I don’t know what I was looking for when I came across it, but a couple of days back I found myself reading The Role of Knowledge in Health Transitions by Dr John Powles.
“Reading” might be the wrong word. The pdf is actually arranged more as a set of slides to accompany a lecture. There’s hardly anything to read.
It starts off by asking why child mortality started plummeting after 1900.
There was much the same trend in Australia and the USA. Had clinical medicine improved? No. Were children better fed and housed? Not really. Whatever had changed affected the upper social strata. Likely candidates were: improved sanitary infrastructure, universal education, and rising incomes. Plus the new germ theory by which infections were caused by bacteria.
Changes of behaviour were encouraged: breast feed, boil cow’s milk and sterilise bottles, control flies, wash hands, and protect infants from infective persons. This advice came out in books and magazines and newspapers. In the early 20th century, knowledge was put to work to reduce infant mortality.
This was all pretty familiar stuff for me. Disease isn’t caused by sour milk, unripe fruit, inhalation of sewer gases, or emanations from the soil. It was caused by bacteria (and also by viruses), and the trick was to avoid the ready transmission of these from the infected to the uninfected.
The next question was: what was the cause of the reduction of adult male mortality?
In this case, however, there was no discussion of possible causes. Instead, a single conclusion was presented:
The biggest single contribution came from the decline in smoking.
Tobacco control has been the defining issue for public health in the later C20.
The 1950 Doll and Hill London Hospitals study was cited.
Once the scientific evidence began to unfold, the central challenge for those who appreciated its import and wished to reduce the harm to smokers, was to achieve consensual change in a health-damaging behaviour that was normative among adult men.
‘It can be done,’ George Godber. ‘What we have to do here is not something that can be done to people or imposed on them by compulsion. It is a matter of education and persuasion… We are asking for an almost infinite number of acts of self discipline.’
The involvement of the RCP, the BMA, ASH, WHO and UK government is then traced.
There’s a third section, which is concerned with a public health failure of adult health in the USSR and Eastern Europe after the 1960s. It’s put down to Lysenkoism, isolation from international developments, alcohol consumption, and economic liberalism without the rule of law. I confess I didn’t really understand the third section.
But back to the second section, which was about the fall in adult male mortality in the late 20th century. I was very surprised that no other possible cause, apart from the reduction in smoking, was considered.
But also, from the graph shown above, apart from a slight glitch in the 1940s, the probability of adult males dying before the age of 70 had been falling rapidly at about the same rate throughout the entire 20th century. Why had that happened? In fact, I could discern little difference between this graph and the earlier one of infant mortality. Both start falling around 1900.
The obvious deduction is that the measures taken to reduce infant mortality also served to reduce adult mortality. After all, adults can just as easily become infected by transmissible diseases as children.
But the other striking thing is that, while the decline in smoking in the late 20th century is given as the principal (and in fact only) explanation for increased male longevity, the rise in cigarette smoking in the first half of the 20th century is not accompanied by corresponding decreased longevity. Indeed the probability of adult males dying before age 70 starts falling precipitately just at the moment when they are starting to smoke cigarettes. Which would almost suggest that it was taking up smoking that helped prolong life.
I also thought it was interesting that, apart from the 2006 study by Richard Peto et al., the only study that was cited was the 1950 London Hospitals study. This is a dreadful piece of research, in which 98% of the those sampled, in both the study and the control group, were smokers, and accordingly 98% of any hospital patients suffering from any disease at all could confidently be expected to be smokers. And in the case of lung cancer, over 99% of patients were indeed smokers, which is more or less exactly what was to be expected.
It was also during this study that Richard Doll jumped to the conclusion, before all the results had been gathered, that smoking caused lung cancer, and gave up smoking. No other possibility was considered, or nothing was ever published about possible alternative causes.
I had the same sense reading the present paper: that people had jumped to a conclusion without considering alternative hypotheses. And all this despite the fact that the evidence presented argued fairly conclusively that smoking was not the cause of increased mortality, and stopping smoking of decreased mortality.
And also, although Tobacco Control is presented as a public health advance comparable to the rise of germ theory just prior to 1900, the underlying science is radically different. The epidemiologists 100 years ago were finding particular strains of bacteria in people who were suffering from particular recognised diseases. They could see them and count them with their microscopes. They could also see, once again using microscopes, that that healthy people did not have such bacterial infections. It was rational for them to conclude that it was these bacterial (and viral) infections that brought on the disease symptoms.
