The Clove Cigarette Story
Field-Testing a toxin on our Teen-agers:
An example of Corporate Hubris and Governmental Apathy

CDC (Centers for Disease Control) MMWR

ANNOTATED BIBLIOGRAPHY

1. McLellan, Dennis: " Death Sparks Concern Over Clove Cigarettes," Section V, VIEW/Health, Los Angeles Times, Part V, Tuesday, December 4, 1984, pp 1-2. This was the initial media report which concerned the mounting evidence that clove cigarettes were harmful to many individuals. The active agent, eugenol is a topical anesthetic and was found to be 2500x more toxic (see LaVoie) when inhaled, as from a burning clove cigarette, than when eaten as when cloves were used as a spice. Tim Cislaw ,17 year-old, high school student and athlete, was the index case of this phenomenon. Dr. Schechter collected approximately 13-15 other bona fide cases and reported them to the Centers for Disease Control (CDC) in Atlanta. Dr. Schechter was reviewing the cases when the Cislaw family decided to bring suit against the distributors of the cigarettes. The case then came to light, and Dr. Schechter felt that it was mandatory that the facts be conveyed accurately; this led to his working on the original report in cooperation with Mr. McLellan.
   

2. Schechter, Frederick G., M.D.: "Illnesses Possibly Associated with Smoking Clove Cigarettes," Morbidity and Mortality Weekly Report (M.M.W.R.)34(21):297-299 (with Editorial Comment and bibliography), May 31, 1985. Dr. Schechter had by this time collected some 13-15 cases of teen-agers who had pulmonary symptoms and signs of a severity requiring hospitalization, surgery, and, in 2 cases, which resulted in death. James W. Stratton, M.D. (then Medical Epidemiologist, Community Toxics Unit, Hazard Evaluation, California Department of Health Services ,Berkeley, CA, and previously at the CDC) visited with Dr. Schechter for two days and reviewed all charts, reports, and notes; 12 cases were considered part of the M.M.W.R. report and 2 cases were outlined. The predominant symptoms given in the report were pulmonary edema, bronchospasm, and hemoptysis. The Orange County branch of the American Lung Association (OCLA) had received many reports of problems associated with smoking the clove cigarettes-largely shortness of breath, coughing, wheezing, and exacerbation of asthma. Of concern was the report of hemoptysis (coughing up blood-streaked sputum, phlegm) by about 25% of the callers. This is an almost unheard of symptom in healthy teens in the modern age. This WAS a common symptom when there was wide-spread TB or uncorrected mitral valve disease in the pre-cardiac surgical era--but not now!!
   

3. LaVoie, E. J.: "Toxicity Studies on Clove Cigarette Smoke and Constituents of Clove: Determination of the LD50 of Eugenol by intratracheal Instillation in Rats and Hamsters," Archives of Toxicology 63:1-6, 63, 1989. This study was begun as a standard evaluation for carcinogenesis of the materials contained in clove cigarettes, but continued as a study of the mechanisms of action and histopathologic effects of inhaled clove cigarette smoke on the small mammalian lung.
   

4. Clark, G. C.: "Comparison of kretek (clove cigarette) smoke with that of American cigarette smoke-I. One day exposure. Archives of Toxicology 63:1-6,1989.
   

5. Guidotti, T.L., Binder, S., Stratton, J.W., Schechter, F.G., and Jenkins, R.A.: "Clove Cigarettes: Development of the Fad and Evidence for Health Effects," in Hollinger, M.A. (Ed): Current Topics in Pulmonary Pharmacology and Toxicology, Vol 2. New York, Elsevier Scientific, 1987, pp 1-23. While Tim Cislaw was in the ICU, his brother told Dr. Schechter that Tim first began to cough following smoking clove cigarettes-and that he "never seemed to get better after that." No one above the age of 20 knew anything about clove cigarettes, it seemed, so, to allay her anxiety, Dr. Schechter suggested to Mrs. Cislaw, Tim's mother, that she could help her son if she could find an expert in airway toxins that could be of help in determining the mechanism of Tim's illness. It wasn't long before Mrs. Cislaw discovered Tee L. Guidotti, M.D., M.P.H., at U. C. San Diego-where he had already noted the fad as a possible public health problem. The fad of smoking clove cigarettes had entered the United States thru the ports of entry where Australian surfers were introducing this Indonesian tobacco product to the American surfing crowd. By the time the reports hit the Newspapers, it was already being used by the Hollywood gang; Movie Producer Peter Weir reported problems with respiration and nasal congestion when smoking the cigarettes. This was the first multidisciplinary report by those initially involved following the report to the CDC.
    
   Suzanne Binder, M.D. was the epidemiologist at the CDC at the time Dr. Schechter first reported the phenomenon. She spear-headed the  M.M.W.R. report after Dr. Stratton had visited with Dr. Schechter, and had made HIS report to the CDC. Dr. Binder was in the middle, politically, between those above her, who were politically oriented-and those outside who felt that this was one of the major breaches of public trust by the tobacco industry. The importers had foisted this high-tar, high- nicotine, cigarette, with its pleasant-smelling airway anesthetic which had its own brand of untested toxicity, inhaled eugenol. Further, the smoking of clove cigarettes had a certain exotic allure-and became an entry-level drug abuse to the hard core drug society--an introduction to hardcore drug abuse, for children, if you will!!