Cause and Effect

Chris Snowdon reports on the inexplicable failure of Maltese heart attack rates to fall after their smoking ban was introduced:

Malta smoking ban fails to stub out heart disease

We are shocked over smoking ban results

The smoking ban may have led to a decrease in the heart disease death rate and hospital admissions in every country where it was introduced, but it has had absolutely no impact in Malta, a medical study has revealed

I’m sure that some ad hoc explanation will be found for it. Perhaps that Malta is a small island on which only two or three people live, and so can hardly be expected to replicate results found elsewhere among higher populations.

The other explanation, of course, is that all the other results have been, as Chris Snowdon suggests, the product of cherry-picking, and that the Maltese result is actually the only accurate one. For the others were studies designed to generate headlines trumpeting the success of smoking bans. They were press release science, intended to be reproduced uncritically in the mass media, which of course they duly were. They have since become established scientific ‘facts’. Indeed ASH’s Deborah Arnott was repeating the claims on radio only a week or two back.

It is seldom remarked that the purpose of the famous British Doctors study that began in 1951, and ran for 50 years, was also to generate headlines – as a brief announcement in the BMJ a few years ago revealed:

Doctors’ smoking cohort study ends

Martin Gaba – BMJ. 2001 December 1; 323(7324): 1270.

After running for 50 years, the cohort study on the smoking habits of 40,000 British doctors, which helped to established the link between smoking and lung cancer, has ended with a valedictory thank you letter to the surviving doctors who were recruited in 1951.

Professor Sir Richard Doll, emeritus professor of medicine at Oxford University, who wrote the letter and was involved in the study since its inception, said it was devised by Sir Austin Bradford Hill to achieve maximum publicity for the critical relationship between smoking and lung cancer. The link was first established by him in a trial in 1947-49, but “rejected by the Department of Health cancer committee,” and “not believed by a public, in which 80% of men smoked.”

Dr Maurice Gaba, 89, a former GP in Glasgow, was one of those recruited at the beginning of the study. Dr Gaba, who now lives in Jerusalem, said: “I was a forty a day man, when I received a letter in 1951 from a professor asking me about my smoking history, ending with a request to view my death certificate. I thought this doctor cares more about my health than I do, and I have never smoked since.”

So there you have it, straight from the horse’s mouth: The study was devised to achieve maximum publicity for the link between smoking and lung cancer.

And very successful it was too. The long-running study released regular reports every 5 or 10 years for over 50 years, garnering publicity every time, in a drumbeat that slowly hammered into everybody’s head the ‘link’ between smoking and lung cancer, with the ‘link’ always being supposed to be causal.

The brief article also reveals that the ‘link’ being publicised was found in an earlier study by the same Doll and Hill duo. This was the London Hospitals study which was published in 1950, in which it was found that over 99% of lung cancer cases were found among smokers, with the inference that the one caused the other. From Richard Doll’s Telegraph obituary:

The report, published in the British Medical Journal in 1950, was based on a survey of lung cancer patients in 20 London hospitals; it found that smoking was the only factor overwhelmingly implicated in lung cancer, and that it was rare for non-smokers to suffer from the disease.

BBC obituary of Richard Doll:

His seminal 1950 study, which he wrote with Austin Bradford Hill, said smoking was “a major cause” of lung cancer.

What isn’t quite so often mentioned is that in this study pretty well all the patients, in both the control group and the study group, were smokers (the more precise figure is 98% of them), and that even if smoking had no causal link whatsoever with lung cancer, 98% of lung cancer patients would have still been found to be smokers. Much in the same way that quite possibly 98% of the same lung cancer patients would also have been found to be Londoners. Or tea drinkers.

It was objections of this sort that led to the study being rejected, and widely disbelieved. But Richard Doll remained a true believer. As did a number of other doctors, including George Godber, who was to help launch the passive smoking scare in 1975. And the subsequent British Doctors study (in which 87% of the doctors were smokers) rammed their message home over the next 50 years until absolutely everybody knew that smoking caused lung cancer, and nobody questioned it any more – if only because most of the early 1950s critics  had died in the intervening years.

Bradford Hill, who was co-author with Richard Doll in both the London Hospital study and the subsequent British Doctors study, devised the Bradford-Hill Criteria

…otherwise known as Hill’s criteria for causation, are a group of minimal conditions necessary to provide adequate evidence of a causal relationship between an incidence and a consequence,

the gist of which are that if some consequence follows on from some incidence of something, with sufficient regularity and plausibility, then the one must be the cause of the other. The causal link between smoking and lung cancer is perhaps the most famous example of the application of the Bradford-Hill Criteria. Millions of people started smoking cigarettes in the early 20th century, and a few years later an epidemic of lung cancer started. Cause and effect.