But Doll and Hill (and almost all their co-workers) were not using microscopes, but mathematics. They were using statistical techniques developed by pioneers like Sir Ronald Fisher. And Fisher strongly disagreed with the use to which Doll and Hill put those techniques. Doll and Hill did not find causes of diseases: they conjured up mathematical associations between smoking and disease.
Also, I couldn’t help but think that, if germ theory had served to dispel fears about “sewer gases”, Doll and Hill (or more particularly George Godber) had served to re-introduce such irrational fears, only this time with secondhand smoke replacing sewer gases and “emanations from the soil”. Thanks to these people, we have returned to a mediaeval, pre-scientific era of irrational fear and superstition.
And finally, despite Godber’s injunction that discipline could not be imposed upon people by compulsion, it is precisely such compulsion that is now being used, in the form of widespread government-enforced smoking bans, refusal of medical treatment to smokers, and smokers being evicted from their homes or fired from their jobs.
And this, above all, is why Tobacco Control will be seen one day not as a blessing, but as a terrible blight upon the whole world during the late 20th and early 21st century.
Frank Davis 
Frank by GAWD you nailed it!
Finally a piece that puts the end points of tobacco controls true disease on mankind and why its so deplorable. It has indeed set the scientific process back 100 years!
After thought too,they make the claim first and then try and proove it,like with smoking causing LC. Right after the 1964 SG report they started tearing into to prove smoking caused cancer but never could. The last attempt I believe was in 1998 and was quickley disregarded then in 2004 the COT came out and admitted its never been proven but still maintained all those claims with no proof to back up any claim.
Sometimes, when I read a particularly powerful post like this one, I almost despair.
Most of the sheep out there will never read this. They don’t forage for information, they just passively swallow the processed “It’s-good-for-you” rubbish that’s poured into their trough. (Mixed metaphor?)
If it weren’t for the internet, and people like you, Frank, I might never have rediscovered my rebellious streak.
People like you will always keep cropping up, (Until TPTB bring in selective breeding), but what a stroke of luck that we got the internet just in time to counter this new age of disinformation and control.
How they must dream of suppressing the internet. In the name of fighting terrorism, paedophiles, organised crime, blah blah.
Zaphod
They don’t forage for information, they just passively swallow the processed “It’s-good-for-you” rubbish that’s poured into their trough. (Mixed metaphor?)
Its precisely where the term ” The Sheeple” comes from,but the paradox is that it desensitizes the sheeple after so long. It in time makes the latest health campaign study being paraded by the media on the medical moment nothing but a laughable comic strip. Even kids trading diseased smoking packs pics with each other like baseball cards have no effect. Kids, they hear something then they look at 80 year old great grandpa still smoking and they see his friends still smoking and they learn quickly these claims put out are total B.S. Proof is something long ago traded in for political witch hunts using public health as its warrior!
Personally, I think it was all rigged from the start, Doll’s brief being: show that lung cancer is caused by smoking (ie not all those other things that are far more likely to be the cause, which we’re not going to stop doing because they’re making us very rich). He was willing, so he got the commission. Either that, or he was a very bad epidemiologist.
Richard Peto et al
This guy created his own system. The Peto odds ratio to kinda bump up a better RR in these Meta studies to give TC more pump for their propaganda dollars in the form of grants!
Peto odds ratio meta-analysiswww.statsdirect.com/help/meta…/peto_odds_ratio_meta_analysis.htmCached – Similar
This method is not mathematically equal to the classical odds ratio but it has come to be known as the ‘Peto odds ratio’. The Peto odds ratio can cause bias, …
http://www.statsdirect.com/help/meta_analysis/peto_odds_ratio_meta_analysis.htm
Its my understanding this method was introduced in about 1988 right on time for the great EPA shs study to come about. Lets also not forget the political background was being laid for epa to get their foot int he door using the new powers of the RADON ACT. The radon act I believe was what was going to be used after the 1992-3 EA SHS STUDY was completed to come into our houses and businesses to force smoking bans on all of us! Thank goodness Big Tobacco sued and showed it to be the junk science it was!
Smokers found to take more sick daysResearch shows UK smokers on leave cost employers £1.4bn in annual productivity but quit programmes can claw it back
http://www.guardian.co.uk/society/2012/oct/31/smokers-take-more-sick-days
Now we can see why the study was conducted,to sell more NRT PRODUCTS for Big Pharma!
