The Scientific Scandal of Antismoking

---

• From: Ray Johnstone <ray@xxxxxxxxxxxx>
• Date: Fri, 23 May 2008 01:33:16 +0800

---

The Scientific Scandal of Antismoking

By

J. R. Johnstone, PhD (Monash)

and

P.D.Finch, Emeritus Professor of Mathematical Statistics (Monash)





Science is not always a neutral, disinterested search for knowledge,
although it may often seem that way to the outsider. Sometimes the
story can be very different.



Smoking and health have been the subject of argument since tobacco was
introduced to Europe in the sixteenth century. King James I was a
pioneer antismoker. In 1604 he declared that smoking was "a custome
lothsome to the eye, hatefull to the Nose, harmefull to the braine,
dangerous to the Lungs, and in the blacke stinking fume thereof,
neerest resembling the horrible Stigian smoke of the pit that is
bottomelesse." But like many a politician since, he decided that
taxing tobacco was a more sensible option than banning it.

By the end of the century general opinion had changed. The Royal
College of Physicians of London promoted smoking for its benefits to
health and advised which brands were best. Smoking was compulsory in
schools. An Eton schoolboy later recalled that "he was never whipped
so much in his life as he was one morning for not smoking". As
recently as 1942 Price’s textbook of medicine recommended smoking to
relieve asthma.

These strong opinions for and against smoking were not supported by
much evidence either way until 1950 when Richard Doll and Bradford
Hill showed that smokers seemed more likely to develop lung cancer. A
campaign was begun to limit smoking. But Sir Ronald Fisher, arguably
the greatest statistician of the 20th century, had noticed a bizarre
anomaly in their results. Doll and Hill had asked their subjects if
they inhaled. Fisher showed that men who inhaled were significantly
less likely to develop lung cancer than non-inhalers. As Fisher said,
"even equality would be a fair knock-out for the theory that smoke in
the lung causes cancer."

Doll and Hill decided to follow their preliminary work with a much
larger and protracted study. British doctors were asked to take part
as subjects. 40.000 volunteered and 20,000 refused. The relative
health of smokers, nonsmokers and particularly ex-smokers would be
compared over the course of future years. In this trial smokers would
no longer be asked whether they inhaled, in spite of the earlier
result. Fisher commented: "I suppose the subject of inhaling had
become distasteful to the research workers, and they just wanted to
hear as little about inhaling as possible". And: "Should not these
workers have let the world know not only that they had discovered the
cause of lung cancer (cigarettes) but also that they had discovered
the means of its prevention (inhaling cigarette smoke)? How had the
MRC [Medical Research Council] the heart to withhold this information
from the thousands who would otherwise die of lung cancer?"

Five year’s later, in 1964, Doll and Hill responded to this damning
criticism. They did not explain why they had withdrawn the question
about inhaling. Instead they complained that Fisher had not examined
their more recent results but they agreed their results were
mystifying. Fisher had died 2 years earlier and could not reply.

This refusal to consider conflicting evidence is the negation of the
scientific method. It has been the hallmark of fifty years of
antismoking propaganda and what with good reason may well be described
as one of the greatest scandals in 500 years of modern science.

A typical example of such deception appeared in the same year from the
American Surgeon General. This was "Smoking and Health",

the first of many reports on smoking and health to be produced by his
office over the next 40 years. It declared that in the Doll and Hill
study "…no difference in the proportion of smokers inhaling was found
among male and female cases and controls." Fisher had shown this was
not so. Fisher’s assessment and criticism of the Doll and Hill results
is not mentioned, not even to be rejected. Unwelcome results are not
merely considered and rejected. They cease to exist.

The work of Doll and Hill was continued and followed up over the next
50 years. They reintroduced the question about inhaling. Their results
continued to show the inhaling/noninhaling paradox. In spite of this
defect their work was to become the keystone of the modern
anti-smoking movement: Defects count for nothing if they are never
considered by those who are appointed to assess the evidence.

But their work had a far more serious and crippling disability.

From its inception the British doctors study was known to have a

critical weakness. Its subjects were not selected randomly by the
investigators but had decided for themselves to be smokers, nonsmokers
or ex-smokers. The kind of error that can result from such non-random
selection was well demonstrated during the 1948 US presidential
election. Opinion polls showed that Dewey would win by a landslide
from Truman. Yet Truman won. He was famously photographed holding a
newspaper with a headline declaring Dewey the winner. The pollsters
had got it wrong by doing a telephone poll which at that time would
have targeted the wealthier voters. The majority of telephone owners
may have supported Dewey but those without telephones had not. A true
sample of the population had not been obtained.

The new Doll and Hill study was subject to a similar error. Smokers
who became ex-smokers might have done so because they were ill and
hoped quitting would improve them. Alternatively, they might quit
because they were exceptionally healthy and hoped to remain so.
Quitting could appear either harmful or beneficial. To avoid this
source of error another project, the Whitehall study, was begun.

In 1968 fourteen hundred British civil servants, all smokers, were
divided into two similar groups. Half were encouraged and counselled
to quit smoking. These formed the test group. The others, the control
group, were left to their own devices. For ten years both groups were
monitored with respect to their health and smoking status.

Such a study is known as a randomised controlled intervention trial.
It has become increasingly the benchmark, or as it is often referred
to, the "gold standard" of medical investigation. Any week you can
open The Lancet or British Medical Journal and you will likely find an
example of such a trial to determine the benefits or harm of some new
therapy. Such trials are fundamentally different to that of Doll and
Hill. This is ironic because Hill had published the influential and
much-reprinted textbook "Principles of Medical Statistics" where he
considers the relative merits of controlled and uncontrolled trials.
His praise is reserved for the former. Of the latter he is
particularly critical: Such work uses "second-best" or "inferior"
methods. "The same objections must be made to the contrasting in a
trial of volunteers for a treatment with those who do not volunteer,
or in everyday life between those who accept and those who refuse.
There can be no knowledge that such groups are comparable; and the
onus lies wholly, it may justly be maintained, upon the experimenter
to prove that they are comparable, before his results can be
accepted." This criticism by Hill can accurately be applied to the
Doll and Hill study. According to Hill’s own criteria, his work with
Doll can only be described as second-rate, inferior work. It would be
for others to conduct properly controlled trials.

So what were the results of the Whitehall study? They were contrary to
all expectation. The quit group showed no improvement in life
expectancy. Nor was there any change in the death rates due to heart
disease, lung cancer, or any other cause with one exception: certain
other cancers were more than twice as common in the quit group. Later,
after twenty years there was still no benefit in life expectancy for
the quit group.

Over the next decade the results of other similar trials appeared. It
had been argued that if an improvement in one life-style factor,
smoking, were of benefit, then an improvement in several - eg smoking,
diet and exercise - should produce even clearer benefits. And so
appeared the results of the whimsically acronymed Multiple Risk Factor
Intervention Trial or MRFIT, with its 12,886 American subjects.
Similarly, in Europe 60,881 subjects in four countries took part in
the WHO Collaborative Trial. In Sweden the Goteborg study had 30,022
subjects. These were enormously expensive, wide-spread and
time-consuming experiments. In all, there were 6 such trials with a
total of over a hundred thousand subjects each engaged for an average
of 7.4 years, a grand total of nearly 800,000 subject-years. The
results of all were uniform, forthright and unequivocal: giving up
smoking, even when fortified by improved diet and exercise, produced
no increase in life expectancy. Nor was there any change in the death
rate for heart disease or for cancer. A decade of expensive and
protracted research had produced a quite unexpected result.

During this same period, in America, the Surgeon General had been
issuing a number of publications about smoking and health. In 1982,
before the final results of the Whitehall study had been published,
the then Surgeon General C. Everett Koop had praised the study for
"pointing up the positive consequences of smoking in a positive
manner". But now for nearly ten years he fell silent on the subject
and there was no further mention of the Whitehall study nor of the
other six studies, though thousands of pages on the dangers of smoking
issued from his office. For example in 1989 there appeared "Reducing
the Health Consequences of Smoking: 25 Years of Progress". This
weighty work is long on advice about the benefits of giving up smoking
but short on discussion of the very studies which should allow the
evaluation of that advice: you will look in vain through the thousand
references to scientific papers for any mention of the Whitehall study
or most of the other six quit studies. Only the MRFIT study is
mentioned, and then falsely:

"The MRFIT study shows that smoking status and number of cigarettes
smoked per day have remained powerful predictors for total mortality
and the development of CHD [coronary heart disease], stroke, cancer,
and COPD [chronic obstructive pulmonary disease]. In the study
population, there were an estimated 2,249 (29 percent) excess deaths
due to smoking, of which 35 percent were from CHD and 21 percent from
lung cancer. The nonsmoker-former smoker group had 30 percent fewer
total cancers than the smoking group over the 6-year follow up."

This was untrue, as the Surgeon General was later to admit.



