The caller was looking for help. Twenty-eight times, she dialed a different New York area hospital, said she was a heavy smoker and asked what she should do. Three of the hospitals referred her to a smoking cessation course. One suggested a hypnotist.
Twenty-four times, all she got was a telephonic shrug.
Dr. Ernst Wynder, president of the American Health Foundation, told of that small experiment at a 2 1/2-day meeting at the National Cancer Institute last month of many of the world's leading experts on smoking.
"At a time when our hospitals have all kinds of medical specialty clinics, they are unwilling to help heavy smokers who cannot stop smoking on their own," complained Wynder. Moreover, he said, the cost for such help ought to be reimbursed by health insurers.
It was Wynder who, 40 years ago postulated a link between smoking and health problems. NCI director Dr. Vincent DeVita called that a "monumental observation, which has yet to receive all the proper recognition it should get." The medical indictment of smoking is no longer considered arguable by the scientific community.
What is left is to translate the laboratory discoveries into the community. In other words, get people to stop smoking.
No easy task. Although some 30 million people have quit over the past two decades, there are still an estimated 53 million smokers in this country alone.
The experts have to wrestle with another hard fact: Of those who have quit smoking, 95 percent did it on their own, cold turkey. According to Wynder, whose American Health Foundation is devoted to the promotion of preventive medicine, smoking cessation programs have a success rate of about 25 percent -- good, he says, but still not good enough.
Surgeon General C. Everett Koop, in a blistering condemnation of the tobacco industry, laid much of the failure of anti-smoking efforts among young people at the door of tobacco interests. He told the conference: "We need to invest more time and effort getting the no-smoking message across to the young people of America. I recognize that that's easier to say than do, not because of the audience, although they are not easy to convince about anything, but because of the opposition -- the cigarette industry.
"They are literally pouring money into advertising and promotion, billboards, magazines, newspapers, cultural events, sports events -- you name it," Koop said.
"They're not allowed to advertise on radio and TV, but the cigarette industry's annual investment in advertisement and promotion is over $2 billion, or about eight bucks for every man woman and child in the United States, whether he smokes or not.
"Most of the efforts are directed at young people. The companies deny this, of course, but it is true.
"The fact of the matter is that the future of the cigarette industry depends on its being able to find new smokers to take the place of those who quit, and, of course, of those 350,000 customers who lose their lives to smoking each year."
By and large, measured per capita, smoking consumption is going down, Koop said, and has reached its lowest point in about 40 years, "despite the enormous industry budget for advertising and promotion."
Moreover, he said, 90 percent of the adults who smoke "know that it's bad for them, and that's a switch from what it used to be. The latest surveys indicate that 90 percent would quit if they could.
"If that's not evidence of addiction," Koop said, "I don't know what is."
The rates are down for both sexes, but, said Koop, "the only discouraging sign is that the decrease among women is hardly perceptible, which explains why lung cancer is now the leading cause of cancer deaths among women and will possibly continue to be for many years to come, and that's a shame."
Wynder, who spent much of his career proving the link between smoking and ill health he postulated when he was still a medical student, noted that education is a factor in smoking statistics. Educated white males, for example, are showing decreased rates of cigarette consumption. This is not true of educated white women, however, and Wynder speculates that knowledge about the ill effects of smoking is offset by fear of weight gain if smoking is stopped.
Wynder, who has published some 400 scientific papers and was the first researcher to produce skin cancer in rodents with tobacco tar applications, called on his colleagues to "practice what we have already learned." His organization sponsors an in-school "know your body" program, which Wynder believes could "immunize" youngsters against smoking.
Koop outlined a four-point strategy that would, among other things, capitalize on "the newfound militancy of the nonsmoker, who is literally clearing the air" by "demanding and getting the no smoking" laws now going into effect "all over the country."
Other elements of the Koop strategy: economic -- raise per pack taxes, educational -- use biobehavioral data and research -- continue current efforts.
Still, speakers such as former Federal Trade Commission Chairman Michael Pertschuk and Matthew L. Myers, head of the Coalition on Smoking or Health, warned that the scientists will have to come out of their laboratories and "get their hands dirty." Said Myers, "social institutions react only when people make them believe that they want action. Frankly, this means dirtying all of our hands in that political process. If we act, government will react. And if they don't act, we won't succeed despite all the research in the world."
Ernst Wynder likes to tell this story:
"A man goes to his doctor and asks, 'Look Doc, how do I keep from getting old?'
" 'Do you smoke?' the doctor asks.
" 'Yes,' says the man.
" 'Well,' answers the doctor, 'you're on the right track.' "