Was acceptance of the lung cancer and smoking relation delayed because the Nazis discovered it first?

by Keithious

I heard this in Stephen Pinker's book "The Blank Slate"

mkwiat

The discovery of the connection between smoking and lung cancer is a fascinating subject. Siddhartha Mukherjee discusses it in his excellent book The Emperor of All Maladies.

When tobacco was first introduced to the west it was not at all obvious that it caused cancer. Mostly because so many other things were likely to kill you before you lived to the ripe old age of forty-five and developed cancer.

In 1761 John Hill published Cautions against the Immoderate Use of Snuff in which he linked throat and mouth cancer to the use of snuff^1. Unfortunately, because his evidence was conjectural, he himself was a dilettante and his pamphlet informal, his work was largely ignored.

In the subsequent decades tobacco usage soared. From The Emperor of All Maladies:

As the Oxford epidemiologist Richard Peto put it: “By the early 1940s, asking about a connection between tobacco and cancer was like asking about an association between sitting and cancer^2.

Britain's Ministry of Health noted a fifteen fold increase in lung cancer from 1927 to 1947. Mukherjee doesn't say so, but I suspect that the discovery of antibiotics and their increasing availability in the post-war years eliminated such perennial 19th century killers as tuberculosis and thus enabled more people to live long enough to die of lung cancer. A detailed study, the first of it's kind, was commissioned.

One of the researchers, Richard Doll, himself a smoker, was convinced that tobacco had nothing to do with lung cancer. He included a question about smoking with many others, including whether patients ate fried fish, in a detailed survey sent to lung cancer patients and a control group.

Midway through the study, the correlation between smoking and lung cancer was so clear that Doll gave up smoking.

This survey was still not rigorous enough to conclusively show that smoking caused lung cancer. What was needed was a long term, randomized trial with both smokers and non-smokers. In 1951 Doll and his partner Hill found a database that could be used as a natural trial; detailed records of doctors who had died and for whom detailed notes about cause of death were available^3.

Doll and Hill published their findings in 1956.

What Mukherjee really makes clear in describing the history of lung cancer research is that while tobacco had long been suspected of being linked to cancer, there wasn't hard medical evidence of it.

I am not familiar with Franz Muller's research on smoking. It is possible that English and American researchers were familiar with it but it didn't rise to the level necessary to take on the tobacco lobby. It's possible that it was ignored as being part and parcel with other un-scientific Nazi beliefs.

I think it's safe to say the given the timing - Muller's work was published, in German, in 1937 - it's not likely that progress in the UK and US would have been that much faster had researchers known of and had faith in Muller's research.

Notes:

1 Mukherjee, Siddhartha. The Emperor of All Maladies: A Biography of Cancer (p. 239). Scribner. Kindle Edition.

2 Mukherjee, Siddhartha. The Emperor of All Maladies: A Biography of Cancer (p. 241). Scribner. Kindle Edition.

3 Mukherjee, Siddhartha. The Emperor of All Maladies: A Biography of Cancer (p. 249). Scribner. Kindle Edition.

droidbrain

I’m in rhetoric rather than history and my focus has been more on the tactics used by tobacco companies, but I think there’s a strong argument to be made that no, acceptance of the link between tobacco and smoking was not significantly delayed because some of the work was carried out by Nazis. I’ll break it down into medical acceptance and public acceptance of the link.

Medical Acceptance

Even in the 1930s, the Germans weren't the only ones looking at the link between tobacco and cancer. In particular, Argentinian doctor Angel Roffo published animal studies demonstrating the link between tobacco and cancer in the 1930s, and in 1939 he identified the presence of polycyclic aromatic hydrocarbons (known carcinogens even then) in cigarette smoke. Other pathologists in the 1930s began noticing that cigarette smoke caused conditions that they suspected were precursors for lung cancer.

So Nazi scientists were definitely not the only ones who suspected a link between smoking and cancer, and Roffo’s work was being cited within the tobacco industry as early as 1947. Other internal documents show that tobacco companies accepted the link between smoking and cancer in the 40s and 50s, and by the early 50s there was a wealth of evidence linking tobacco to cancer that had nothing to do with the Nazis.

Public Acceptance

Where the public is concerned, acceptance of the link between tobacco and smoking was primarily delayed by deliberate obfuscation on the part of the tobacco industry. They had a pretty broad array of tactics:

  • Dispute the studies: Every study has its flaws, and the tobacco industry took advantage of this to make it look like there were no definitive studies linking tobacco to cancer. Is it an epidemiological study? Correlation is not causation; the sample size isn’t large enough. Animal study? Animals aren’t humans. No acknowledgement that multiple (necessarily imperfect) lines of evidence can build up to a very strong case.

  • Make your own: The tobacco industry wasn’t above paying for their own studies to show no link between tobacco and cancer.

  • Attack the agenda: If the first two tactics failed, tobacco companies also attacked results as being politically motivated. Tobacco companies took the stance that researchers had an agenda to push, one that attacked American freedoms to buy and smoke what they want.

That last one is where I would expect the Nazis to come in, but I’ve only seen the Nazis invoked to attack tobacco control policies, not the science. I’ve read most of the major tobacco industry playbooks from the 50s and 60s, and not seen any mention of the Nazis. That’s not to say that line of attack was never used, but if it was, it was likely only a drop in the bucket of denial.

Sources