What the MRFIT authors themselves had to say about their work was
quite different:

"In conclusion we have shown that it is possible to apply an intensive
long-term intervention program against three coronary risk factors
with considerable success in terms of risk factor changes. The overall
results do not show a beneficial effect on CHD or total mortality from
this multifactor intervention." (Multiple Risk Factor Intervention
Trial Research Group, 1982)

But in 1990 the Surgeon General published "The Health Benefits of
Smoking Cessation" and at last the subject was addressed. The
Whitehall study was rejected because of its "small size". A once
praiseworthy study had become blameworthy. The MRFIT results were
described, this time truthfully: "there was no difference in total
mortality between the special intervention [quit] and usual care
groups." This and the other studies were rejected because the combined
change in other factors - eg diet and exercise - made it impossible to
apportion benefit due to smoking alone. This is absurd and illogical
reasoning. If, say, a 10% improvement in life expectancy had been
found then it might indeed be difficult if not impossible to say how
much was due to smoking alone. But there was no improvement. There was
nothing to apportion. Nevertheless, with such deceptive words the
Surgeon General turned to an unpublished, unreviewed, un-controlled,
non-intervention, non-randomised survey conducted for the American
Cancer Society ("American Cancer Society: Unpublished tabulations").
The gold standard of modern science was rejected and replaced by the
debased currency of what is by comparison little better than opinion
and gossip.

This rejection of consistent results from controlled trials and the
acceptance of far inferior data would not be countenanced in any other
area of medical science. Anyone who suggested doing so would be met
with howls of derision and questions as to their intelligence if not
their sanity. But where smoking and health are being considered this
debasement of science is commonplace and passes without comment.

In Australia in the same year there appeared a similar publication
"The Quantification of Drug Caused (sic) Mortality and Morbidity in
Australia" from the Federal Department of Community Services and
Health. Its authors waste no time in discussing intervention trials.
These receive not a mention, not even to be rejected. Instead the
authors turned to several surveys of the kind ultimately used by the
Surgeon General. In particular they used yet another study conducted
for the American Cancer Society by E.C.Hammond, a gigantic study of a
million subjects, another uncontrolled, non-intervention,
non-randomised survey. This was a particularly bad choice. The dangers
of very large surveys are well known to statisticians: because of
their size it is difficult to do them accurately. The flaws in
Hammond’s work were revealed when the initial results were published
in 1954. Hammond himself was later to admit that his study had not
been conducted as he had intended and as a consequence his results are
to an unknown extent erroneous. But it was worse than that. His work
became literally a textbook example of how not to do research. It can
be found as example 287 in "Statistics A New Approach" by W.A.Wallis
and H.V.Roberts. This was the ignominious and undignified fate of work
which should only be quoted as a salutary example of the pitfalls
which can await the researcher.

Two problems bedevil both Hammond’s work and other similar studies.

First, some of the volunteers who enrolled their subjects told Hammond
that contrary to his instructions they had selectively targeted ill
smokers. These results he was able to scrap but necessarily an unknown
proportion of his final results must be suspect. Second, as was
demonstrated at the time, his subjects were quite unrepresentative of
the general public in a number of respects. In particular, there were
relatively few smokers. It seems quite plausible that many healthy if
indignant smokers would refuse to take part in his trial and this
would produce such an aberration. These two vitiating defects are of
the kind which have led to the widespread preference for gold standard
trials.

But the continuation of Hammond’s work, with its demonstrated

faulty methodology, was used by the Australian authors to deduce that
smoking causes premature death to the extent of 17,800 per year in
Australia. Their conclusions should be compared with the results of a
survey by the Australian Statistician in 1991 of 22,200 households,
chosen at random. This showed "long term conditions", including cancer
and heart disease, to be more common in non-smokers than smokers.

Even if they had used sound data to calculate deaths caused by
smoking, this still would not have shown that smoking is overall
harmful or causes an excess of deaths. Antibiotics kill some
susceptible, allergic individuals but this fact does not show that
antibiotics reduce life expectancy. If the data used by these authors
is examined more closely it can in fact be shown that the mean age at
death from smoking-related causes (eg lung cancer) is about 1 year
greater than from nonsmoking-related causes (eg tetanus). See:
http://members.iinet.net.au/~ray/finch2.pdf

for details. This result does not necessarily show that smokers live
longer than nonsmokers: smokers as well as nonsmokers die from both
nonsmoking-related causes and smoking-related causes. But it is
certainly not evidence for the belief that smoking reduces life
expectancy.

During all this time health authorities have repeatedly and
persistently lied to the public. Consider just one of innumerable
examples. In June 1988, in Western Australia the Health Department in
full page advertisements in local papers declared: "The statistics are
frightening. Smoking will kill almost 700 women in Western Australia
this year. If present trends continue, lung cancer will soon overtake
breast cancer as the most common malignant cancer in women". What was
frightening was not the statistics but the fact that a Health
Department should lie about them. In 1987 the same Health Department
in its own publications had said: "Suggestions by some commentators
that lung cancer deaths in women will overtake breast cancer deaths in
the next few years look increasingly unlikely…female lung cancer death
rates have fallen for the last 2 years." It was predicted that breast
cancer would far outweigh lung cancer for the next 14 years. What the
public were told was not just an untruth but the reverse of the truth.
This is classic Orwellian Newspeak. The public are given what George
Orwell in "1984" named "prolefeed" – lies. Orwell must have smiled
wryly in his grave.

Above all has been the repeated and world-wide directive that smokers
should quit and live longer when every controlled trial without
exception has demonstrated this claim to be false.

Is there anything that can be said with certainty about the health and
life expectancy of smokers and non-smokers? The evidence indicates
little difference. One important fact often causes confusion: an agent
can be a certain cause of death and yet have the effect of extending
life. Smoking could be a major cause of lung cancer or even the only
cause yet also be associated with long life. The Japanese are amongst
the heaviest smokers in the world. They also live the longest. The
Frenchwoman Jeanne Calment smoked for a hundred years before dying at
122 as the world’s oldest ever person.

The resolution of this paradox lies in the simple fact that most
agents have both good and bad effects on health and life expectancy
and it is the net result which is of primary importance. This simple
but crucial fact is often ignored or forgotten by medical researchers.
Coffee causes pancreatic cancer says the newspaper article. Perhaps it
does, but if it has a bigger and beneficial effect on heart disease
then those who drink coffee may well live longer than those who don’t.
Hormone replacement therapy may increase the incidence of certain
cancers yet still have overall a beneficial effect. (See "The
Contrapuntists").

It may now be apparent why there is such a general belief that smoking
is dangerously harmful. There are 3 reasons. First, studies which in
any other area of science would be rejected as second-rate and
inferior but which support antismoking are accepted as first-rate.
Second, studies which are conducted according to orthodox and rigorous
design but which do not support the idea that smoking is harmful are
not merely ignored but suppressed. Third, authorities who are
duty-bound to represent the truth have failed to do so and have
presented not just untruths but the reverse of the truth.

It may be argued that this is news about an old and settled subject.
And who cares about smoking anyway. But smoking is really a secondary
issue. The primary issue is the integrity of science. This has no
use-by date. When the processes of science are misused, even if for
what seems a good reason, science and its practitioners are alike
degraded.



The Contrapuntists

A Parable

By

P.D. Finch

In a few years time an accidental by-product of genetic engineering
leads to the discovery that certain living vibrating crystals can be
manufactured very cheaply. When encased in a suitable holder and
inserted in the ear one can hear, just for a few minutes, until body
heat kills the crystal, beautiful melodies, rhythms and fascinating
counterpoint. They are marketed as aural contrapuntive devices. Since
they are cheap and become very popular, the Government taxes them.
Users of the device become known as contrapuntists.

Some years later a new disease is identified when an increasing number
of people drop dead, suddenly, for no apparent reason. Autopsies
reveal a strange deterioration in the brain cells of those affected.
An observant pathologist notes that in most of the associated
post-mortem examinations an aural contrapuntive device was found in an
ear of the deceased and the disease becomes known as SADS, an acronym
for Sudden Aural Death Syndrome. Epidemiologists find that people who
are not contrapuntists seldom fall victim to SADS and that, in fact,
about 98 per cent of all such deaths are either current or former
contrapuntists. The strength of association between aural
contrapuntism and SADS is undeniable, the relative risk is as high as
50, i.e. a contrapuntist has about 50 times the chance of falling to
SADS as does a non-contrapuntist.

An anti-contrapuntist health campaign is initiated and aural
contrapuntive devices are taxed more and more heavily in an attempt to
dissuade people from using them. The campaign is very successful and
is vigorously supported by an unexpected alliance between animal
liberationists, the music industry and the tone-deaf. Attention then
shifts to passive aural contrapuntism, viz. the dangers posed by the
sidestream melodic overflow from the devices in the ears of
contrapuntists, in particular on the occurrence of SADS in
non-contrapuntal spouses of contrapuntal men, the harm contrapuntal
parents may do their children and the possible ill-effects suffered by
the foetus of a contrapuntal pregnant woman.