Submitted by Norm K
“133:5.6 Mathematics asserts that, if one person stands for a certain unit
of intellectual and moral value, ten persons would stand for ten times this
value. But in dealing with human personality it would be nearer the truth to
say that such a personality association is a sum equal to the square of the
number of personalities concerned in the equation rather than the simple
arithmetical sum. A social group of human beings in co-ordinated working
harmony stands for a force far greater than the simple sum of its parts.”
Added Note: Conversely, if at odds with each other and not in harmony, the
force applied by the 10 is the square root of 10 (3.16) versus the
harmonious square of 10 (100). Which result would any 10 honest and
productive people desire? Why tolerate undermining influences?
I’ve found this very informative piece about Doll, his connection with industries, the dirty tricks used, the loss of scientific integrity. Sorry I don’t know how to reproduce a link here, but it’s http://www.whale.to/v/walker_doll.l
It’s quite long but worth wadiing through.
VICTORY FOR SMOKERS
4th November 2012 By Daily Star reporter
HOSPITAL bosses have lifted a smoking ban after losing a five-year battle to enforce it.
They are now building three smoking shelters costing £17,000 at Queen Elizabeth Hospital in King’s Lynn, Norfolk.
The hospital said the no-fag rule was impossible to enforce legally and some smokers had threatened and abused staff.
At the main entrance smokers had been lighting up within yards of signs declaring the hospital a smoke-free site.
http://www.dailystar.co.uk/news/view/280589/
No comments unfortunately
Absolutely right, Frank. It’s cigarettes, more than pipes or cigars, that carry health risk, and it has always stared us in the eye that cigarette smoking took hold in the late nineteenth century, and firmer hold around the First World War, and peaked with the generation that fought the Second World War, and also that the cigarette smoking generations are the healthiest longest-lived generations in all of human history.
Indeed the generation that smoked the most (my parents’: my own generation — I’m 56 — is only starting to die off in considerable numbers at this point) lived the longest. Longevity increased markedly and directly in line with the advance in cigarette smoking.
Does this mean cigarette smoking increases health and life span? Of course not; that would be a facile asinine assumption of the sort wacky Antis make (but won’t in this case). We can note that smoking began to drop off in the ’60s, and longevity continues to increase, although no quicker than it had been increasing since the end of the nineteenth century. Smoking simply has not affected statistical longevity all that much.
So what is the logical conclusion? What you say. Advances in industry and a resultantly higher standard of living and better nutrition, knowledge of germs and advances in eradicating infectious diseases, along with the development of antibiotics for infections, as well as, but to a lesser extent, surgical advances such as in heart surgery, all helped make for healthier people who lived longer. We’re also bigger people, generally, than were our forbears. It could also be noted that manufactured cigarettes, a product of the machine age, appeared coincidentally with advances in industry generally, which produced an overall improvement in life and in life span.
The Healthists/Eugenicists (H/E) have the universal characteristic of never seeing what stares us all in the eye. They don’t think. They only speak: they only mimic each other in saying asinine things. Their brains contain, and are capable of containing, nothing whatsoever apart from the dogmatic drivel they shout at us incessantly. Now, people are living longer, than they did long ago. To an H/E that situation has to be be “caused by” asinine H/E pronouncements. The favorite asinine H/E pronouncement of the era is that death is “caused by” smoking. Ergo smoking is the only factor that influences death. That is what they think. Because they don’t think!
Of course, reduction of stillbirths and childhood deaths, and longer life spans generally, rise from better living and from some real medical advances (which have occurred in spite of rather than because of H/E asininity.) Rather than dying young of, for instance, cholera or an infected cut, as folks commonly did in eras past, you’re more likely these days to die of, perhaps, a heart attack or cancer in your seventies or so. That doesn’t give us license to get drunk and chain-smoke every day. But even if you do you might well live longer than your great-grandaddy with similar habits did.
Too much drinking isn’t good for your liver and too much smoking isn’t good for your lungs and too much of either isn’t really good for you generally. You can’t just look at Richard Doll’s statistical research alone. Excess, in most anything, does carry risk. When it comes to cigarettes that risk could have been virtually eliminated (look up Gio Gori’s research on that.) H/E types put the kibosh on that too. They say the only remediation for smoking is universal abstention. They say smoking a cigarette in London kills babies in Shanghai. They say and live by asinine ideas, and create misery and death, by insisting that we must obey them.