But it’s not the only example. For the same causal claim is being made about the link between the rise in carbon dioxide in the atmosphere and the subsequent rise of global temperatures. There seemed to be no other obvious explanation for the rise in temperature, even if the exact mechanism wasn’t fully understood (just as the exact mechanism by which smoking causes lung cancer has never been understood).

The problem of causality is a philosophical problem of some antiquity, and was discussed by, among others, David Hume in the 18th century. It is also closely related to the Problem of Induction, of deriving general laws from particular cases. It might be said that the dispute between the inductivists (as exemplified by Doll and Hill, and by global warming alarmists) and sceptical deductivists is the continuation of a very long-running debate. The former believe that scientific laws can be generated by statistical analysis of data to show causal links between one event and another. The latter tend to believe that causation can only be demonstrated by showing deductively how one event necessarily leads to another.

Malaria, for example, was inductively linked to malodorous swamps, and ‘bad air’ was for a long time regarded as the cause of ‘malaria’. Subsequently, it was found that swamp-breeding mosquitoes carrying the Plasmodium parasite introduced it into humans they bit, giving rise to the symptoms of malaria when the parasites subsequently multiplied. In this manner an entire chain of cause and effect was deductively established, showing that neither swamps nor ‘bad air’ were the true cause of malaria, and allowing a variety of interventions (insecticides, net curtains, quinine, etc, at various stages in the chain.)

It might also be said that whenever some scientific law has only been inductively established, it entails an element of belief or ‘faith’, quite simply because the deductive path that ties cause to effect has not been established. And therefore, in the case of global warming, ‘deductivist’ sceptics want to know exactly how carbon dioxide in the atmosphere can cause global temperatures to rise to the extent forecast by alarmists, and will not be fully persuaded until they have had all the steps described in detail. And this may also be why ‘deductivists’ are also more readily persuaded by hypotheses such as those of Henrik Svensmark, with his detailed account of how a surfeit or deficit of cosmic rays striking the atmosphere might increase or decrease terrestrial cloud, and cause either cooling as more clouds reflect more sunlight, or warming as fewer clouds reflect less sunlight.

Another way of thinking about it might be to regard inductive science as the kind of preliminary science by which general laws are first empirically derived, and deductive science as the kind of science by which such laws are subsequently understood. Thus an example of an inductive law might be the gas law whereby the pressure of a gas is experimentally found to vary linearly with its temperature, with nobody knowing quite why this should be so. But subsequently other scientists were able to explain mathematically how particles of gas bouncing around inside a chamber would exert a higher pressure on its walls the faster they were moving (i.e. the hotter they were). These theoretical physicists were able to deduce the gas laws that their predecessors had discovered by experimentation.

Nevertheless the argument between inductivists and deductivists looks set to run and run.

About Frank Davis

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24 Responses to Cause and Effect

  1. JJ says:

    Great post Frank. I particularly like this example below. I think it’s called ‘smoke and mirrors’.

    ‘even if smoking had no causal link whatsoever with lung cancer, 98% of lung cancer patients would have still been found to be smokers’.

  2. Tom says:

    If 80% of the population smoked back then, then it was easy to blame anything and everything on the obvious, which is a lot of people smoked.

    With smoking banned they will have to find a new lie to spread, maybe drinking or maybe obesity, whatever the largest percent of the population is the most obvious so that “common sense” will turn fictitious guesswork and playing word games with numbers into “fact”.

    Still, nobody dares mention Doll’s payola or the graft taken by the likes of ASH, to throw further evidence on the fact that these people are biased to begin with, thus lying through their teeth to take in more graft.

    • Frank Davis says:

      Lots of figures get tossed around. There’s the 80% in this article. In the British Doctors study, 87% were smokers. But only something like half of all doctors approached signed up for the study. Were they just the smoking doctors? In the London Hospitals study, 98% of patients were smokers. And, yes, it’s easy to blame something on something more or less everyone does – or at least what most men did.

  3. gimper30 says:

    My “gut” and my 70 years of experience leads me to believe that at some time in the future science will have to admit that smoking itself has little to do with anything. Once they really get around to studying diseases instead of moving numbers around, they’re going to find out that it’s got something to do with a person’s unique genetics coupled with the stressors of everyday life that finds a non-smoker dying at an early age and a smoker living to be 100. I’ll probably be long gone before they “discover” this but remember “I told you so” when they are “forced” to admit it.