After great initial success, however, the campaign falters when it
becomes widely known that even though aural contrapuntism is so
strongly associated with SADS, relatively few contrapuntists die from
it each year and those that do have lived, on average, about one year
longer than do non-contrapuntists and, moreover, at each age, are much
more likely to die of other causes than of SADS itself. Politicians
realise very quickly that they can now, with a clear conscience and
with profit, tax aural contrapuntal devices even more heavily.



1 http://www.la.utexas.edu/research/poltheory/james/blaste/blaste.html

2 Keynes, G (1978), "The Life of William Harvey", Oxford,



3 Lyte, H.C.M. (1899), "A History of Eton College (1440-1898",
Macmillan



4 Price, F.W. (ed.) (1942), "A Textbook of the Practice of Medicine",
6th edition, Oxford University Press



5 Doll, R. and Hill, A.B. (1950), "Smoking and carcinoma of the lung",
British Medical Journal, ii pp739-48

6 Fisher, R.A. (1959) "Smoking: The Cancer Controversy", Oliver and
Boyd



7 Doll, R. and Hill, A.B. (1954), "The mortality of doctors in
relation to their smoking habits", British Medical Journal, i pp1451-5



8 Doll, R. and Hill, A.B. (1964), "Mortality in relation to smoking:
ten years' observations of British doctors", British Medical Journal,
i pp1460-7

9 Surgeon General (1964), "Smoking and Health"
http://www.cdc.gov/tobacco/sgr/sgr_1964/sgr64.htm

10 Rose, G. and P.J.S. Hamilton (1978), 'A randomised controlled trial
of the effect on middle-aged men of advice to stop smoking', Journal
of Epidemiology and Community Health, 32, pages 275-281.



11 Hill, A.B.(1971, 9th ed.) "Principles of Medical Statistics", The
Lancet



12 Rose, G., P.J.S. Hamilton, L. Colwell and M.J. Shipley (1982), 'A
randomised controlled trial of anti-smoking advice: 10-year results',
Journal of Epidemiology and Community Health, 36, pages 102-108



13 Multiple Risk Factor Intervention Trial Research Group (1982),
'Multiple risk factor intervention trial: risk factor changes and
mortality results', Journal of the American Medical Association, 248,
pages 1465-1477.



14 WHO European Collaborative Group (1986), 'European collaborative
trial of multifactorial prevention of coronary heart disease: final
report on the 6-year results', Lancet, 1, pages 869-872.



15 Wilhelmsen, L., G. Berglund, E. Elmfeldt, G. Tibblin, H. Wedel, K.
Pennert, A. Vedin, C. Wilhelmsson and L. Werks (1986), 'The
multifactor primary prevention trial in Goteborg', European Heart
Journal, 7, pages 279-288.



16 Miettinen, T.A., J.K. Huttunen, V. Naukkarinen, T. Strandberg, S.
Mattila, T. Kumlin and S. Sarna (1985), 'Multifactorial primary
prevention of cardiovascular diseases in middle-aged men: risk-factor
changes, incidence and mortality', Journal of the American Medical
Association, 254, pages 2097-2102.



17 Puska, P., J. Tuomilehto, J. Salonen, L. NeittaanmSki, J. Maki, J.
Virtamo, A. Nissinen, K. Koskela and T. Takalo (1979), 'Changes in
coronary risk factors during comprehensive five-year community
programme to control cardiovascular diseases (North Karelia project),
British Medical Journal, 2, pages 1173-1178.



18 Leren, P., E.M. Askenvold, O.P. Foss, A. Fr¨ili, D. Grymyr, A.
Helgeland, I. Hjermann, I. Holme, P.G. Lund-Larsen and K.R. Norum
(1975), 'The Oslo study. Cardiovascular disease in middle-aged and
young Oslo men', Acta Medica Scandinavica [Suppl.], 588, pages 1-38.



19 Surgeon General (1982) The Health Consequences of Smoking - Cancer:
A Report of the Surgeon General.



20 Surgeon General (1989) Reducing the Health Consequences of Smoking:
25 Years of Progress: A Report of the Surgeon General: Executive
Summary and Full Report



21 Surgeon General (1990) The Health Benefits of Smoking Cessation: A
Report of the Surgeon General



22 Commonwealth Department of Community Services and Health, Canberra
(1988) "The Quantification of Drug Caused Morbidity and Mortality in
Australia".



23 http://members.iinet.net.au/~ray/hammond3.html

Wallis, W.A. and Roberts, H.V. (1962) "Statistics: A New Approach",
Methuen and Co. Ltd.



24 Australian Bureau of Statistics: Smokers are less likely to have
cancer, heart disease 1

Australian Bureau of Statistics, No 4382.0, "1989-90 National Health
Survey: Smoking"

http://members.iinet.net.au/~ray/19jun2006.htm



25 Australian Bureau of Statistics: Smokers are less likely to have
cancer, heart disease 2

http://members.iinet.net.au/~ray/ABS43820d.jpg



26 Two messages from the Western Australian Health Department

Subiaco Post, 28 June 1988: 12

Hatton, W.M. (1987), Cancer Projections: Projections of numbers of
incident cancers in Western Australia to the Year 2001, Perth:
Epidemiology Branch, Health Department of Western Australia.

Hatton, W.M. and M.D. Clarke-Hundley (1987), Cancer in Western
Australia: an analysis of age and sex specific rates, Perth: Health
Department of Western Australia.



http://members.iinet.net.au/~ray/HealthDept1.jpg

http://members.iinet.net.au/~ray/HealthDept2.jpg







The Scientific Scandal of Antismoking

By

J. R. Johnstone, PhD (Monash)

and

P.D.Finch, Emeritus Professor of Mathematical Statistics (Monash)





Science is not always a neutral, disinterested search for knowledge,
although it may often seem that way to the outsider. Sometimes the
story can be very different.



Smoking and health have been the subject of argument since tobacco was
introduced to Europe in the sixteenth century. King James I was a
pioneer antismoker. In 1604 he declared that smoking was "a custome
lothsome to the eye, hatefull to the Nose, harmefull to the braine,
dangerous to the Lungs, and in the blacke stinking fume thereof,
neerest resembling the horrible Stigian smoke of the pit that is
bottomelesse." But like many a politician since, he decided that
taxing tobacco was a more sensible option than banning it.

By the end of the century general opinion had changed. The Royal
College of Physicians of London promoted smoking for its benefits to
health and advised which brands were best. Smoking was compulsory in
schools. An Eton schoolboy later recalled that "he was never whipped
so much in his life as he was one morning for not smoking". As
recently as 1942 Price’s textbook of medicine recommended smoking to
relieve asthma.

These strong opinions for and against smoking were not supported by
much evidence either way until 1950 when Richard Doll and Bradford
Hill showed that smokers seemed more likely to develop lung cancer. A
campaign was begun to limit smoking. But Sir Ronald Fisher, arguably
the greatest statistician of the 20th century, had noticed a bizarre
anomaly in their results. Doll and Hill had asked their subjects if
they inhaled. Fisher showed that men who inhaled were significantly
less likely to develop lung cancer than non-inhalers. As Fisher said,
"even equality would be a fair knock-out for the theory that smoke in
the lung causes cancer."

Doll and Hill decided to follow their preliminary work with a much
larger and protracted study. British doctors were asked to take part
as subjects. 40.000 volunteered and 20,000 refused. The relative
health of smokers, nonsmokers and particularly ex-smokers would be
compared over the course of future years. In this trial smokers would
no longer be asked whether they inhaled, in spite of the earlier
result. Fisher commented: "I suppose the subject of inhaling had
become distasteful to the research workers, and they just wanted to
hear as little about inhaling as possible". And: "Should not these
workers have let the world know not only that they had discovered the
cause of lung cancer (cigarettes) but also that they had discovered
the means of its prevention (inhaling cigarette smoke)? How had the
MRC [Medical Research Council] the heart to withhold this information
from the thousands who would otherwise die of lung cancer?"

Five year’s later, in 1964, Doll and Hill responded to this damning
criticism. They did not explain why they had withdrawn the question
about inhaling. Instead they complained that Fisher had not examined
their more recent results but they agreed their results were
mystifying. Fisher had died 2 years earlier and could not reply.

This refusal to consider conflicting evidence is the negation of the
scientific method. It has been the hallmark of fifty years of
antismoking propaganda and what with good reason may well be described
as one of the greatest scandals in 500 years of modern science.

A typical example of such deception appeared in the same year from the
American Surgeon General. This was "Smoking and Health",

the first of many reports on smoking and health to be produced by his
office over the next 40 years. It declared that in the Doll and Hill
study "…no difference in the proportion of smokers inhaling was found
among male and female cases and controls." Fisher had shown this was
not so. Fisher’s assessment and criticism of the Doll and Hill results
is not mentioned, not even to be rejected. Unwelcome results are not
merely considered and rejected. They cease to exist.

