x~~•. rxrd>>t c., r61vy. ,

s Ivt,oL vL
x~~ . rxrd>>t c., r 61vy .
,nim(z)o CoalPATtx
"SCIFATIxIC AMD ?Ithhn7CAL /LSPIX.'M OF THE 'S.\."Qn'G AND
lIF1sLTfi OD'ZTFtf'JVI~.RS'lc' - S(!Nt1F,' PAR11D0?M AN31?ALi..ACTES"
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
,

V
d
TnBr .ii Or OUYI'l•N1S
. s
Cii)jeaive
«
Scientific and Medical Mpects of the Snx)king and ]Ioa1th Cc)ntroveisy--
Sorrie I'a.radoxes and 1 allrIci .es .
X . Sources of Ini'on7ntion - Rib]icztions and Sci .Untists
II . '/he Meanint; and Consequencc~-; of the "Contibvezsy"
' xIZ. Br9.ef ]listorical Coiment
XV. Tr,e 19Gi "Strrgec• :~ General's Report", Fol]otv-Up' Reports and
their I3iases 8
V. My is the Contlbversy "Nervs"?
V7. I?iseases .117.eged to be I .i.nked to 57rblcing
VXI . Association and Causation in I-IrIImn piseases -- Definitions,
Diiii.culties," and Fallacies 1 .7
.
VIII . Statistics on Srrt:~a.ng and Ilea.l.th, - Iung Cancer and General bSorta .Zity 20
' 1. General Comnents 20
~ 2 . General Methodological j','ealmesse ; a.nd Iack of Representativenesses
of the ASost Inportant Statistical Studies
3. 14eaknesses and Paradoxes of the Minmond Study
IX. 7he Relation between Diaz,nostic Errors arid the Degree of Alleged
Increase of Lung Cancer, with :.ome Crnments on Recent Decreases
of hmg Cancer -
X. Sorne other haradoxes on Lung Cancer
X1' . Sare Limited Cam7ierits on Statistical Irdta on Chronic Respiratory
IJ;,smses and ]feart and Related hiseases
XIX . Itie Alternati.ve I .Nplanat :i.on w 7he Constltutiona .l Hypothc!~is
XIII . Mim;lIbcperiments •
1. General Coimamts . 40
2 . .,~-.in Painting
3. 71~e Sn>lcing I3eagles - 41
4 . I .iiesprui I :x-tending Effect of Cigarette 9n7ldng on Mmsters 42
X1V. Snoke Constituents
X "!`ar"
2 . Nicotine
3. Crcrtx,n rUncxi dc
4. ]~Ydlof;en :,yzni .de
5. Nitrogen Oxic!e
XV . •1l1e F)id : i'9 tvlii n,°C" i.s narhtirous to Your ]Ie,zl t.h - 48
} 311 . ConcllLSion /18
13Ibliogz•aphy • 49
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
2
11
32
21
23
35
44
'15
45
46
47
,_ :

9ltbl0 3.,
Table 2 .
71able 3 .
Tabl.e 4 .
7`able 5 .
7`dble 6 .
7abl.e 7 .
. Zable 8 .
Tabl.e 9 .
h! g. I .
ng. 2 .
OF •rni3 IE-3
Morbidity and Mortality in U .S. from Cancer Ibs.sibly Itelated
to Di.et - Coriy~ti*.•ed to Lung Czncer, etc . 4
s
P -IG o
DlseaSEs and DlseilSe-GJndl.tions Al1egCd to be Associated with
S~king 12 •
biost zrrPortant Groups of Dise,tises Al.leged to be Associated with .•
Sroki_ng 16
Age--Adjusted heath Itates per 1,000 Man-Years for rTon-,%Dlcers,
Fkmkers, (Cigarettes only - Age 35 and over), by Anuunt &mked,
in Seven Studies and for U . S . Mzite L1a7.es 22
ConTparison of the ACS (ID3nrrond) and U .S . Populations : Percen :age
nistribution by Iieioit .
Age-Standardiled Death Rates per ] .00,000 T.ian--Years for vari_ous
Groups of Men, Aged 40-69 . Men tibo never s-:-oked Itegularly
oonpared with Tien Currently SYroking 20 or rrore Cigarettes a Day ;
at 7tiM of T.nrollmex~t
Cigarette Srrr.,king and Kon-Prc•wrtem Diagiiosi .s in Patients with
Ixuig Cancer at Necropsy 27
Incidence and Site of I)zapiosed and Jndiagliosed Carcinanzas 28
Deaths in U .S. Physi.cians'
TAb1_R OF FIGURFS
Title and Conclusion of Janm- 1 ., 1604-
Title of Karbacke, 1602 . 8
11g. 3 . . CDrharison of ACS and U .S . Populations : hercentage Distri .bution
by Age 23
9 . I'ercentlge of m^n in the Keys' American Ileart Association Study,
Itegul :Lrly 4Al:f ng at Ieast 10 Cigarettes evezy Day
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
?A
.5

