Tobacco Documents Online

r PEOM!NENT PP, OI~.~NENTS AND OPPO~ESTS OF SMOKING- LUNG CANCFZ{ THEO~tY Four American retrospective studies were published: (a) Levin, M. L.~ Goldstein, E.~ and Gerhardk~ Cancer and Tobacco S~oklng: A Preli~In=ry !2eport, Journal of Amerlcan Medical Associa- Mllls~ C. A., and Porter, Tobacco Smoklng Hab!ts and Cancer of the Mouth and Eesplratory System. Cancer Re- search, ~eptember, 1950. Except for Mills and Porter~ these w$r~ reports of comparison of smoking habits of Itmg c~nc~r ~at~nts with those of patients with other diseases in hospital groups. Mills and Porter sarveyed a group of ~30 white males in Columbus, Ohlo. The conclusions reported were: I. Levln et al "Th data suggest, although they do not establish, a causal relationship between cigarette and pipe smokln~ and cancer of the lung and lip, respectively. The statistical association may, of course, be due to some other unldentlfle~ common factor between these t~em of smoking and l~g and llp cancer". 2. Mills and Porter "Cigarette smoklns s~ems to b~ar a highly significant relation to cancers of the respirstory tract * * * ".

3- Schrek "There is strong circumstantial evl- dence thmt cigarette smoking was an etiologic factor in cancer of the respiratory tract." 4. W~nder and Graham "E~cesslve and prolonged use of tobacco, especially cigarettes, seems to be an important factor in the induction of bronchiogenic carcinoma. ~' There was one English retrospective study by Doll and H~II. They compared the smokln~ habits of hospital~I.,~,....~ cancer patients with those of hcsplt~l patients with other diseases. T smoking is a factor~ and an important facto=~ in the production of carcino~ of the l~g" ~ey stated thor ~'It would app~r that lung c~rcinoma patients inhale sligh~ly less often than other p~tients." The stud~ was extend~ ~nd w~s the s~bJ~t of a further report publish~ in December, ~:4ynder and Cornfield published an article en- titled ~Cancer of the L,~ in Physicians" in the Msrch 12, 1953 issue of the New F.~ugland Journal of Medicine. The smoking habits of sixty-three physicians with cancer of the lung were compared with those of one hu/~dred and thlrty-three physicians with cancer out- side the respiratory tract. The authors concl~ded that "A highly si~nlflea~t association between the use of tobacco and the ~evelopment of pulmonary cancer was found amon~ physlcians'~. Sadowsky, Gilliam and Cornfield published an article entitled ".The Statistical Association Between Smoking and Carcinoma of the IAung" in the April, 1953 issue of the Journal of the National Cancer Institute. Smoking histories of patients with cancer of the lun~ - 2 -

were compared with those of patients with illnesse~ other %hun cancer. The authors ceported an associa- tlon between cigarette smoking and cancer of the lur~. Time .~gazlne on November 3,9, 1953 ran a s~ory entitled '*Beyond Any Doubt". This was based upon the mouse painting experiments of Wynder~ Graham and ,:ronlnger. Dr. Graham was quoted as s~ying: "Dr. Ernest L, Wynder and I have reproduced cancer experimentally in mice by using • merely the tars from tobacco smoke. This ...... sho~s conclusively that there is something in cigarette smoke which can produce cancer. - ~Thls is no lon~e~ merely a possibility. Our experiments have proven it beyond any doubt~'. The wynder~ Graham and Cronln~er article which was an- tlt£ed "'~.xperlmental Production of Jarclnoma with 31g~rette Tar:'~appea~ed In th~ issue of Cancer ~esearch and concluded that the resui~s "establish condensed cigarette tar as a carcinogen for a mouse epldmrmls'. Breslow and others published sn article entitled ~C¢cupatlons and Cigarette Smoking as Factors in Lthng Cancer~ in the February 1754 issue of the &~erlcan Journal of Public Health. This was a retrospective study in which the smoking habits of lung cancer patlen~s were compared with those of other pub!ants. The authors concluded that their data ':constitute still another llnk in the ch~n of evidence connectln~ lung cancer ~¢ith cigarette smokln~". There hsd been an earlier ~eport by the same at~tho~s cove~In~ fewer cases published in 1951. Breslow is Chief of the Bureau of Chronic Diseases, California State Department of Public Health. -3-