The work of Doll and Hill was continued and followed up over the next
50 years. They reintroduced the question about inhaling. Their results
continued to show the inhaling/noninhaling paradox. In spite of this
defect their work was to become the keystone of the modern
anti-smoking movement: Defects count for nothing if they are never
considered by those who are appointed to assess the evidence.

But their work had a far more serious and crippling disability.

From its inception the British doctors study was known to have a

critical weakness. Its subjects were not selected randomly by the
investigators but had decided for themselves to be smokers, nonsmokers
or ex-smokers. The kind of error that can result from such non-random
selection was well demonstrated during the 1948 US presidential
election. Opinion polls showed that Dewey would win by a landslide
from Truman. Yet Truman won. He was famously photographed holding a
newspaper with a headline declaring Dewey the winner. The pollsters
had got it wrong by doing a telephone poll which at that time would
have targeted the wealthier voters. The majority of telephone owners
may have supported Dewey but those without telephones had not. A true
sample of the population had not been obtained.

The new Doll and Hill study was subject to a similar error. Smokers
who became ex-smokers might have done so because they were ill and
hoped quitting would improve them. Alternatively, they might quit
because they were exceptionally healthy and hoped to remain so.
Quitting could appear either harmful or beneficial. To avoid this
source of error another project, the Whitehall study, was begun.

In 1968 fourteen hundred British civil servants, all smokers, were
divided into two similar groups. Half were encouraged and counselled
to quit smoking. These formed the test group. The others, the control
group, were left to their own devices. For ten years both groups were
monitored with respect to their health and smoking status.

Such a study is known as a randomised controlled intervention trial.
It has become increasingly the benchmark, or as it is often referred
to, the "gold standard" of medical investigation. Any week you can
open The Lancet or British Medical Journal and you will likely find an
example of such a trial to determine the benefits or harm of some new
therapy. Such trials are fundamentally different to that of Doll and
Hill. This is ironic because Hill had published the influential and
much-reprinted textbook "Principles of Medical Statistics" where he
considers the relative merits of controlled and uncontrolled trials.
His praise is reserved for the former. Of the latter he is
particularly critical: Such work uses "second-best" or "inferior"
methods. "The same objections must be made to the contrasting in a
trial of volunteers for a treatment with those who do not volunteer,
or in everyday life between those who accept and those who refuse.
There can be no knowledge that such groups are comparable; and the
onus lies wholly, it may justly be maintained, upon the experimenter
to prove that they are comparable, before his results can be
accepted." This criticism by Hill can accurately be applied to the
Doll and Hill study. According to Hill’s own criteria, his work with
Doll can only be described as second-rate, inferior work. It would be
for others to conduct properly controlled trials.

So what were the results of the Whitehall study? They were contrary to
all expectation. The quit group showed no improvement in life
expectancy. Nor was there any change in the death rates due to heart
disease, lung cancer, or any other cause with one exception: certain
other cancers were more than twice as common in the quit group. Later,
after twenty years there was still no benefit in life expectancy for
the quit group.

Over the next decade the results of other similar trials appeared. It
had been argued that if an improvement in one life-style factor,
smoking, were of benefit, then an improvement in several - eg smoking,
diet and exercise - should produce even clearer benefits. And so
appeared the results of the whimsically acronymed Multiple Risk Factor
Intervention Trial or MRFIT, with its 12,886 American subjects.
Similarly, in Europe 60,881 subjects in four countries took part in
the WHO Collaborative Trial. In Sweden the Goteborg study had 30,022
subjects. These were enormously expensive, wide-spread and
time-consuming experiments. In all, there were 6 such trials with a
total of over a hundred thousand subjects each engaged for an average
of 7.4 years, a grand total of nearly 800,000 subject-years. The
results of all were uniform, forthright and unequivocal: giving up
smoking, even when fortified by improved diet and exercise, produced
no increase in life expectancy. Nor was there any change in the death
rate for heart disease or for cancer. A decade of expensive and
protracted research had produced a quite unexpected result.

During this same period, in America, the Surgeon General had been
issuing a number of publications about smoking and health. In 1982,
before the final results of the Whitehall study had been published,
the then Surgeon General C. Everett Koop had praised the study for
"pointing up the positive consequences of smoking in a positive
manner". But now for nearly ten years he fell silent on the subject
and there was no further mention of the Whitehall study nor of the
other six studies, though thousands of pages on the dangers of smoking
issued from his office. For example in 1989 there appeared "Reducing
the Health Consequences of Smoking: 25 Years of Progress". This
weighty work is long on advice about the benefits of giving up smoking
but short on discussion of the very studies which should allow the
evaluation of that advice: you will look in vain through the thousand
references to scientific papers for any mention of the Whitehall study
or most of the other six quit studies. Only the MRFIT study is
mentioned, and then falsely:

"The MRFIT study shows that smoking status and number of cigarettes
smoked per day have remained powerful predictors for total mortality
and the development of CHD [coronary heart disease], stroke, cancer,
and COPD [chronic obstructive pulmonary disease]. In the study
population, there were an estimated 2,249 (29 percent) excess deaths
due to smoking, of which 35 percent were from CHD and 21 percent from
lung cancer. The nonsmoker-former smoker group had 30 percent fewer
total cancers than the smoking group over the 6-year follow up."

This was untrue, as the Surgeon General was later to admit.



What the MRFIT authors themselves had to say about their work was
quite different:

"In conclusion we have shown that it is possible to apply an intensive
long-term intervention program against three coronary risk factors
with considerable success in terms of risk factor changes. The overall
results do not show a beneficial effect on CHD or total mortality from
this multifactor intervention." (Multiple Risk Factor Intervention
Trial Research Group, 1982)

But in 1990 the Surgeon General published "The Health Benefits of
Smoking Cessation" and at last the subject was addressed. The
Whitehall study was rejected because of its "small size". A once
praiseworthy study had become blameworthy. The MRFIT results were
described, this time truthfully: "there was no difference in total
mortality between the special intervention [quit] and usual care
groups." This and the other studies were rejected because the combined
change in other factors - eg diet and exercise - made it impossible to
apportion benefit due to smoking alone. This is absurd and illogical
reasoning. If, say, a 10% improvement in life expectancy had been
found then it might indeed be difficult if not impossible to say how
much was due to smoking alone. But there was no improvement. There was
nothing to apportion. Nevertheless, with such deceptive words the
Surgeon General turned to an unpublished, unreviewed, un-controlled,
non-intervention, non-randomised survey conducted for the American
Cancer Society ("American Cancer Society: Unpublished tabulations").
The gold standard of modern science was rejected and replaced by the
debased currency of what is by comparison little better than opinion
and gossip.

This rejection of consistent results from controlled trials and the
acceptance of far inferior data would not be countenanced in any other
area of medical science. Anyone who suggested doing so would be met
with howls of derision and questions as to their intelligence if not
their sanity. But where smoking and health are being considered this
debasement of science is commonplace and passes without comment.

In Australia in the same year there appeared a similar publication
"The Quantification of Drug Caused (sic) Mortality and Morbidity in
Australia" from the Federal Department of Community Services and
Health. Its authors waste no time in discussing intervention trials.
These receive not a mention, not even to be rejected. Instead the
authors turned to several surveys of the kind ultimately used by the
Surgeon General. In particular they used yet another study conducted
for the American Cancer Society by E.C.Hammond, a gigantic study of a
million subjects, another uncontrolled, non-intervention,
non-randomised survey. This was a particularly bad choice. The dangers
of very large surveys are well known to statisticians: because of
their size it is difficult to do them accurately. The flaws in
Hammond’s work were revealed when the initial results were published
in 1954. Hammond himself was later to admit that his study had not
been conducted as he had intended and as a consequence his results are
to an unknown extent erroneous. But it was worse than that. His work
became literally a textbook example of how not to do research. It can
be found as example 287 in "Statistics A New Approach" by W.A.Wallis
and H.V.Roberts. This was the ignominious and undignified fate of work
which should only be quoted as a salutary example of the pitfalls
which can await the researcher.

Two problems bedevil both Hammond’s work and other similar studies.

First, some of the volunteers who enrolled their subjects told Hammond
that contrary to his instructions they had selectively targeted ill
smokers. These results he was able to scrap but necessarily an unknown
proportion of his final results must be suspect. Second, as was
demonstrated at the time, his subjects were quite unrepresentative of
the general public in a number of respects. In particular, there were
relatively few smokers. It seems quite plausible that many healthy if
indignant smokers would refuse to take part in his trial and this
would produce such an aberration. These two vitiating defects are of
the kind which have led to the widespread preference for gold standard
trials.

But the continuation of Hammond’s work, with its demonstrated

faulty methodology, was used by the Australian authors to deduce that
smoking causes premature death to the extent of 17,800 per year in
Australia. Their conclusions should be compared with the results of a
survey by the Australian Statistician in 1991 of 22,200 households,
chosen at random. This showed "long term conditions", including cancer
and heart disease, to be more common in non-smokers than smokers.

