CORRESPONDENCE

probably been the most compre- hensively studied with regard to their absence of CHD. The Masai have been the subjects of so many medical studies, not only because of their lack of CHD, but also be- cause their dietary staple is milk, with saturated fat constituting 66 percent of their total caloric intake [4]. Intimal thickening and consid- erable atherosclerosis have been noted in the coronary arteries of el- derly male Masai, but at the same time their coronary vessels appear to enlarge with age and become wide enough to prevent occlusive coronary disease [5].

Although it has been suggested that the Masai’s protection against CHD is provided by their excep- tional levels of physical fitness [4,5 , the day-to-day physical ac-

1 tivi y associated with these levels of fitness has never been studied, and vigorous exertion is reported to be rare among Masai adults [6]. A pilot study we conducted in Masai- land suggests that it is indeed rare for adult Masai to participate in physical activity that is more vigor- ous than walking.

The Reply: Apparently Drs. Abbott and Peters interpreted our report to the effect that physical activity was the main influence acting to protect recent hunter-gathers, other traditional peoples, and Paleolithic humans against coronary heart disease (CHD). We believe their interpre- tation is a misconstruction. Be that as it may, we did not mean to sug- gest that exercise was the primary or even necessarily a major factor.

People whose lives include es- sential elements of our remote an- cestors’ lifeways are protected against atherosclerosis because: (1) They have little or no hyperten- sion. (Our originally submitted manuscript, available on request, included a table listing 26 such cul- tures with supportive references.) (2) They have little or no exposure to tobacco. Our African and Eura- sian antecedents had none because tobacco is indigenous to the Ameri- cas. (3) Their serum cholesterol levels average below 150 mg/dl (see Table VI in our report).

If extensive walking is sufficient to protect us from CHD in the pres- ence of a high-fat diet, this would have important public health im- plications. There is a need to docu- ment the actual intensity and du- ration of daily physical activities in the few remaining traditional cul- tures that have a recorded paucity of CHD in order to clarify these re- lationships.

There have been many investiga- tions of the relationship between physical exercise and CHD. Paf- fenbarger and Hyde’s [l] work in this regard is highly informative, and a recent contribution from the Centers for Disease Control [2] re- views 43 such studies. This analysis concludes that physical inactivity should be considered a major risk factor.

ALLAN V. ABBOTT, M.D. RUTH K. PETERS, s~.D.

University of Southern California School of Medicine

Parkview Medical Building B-207

1420 San Pablo Street LOS Angeles, California 90033

1. Peters RK. Cady LD Jr, Bischoff DP. Pemstein L. Pike MC: Physical litness and subsequent myocardial infarction in healthy workers. JAMA 1983: 249: 3052-3056’. 2. Wllhelmsen L. Tibblin G. Awell M. et al: Physical activity, physical fitness and risk of myocardial infarc- tion. Adv Cardiol 1976; 18: 217-230. 3. LaPorte RE. Adams LL, Savage CID. ef &The spec- trum of physical activity, cardiovascular disease and health: an epidemiologic perspective. Am J Epidemiol 1984: 120: 507-515. 4. Mann GV, Shaffer RD, Anderson RS. Sandstead HH: Cardiovascular disease in the Masai. J Ather- oscler Res 1964; 4: 289-312. 5. Mann GV. Spoerry A, Gray M. Jarashow D: Athero- sclerosis in the Masai. Am J Epidemiol 1972: 95: 26- 37. 6. Mann GV. Shaffer RD, Rick A: Physical fitness and immunity to heart disease in Masai. Lancet 1965; II: 1308-1310.

Numerous beneficial influences operated jointly to protect our an- cestors from CHD. If we can rein- stibte these elements into our cur- rent lifestyle, we should be able to greatly reduce the prevalence of this disorder in today’s humans. Our recent monograph f3] explores this concept in greater detail.

S. BOYD EATON, M.D. MARJORIE SHOSTAK

MELVIN KONNER, M.D., Ph.D. Emory University

Atlanta, Georgia 30322

1. Paffenbarger RS. Hyde RT: Exercise as a protec- tion against heart attack. N Engl J Med 1980: 302: 1026-1027. 2. Casperson CJ: Protective effect of physical activity on coronary heart disease. MMWR 1987: 36: 426- 430. 3;Eaton SB. Shostak M, Konner M: The Paleolithic prescription. New York: Harper & Row, 1988.

Submitted June 15, 1988, and accepted August 1, 1988

PHARMACEUTICAL COMPANY- SPONSORED SYMPOSIA AND MEDICAL ETHICS To the Editor: I am pleased to announce the re- sults of the First Annual Juried

596 October 1988 The American Journal of Medicine Volume 85

Competition for Creative Titling of a Drug Company-Sponsored Sym- posium. This competition was es- tablished in response to pressures from the academic community [l- 31 for the purpose of recognizing publishers who have created dis- tindtive names for symposia that deal with a specific drug and are supported by the company that makes that drug. In evaluating each entry, the judges consider (1) creativity and (2) pretension.

The first award has been granted to Cahners Publishing Company for their publication entitled, “Proceedings of a Symposium. Ad- vanced Technology in Cardiovas- cular Therapy: Investigators’ Dia- logue” (Am J Med 1987; 83(suppl 6B): l-33). This publication dealt with a controlled-release oral dos- age form of nifedipine and was sponsored by Pfizer Laboratories.

In giving the award, the jury cited the imaginative focus on technology in the title. Through a clever choice of words that shifted the emphasis to modern technolo- gy and altogether away from medi- cation, the publishers were judged to have thoroughly (and imagina- tively) obscured the basic purpose of the symposium. Essential to re- ceiving the award for pretension is that the title promises far more than it gives. Once again, the ap- peal to technology and the empha- sis on the word “advanced” were what gave this work ascendancy over the runners-up, which often simply promised to provide a gen- eral updating in a field or intensive teaching about a particular clinical problem. Although hardly novel, the concept that a series of articles all sponsored by a single company and published in a supplementary issue of a journal might properly be regarded as a “dialogue” gave fur- ther support to the selection of this symposium for the award.

A check for $10 has been mailed to the President of Cahners Pub- lishing Company along with a let- ter of congratulations.

DANIEL M. MUSHER, M.D. Veterans Administration

Medical Center 2002 Holcombe Boulevard

Houston, Texas 77211

I. Rochmis PG: Seminars for physicians. JAMA 1982; 248: 1580-1581. 2. Soffer A: Hazards in publication of proceedings. Arch Intern Med 1982: 142: 2074-2076. 3. Musher DM: Antibiotics: the medium is the mes- sage. Rev Infect Dis 1983: 5: 809-812.

SubmItted February 10. 1986, and accepted August 8, 1988