  4. Rose says:

    “We are shocked over smoking ban results”

    In a way, I find that almost endearing. Like those poor souls who had been persuaded that the world would end on Jan 1st 2000, and gave all their posessions away believing it with all their hearts.
    Poor lambs, no one seems to have explained to the Maltese that you need a stage magician to produce a miracle these days.

  5. harleyrider1978 says:

    http://www.theheart.org/article/1318775.do?utm_campaign=newsletter&utm_medium=email&utm_source=20111129_exclusive

    Minister of death” takes Holland back to the dark ages

    Stam, meanwhile, warned attendees at the AHA meeting that Europe is by no means out of the woods when it comes to tobacco control. “Europe isn’t doing very well, especially if we look at national policies on packaging and labeling, the way they attract smokers, and only a small message that smoking is deadly,” he noted, adding that tobacco-dependence treatment also takes a back seat in a lot of European countries.

    German cigarette advertisement [Source: CFTFK]

    And using the Netherlands as an example, Stam explained how quickly things can turn around if the political will to tackle tobacco addition suddenly wanes. The result is a horror story.

    At the end of the 1990s, the prevalence of smoking in Holland was about 35%, he explained. “The government was active, there was a millennium campaign, and in 2004 legislation concerning smoke-free work places and reimbursement for smoking cessation was introduced.” And in 2006, an alliance of health charities, backed by the previous government, aimed to reduce the number of smokers from what was then 28% to 20% by 2010, he noted.

    “But then a disaster came over Holland, with an extreme right-wing government and a smoker as minister of health, Edith Schippers. We call her minister of death.” Among Schippers’s first moves, said Stam, was to state that adults should have a free choice to smoke: “the state is not a nanny.” Then last year, she partially reversed the smoke-free legislation, “so now in almost 50% of all cafes and bars people smoke again.” From 2012, she has decided to end reimbursement for pharmacological tobacco-dependence treatment and also plans to end mass-media and governmental campaigns for tobacco control, including the cessation of support for the leading antitobacco group, STIVORO, he added.

    A disaster came over Holland, with a smoker as minister of health. We call her minister of death. “And she has declared already that she will give no support to or implement the European product directive [regarding] further tax increases on tobacco.” In addition to this, “the tobacco industry is very, very active and clever in lobbying,” Stam notes.

    “But do we sit still in the Netherlands? We do not.” The first move has come from an activist organization, Clean Air Netherlands, which has now sued the minister of health, stating that her decision to exempt small bars and cafes from the smoking ban contravenes the tobacco act and the WHO FCTC, to which the Netherlands is a signatory. Many other actions are planned, he noted, including the presentation of an important report by January 2012.

    “Let’s hope we can turn around what is happening in the Netherlands,” he concluded.

    • Frank Davis says:

      takes Holland back to the dark ages

      It’s interesting to me how they always frame the debate in terms of ‘progress’ in this way, and how we can never go back. I suppose it will be ‘progress’ when alcohol gets banned, or meat, or butter. There’ll be no going back to the ‘bad old days’, they’ll say. We’ve ‘moved on’, they’ll add.

      • harleyrider1978 says:

        Frank, a good story would be if the EU falls what will be the fate of the WHO and its anti-tobacco treaty and smoking bans. Will the IMF,world bank stay in business or be disbanded as failed institutions of the one world order gang. Ive thought about it to no end over the last 2 years. Yes I hope the whole bloody messs collapses and soon. That failure there will surely flow over into america. With no money,theres no tobacco control and no propaganda machine. It will force the US federal govmnt to find every nickle it can and wipe out useless scams like smokefree.

        Face it,smoking makes money which begats revenue streams. Smokefree costs tax money,decreaces revenue flow and causes job losses in all sectors.

  6. Rose says:

    “Much in the same way that quite possibly 98% of the same lung cancer patients would also have been found to be Londoners. Or tea drinkers.
    It was objections of this sort that led to the study being rejected, and widely disbelieved.”
    “nobody questioned it any more – if only because most of the early 1950s critics had died in the intervening years.”

    But we can still hear their voices and the clues they left are still there to find.