Dr. H~lton E. Rosenblett delivered ~ paper entitled ~;Relationshlp cf Smokin~ to Cancer of the Lung" on March 16, 195~ at e ~-edical conference held by the Society of the New York Medical College. He stated that "Numerous attempts have been m~de to demon- strate the carcinogenic effect of tobacco during the past 50 years and the results are still very equivocal". He concluded that ' ~*[~ ~rreat deal more research must be done : ,~ before one can establish the etiology of.~ ~un~ The k~Ite Paper was distributed in April, In J~e, 19~ Hammond and Horn presented pre- limlnary findi~s at a meetln~ of the A.M.A. in San Francisco. Their~study-was a prospective one cover- ing approxi~mte!y £88,000 men and after two and one- half years they reported a definite association between smoking habits and death rates. They conc!~ded: '"We are of the opinion that the associa- tions found between regular cigarette smoking ~nd death rates from diseases of the coronary arteries and between regular cigarette smoklr, g and death rates from cancer reflect cause and effect relation- sh~ps" . Doll ~nd Hill published a preliminary report entitled "The Mortality of Doctors in halation to Their Smoking Habits" ~.n the June 26, 19~+ British Medical Journal. British doctors. Their prospective s~udy covered They reported that "Though the numbers of deaths at present available are s~all, the resultln~ rmtes reveal a si~n~flcant rlsln~ mortal~ty from deaths du~ to cancer of the lung as the amount of tobacco smoked increases". There was no discussion of causation.

Herbert [.rki,~, Ph.D., c~Itlcized the 195% Hammond-Horn report in an srticie entitled "Eelatlon- the Ap~!l, 1.9~{ issu~ of :~rent Medle~i D~gest. He stated greater degree in smokers ~han in non-smokers. clusions wer~ state<~. "~ • • I do not believe that from the statis- tical stadi~s ao f~r ~cco)~pllshed one can conclude definitely tha~ smoking causes cancer, or even tha~ necessarily it Is "associa~d' with i~.'~

19~6 An article by Dr. c~arles S. Csmercn, then ~edlcal and Sclenti£1c Director o£ the American C~ncer Society appeared in the Jan~u~ry, 1956 issue of f:tlantlc :bnthly. He stated that cn a retrospective study in an article entitl~l "L}.Lnz Cancer in ~Jonen" 'in the December 13, 19~6 New England Jc,'~l ef ~;edlcine, Smokt~ ~mblts of ~men %~ith i'~ cancer were ~apared with t~se of ~,~men with cancer of ot~er sites. ~hey fcun.d more smoker, among the ltu~f~ cancer -patients and found that the smokers in this group smoked ~or~ ~leavlly. "Science L~oks at Smeklng" by Eric Northrup with an introduction by Dr. Oeeene was ~llsbed £n 19~. • Dr. Greene re~rt~ n~ative resets f~m application of cigarette tar to embr~nic tissues of ~use l,~s stated t~t

s~atlstlcal and experhmental) does not appear sulf.[e±ently significant tc me to %re=rant forsek].)~ the pleasu2e of smokln~," The Gt" ~ • ;~ay Group r~x~rt %,ms made public in i~rch 1957. Meab~rs were Richmrd J. ~n~, R. E. Dyer, ~. ',' Lille~feld, Norton N~is~n, Hic~mel B, ShLmken, David H. Spain, F, ,M. Stron~ and Dean F. Davies, The ~t~dy Group re~orted: -~'The s,J~.~ total of sclentific~-~idence sstabllshes ./ .V~7~'~ beam% reaso~ble doubt t~t clsarette ~k~ is a causative factor ~ the rapi~y inor~s~ , Incidence of h~l 8plder~id carel~ma of the ~ond s.nd Horn ~resentsd their final report ¢.n thei~ prospective study ~t an A..~,I.A. )neeti~ ~n New ~crk on j,m@]~ ~9~7. ~ Phe ~ubl~=h~ re~?t ~ntitled "S~king~ and D~,th Rates - Re~t on Fort~l;'ou? ~aths cf .r~lle~.~-bp cf ~ < published In th~ J,~..M,A, "> " I,~?,783 MeW' ~,~,~s an sxtreme!y ~i£h degree cf asscclatlcn with clgorette and stated that there no doubt In our mind~ as to the validity the association fo,.Lud between cigarette a~.~oklng and cancer of. th~ l~mag $ • ~.,, The British Hedlcal Research Council issued its re~ort In June, I~57 cono].udir~ that the ~st re~ble Inte~pretatlon of the evidence r~lew~! Is t~t the direct cause and effect. These flndi~s were accepted by the ~ver~ent, -7-

