of the composition and dangers of the fenproporex-based diet pills imported from South America.

He concludes that "Given the wide variety of potential adverse effects from the medications included in these diet pills, patients attempting to lose weight who experience unexplained symptoms should be specifically questioned regarding the use of imported diet pills."

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