0
I
o~tiJE~c ~ xv~~
S1•SOKI.NG AN[) 11? :A1 :1'ii UPDATE
_ . .~.. ._.~~.~. ...._ . .~ .,~~_ .~. . ...... ... .._. .~_~_ ,
"SCXfMli?TC I1ND 1•it?DICAI . ASPI:CTS 0r .flir srtoKl'NC: At~.)
IlEA1 ..Tt1 C0NT120V1;RSY~- SO~ST; PI11tAl)OXrS AND }'I1I,LACxI :S"
nX r)r~. rrank_co1bY - RIItT
What we want to convey can aln,ost be sunimari .zed in one sentence :
1yhe~smoking and health_controversy_i_s~just that - i~t i .s a_controvez-sy .
The smok ;.ng and health controversy is a very important questi .on ;
. . our Industry has been - and is, of course, trying to provide the
answer . If there ever should be any component or components, as
found in'smoke, that can be proven to be, or contribute to be, a
cause of Any'disease in man, we will of course, take them out .
. ._ . . . . .,. . .. . . . _ . . ../.• ~ .. .. , . . .~ .~~~ : , . ._ . . . . . ._e< . . ,r.,., . , r~. . . .r.r__ . . . . ,;5' . .,-. .f :`i. . . . . ._ . . . .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
s

•
0
SCIENT]'1;'IC At%l) tiCDICAL ASPECTS Ol"• •)'ill; SMOKING AND l1i:A]..1'fI CoNTrovI,RSY
SOME"PARADOXIa AND FALT ..AC].1;S :
SOURCES OF 7NFOI&fA7'XUI'd - PUBL1 CA1'IO\S AND SCII :I~''1'T. STS .
The topic which has been assigned to rne is to di scuss the
sci.enti_fic/medica1 aspects of the smoking and healt•h controversy
and more particularly, some of its par.adoxes and fallacies . ;Iow--
c.ver, there is no -way to revi.ew here even the highlights of thi .s
controversy . I will, therefore, only discuss a few topics as
illustrative examples .
The f_aanous Surgeon Genera7's report 'al one covers almost 400
printed "pages . J.,ach year there appear, in medi .call and other .
scientific publications al_one, about 5,000 scienti fi .c papers ;
this does not consider that almost as many papers on these topics
are given at scientific meetings . F'urthermor.e, -it is a fact that
•- these ilumbex•s ' are zncreZsing and increasing each year . This does'
l,
not count the still much-more numerous articles, discussions, etc .,
` Vhich appear in newspapers, general magazines, 'the non-sci_entific
press 3.n general, and which are broadcast on radio and T .V .
trhil .e it is dxff.a.cu]_t e:zouF;h t:o c()i~e with what is happening
in the medical and sczent :i.fxc world, it is in some respects even
vore dif{'i.cul,t to deal wi_tai rahat: is appearing in newspapers, on .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
r
e