Even if they had used sound data to calculate deaths caused by
smoking, this still would not have shown that smoking is overall
harmful or causes an excess of deaths. Antibiotics kill some
susceptible, allergic individuals but this fact does not show that
antibiotics reduce life expectancy. If the data used by these authors
is examined more closely it can in fact be shown that the mean age at
death from smoking-related causes (eg lung cancer) is about 1 year
greater than from nonsmoking-related causes (eg tetanus). See:
http://members.iinet.net.au/~ray/finch2.pdf

for details. This result does not necessarily show that smokers live
longer than nonsmokers: smokers as well as nonsmokers die from both
nonsmoking-related causes and smoking-related causes. But it is
certainly not evidence for the belief that smoking reduces life
expectancy.

During all this time health authorities have repeatedly and
persistently lied to the public. Consider just one of innumerable
examples. In June 1988, in Western Australia the Health Department in
full page advertisements in local papers declared: "The statistics are
frightening. Smoking will kill almost 700 women in Western Australia
this year. If present trends continue, lung cancer will soon overtake
breast cancer as the most common malignant cancer in women". What was
frightening was not the statistics but the fact that a Health
Department should lie about them. In 1987 the same Health Department
in its own publications had said: "Suggestions by some commentators
that lung cancer deaths in women will overtake breast cancer deaths in
the next few years look increasingly unlikely…female lung cancer death
rates have fallen for the last 2 years." It was predicted that breast
cancer would far outweigh lung cancer for the next 14 years. What the
public were told was not just an untruth but the reverse of the truth.
This is classic Orwellian Newspeak. The public are given what George
Orwell in "1984" named "prolefeed" – lies. Orwell must have smiled
wryly in his grave.

Above all has been the repeated and world-wide directive that smokers
should quit and live longer when every controlled trial without
exception has demonstrated this claim to be false.

Is there anything that can be said with certainty about the health and
life expectancy of smokers and non-smokers? The evidence indicates
little difference. One important fact often causes confusion: an agent
can be a certain cause of death and yet have the effect of extending
life. Smoking could be a major cause of lung cancer or even the only
cause yet also be associated with long life. The Japanese are amongst
the heaviest smokers in the world. They also live the longest. The
Frenchwoman Jeanne Calment smoked for a hundred years before dying at
122 as the world’s oldest ever person.

The resolution of this paradox lies in the simple fact that most
agents have both good and bad effects on health and life expectancy
and it is the net result which is of primary importance. This simple
but crucial fact is often ignored or forgotten by medical researchers.
Coffee causes pancreatic cancer says the newspaper article. Perhaps it
does, but if it has a bigger and beneficial effect on heart disease
then those who drink coffee may well live longer than those who don’t.
Hormone replacement therapy may increase the incidence of certain
cancers yet still have overall a beneficial effect. (See "The
Contrapuntists").

It may now be apparent why there is such a general belief that smoking
is dangerously harmful. There are 3 reasons. First, studies which in
any other area of science would be rejected as second-rate and
inferior but which support antismoking are accepted as first-rate.
Second, studies which are conducted according to orthodox and rigorous
design but which do not support the idea that smoking is harmful are
not merely ignored but suppressed. Third, authorities who are
duty-bound to represent the truth have failed to do so and have
presented not just untruths but the reverse of the truth.

It may be argued that this is news about an old and settled subject.
And who cares about smoking anyway. But smoking is really a secondary
issue. The primary issue is the integrity of science. This has no
use-by date. When the processes of science are misused, even if for
what seems a good reason, science and its practitioners are alike
degraded.



The Contrapuntists

A Parable

By

P.D. Finch

In a few years time an accidental by-product of genetic engineering
leads to the discovery that certain living vibrating crystals can be
manufactured very cheaply. When encased in a suitable holder and
inserted in the ear one can hear, just for a few minutes, until body
heat kills the crystal, beautiful melodies, rhythms and fascinating
counterpoint. They are marketed as aural contrapuntive devices. Since
they are cheap and become very popular, the Government taxes them.
Users of the device become known as contrapuntists.

Some years later a new disease is identified when an increasing number
of people drop dead, suddenly, for no apparent reason. Autopsies
reveal a strange deterioration in the brain cells of those affected.
An observant pathologist notes that in most of the associated
post-mortem examinations an aural contrapuntive device was found in an
ear of the deceased and the disease becomes known as SADS, an acronym
for Sudden Aural Death Syndrome. Epidemiologists find that people who
are not contrapuntists seldom fall victim to SADS and that, in fact,
about 98 per cent of all such deaths are either current or former
contrapuntists. The strength of association between aural
contrapuntism and SADS is undeniable, the relative risk is as high as
50, i.e. a contrapuntist has about 50 times the chance of falling to
SADS as does a non-contrapuntist.

An anti-contrapuntist health campaign is initiated and aural
contrapuntive devices are taxed more and more heavily in an attempt to
dissuade people from using them. The campaign is very successful and
is vigorously supported by an unexpected alliance between animal
liberationists, the music industry and the tone-deaf. Attention then
shifts to passive aural contrapuntism, viz. the dangers posed by the
sidestream melodic overflow from the devices in the ears of
contrapuntists, in particular on the occurrence of SADS in
non-contrapuntal spouses of contrapuntal men, the harm contrapuntal
parents may do their children and the possible ill-effects suffered by
the foetus of a contrapuntal pregnant woman.

After great initial success, however, the campaign falters when it
becomes widely known that even though aural contrapuntism is so
strongly associated with SADS, relatively few contrapuntists die from
it each year and those that do have lived, on average, about one year
longer than do non-contrapuntists and, moreover, at each age, are much
more likely to die of other causes than of SADS itself. Politicians
realise very quickly that they can now, with a clear conscience and
with profit, tax aural contrapuntal devices even more heavily.



1 http://www.la.utexas.edu/research/poltheory/james/blaste/blaste.html

2 Keynes, G (1978), "The Life of William Harvey", Oxford,



3 Lyte, H.C.M. (1899), "A History of Eton College (1440-1898",
Macmillan



4 Price, F.W. (ed.) (1942), "A Textbook of the Practice of Medicine",
6th edition, Oxford University Press



5 Doll, R. and Hill, A.B. (1950), "Smoking and carcinoma of the lung",
British Medical Journal, ii pp739-48

6 Fisher, R.A. (1959) "Smoking: The Cancer Controversy", Oliver and
Boyd



7 Doll, R. and Hill, A.B. (1954), "The mortality of doctors in
relation to their smoking habits", British Medical Journal, i pp1451-5



8 Doll, R. and Hill, A.B. (1964), "Mortality in relation to smoking:
ten years' observations of British doctors", British Medical Journal,
i pp1460-7

9 Surgeon General (1964), "Smoking and Health"
http://www.cdc.gov/tobacco/sgr/sgr_1964/sgr64.htm

10 Rose, G. and P.J.S. Hamilton (1978), 'A randomised controlled trial
of the effect on middle-aged men of advice to stop smoking', Journal
of Epidemiology and Community Health, 32, pages 275-281.



11 Hill, A.B.(1971, 9th ed.) "Principles of Medical Statistics", The
Lancet



12 Rose, G., P.J.S. Hamilton, L. Colwell and M.J. Shipley (1982), 'A
randomised controlled trial of anti-smoking advice: 10-year results',
Journal of Epidemiology and Community Health, 36, pages 102-108



13 Multiple Risk Factor Intervention Trial Research Group (1982),
'Multiple risk factor intervention trial: risk factor changes and
mortality results', Journal of the American Medical Association, 248,
pages 1465-1477.



14 WHO European Collaborative Group (1986), 'European collaborative
trial of multifactorial prevention of coronary heart disease: final
report on the 6-year results', Lancet, 1, pages 869-872.



15 Wilhelmsen, L., G. Berglund, E. Elmfeldt, G. Tibblin, H. Wedel, K.
Pennert, A. Vedin, C. Wilhelmsson and L. Werks (1986), 'The
multifactor primary prevention trial in Goteborg', European Heart
Journal, 7, pages 279-288.



16 Miettinen, T.A., J.K. Huttunen, V. Naukkarinen, T. Strandberg, S.
Mattila, T. Kumlin and S. Sarna (1985), 'Multifactorial primary
prevention of cardiovascular diseases in middle-aged men: risk-factor
changes, incidence and mortality', Journal of the American Medical
Association, 254, pages 2097-2102.



17 Puska, P., J. Tuomilehto, J. Salonen, L. NeittaanmSki, J. Maki, J.
Virtamo, A. Nissinen, K. Koskela and T. Takalo (1979), 'Changes in
coronary risk factors during comprehensive five-year community
programme to control cardiovascular diseases (North Karelia project),
British Medical Journal, 2, pages 1173-1178.