Heart attacks and most types of cancer tend to happen to old folks. That’s why today’s more greatly aging population has higher rates of heart attacks and cancer than did nineteenth century populations; most folks simply didn’t live long enough to get heart attacks or cancer back when, and it’s also evident that cancer, back when, was often not diagnosed even when it happened.
When you look at life span statistics going back a hundred years and more it becomes patently obvious that smoking could not possibly be a major determinant in life expectancy. But here’s one other point along the same line. Call it the flip side of the point made by historical statistics.
Let’s say you do die of lung cancer. Lung cancer is the cancer most strongly associated with smoking statistically but it affects both smokers and never smokers. The average age at death from lung cancer according to the most recent available 2008 US National Center for Health Statistics final data (and the figure is similar for most of the West and generally for developed nations) is 71 years old. The US average age at death from all causes is 73 years old.
Asinine H/E types say smoking is “the cause of lung cancer”. You’ll never talk them out of that so don’t try. But you could mention to them that those who die of lung cancer live an average lifespan just two years or 3% shorter than do folks who die of anything else. You could add that lung cancer kills a single-digit percentage of the population (about 6.5% of all deaths in the US in recent times) and that a single-digit percentage of the population that lives 97% as long as does everybody else doesn’t materially effect longevity statistics overall. Also mention that everyone does die. They won’t believe that either.
The lack of logic in the ‘smoking causes —-‘ case, the easily-spotted flaws in every study it produces, and its complete disconnection from and disregard of reality, makes it very difficult NOT to believe in a great big conspiracy.
Ordinary people with no axe to grind who don’t bother looking into it all – it’s understandable that they’d buy the lies. But proper highly-qualified scientists? They absolutely must know it’s bunkum. They are muzzled, their jobs are at stake if they speak out. What else can this be but a conspiracy?
A quick comment.
The Hospital Study reported in 1950. The Doctors Study started in 1951.
The Hospital Study had about 2000 participants. The Doctors Study had some 40,000 (of which some 34,000 were male.
Consider the lead time which must have been required to set up these studies. It must have taken years to set up the organisation, method and funding for these studies. We shall never know how long.
I have come to the conclusion that both of the studies were planned together many years in advance. Even, possibly, before WW2. Considering that Prohibition was repealed only in 1933, it is not unreasonable that the Eugenicists had simply changed their target to tobacco. There is little doubt in my mind, that at least part of the funding for these studies came from the Rockefeller Foundation since Doll was a ‘Rockefeller student’ at the beginning of his career.
I am not saying (or am I?) that Doll, Hill, Peto et al were dishonest. But it is possible that a bit of ‘fixing’ occurred . With so few lung cancer deaths over such a long period of time, it is possible for a person who got lung cancer and smoked only a little to be moved from the non-smoking category to the smoker category, and vice versa. Doll was a zealot and not entirely as honest as you might think. Also, doctors marginally positioned on the border of ‘moderate’ smoker could be moved to ‘heavy’ smoker.
Think about the numbers. In the first twenty years, 10,000 doctors died. On average, that is one and a half deaths per day (r three every two days, if you prefer!). Such numbers hardly need an awful lot of time to process. “What shall I do with this one, Mr Doll? He died from lung cancer aged 53 and says that he smoked 20 cigs per day and a pipe or two at weekends” “Put him in the heavy smoker of cigarettes category, Gladys”.
Doll was a ‘Rockefeller student’ at the beginning of his career.
Was he? I had the impression that he was at one time. But I later came to think that he wasn’t. It goes back to about 1947, before the London Hospitals study, when someone said “We have a Rockefeller student we could use.” Was that Doll? I’m not sure it was.
But the point perhaps is that a lot of these people have a history of coming out of one organisation or other. The Rockefeller Foundation is one. The London School of Tropical Medicine (or similar name) is another. The RCP. WHO. And so on.
It may simply be that, when you passed through these organisations, you absorbed their culture. You attended their lectures. You read their publications. And by the time you left you were pretty firmly of the belief that smoking was the cause of all diseases, but it just needed to be ‘scientifically’ proved that it was.