television, ur, radio and in other non--scientifi.c media, because
all too often we find that the guideli.ne seems to be : "Never let
the facts interfere with a good story - or with a good headline ."
Now, there can be no argument that - i_h terms of numbers - the
vast majority of medical and other scientists discussing the smoking
and health controversy allege that ci_garett :e smoking -is the major -
cause, or, at least a major cause, of lung cancer and/or other
diseases . But, i_f wF• confine ourselves to those sci_entists who
are doing actual research, this majority is much less overwhelming .
One aspect which makes a discussion of this controversy so
very difficult is, that it i s fraught wi .th so much emotionalism .
Kiny, otherwise sober and logical, physici ans and other scientists
seem to lose all sense of measure and perspective when it comes to
tal.king about smoking and health . Now, this emotionalism is such,
that the anti-cigarette forces often abuse those who try to present
a more objective and more sober point of view, even threatening
them in their livelihood, and particularly accusing them of sE-ving
"werchants of death" or serving "vested interests ." But, here we
shuulu not forget, that many of the physicians and other scientists
who"aXlege that cigarette smoking is responsible for shortening the
lifespan off smokers, and that it is, mainly or"at least in part,
responsible for so many medical ailments, equally represent "vested
interests", because their scientific reputation and their liveli-
hood depend on just that .
Nowever, there seem to be lately some changes in that one-
sidedness, because a few of t :hese sci .ent: sts no longer .:onc-entrate
exclusive', .y on cagarettes, but are devoting their attention to our
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 3
,

daily food, and I mm iiot talking about food additi .ves or pesticides
or other contaminants ; I'm tnl.king nbout the food themselves, such
as ineats, vegetables, dairy products and their mai .n ingredients,
such as proteins, sugars, starches, fats, and even vitamins, as I
shall show in a while . 3ust one set of figures, the following
table shows that there are, in the U . S ., about 200,000 new cases
and over 100,000 deaths for the cancers possibly related to diet
(1-) •
Table . Morbi di ty and_ Mortality ! in _U . S .__from Cancer Possibly
r lan- Sitc
F __--
Esophagus
Stomach
Colon
Breast
Liver (and Bile Ducts)
Lung Cancer, and other
respiratory cancers
Rel~at ed to Di-eL - _Cornpared to T .umg_ Cancer,Y etc .
Estimated Stati-sti_cs
for 1975
7,400 6,500
22,900 14,400
69,000 38,600-
88,700 32,900
112.500 800
199,500 102,200
665,000
103,000 -
365,000
86,000
I;y compari_son, we have the following figures for' lung and
other respiratory cancers alleged to be associated wi .t.h smoking :
103,000 new cases - 86,000 deaths . For perspecti_ve, I would
like to mention that t:he total number of deaths in the U . S .,
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
(1 and ACS)
>

in 1975, was about 1 .9 million .
)'ncide»tally, very few people realize, that if today by magic
all cnncers should disappear, i .e ., not just: lung cancer, but also
diet related cancers, other cancers, etc . the total lifespan in the
. U . S . would only increase by about 2-1/3 years for those born this
year - and only about 1 .2 years for those at af;e 65 "(2) .
fx . TIIE MEANING ANn CONSL UI;NCI~S Ol~ `1'FlE "CONTROVF.RSY"
~
As menti oned, the tlu ust- of my presentation i s to convince
you that the smoking and health controversy is a controversy .
F:xpressec; differently, this means two things : On the one
hand, it means that none of the many allegations which have been
made against tobacco, and specifically aga,_nst cigarette smoking
as being a cause of lung cancer and/or other diseases, have been
proven . On the other hand, it also means the corollary, and this
also cannot be emphasized strongly enough . It also means that we
cannot prove that ci.garett:e smoking can he exoneratod of siispi_ci_on
as a possible health hazard .
• Simil.arly, no component or group of components, as fotmd in
smoke, has ever been proven to be the cause of .aay disease in man .
Analogously, it is,at this time, impossible to-exonerate unequx-
vocall.y any of the smoke components, singled 6ut by the anti-•
tobacco forces, of any: involvement in the human diseases allegedly .
].iaked to smoking .
,1ust briefly at this point, this is why, in m 3udgment, it
i s very hazardous to modify cigarettes, and at the same time to
seemingly offerr what : could be construed to be an, at least implici t,
warranty of safety . Fortunatcly, in the U . S ., a',_ll members of our
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 5
,