18 Leren, P., E.M. Askenvold, O.P. Foss, A. Fr¨ili, D. Grymyr, A.
Helgeland, I. Hjermann, I. Holme, P.G. Lund-Larsen and K.R. Norum
(1975), 'The Oslo study. Cardiovascular disease in middle-aged and
young Oslo men', Acta Medica Scandinavica [Suppl.], 588, pages 1-38.



19 Surgeon General (1982) The Health Consequences of Smoking - Cancer:
A Report of the Surgeon General.



20 Surgeon General (1989) Reducing the Health Consequences of Smoking:
25 Years of Progress: A Report of the Surgeon General: Executive
Summary and Full Report



21 Surgeon General (1990) The Health Benefits of Smoking Cessation: A
Report of the Surgeon General



22 Commonwealth Department of Community Services and Health, Canberra
(1988) "The Quantification of Drug Caused Morbidity and Mortality in
Australia".



23 http://members.iinet.net.au/~ray/hammond3.html

Wallis, W.A. and Roberts, H.V. (1962) "Statistics: A New Approach",
Methuen and Co. Ltd.



24 Australian Bureau of Statistics: Smokers are less likely to have
cancer, heart disease 1

Australian Bureau of Statistics, No 4382.0, "1989-90 National Health
Survey: Smoking"

http://members.iinet.net.au/~ray/19jun2006.htm



25 Australian Bureau of Statistics: Smokers are less likely to have
cancer, heart disease 2

http://members.iinet.net.au/~ray/ABS43820d.jpg



26 Two messages from the Western Australian Health Department

Subiaco Post, 28 June 1988: 12

Hatton, W.M. (1987), Cancer Projections: Projections of numbers of
incident cancers in Western Australia to the Year 2001, Perth:
Epidemiology Branch, Health Department of Western Australia.

Hatton, W.M. and M.D. Clarke-Hundley (1987), Cancer in Western
Australia: an analysis of age and sex specific rates, Perth: Health
Department of Western Australia.



http://members.iinet.net.au/~ray/HealthDept1.jpg

http://members.iinet.net.au/~ray/HealthDept2.jpg







Installed 31 July 2006

















7
The Scientific Scandal of Antismoking

By

J. R. Johnstone, PhD (Monash)

and

P.D.Finch, Emeritus Professor of Mathematical Statistics (Monash)





Science is not always a neutral, disinterested search for knowledge,
although it may often seem that way to the outsider. Sometimes the
story can be very different.



Smoking and health have been the subject of argument since tobacco was
introduced to Europe in the sixteenth century. King James I was a
pioneer antismoker. In 1604 he declared that smoking was "a custome
lothsome to the eye, hatefull to the Nose, harmefull to the braine,
dangerous to the Lungs, and in the blacke stinking fume thereof,
neerest resembling the horrible Stigian smoke of the pit that is
bottomelesse." But like many a politician since, he decided that
taxing tobacco was a more sensible option than banning it.

By the end of the century general opinion had changed. The Royal
College of Physicians of London promoted smoking for its benefits to
health and advised which brands were best. Smoking was compulsory in
schools. An Eton schoolboy later recalled that "he was never whipped
so much in his life as he was one morning for not smoking". As
recently as 1942 Price’s textbook of medicine recommended smoking to
relieve asthma.

These strong opinions for and against smoking were not supported by
much evidence either way until 1950 when Richard Doll and Bradford
Hill showed that smokers seemed more likely to develop lung cancer. A
campaign was begun to limit smoking. But Sir Ronald Fisher, arguably
the greatest statistician of the 20th century, had noticed a bizarre
anomaly in their results. Doll and Hill had asked their subjects if
they inhaled. Fisher showed that men who inhaled were significantly
less likely to develop lung cancer than non-inhalers. As Fisher said,
"even equality would be a fair knock-out for the theory that smoke in
the lung causes cancer."

Doll and Hill decided to follow their preliminary work with a much
larger and protracted study. British doctors were asked to take part
as subjects. 40.000 volunteered and 20,000 refused. The relative
health of smokers, nonsmokers and particularly ex-smokers would be
compared over the course of future years. In this trial smokers would
no longer be asked whether they inhaled, in spite of the earlier
result. Fisher commented: "I suppose the subject of inhaling had
become distasteful to the research workers, and they just wanted to
hear as little about inhaling as possible". And: "Should not these
workers have let the world know not only that they had discovered the
cause of lung cancer (cigarettes) but also that they had discovered
the means of its prevention (inhaling cigarette smoke)? How had the
MRC [Medical Research Council] the heart to withhold this information
from the thousands who would otherwise die of lung cancer?"

Five year’s later, in 1964, Doll and Hill responded to this damning
criticism. They did not explain why they had withdrawn the question
about inhaling. Instead they complained that Fisher had not examined
their more recent results but they agreed their results were
mystifying. Fisher had died 2 years earlier and could not reply.

This refusal to consider conflicting evidence is the negation of the
scientific method. It has been the hallmark of fifty years of
antismoking propaganda and what with good reason may well be described
as one of the greatest scandals in 500 years of modern science.

A typical example of such deception appeared in the same year from the
American Surgeon General. This was "Smoking and Health",

the first of many reports on smoking and health to be produced by his
office over the next 40 years. It declared that in the Doll and Hill
study "…no difference in the proportion of smokers inhaling was found
among male and female cases and controls." Fisher had shown this was
not so. Fisher’s assessment and criticism of the Doll and Hill results
is not mentioned, not even to be rejected. Unwelcome results are not
merely considered and rejected. They cease to exist.

The work of Doll and Hill was continued and followed up over the next
50 years. They reintroduced the question about inhaling. Their results
continued to show the inhaling/noninhaling paradox. In spite of this
defect their work was to become the keystone of the modern
anti-smoking movement: Defects count for nothing if they are never
considered by those who are appointed to assess the evidence.

But their work had a far more serious and crippling disability.

From its inception the British doctors study was known to have a

critical weakness. Its subjects were not selected randomly by the
investigators but had decided for themselves to be smokers, nonsmokers
or ex-smokers. The kind of error that can result from such non-random
selection was well demonstrated during the 1948 US presidential
election. Opinion polls showed that Dewey would win by a landslide
from Truman. Yet Truman won. He was famously photographed holding a
newspaper with a headline declaring Dewey the winner. The pollsters
had got it wrong by doing a telephone poll which at that time would
have targeted the wealthier voters. The majority of telephone owners
may have supported Dewey but those without telephones had not. A true
sample of the population had not been obtained.

The new Doll and Hill study was subject to a similar error. Smokers
who became ex-smokers might have done so because they were ill and
hoped quitting would improve them. Alternatively, they might quit
because they were exceptionally healthy and hoped to remain so.
Quitting could appear either harmful or beneficial. To avoid this
source of error another project, the Whitehall study, was begun.

In 1968 fourteen hundred British civil servants, all smokers, were
divided into two similar groups. Half were encouraged and counselled
to quit smoking. These formed the test group. The others, the control
group, were left to their own devices. For ten years both groups were
monitored with respect to their health and smoking status.

Such a study is known as a randomised controlled intervention trial.
It has become increasingly the benchmark, or as it is often referred
to, the "gold standard" of medical investigation. Any week you can
open The Lancet or British Medical Journal and you will likely find an
example of such a trial to determine the benefits or harm of some new
therapy. Such trials are fundamentally different to that of Doll and
Hill. This is ironic because Hill had published the influential and
much-reprinted textbook "Principles of Medical Statistics" where he
considers the relative merits of controlled and uncontrolled trials.
His praise is reserved for the former. Of the latter he is
particularly critical: Such work uses "second-best" or "inferior"
methods. "The same objections must be made to the contrasting in a
trial of volunteers for a treatment with those who do not volunteer,
or in everyday life between those who accept and those who refuse.
There can be no knowledge that such groups are comparable; and the
onus lies wholly, it may justly be maintained, upon the experimenter
to prove that they are comparable, before his results can be
accepted." This criticism by Hill can accurately be applied to the
Doll and Hill study. According to Hill’s own criteria, his work with
Doll can only be described as second-rate, inferior work. It would be
for others to conduct properly controlled trials.

So what were the results of the Whitehall study? They were contrary to
all expectation. The quit group showed no improvement in life
expectancy. Nor was there any change in the death rates due to heart
disease, lung cancer, or any other cause with one exception: certain
other cancers were more than twice as common in the quit group. Later,
after twenty years there was still no benefit in life expectancy for
the quit group.

