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There was no question of refusal

An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition

North America Heated Tobacco Products Market Size and Forecast, By Distribution Channel (2025-2032) 6.2.1

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In a 1982 memo, the then-editor of JAMA cautioned the journals editorial staff to exercise appropriate caution in our JAMA publications on tobacco and control of tobacco use, nuclear war, and abortion. In providing this preventive advice, he noted that sensitivities are particularly high prior to the meetings of the Board of Trustees and the Annual and Interim Meetings of the House of Delegates. But what about other major health professional organizations and medical specialty associations