Xndustry have too hiF,h a scnsC of social reshonsi,bxli.t•y to l.,i].X
into thaC latter trap .
riodi,fication of cigarettes based on mere conjectures is, "by
. . . . , . . . .
• defi-inition", devoid of meaningful sci,entific merit - not : tiie least
because a series of contradi~ctoKy remedies are suggested to this
Xndust'ry . Most of our advers aries recommend lotier "tax" and
ni_cotine . Others recommend only lowcr nicotine . Sti1.ldiff•erent
recon-criendati.ons suggest only lower "t-ar", but leave the nicotine
unchanged .
. On the other hand, as late as 1965, the U . S . Federal Trade
ContaAssion and the Surgeon General took the position, t`:at "while
it seems at least pjausible that cigarettes 1oith lower tarr and
nicoti.ne may present lesser health hazards, there is presently no
F•roof that this is so", (3)
: they changed their mind in 1966 ; how
do we know whether they mi_ghtt not change their mind again in 1977?
Stxl.l. others recorrunend to add and/or decrease still . other ingredi-
._ . . _
. r"
unts of tobacco and/or srnoke . . '
111 . BRIEF HT.STORxCl'.L CMMENT
Most of yru and . most of our customers and, •most cert :al.nly •
~•most of the public at large, believe that the smoking and, health
, controversy is something wl .i.ch got sta; ted• during the iast 10
15 years, or at most 25 years ago
. However, this is just one of
of the many myths about the tobacco and heali_h probZems .
• Until the colonization of,the Americas, tobacco was unknown
in t-ho rest of the ;acrl.d, and only a short time 7 .acer, •i_n 16042
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
k?age 6
J. .
.

l
Kiit£ James I of England, (4), calle .d the use of tobacco "a custort
loathsome to the cye, hateful to the nose, harmful to the brain,
dangerous to the 1ungs"
. I believe the following illustration will
be of interest, because it shows what• this first "Surgeon Ceneral's
lteport" ] .ooked ].ikc .
).
~ f~1 ~h1 r> )~~~

Itut, at about the samc one Dr . Rogex- Tfarbecke publ.i.slu•d,
in 1E02, a work entitled : "A Defence of Tabacco", (5) wherein
he recommends smoking in moderation as benefi_ciall am' the following
3 .l.lustrati .on shows whaL the cover of this book looked like . (Figure
2 : - 1'Y1'Li: OF MARBECKE, 1602 (5))
A , DEFENCE
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
TABA CC; o . VV z TH A
FRIENnX,Y ANSWF :R TO TIM
latcprintcd l3ookc c-1llcd
ff'rorlCe f'or C~ j;rlr y~-S1 Pcc-
• Pcrs;&c .
. Siiudicas,cognofcc :fiRcxcs,iubc.
hoNnoN,
I'riu ;c~ by ri: hard Fr'~td for zl,o,u .uC .Sltkn6 tGo
: .
I

