The possibility of recall bias and other methodologic problems may influence the results of case-control studies of environmental tobacco smoke. Nonetheless, our findings regarding exposure during early life suggest that approximately 17 percent of lung cancers among nonsmokers can be attributed to high levels of exposure to cigarette smoke during childhood and adolescence.

There is a gap between accepted legal and ethical theories concerning consent and the patients' account of their experiences with surgical treatment of esophageal cancer. Although our findings should not be used to circumvent the ethical and legal requirements of the consent process and are limited to survivors of treatment of life-threatening disease, they support a careful reassessment of informed consent that includes the perspective of patients.

Most patients are not worried about possible financial relationships between their surgeon and industry. They clearly distinguish financial relationships that benefit current or future patients from those that benefit the surgeon or device manufacturer. They favor disclosure with professional oversight as a method of managing financial relationships between surgeons and manufacturers.

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A hypothetical case that involves a surgical innovation is used to illustrate three ethical issues in surgery: the profound trust that vulnerable patients feel toward their surgeons, even when they innovate; the disequilibrating effect of new procedures on traditional safeguards of surgical competence; and the need for a systematic approach to the evaluation of new surgical procedures.

Carcinoid tumors of the lung and bronchi are usually benign lesions with no influence on life expectancy, although occasionally, they are malignant with a poor prognosis. Between these two extremes are atypical carcinoids, which can be slow-growing tumors with an average 5-year survival of 60% and an average 10-year survival of 40%. The myriad names used to describe these lesions complicates the understanding of their behavior, especially as the term carcinoid is used to describe the complete spectrum of disease or exclusively the benign well differentiated lesions with an excellent prognosis. Thymic carcinoids are uncommon lesions. Their prognosis is poor, even in cases that appear favorable in terms of resectability and histology. Pulmonary carcinoids present uncommonly with a paraneoplasic syndrome. Both carcinoid and Cushing syndromes are seen with approximately 2% of these lesions. Cushing syndrome can be present in as many as one-third of patients with thymic carcinoids but an association with the carcinoid syndrome has never been described.

This is the largest study to date of dietary factors and lung cancer in nonsmokers; results suggest that dietary beta carotene, raw fruits and vegetables, and vitamin E supplements reduce the risk of lung cancer in nonsmoking men and women.