    Mortality in the London Boroughs, 1950—52, with Special Reference to Respiratory Disease

    “It is interesting to note the parallel between these figures and those of a recent study of cancer among British immigrants in New Zealand ( Eastcott, 1956)

    Compared with the native born population, British immigrants had an excessive risk of death from cancer of the lung (but no other site),and this excess was sufficiently greater for persons who had lived in Britain until they were 30 years old than for those who migrated at an earlier age.

    Thus emerges from both studies a consistent relationship between duration of exposure to the putatively noxious environment and risk of later death from respiratory disease.”
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1058618/?page=4

    1953
    “Bessy Braddock, Labour MP for Liverpool Exchange, favoured an environmental explanation, and therefore found the urban–rural divide a barrier to acceptance of the smoking–lung cancer connection.
    ‘In view of the fact that cigarette and pipe smoking goes on all over the country, it is folly to say that it is the main cause of lung cancer.’

    “Dr Guy Scadding, taking part, expressed the views clearly:smoking cannot be called the cause of lung cancer, since non-smokers also get the disease, and moreover the increase in cigarette smoking is not likely to be the only cause of the increase in the lung cancer death rate.
    “The effect of smoking cannot explain the difference in mortality between town and country dwellers.”

    Click to access 0-19-926030-3.pdf

    Boston December 30th 1959

    Lung Cancer Cause
    A man who has devoted his scientific career to a study of the causes of cancer warns that air pollution is a more important factor than cigarette smoking in the increase of lung cancer.
    He is Dr, Wilhelm C Hueper, chief of the environmental section of the National Cancer Institute at Bethesda, and he makes the significant observation that the upsurge in lung cancer first was noted between 1900 and 1920, several years before the practice of cigarette smoking was widespread.
    Boston, having one of the most serious air pollution in the entire United States, cannot fail to be impressed – and disturbed – by Dr Hueper’s findings.”
    http://legacy.library.ucsf.edu/action/document/page;jsessionid=431567CE1BD9A55DA749F6EE58FC5DD1?tid=jsv02a00

    “The cigarette theory has been used as a red herring to distract attention from the horrible pollution of’the atmosphere by the diesel engine. all we’ve had up till now has been a flood of propaganda and the virtual suppression of all criticisim and discussion.

    I appeal to the Fellows of’the Royal College of Physicians to have the courage to support a fresh and unbiassed investigation.
    Somebody dies of lung cancer in England and Wales every 18 minutes. I believe that a complete mis-diagnosis of the cause of the increase in lung cancer has unfortunately been made, and that suffering humanity has the right to a second opinion.”
    http://tobaccodocuments.org/lor/00622096-2098.html

    The Urban Distribution of Lung Cancer Mortality in England and Wales 1980-1983

    “Lung cancer area mortality rates for the period 1980-1983 in England and Wales followed the pattern observed for previous years, with high rates concentrated in urban districts and low rates in remote rural districts.”
    http://usj.sagepub.com/content/25/6/497.short

  7. Jay says:

    “I thought this doctor cares more about my health than I do, and I have never smoked since.”

    I think that my reaction would’ve been “presumptuous git”

    I find myself unsure these days whether professionals truly believe that smoking causes X (in which case it’s very worrying) or whether they feel obliged to parrot the propaganda. The dental hygienist who was recently lecturing me about smoking shut up smartish when I pointed out that, if two people died of a heart attack, one a smoker, the other not, there was no rational basis for not concluding that the underlying cause could have been the same.

    • Gary K. says:

      True indeed!
      Smokers and nonsmokers have similar lifetime risks for cardiovascular disease.

      http://www.foxnews.com/story/0,2933,184016,00.html

      First Lifetime Heart Disease Risk Assessment Developed
      Monday , February 06, 2006

      The researchers reviewed the medical records of 3,564 men and 4,362 women who did not have any record of cardiovascular disease at age 50.

      The men and women were followed for several decades and all cases of heart attack, coronary heart disease, angina, stroke, claudication (pain in the legs caused by circulation problems), and death from cardiovascular disease were recorded.

      When the researchers calculated the impact of modifiable risk factors such as body weight, smoking history, cholesterol levels, and blood pressure, they found that:

      –Smokers and nonsmokers had similar lifetime risks for cardiovascular disease.

      • harleyrider1978 says:

        Smokers and nonsmokers had similar lifetime risks for cardiovascular disease, [[but smokers developed cardiovascular problems earlier in life and died an average of five years sooner]]. The researchers note that this might be due to other smoking-related causes such as lung disease and cancer.

        Then

        These low-risk 50-year-olds tended to live into their 90s, whereas the median survival for men and women with two major cardiovascular risk factors was roughly a decade shorter.