Tl;erefore, even a t th a t time th e re was controversy - an :I this
has really continued evor since . Ilowever, i ti.s true that, only in
xea ;,tive)y recent years, has the smoking and health c I ontroversy come .
into 'major prominence, as exemplified by very frequent. front pa~,;e .
or T .V . or radio coverage .
A . . _ . . . . . .
~
xV. T,iil 3.964 ON GEr:F_.P.AL' S REPORT" FOLTA~J-UP Ri"JuY,TS AND
7IIEIR - BXASES
However, the most important event S.n thi-s history was undoubt- .
edly* the publ: ^ation in 1_964, of what is now generally called the
Sur~Zeon General's~ Report on Smoki_ng and Heal t`h~ (6) .*
•And, since 1957, the Public Health Service of the U . S .
he:partment of Health, Education and Welfare, has been under
obli.gat3_on of publishing annuall follow-up repo,: Ls or supplements
to the original Surgeon General's Report and the--e are entitled :
Health Consequences of Smoking . Th•. most important of these is
the report for 1971, (T), .because its purpose was to sununari_ze
cverything published up to that time, including the 1964 report .
• : Now, all these reports by the Surgeon General aze rather one-
si.ded, 'in that *they are very heavily weighted against cigarettes
.
and tobacco in general, and, more or less, i.gnore or play down any
y contrary evi_dence, no matter how solid . In rriy judgment, the
relatively least biased was the tir st., or 1964, Surgeon General .'s
'.teport, at' ieast: to those t~ho were able to read ~~nd understand the
!'u11f text and especially the datz ir, tiie Lables and fi.gures .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
1'age, 9 .
a
f) ;
. r :.
,

.
7n 1968, tthe then Sccretary of the U . S . Dcpa): ti»ent: of 1(cazth,
Education and Wcl.fare, made a gesture and asked the Xndu ;:tr.y to
.
present: its point of view on t•he•• smoking and health controversy
.,
prior to the publication of the 1968 Suhpl .ement . A gioup of us,
l.abored many weeks, including nights,
to put together a comprehensive report• . llowever, al.ll those, efforts
.
were in vain and our report was compietel_y ignored by the Government .
Another flagrant example of extreme bias was the just mcntioned
sumrnary report for 1971, published in 1972, wherein the Government
chose to ignore completely, or almost completely, any reference to
any medi.cal evidence which dzd not conform to the dogmas of the
anti-tobacco lobby .
'xn the course of the U . S . Senate Hearings, held in February
1972, (7a), the Cnairmarn asked Dr . Sommers, Chairman of the Advisory
8oard to the Councill for Tobacco Research, for a list of reicrences
omi..tted from xhe U. S . Government reports on smoking and heal .th,
and Dr . 'Sornmers supplied a collection off almost 2,000 references,
which were included in the printed pvoceedi,ngs Qf these Hearings .
Hot•lever, the next report was only s1~i~htly less flagrantly biased .
I am mentioning this merely as an illustration of the difficulties
of those who try to present a more objective scientific point of
view . Tbxs applies regardless of whether such scientific studies
< are or are nott supported by the tobacco industry . Fortunately -
at least in the U . S . - it is possible, though difficult, to ge4
studies, which are not; 'biased again : t- smoking, pubiished in the
scliol_arly ;»edicall and scienti .t"ic Xiteratur.e . Nowever, it i_s aimosi:
-al.ways impossible to get such i_nformat :ion into major media outlets,
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
1'age 10
•

such as large circulation n ::wsparcrs, widely read magavi .nes, tele-
vision, etc ., on which you, our custt>mers, and the public at large,
have to rely to F,et their informati on . Because, as mentioned, the
guideline secros to be "Never let the facts iiiterfere with a good
story or agood headline ." So,~theref.ore, w~henwe_xouysee _any
such informat•i.on whi .ch is not one-•sidcdly anti~-tobacco 3~n~your
ne4isnarers or_elsew:lere,_i.L~ iws Particularly i-nrortant Co convey
this information to us .
V . WFiY IS THE CONrROVI,RSY "NEWS"?
Now, what are the reasons .why the smoking and health contro-
versy has become front-page news only during che last 25-30 years?
I think there are probably many reasons . One is that cigarctte
smoking has become a widespread custom in the United Stat•es,
Canada, and some European countries only af ;:er World War I and
other countries after World War 71 or later, i .e ., it was not
"available" as a scapegoat . Another reason is, that since thee
end of World War 7Y-, medical science has been able to conquer
many of the diseases that were important causes of death until
then, and which were caused by clearly i-denLifi.able agents, such
as what is popularly called "a bug", for example the ''i~B bacter-a,
etc . This has, of course, had the consequence that other di .,,eases,
which aree called chronic diseases, have become the most import-ant
causes of death . xt is mainly these chronic diseases, which are
alleged to be l.inked to smoking . Another reason is the ever-
increasing dominance and availability of the mass media, such as
newspapers, T,V ., etc ., and also a rnore predoM,infint pre-•occupation
of the public with matt:ers of health .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 11
in
F?