Over the next decade the results of other similar trials appeared. It
had been argued that if an improvement in one life-style factor,
smoking, were of benefit, then an improvement in several - eg smoking,
diet and exercise - should produce even clearer benefits. And so
appeared the results of the whimsically acronymed Multiple Risk Factor
Intervention Trial or MRFIT, with its 12,886 American subjects.
Similarly, in Europe 60,881 subjects in four countries took part in
the WHO Collaborative Trial. In Sweden the Goteborg study had 30,022
subjects. These were enormously expensive, wide-spread and
time-consuming experiments. In all, there were 6 such trials with a
total of over a hundred thousand subjects each engaged for an average
of 7.4 years, a grand total of nearly 800,000 subject-years. The
results of all were uniform, forthright and unequivocal: giving up
smoking, even when fortified by improved diet and exercise, produced
no increase in life expectancy. Nor was there any change in the death
rate for heart disease or for cancer. A decade of expensive and
protracted research had produced a quite unexpected result.

During this same period, in America, the Surgeon General had been
issuing a number of publications about smoking and health. In 1982,
before the final results of the Whitehall study had been published,
the then Surgeon General C. Everett Koop had praised the study for
"pointing up the positive consequences of smoking in a positive
manner". But now for nearly ten years he fell silent on the subject
and there was no further mention of the Whitehall study nor of the
other six studies, though thousands of pages on the dangers of smoking
issued from his office. For example in 1989 there appeared "Reducing
the Health Consequences of Smoking: 25 Years of Progress". This
weighty work is long on advice about the benefits of giving up smoking
but short on discussion of the very studies which should allow the
evaluation of that advice: you will look in vain through the thousand
references to scientific papers for any mention of the Whitehall study
or most of the other six quit studies. Only the MRFIT study is
mentioned, and then falsely:

"The MRFIT study shows that smoking status and number of cigarettes
smoked per day have remained powerful predictors for total mortality
and the development of CHD [coronary heart disease], stroke, cancer,
and COPD [chronic obstructive pulmonary disease]. In the study
population, there were an estimated 2,249 (29 percent) excess deaths
due to smoking, of which 35 percent were from CHD and 21 percent from
lung cancer. The nonsmoker-former smoker group had 30 percent fewer
total cancers than the smoking group over the 6-year follow up."

This was untrue, as the Surgeon General was later to admit.



What the MRFIT authors themselves had to say about their work was
quite different:

"In conclusion we have shown that it is possible to apply an intensive
long-term intervention program against three coronary risk factors
with considerable success in terms of risk factor changes. The overall
results do not show a beneficial effect on CHD or total mortality from
this multifactor intervention." (Multiple Risk Factor Intervention
Trial Research Group, 1982)

But in 1990 the Surgeon General published "The Health Benefits of
Smoking Cessation" and at last the subject was addressed. The
Whitehall study was rejected because of its "small size". A once
praiseworthy study had become blameworthy. The MRFIT results were
described, this time truthfully: "there was no difference in total
mortality between the special intervention [quit] and usual care
groups." This and the other studies were rejected because the combined
change in other factors - eg diet and exercise - made it impossible to
apportion benefit due to smoking alone. This is absurd and illogical
reasoning. If, say, a 10% improvement in life expectancy had been
found then it might indeed be difficult if not impossible to say how
much was due to smoking alone. But there was no improvement. There was
nothing to apportion. Nevertheless, with such deceptive words the
Surgeon General turned to an unpublished, unreviewed, un-controlled,
non-intervention, non-randomised survey conducted for the American
Cancer Society ("American Cancer Society: Unpublished tabulations").
The gold standard of modern science was rejected and replaced by the
debased currency of what is by comparison little better than opinion
and gossip.

This rejection of consistent results from controlled trials and the
acceptance of far inferior data would not be countenanced in any other
area of medical science. Anyone who suggested doing so would be met
with howls of derision and questions as to their intelligence if not
their sanity. But where smoking and health are being considered this
debasement of science is commonplace and passes without comment.

In Australia in the same year there appeared a similar publication
"The Quantification of Drug Caused (sic) Mortality and Morbidity in
Australia" from the Federal Department of Community Services and
Health. Its authors waste no time in discussing intervention trials.
These receive not a mention, not even to be rejected. Instead the
authors turned to several surveys of the kind ultimately used by the
Surgeon General. In particular they used yet another study conducted
for the American Cancer Society by E.C.Hammond, a gigantic study of a
million subjects, another uncontrolled, non-intervention,
non-randomised survey. This was a particularly bad choice. The dangers
of very large surveys are well known to statisticians: because of
their size it is difficult to do them accurately. The flaws in
Hammond’s work were revealed when the initial results were published
in 1954. Hammond himself was later to admit that his study had not
been conducted as he had intended and as a consequence his results are
to an unknown extent erroneous. But it was worse than that. His work
became literally a textbook example of how not to do research. It can
be found as example 287 in "Statistics A New Approach" by W.A.Wallis
and H.V.Roberts. This was the ignominious and undignified fate of work
which should only be quoted as a salutary example of the pitfalls
which can await the researcher.

Two problems bedevil both Hammond’s work and other similar studies.

First, some of the volunteers who enrolled their subjects told Hammond
that contrary to his instructions they had selectively targeted ill
smokers. These results he was able to scrap but necessarily an unknown
proportion of his final results must be suspect. Second, as was
demonstrated at the time, his subjects were quite unrepresentative of
the general public in a number of respects. In particular, there were
relatively few smokers. It seems quite plausible that many healthy if
indignant smokers would refuse to take part in his trial and this
would produce such an aberration. These two vitiating defects are of
the kind which have led to the widespread preference for gold standard
trials.

But the continuation of Hammond’s work, with its demonstrated

faulty methodology, was used by the Australian authors to deduce that
smoking causes premature death to the extent of 17,800 per year in
Australia. Their conclusions should be compared with the results of a
survey by the Australian Statistician in 1991 of 22,200 households,
chosen at random. This showed "long term conditions", including cancer
and heart disease, to be more common in non-smokers than smokers.

Even if they had used sound data to calculate deaths caused by
smoking, this still would not have shown that smoking is overall
harmful or causes an excess of deaths. Antibiotics kill some
susceptible, allergic individuals but this fact does not show that
antibiotics reduce life expectancy. If the data used by these authors
is examined more closely it can in fact be shown that the mean age at
death from smoking-related causes (eg lung cancer) is about 1 year
greater than from nonsmoking-related causes (eg tetanus). See:
http://members.iinet.net.au/~ray/finch2.pdf

for details. This result does not necessarily show that smokers live
longer than nonsmokers: smokers as well as nonsmokers die from both
nonsmoking-related causes and smoking-related causes. But it is
certainly not evidence for the belief that smoking reduces life
expectancy.

During all this time health authorities have repeatedly and
persistently lied to the public. Consider just one of innumerable
examples. In June 1988, in Western Australia the Health Department in
full page advertisements in local papers declared: "The statistics are
frightening. Smoking will kill almost 700 women in Western Australia
this year. If present trends continue, lung cancer will soon overtake
breast cancer as the most common malignant cancer in women". What was
frightening was not the statistics but the fact that a Health
Department should lie about them. In 1987 the same Health Department
in its own publications had said: "Suggestions by some commentators
that lung cancer deaths in women will overtake breast cancer deaths in
the next few years look increasingly unlikely…female lung cancer death
rates have fallen for the last 2 years." It was predicted that breast
cancer would far outweigh lung cancer for the next 14 years. What the
public were told was not just an untruth but the reverse of the truth.
This is classic Orwellian Newspeak. The public are given what George
Orwell in "1984" named "prolefeed" – lies. Orwell must have smiled
wryly in his grave.

Above all has been the repeated and world-wide directive that smokers
should quit and live longer when every controlled trial without
exception has demonstrated this claim to be false.

Is there anything that can be said with certainty about the health and
life expectancy of smokers and non-smokers? The evidence indicates
little difference. One important fact often causes confusion: an agent
can be a certain cause of death and yet have the effect of extending
life. Smoking could be a major cause of lung cancer or even the only
cause yet also be associated with long life. The Japanese are amongst
the heaviest smokers in the world. They also live the longest. The
Frenchwoman Jeanne Calment smoked for a hundred years before dying at
122 as the world’s oldest ever person.

The resolution of this paradox lies in the simple fact that most
agents have both good and bad effects on health and life expectancy
and it is the net result which is of primary importance. This simple
but crucial fact is often ignored or forgotten by medical researchers.
Coffee causes pancreatic cancer says the newspaper article. Perhaps it
does, but if it has a bigger and beneficial effect on heart disease
then those who drink coffee may well live longer than those who don’t.
Hormone replacement therapy may increase the incidence of certain
cancers yet still have overall a beneficial effect. (See "The
Contrapuntists").

It may now be apparent why there is such a general belief that smoking
is dangerously harmful. There are 3 reasons. First, studies which in
any other area of science would be rejected as second-rate and
inferior but which support antismoking are accepted as first-rate.
Second, studies which are conducted according to orthodox and rigorous
design but which do not support the idea that smoking is harmful are
not merely ignored but suppressed. Third, authorities who are
duty-bound to represent the truth have failed to do so and have
presented not just untruths but the reverse of the truth.

