The New Vital Sign

AT THE turn of the last century, the American medical community developed a standardized assessment to help clinicians confront the leading cause of death at that time, infectious disease. This assessment, known as vital signs, included temperature, pulse rate, respiratory rate, and, later, blood pressure.1-3Over time, the measurement of vital signs became an expected part of every clinic visit and an essential component of the database physicians use to evaluate, diagnose, and treat patients. As we approach the next century, American medicine is challenged by a different cause of illness and death—tobacco use. Cigarettes are now responsible for more than 430000 deaths each year in the United States.4As with past epidemics of this magnitude, institutional changes in the practice of medicine must be adopted to overcome the enormous disease burden resulting from tobacco use. Making smoking status the "new vital