.
I
VX . I)7SI:ASES ALLEGED TO ;tl : 1 .YNKi :1) TO SMOKI NG
Smoking, particularly cigarnL•t :c smoking, has become in
recent years the convenient scapegoat-cause for many diseases
and other condit•i.ons adverse].y affecting our well-being . The
followincr nlnhaheHc :il lict•ins, is by no menns (,xhm,ct-j .,n_
__--__---- -~. -~ ---------•- _--••-- -~ --- -~ --- --~------- -~-----__ . .._ .. . . . .
Table 2 . Diseases and Tl•i-sease-Condi .t•i.ons~Al .lep~ed to he Associated
With` Smoki-nR
ABO}tl' I ON
ABRUPTJO PLACENTA
ACADEitIC ACHIEVL•'P11iNT DhCRI;ASE
ACCIDENI'S
AGI NG
ALLERGIC BRONCHITIS
ALLERGY
ALOPECIA
ALVPOLAR PfACROPHAGES CHANGES
M LYOPJ A
A?•IENOP.RHFA
Ald~IESIA
Ah Et•I1 A
A1VF.STIIESIA CO;iPLICATIONS
ANGINA PECTORIS
ANOREXIA
ANI'EE'ARTUM IiMTfORAGE
ANTI D?:URESI S
:,ORTIC AtiEURYST!
APYETJTI•: LOSS
ARCUS SI:NILIS
ARRYI1L`iIAS
ARTERIOSCLEROSIS
ARTERITIS OBLITERANS
ARYEPIGLOTTIC FOLD CANCER
AST1I,`IA
AT .'1XIA
ATELECTASIS
ATIILET IC PERFORFiANCE DECREASE
AUDITORY DECREASE
A200SPERriIA
BACK PAIN •
BILE DUCT CANCER
BILIARY CANCER
BIRTH DEFECTS
BIRTH WEICIiT DECi :I•:ASE
BLADDER CANCER
BLOOD CARBO~ "IO ::OXIDE INCREASF:
BLOOD CLOTTING TI"fE
BLOOD FATTY ACIDS INCREASE
BLOOD CLUCOSF CIIANGES
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
BLOOD 1'RESStIltli DECREASE
BLOOD PW':SSURT; INCRF:ASE
111 .001) 1'11I0CYAN :'•TE I t;CREASE
B1 .001) TRIGLYCERIDE INCI :I;ASE
BODY WEIGHT CHANCES
BONE LEAI) 121iTENTION
BOUVERETS DISEASE
BRAIN DAt•IAGE .
BRE .'.ST CANCER
BRONCHIECTASIS
BRONCIIIOLITIS
BRONCIIOCuNSTRICTION
BRONCIIOSI'ASM
BUI:RGF:RS DIf:rASE
BULLOUS LUNG DISEASE
BYSSINOSJ.S
CA1'ARfiN
CATECIIOLA?IJNf•. RELEASE
CENTRAL NERVOUS SYST'FA`i DISORDERS
CERF.BELLAR ATAXIA
CEREBROVASCULAR DISEASE
CERVIX CANCER
CIIF:EK CANCER
CHILDHOOD CANCER
CIlILDH00D RESPIRATORY DISEASE
CHROMOS01•iE; ABNORMALITIES
CHRONIC BRONCiIITI .S
CHRONIC COUGH
CHRONIC LARYNGITIS
CHRONIC OBSTRUCTIVE LUNG DISEASE
CHRONIC RNINITIS
CHRONIC SINUSITIS
CILIARY ACTIVITY DECR .:.•'.3E
CIRRIIOSIS
-
COLON CANCER
COLOR BLINDNESS
CJt1Gf:N1'1'AL IIF?.ART DISEASE
CONGL:N ITAL FL1L1'ORI4nTI0NS
CONVULSIONS
COR PULMONALI:
CORO :IP-RY ARTERIOSCLEROSIS
pa E. e 1-2
4
f
P1.