        So which is it 5 years or a decade,either way 90 YEARS OLD id pretty hot!

        Maybe a cigarette after sex increases the quality of the DNA of the herd!

  8. Gary K. says:

    ” Millions of people started smoking cigarettes in the early 20th century, and a few years later an epidemic of lung cancer started. Cause and effect.”

    Ahhhh yes, and the billions of cigars that were smoked every year prior to then contained no tobacco and produced no smoke!!!

    Ahhhh yes, the millions of handmade(roll ups) cigarettes smoked every year prior to then contained no tobacco and produced no smoke!!!

  9. Jay says:

    Many years since I studied Hume but, if I remember, he used the example of one billiard ball hitting another to illustrate his idea about ‘causation’. What ’causes’ the second ball to move? The first ball or, to extend Hume’s example, the cue which hits the first ball or the person who moves the cue? The equivalence in tobacco control’s world would be the carriage which transported the cue holder to the building in which the billiard table was situated!!

  10. harleyrider1978 says:

    gary a new junk study out:
    Secondhand smoke tied to bad heart failure outcomes
    Reuters Health) – If you have chronic heart failure, being around a smoker may be bad for your physical and mental well-being, a new study suggests.
    Researchers found that of 205 non-smokers with heart failure, those who regularly breathed in secondhand smoke reported more problems in their day-to-day functioning — physical and emotional.
    The findings, reported in the Archives of Internal Medicine, do not prove that other people’s smoke was to blame.
    But they add to the large body of evidence tying secondhand smoke to heart disease, researchers say.
    Sounds familiar ehh, mountain of junk questionaire studies!

    http://www.reuters.com/article/2011/11/29/us-secondhand-idUSTRE7AS23520111129?feedType=RSS&feedName=healthNews&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+reuters%2FhealthNews+%28News+%2F+US+%2F+Health+News%29

    Read more: http://www.stltoday.com/news/local/stcharles/st-charles-county-council-won-t-put-smoking-ban-on/article_78f94e0d-f951-5687-b747-2d8a3f663046.html#ixzz1f8SaeaEu

  11. harleyrider1978 says:

    Businesses plan for end of euro
    By Tony Barber in London and Daniel Dombey in Istanbul

    http://www.ft.com/cms/s/0/25ab975a-1a9f-11e1-ae14-00144feabdc0.html#axzz1f6mGiF7R

  12. junican says:

    In all this stuff about ‘borrowings’, the question which has always intrigued me is ‘where does all the money being borrowed come from’? Is there somehow an unlimited supply of money to be borrowed, provided that the interest rate is right? Where does it come from and who owns it? Or is this money just figures in a computer? And would it matter a damn if all these figures disappeared and who would suffer? It strikes me that the only people who would suffer would be the George Soroses of this world, but even they would not starve.

    Why do I get the impression that the whole ‘money market’ is just a huge con?

  13. harleyrider1978 says:

    Junican they got in america M1,M2,M3 all diferent money pits created to keep the money flowing,when one gets low they borrow from paul and pay peter! The debt got so massive and the prices so far out of bounds to relaity the whole shebang burst 4 years ago,theyve been printing money by mouse click to try and cover the losses in inflated values ever since. When you bought that house for 60 grand and 5 years later it was worth 250,000 you walked away smiling wondering how the hell that house was worth that kinda money. Then you bought a small cheap trailer because you didnt want to pay 250,000 for a 60,000 dollar house………..so you spent the proceeds on junk then its all gone vanished………who got it…..the chinese more than likely…….since its their produce thats everywhere. Now the guy who bought your house for 250 grand cant pay the mortgage on 250 grand because he really couldnt afford but to keep the money pit rolling the banks and lenders all said its ok we will toss a bubble in it at 5 years or 3 years and the the bubble burst when the guy couldnt pay that! That money is still on the books, times lets say 200 million times……….They wrote it off youd say,the bank did but the bank went bust over it and then the taxpayer bailed out the banker……..who gets stuck in the end,ALL OF US! enter the great depression!

    • junican says:

      Right, HR…….but it isn’t the borrowing of individual people that I am talking about. It is the borrowing by Governments. When a Government borrows 100 billion $ (or Euros, or whatever) where does the 100 billion $ come from? None of us will ever understand until we know that. WHERE DOES THE BORROWED MONEY COME FROM?

      It may even be true, as far as we know, that even ‘the borrowing’ is fictitious. It may be that we are being fed ‘gross’ figures rather than ‘net’.

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