There was perhaps no formal conspiracy (of the sort that Margo is suggesting). There were just people with a shared set of beliefs. They might just as easily have been Catholics, or Communists, or Buddhists. We are all of us, all the time, passing through these subcultures, and absorbing knowledge and attitudes and beliefs.
I would have to look up the exact details, but I think that it went something like this:
There was talk about moving the tobacco question (?) out of Bradford Hill’s control. He argued against it. One of his arguments was that he had “this Rockefeller student (Doll) who was quite promising”.
Consider the lead time which must have been required to set up these studies. It must have taken years to set up the organisation, method and funding for these studies. We shall never know how long.
I’d like to know where the funding came from. I doubt it was the government, because most people in government didn’t believe that smoking was dangerous. I doubt if it was the pharma companies either.
Of the two studies, it might be said that the London Hospitals study was the one that needed most work, because hundreds of patients needed to be got to answer a questionnaire with quite a few questions on it. And Doll himself didn’t conduct this survey, so most likely it was carried out by people at the hospitals. The research ‘team’ probably consisted of Richard Doll and Bradford Hill. And once Doll had jumped to the conclusion that smoking caused lung cancer (and gave up smoking) midway through the study, all the other questions and answers in the questionnaire were disregarded, and never included in any subsequent paper.
The Doctors study required sending out 60,000 or more letters to doctors. It also required that, upon their death, cause of death be forwarded to the research team by coroners. And it came very slowly. Richard Doll probably devoted a day a month to the data.
Most of the ‘work’ seems to have been publicising their results. And they made a big splash in the newspapers, and started a very public controversy (in which Sir Ronald Fisher, “the father of statistics” became embroiled).
It may not have needed much money. But it probably needed contacts in government, in the media, in the hospitals, etc.
… all the other questions and answers in the questionnaire were disregarded …
I don’t think there were any other questions in the 1950 London hospital study. I think the only questions asked were of the ilk of: do you smoke? how much? how long for?
A ‘smoker’ was anyone who said they’d smoked at least 1 cigarette a day for as long as a year (some of the ‘smokers’ in the study hadn’t smoked for years). This was a ‘men only’ study. Nothing was asked about where they worked and lived etc, whether they were mustard- gassed in the war, whether their fathers/grandfathers had developed cancer – nothing.
And I think this was the study that found that if you inhaled you were less likely to get lung cancer.
Doll left the inhaling question off the subsequent studies.
The doctors’ study had only 7 questions, all about smoking.
What kind of epidemiology is that, for God’s sake?
No, you’re thinking of the British Doctors study that started more or less immediately after the London Hospitals study. It was the British Doctors study that only had one question.
The London Hospitals study had a 2 page questionnaire, which asked questions about (among other things) road tarmac and gas works proximity. I’ve never actually seen the questionnaire, but it certainly wasn’t restricted to just smoking. There was supposed to be a paper on the effect of other factors than smoking, but it was never written. Which is more than remiss.
“On receipt of the notification an almoner, engaged wholly
on research, visited the hospital to interview the patient,
using a set questionary. During the inquiry four almoners
were employed and all the patients were interviewed by one
or other of them.”
(From the Hospital study):
Click to access brmedj03566-0003.pdf
You can read my summary of the Hospital study at:
Between 1945 and 1961 there were at least 500 above ground nuclear weapons tests, I wonder why these are never mentioned when causes of cancer are suggested?
The Fallout Hypothesis
I think that one’s got a lot going for it. So did Alice Stewart, the other epidemiologist, the one who didn’t get the smoking study to do, the one Doll slagged off (though he later used her Oxford Children’s study, extrapolating smoking questions and ansers out of it).
The only thing ever proven to mutate a cell is radioactivity!
Re questionnaires, studies done by the American Cancer Society did ask a decent number of questions. I’ve looked but never found papers that examine these variables in conjunction with smoking. To analyze only a single variable (smoking) is junk science. I suspect they did do an analysis and didn’t like the results. The numbers would be most interesting, but historically the ACS has always refused to release its data to independent researchers.
http://www.cancer.org/Research/ResearchProgramsFunding/Epidemiology-CancerPreventionStudies/StudyQuestionnaires/index
Along with the British Doctors, CPSI (Men In 25 States) was one of the major pieces of “evidence” that the 1964 Surgeon General’s report used to proclaim that smoking causes lung cancer. I’d look at the CPSII (1982) questionnaire since it’s more legible; it’s similar to CPSI.