; .,
Table 2 . . (continued)
CORONARY ARTERY DISEASE
CORONARY T11ROAiBOSIS
COUCa i
CUItSCII!dANN SPIRALS INCREASE
DEAI'N1:SS
DF,N•1'Al, CALCULUS
DENTAL CARIES
DERMnTITIS
DIA1)E"1'ES
DIURFSIS DECREASE
DIZZINESS
DRUG ADDICTION
AUOD1 :NUrl ULCEQ•
DYSI'NEA
EDEPU
k:DENTIA
Ef,KCTROCARDIOGRAM CiU1NGFS `
El .EC1'ROL•'NCL•'1'HALnGRAM CHANGES
F.~i1 :OL>;SPI
t:IvDOCARD ;TIS
ENDOCRINE DISOPJ)ERS
)r:PIGLOTTIS CANCER
F:PILL•'['SY
FSOI'ItACUS CANCER
ESOP1iACUS SPIIItiCTER YRESSUP.I:
F.XERTI0NAL DYSPNEA
EYF IRRITATION '
.
EYF:LID INFLATIMATION
FALLOPIAN TUBE SPAS+`I--
FATIGUE ~
FERi ILITY DECRFJASt;
FETAL GROWTH DECREASE
FMA1. i•SORTAJ,ITY
FII3RINOLYSIS
GAI .I . itLAi)DER CANCER
GANGRENE
GA.STRIC SECRETION
. GASTRIC ULCER
• GASTRITIS
GASTRODUODENAi . ULCER
GASTROESOPHAGI•:AI . REFLUX
GI.STROIA''i>:STINAI . DISORDERS
DECREASE
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Pege 1 .3
GINGIVA A11NOi:PIALII'IES
GINCIVA CANCER
GINCIVITIS
GLANDULAR 11YPERACTIVI".'Y
GLOSSITIS
GOUT
IIAIRY TONGUE
HAND STEADINESS CIIANGES
HARD PAI .ATE . LEUKOI'LAKIA
HEADACHE
HEARING DISORDERS
HEAF.1'BURN
HEART RATE INCREASE
HF.II,ITOCRII' INCREASE
HEPIOGLOItIN INCREASE
HEPIOPTYSIS
HOARSF,NESS
HOR,`fUNE DISORDERS
:IYPERCNOLESTEREMIA
HYPERF:PII A
HYPEI:ESTHESIA
HYP£RGLYCEPIIA
HYPEF.I:ERATOSIS
HYPERTENSION
HYPOGLYCEM?A
HYPOPILARYNX CANCER
INDIGESTION
INFANT rfORTALITY
INFLUENZA
INTELLIGENCE QUOTIENT DECREASE
JUVENILE ARTERIAL INSUFFICIENCY
KIDNEY CANCER
KNEE REFLEX DECREASE
LACTATION DISORDERS
LARYNGITIS
LARYNX CANCEk
LARYNX POLYPS
LEARNING ABILITY DECkF.ASE
LEUKOCYTE INCREASE
LBUKOCYTE DECREASE .
LEUKOPLAKIA
~

