The Nazi Antismoking Legacy 2

If Robert Proctor was prepared to dig into the murky history of Nazi antismoking science, Professor George Davey Smith seems to have been equally vocal in drawing attention to it, particularly when any mention of that history had been omitted by people who should have known better – such as Richard Peto, the long time assistant of Richard Doll. In 1995 he wrote to the editor of the BMJ to say:

EDITOR,—Richard Peto discusses the failure of public health with regard to smoking over the past 40 years,1 but his account could have extended back further. He considers that the Medical Research Council was, in 1957, “the first national institution in the world to accept formally the evidence that tobacco is a major cause of death.” The formal recognition of this fact, however, was explicitly made by many important national institutions in Nazi Germany. The Public Health Office and the German Medical Association, both under the leadership of Dr Gerhard Wagner, repeatedly issued precise pronouncements regarding the dire health consequences of smoking. By 1939 Wagner’s successor, Dr Leonardo Conti, had established the Reich Bureau Against the Dangers of Alcohol and Tobacco.2 The Reich Health Office also made numerous statements, which its president, Hans Reiter, reiterated at his inaugural address at the opening of the “first scientific institute for the struggle against the dangers of tobacco” at the University of Jena in 1942.3 The German Labour Front, under the leadership of Robert Ley, ran many campaigns highlighting the damaging effects of tobacco on health. Like Adolf Hitler, Reiter, Ley, Wagner, and Conti were, publicly at least, vehemently against smoking.2 4 5

Recognition of the damaging effects of smoking on health led to much antismoking legislation6; this included legislation banning smoking in public places by those under 18 and prohibiting both tobacco advertising and smoking in public buildings and on public transport. Pregnant women and those deemed to be sick because of smoking had their tobacco rations withdrawn, and there was serious discussion regarding whether those sick with illness caused by smoking should receive medical care equal to that given to patients whose illnesses were not considered to be self inflicted.5

Ten years later, he was on the blower again, this time to the WHO, to correct some assertions made by Michael J. Thun. In his letter he provides a potted history of German antismoking research:

Editor – In his commentary on early reports on smoking and lung cancer, Michael J. Thun ignores the actual first reports and concentrates on the series of case-control studies published in 1950, first in the United States and then in the United Kingdom (1). He also claims (as others have done) that in the pre-1950 era the most popular hypothesis was that “lung cancer mortality … was more likely to have resulted from the widespread tarring of roads and exhaust from motor vehicles than from cigarette smoking”. Could he please produce contemporary – i.e. pre-1950 – references on this hypothesis that match the veritable mountain of publications from pre-1950 implicating cigarette smoking (2), in particular, formal analytical studies of road tarring and motor exhaust similar to the many analytical studies of smoking and lung cancer?

Of course, as is now well known (3, 4, 5–10), extensive research on smoking and lung cancer appeared before 1950, much – but not all – of it from Weimar and then Nazi Germany. In 1928 Schönherr from Chemnitz drew attention to the high rates of smoking in a series of lung cancer patients (11). He explicitly studied where the lung cancer cases lived and reported they were not closer to roads than expected (tar and exhaust already being an unsupported hypothesis) and suggested that lung cancer in non-smoking wives of smokers was caused by passive smoke inhalation. In his comprehensive review of smoking and lung cancer in 1929 (reviews were already being written 20 years before the 1950 “discovery”) the influential actuary Frederich Hoffman wrote: “Unfortunately, German statistical discussions are invariably confusing and complicated by the omission of proper headings to statistical tables, which makes a full use of the elaborate investigation by Schönherr exceptionally difficult. Exceedingly rigorous reading is required to draw the best results from the mass of evidence presented. But every aspect of the problem is considered by this author, whose observations are deserving of being completely translated into English” (12). In a review published two years later, Hoffman considered that “smoking habits unquestionably increase the liability to cancer of the mouth, the throat, the oesophagus, the larynx and the lungs” (13).

In 1935, Fritz Lickint published an elegant synthetic review that considered time trends in lung cancer and cigarette smoking, ecological associations between smoking and lung cancer, autopsy series, experimental animal studies and clinical reports, which left him in no doubt that smoking was a cause of lung cancer (14). He had entitled a 1929 paper “Tobacco and tobacco smoke as etiological factors for carcinoma” (15); he simply did not think further studies were needed – what was required was to prevent smoking. His extraordinary 800-page work in 1939 (16) summarized all that was currently known from scientific research on the health consequences of smoking.

In 1939, a study of smoking habits of lung cancer cases compared with those of an ill-defined control group carried out by Franz Müller appeared in the Zeitschrift für Krebsforschung (17), a leading international cancer journal of its time (a time when many of the major science journals were in German). Four years later a considerably more sophisticated study by Schairer & Schöniger appeared in the same journal (18); an English translation is now readily accessible (19). This study involved a population and hospital control group (findings were similar in both), analysed the potential effect of people with illnesses quitting smoking, and tabulated results of their study together with previous data to show consistency (a formal statistical meta-analysis was not, unsurprisingly, performed. The odds ratios that can now be calculated from these early studies are very similar to those of the later studies published in the 1950s, and for the Schairer & Schöniger study alone statistical evidence for an association can be shown to be strong (P < 0.0000001).

The study by Schairer & Schöniger was carried out under the auspices of the Institute for the Struggle Against the Dangers of Tobacco based in Jena and supported, in part, by Adolf Hitler’s personal funds. The history of anti-smoking activity in Nazi Germany and its links to the practice and ideology of the ruling party have been discussed in detail elsewhere (3, 5, 6), but there was no simple connection between science and ideology. For example, Fritz Lickint – the most scholarly, best informed and active scientist in this field during the Nazi period – had been a supporter of the Social Democrats and, as one of us (GDS) discovered on a visit to the archives of the Institute in 1994, was subject to an SS investigation because of his suspect (anti-Nazi) politics and was denied employment at the Institute because of this.

It would appear that antismoking professionals are rather divided about how to handle the Nazi antismoking research. Some of them – like Richard Peto and Michael Thun – would seem to prefer that a veil be quietly drawn over it all, and 1950 be made the Year Zero of antismoking science, when 3 papers were published linking smoking and lung cancer in Britain and the USA. Others – like Robert Proctor and George Davey Smith – appear to want let it all hang out, and to re-instate the Nazi science as an example of good science carried out under adverse circumstances.

The understandable concern that acknowledging the roots of scientific investigation of the links between smoking and lung cancer may discredit anti-tobacco activity today is neither congruent with the multifaceted (and in no way simply “Nazi”) history of such science or with a true account of the complex development of scientific ideas.

Multifaceted indeed. I often wonder how ordinary people would react to learning that, far from the link of smoking with tobacco having first been made in 1950 by Doll and Hill in Britain, and Wynder and Graham in America, Nazi scientists (some of them personally funded by Adolf Hitler) had made the link 20 years earlier. I also wonder how they would respond to learning that the Nazi regime had run an anti-tobacco campaign that strangely prefigures the modern global war on tobacco.

Perhaps, as they shivered outside their pubs, they would tell each other that it was a good example of the “multifaceted history” of such science, and of the “complex development” of scientific ideas.

In fact I’m sure they would — if anyone ever told them about it.