On July 12, 1957 S~geon G~neral Le~cy E. B~rney a~nounc~ that "* • • the Public Health Service feels the ~elght of the evidence is Increasln~ly lmlnting in one dlrectlon: t~mt ~xcesslve cigarette smekln~ is one of the causative factors In lung cancer." The Pilatn!ck hearl,n~s ~ere held July 18 to 26, 1957. P~Inclpal s~kesmen for the proponeats were ~rney, }~nd, ~eller and ~;ynder. Greene, Little, ~- ~,~cdonald and .~Igdon presented opposite views, Letters • fro~.~ r~erkson ~nd Rosenblatt were ~ulserted In the record. In ~ovember, 1957 th~ imag-~L~nmr ,study entitled "~:,~oki~Ig. Habits and Mortality ~moag ~crkers in Cigarette Fs.ctories'~ ~a,s presented 1.n ~!la~l ~2each. Their study s~'ed tl~t in contrast ~Ltn some previous studies "~ ~ • this study e~.~loyln~ mo~'tallty rates for a ~;,hole population s~.,s a h!gher-tlmn- average percentage of shakers and a much tha~average rate cf s~ki~ to be as~ciated ~Ith greater ic~evlty~ r~atlvely lo~er death rates from cancer ~ cardiovascular dls~ses a~Id rezplratory cance~• r~tes ~ higher than the ~eneral ~p~atlon." Dr. Little publ~s~~ed an article entitled ~ablic aitl Si.~eking" In the December, 1957 issue of the Atlantic ~nt~ly. He referred to some of the contradictions in the statistical studies and asked for calm deliberation and st~yo Sir Ronald Fisher published an article entitled "Cigarettes, Cancer, and Statistics" in ~he Spri;~, 1958 issue of The Centennial Revle~: of Arts & Sciences. ~le pclnt~ (I) to the s~rt comics of the -8-

t~,t In th~ ~ii a~ ~[ill retrcspeetlve study there ~ere fewe~ In~le~s ~o~ the cancel- pstlents titan ~m~ ths nnn-cancer patient& a~ (3) the desirability of starting research to deterzlne the genetic c~racte~Istles of ~ekson com~ent~h cn t~e Doll and iIill and and Ibm st~.~/le~ in an article entltl~ "~klng ~,*'~,+~'~Ical As~.clntl~.n. f[e did ~t agree t~.t on the establieh~ beyond reascn~ble ~,uht~ t~t ~klng is an L~tant ~ause of l~u~ cancer. from Ca~%eer a[~ Cther l:%se~es" %~%~ presented In ~ndon In a p~cspectlve s~.dy im~n ~md fo!lo~ed ~roxh~tely 2~,~0 veterans ~Idl;~ U.S. ~ve?~ent life Insurance f~s July. 19~ +~ D~e~ber, 1956. "The grentest in.ease for s~kers ~ the risk ef develeph~ d.is~e is ~ncer of the Cn A~ust -~" 19~ Dr. ~{er,..au ~. De~a~aent of ;/ealth. "The ~elatlon (of smoking) to lung ~ncer ha~ be~n studied repeatedly, extensively, and in a numhe~ of different ways, and is s~ well established a~ clear t~at th~ burden of proof -9-

now rests sq~mrely on tb~Be ~o would deny that smokln~ is a causal f~tor." Wynd@r and Lemmn published ~he result retrospective study involving Seventh Day Adventists in an article entitled "Cancer, Coronary Artery Disease and S2~king" which appeared in the October, 1958 issue o~ California Medicine. The study %,as designed to disprove the ~istence " ~ " of a .possible third factor ~hlch %wuld both produce lur4 cancer and make ~ person smoke. The authors conclude i"Wlth the present data added to the already overwhelmin~ evidence linkin~ smokir4~ to cancer (such a third factor would also have ~to act to ~revent) one from Joining the Seventh-Day Adventist Church, a combination of factors virtually Lmpcssible to ~ccept." i{olland~ kilson, :~ceveao, McCall, Clark and Lanz published an artlcle entitled "A Study of Arsenic in ReKular-Sized Unfiltered and !~~iltered Cigarettes" in the November-DecBmber, 1958 issue of Cancer. They report t~hat the "arsenic content of regular-slmed unfiltered American cigarettes ~_as Increased from 7.5 to 30.0 parts per million in 1932 to 1933 to 52.0 parts per million in 1957, an increase of 200~.~ ~ 6o0%" and comment "~ithou~h the evidence llnkin~ the arsenic in cIEarette smoke to lung cancer is highly su~estive~ it is felt that a sober approach • ~ '= is needed • • ~." In 1958 Auerbach and his assoclat~s published another article entitled "Changes in the Bronchial Epithelium in Relation to Smoking and Cancer of the Lung". - IO -