It may be argued that this is news about an old and settled subject.
And who cares about smoking anyway. But smoking is really a secondary
issue. The primary issue is the integrity of science. This has no
use-by date. When the processes of science are misused, even if for
what seems a good reason, science and its practitioners are alike
degraded.



The Contrapuntists

A Parable

By

P.D. Finch

In a few years time an accidental by-product of genetic engineering
leads to the discovery that certain living vibrating crystals can be
manufactured very cheaply. When encased in a suitable holder and
inserted in the ear one can hear, just for a few minutes, until body
heat kills the crystal, beautiful melodies, rhythms and fascinating
counterpoint. They are marketed as aural contrapuntive devices. Since
they are cheap and become very popular, the Government taxes them.
Users of the device become known as contrapuntists.

Some years later a new disease is identified when an increasing number
of people drop dead, suddenly, for no apparent reason. Autopsies
reveal a strange deterioration in the brain cells of those affected.
An observant pathologist notes that in most of the associated
post-mortem examinations an aural contrapuntive device was found in an
ear of the deceased and the disease becomes known as SADS, an acronym
for Sudden Aural Death Syndrome. Epidemiologists find that people who
are not contrapuntists seldom fall victim to SADS and that, in fact,
about 98 per cent of all such deaths are either current or former
contrapuntists. The strength of association between aural
contrapuntism and SADS is undeniable, the relative risk is as high as
50, i.e. a contrapuntist has about 50 times the chance of falling to
SADS as does a non-contrapuntist.

An anti-contrapuntist health campaign is initiated and aural
contrapuntive devices are taxed more and more heavily in an attempt to
dissuade people from using them. The campaign is very successful and
is vigorously supported by an unexpected alliance between animal
liberationists, the music industry and the tone-deaf. Attention then
shifts to passive aural contrapuntism, viz. the dangers posed by the
sidestream melodic overflow from the devices in the ears of
contrapuntists, in particular on the occurrence of SADS in
non-contrapuntal spouses of contrapuntal men, the harm contrapuntal
parents may do their children and the possible ill-effects suffered by
the foetus of a contrapuntal pregnant woman.

After great initial success, however, the campaign falters when it
becomes widely known that even though aural contrapuntism is so
strongly associated with SADS, relatively few contrapuntists die from
it each year and those that do have lived, on average, about one year
longer than do non-contrapuntists and, moreover, at each age, are much
more likely to die of other causes than of SADS itself. Politicians
realise very quickly that they can now, with a clear conscience and
with profit, tax aural contrapuntal devices even more heavily.



1 http://www.la.utexas.edu/research/poltheory/james/blaste/blaste.html

2 Keynes, G (1978), "The Life of William Harvey", Oxford,



3 Lyte, H.C.M. (1899), "A History of Eton College (1440-1898",
Macmillan



4 Price, F.W. (ed.) (1942), "A Textbook of the Practice of Medicine",
6th edition, Oxford University Press



5 Doll, R. and Hill, A.B. (1950), "Smoking and carcinoma of the lung",
British Medical Journal, ii pp739-48

6 Fisher, R.A. (1959) "Smoking: The Cancer Controversy", Oliver and
Boyd



7 Doll, R. and Hill, A.B. (1954), "The mortality of doctors in
relation to their smoking habits", British Medical Journal, i pp1451-5



8 Doll, R. and Hill, A.B. (1964), "Mortality in relation to smoking:
ten years' observations of British doctors", British Medical Journal,
i pp1460-7

9 Surgeon General (1964), "Smoking and Health"
http://www.cdc.gov/tobacco/sgr/sgr_1964/sgr64.htm

10 Rose, G. and P.J.S. Hamilton (1978), 'A randomised controlled trial
of the effect on middle-aged men of advice to stop smoking', Journal
of Epidemiology and Community Health, 32, pages 275-281.



11 Hill, A.B.(1971, 9th ed.) "Principles of Medical Statistics", The
Lancet



12 Rose, G., P.J.S. Hamilton, L. Colwell and M.J. Shipley (1982), 'A
randomised controlled trial of anti-smoking advice: 10-year results',
Journal of Epidemiology and Community Health, 36, pages 102-108



13 Multiple Risk Factor Intervention Trial Research Group (1982),
'Multiple risk factor intervention trial: risk factor changes and
mortality results', Journal of the American Medical Association, 248,
pages 1465-1477.



14 WHO European Collaborative Group (1986), 'European collaborative
trial of multifactorial prevention of coronary heart disease: final
report on the 6-year results', Lancet, 1, pages 869-872.



15 Wilhelmsen, L., G. Berglund, E. Elmfeldt, G. Tibblin, H. Wedel, K.
Pennert, A. Vedin, C. Wilhelmsson and L. Werks (1986), 'The
multifactor primary prevention trial in Goteborg', European Heart
Journal, 7, pages 279-288.



16 Miettinen, T.A., J.K. Huttunen, V. Naukkarinen, T. Strandberg, S.
Mattila, T. Kumlin and S. Sarna (1985), 'Multifactorial primary
prevention of cardiovascular diseases in middle-aged men: risk-factor
changes, incidence and mortality', Journal of the American Medical
Association, 254, pages 2097-2102.



17 Puska, P., J. Tuomilehto, J. Salonen, L. NeittaanmSki, J. Maki, J.
Virtamo, A. Nissinen, K. Koskela and T. Takalo (1979), 'Changes in
coronary risk factors during comprehensive five-year community
programme to control cardiovascular diseases (North Karelia project),
British Medical Journal, 2, pages 1173-1178.



18 Leren, P., E.M. Askenvold, O.P. Foss, A. Fr¨ili, D. Grymyr, A.
Helgeland, I. Hjermann, I. Holme, P.G. Lund-Larsen and K.R. Norum
(1975), 'The Oslo study. Cardiovascular disease in middle-aged and
young Oslo men', Acta Medica Scandinavica [Suppl.], 588, pages 1-38.



19 Surgeon General (1982) The Health Consequences of Smoking - Cancer:
A Report of the Surgeon General.



20 Surgeon General (1989) Reducing the Health Consequences of Smoking:
25 Years of Progress: A Report of the Surgeon General: Executive
Summary and Full Report



21 Surgeon General (1990) The Health Benefits of Smoking Cessation: A
Report of the Surgeon General



22 Commonwealth Department of Community Services and Health, Canberra
(1988) "The Quantification of Drug Caused Morbidity and Mortality in
Australia".



23 http://members.iinet.net.au/~ray/hammond3.html

Wallis, W.A. and Roberts, H.V. (1962) "Statistics: A New Approach",
Methuen and Co. Ltd.



24 Australian Bureau of Statistics: Smokers are less likely to have
cancer, heart disease 1

Australian Bureau of Statistics, No 4382.0, "1989-90 National Health
Survey: Smoking"

http://members.iinet.net.au/~ray/19jun2006.htm



25 Australian Bureau of Statistics: Smokers are less likely to have
cancer, heart disease 2

http://members.iinet.net.au/~ray/ABS43820d.jpg



26 Two messages from the Western Australian Health Department

Subiaco Post, 28 June 1988: 12

Hatton, W.M. (1987), Cancer Projections: Projections of numbers of
incident cancers in Western Australia to the Year 2001, Perth:
Epidemiology Branch, Health Department of Western Australia.

Hatton, W.M. and M.D. Clarke-Hundley (1987), Cancer in Western
Australia: an analysis of age and sex specific rates, Perth: Health
Department of Western Australia.



http://members.iinet.net.au/~ray/HealthDept1.jpg

http://members.iinet.net.au/~ray/HealthDept2.jpg







Installed 31 July 2006

















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Relevant Pages Re: DOF Sept 4, 2005 ... I'm sorry you have had so many health issues to deal with, ... > not smoking. ... > all the years, who had suffered hourly, trying to quit smoking at AS3. ... > for 3 weeks for a med adjustment in April as one of the new meds I was ... (alt.support.stop-smoking) Re: Heres a thought ... would STILL come up with a reason try continue to ban smoking. ... antis are not interested in our health. ... Our local newspaper's "Sound Off" column this week was devoted to an informal man-on-the-street poll on the ban. ... "Man, once surrendering his reason, has no remaining guard against absurdities. ... (alt.smokers.pipes) Re: The Decline of American Capitalism ... Shall we lump tobacco in with the other drugs ... the health of the citizens can be made without excessive costs. ... If you consider the abolition of smoking will result in a general ... (soc.retirement) Re: Heres a thought ... would STILL come up with a reason try continue to ban smoking. ... antis are not interested in our health. ... Our local newspaper's "Sound Off" column this week was devoted to an informal man-on-the-street poll on the ban. ... fear of second-hand smoke is a feature in three of the four cases. ... (alt.smokers.pipes) Re: Next target: ban smoking in home ... results of the smoking ban in Scotland (which have been replicated in other ... doubt that passive smoking is harmful to health. ... Even were I to agree with your "beyond doubt" claim (the statistics to ... to parents suspected of allowing their children to eat unhealthy food. ... (uk.legal)

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