11'nble 2 . (continued)
LI BI DO D1iCREASI:
LIFE rxPrCrANCY DECREASE
LIP JiURNS
LIP CANCER
LIP LEUKUPLAKIA
LIVI:R CANCER
1.UNG CALCIFICATION
LUNG CANCER
LUNG CAVITATION
LUNG 1iMI'HYSEMA
LUNG FIBROSIS
LUNG SCLEROSIS
LUNG TUJtERCULOSIS
LYt9P110CYTE ACTIVITY ClIANGES
LYNP110SARCOMI}l '
1•fACROCYTOS I S
1•LATEIWAL IdILK VIMMIN C DECRI:ASE
H1'NOPAUSE DISORDERS
TiENSTRUAL'LISORDERS
}'nUTIi CANCER
MULTIPLE SCLEROSIS
MUSCLE ACTIVITY
HYUCARDIAL INFARCTJON
1•IYRI NGOPLAST Y F'AI LUItI:
NASAL CANCER
NAUSEA
NERVOUS SYSTEM DISORDERS
NERVOUS TIiNSI01
NEUROSIS
NUCLEAR ATYPISM
NYSTAGPfUS
OCULOrtOTOR PARESIS
OLFACTORY ACUITY DECREASE
OPTIC NEURITIS ORA1
. CANCER
ORAL LEUKOPLAKIA
OROPlU1RYNX CANCER
OSTEOPOROSIS
' PALATE CANCER
PALATE LEUKOPI .A,LIA
PALLOR
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
a
PANCREAS CANCER
PANCRL•'A•rJTIS
PAROTID SALIVARY SECRETION INCREASE
Pr:I.LAGRA
PF:PTIC ULCER
1'1:RIODONTAI. DISEASE
P1iRI PHERAL ARTI;RY 'DI SF.ASE
PERIPHERAL VASCULAR DISF.ASE
P11 .,RYNX CANCER
PT1i .EBITIS
PHYSICAI. FITNESS DECREASE
PINOCYTOSIS
PLATELET ADHESION
PNEU:fOCONIOSIS
1'NEU1d0NIA
PNEUMr'.JITIS
PNEUMO'1'IIGRAX
POLYCYT1tEP1IA
POLYTtER ME FEVER SUSCEPTIBILITY
POOR DEIJTAL HYGIENE
POSTSURGERY COMPLICATIONS
POSTURAL REFLEX
PRFECLA.`iPSIA
PREGNANCY COMPLICATIONS
PREFi,MIRITY
PROSTATE CANCER
PSYCHOMOTOR PERFORr, .`.NCE
PU1 .I:ONARY INFARCTION•
PYr:LONF.PItRITIS
PYLORUS REFLEX
PYRI1'ORrt SINUS CANCER
MYNAUDS DISEASE
RFACTIVF. HYPERF,MIA
REFLEX ACTION DECREASE
RESPIRATORY FUNCTION DECRF :ASE
RE1'JCULUi4 CELL SARCOMA
RETINAL ANGIGSCOTOMA tNCREASE
RETROBULBAR NEURITIS
1WEUFIATIC ENDOCARDITIS
S:U' .IVARY SI:CRETION CHANGES
SENILITY .
P,qp,e 14
Ir. .

y
Trable 2 . (continued)
SENSORY PERCEPTION Cl1tiVGES
SEXUAL AC'ViTY DECREASI's
S1CIl flRI ;QUENCY
SINUSITIS
SF:IN CANCER
. SKIN TEt-IPEPJITURE DECREASE
SKIN WR1Nl :LING
.SLEEP BEtIAVIOR
S~UtLL INTESTINF. MUSCLE RESPONSE
SI'EFW .C}41NGES
SPINAL CORD DEGENERATION
SPINAL REFLEX DEPRESSION
STOrtACli ACI1)ITY CHANGES
STOMACH C".hCER
STOMACH DISORDERS
STO :tACN PAIN
STWLITITIS NICOTINA
TACHYPNEA ' '
TARTAR FO}ULITION
;TAS1'E SENSITIVIT'Y DECREASE
TNROMROANG11TIS OBLITERANS '
-T1IYROID DISORDERS
TINNITUS
TOKYO YOKOHAPLI ASTHtdA
TONGUE CANCER
TONCUE LESIONS
TONGUE LEUKOPLAKIA
TONSIL CANCER
TOOTH LOSS
TOTAL TiORhIDITY
TOTAL HORTALITY
TRACHEA CANCER
TRACHEITIS
TRAFFIC ACCIDENT
TRYPTOPIIAN lIETAItOLISM
1WIN nIRTIi RATE INCREASE
ULCER0:1EtSBRAN0i1S GINGIVITI5
URETER PERISTALSIS INCREASE
URTICARIA
UTERUS CONTRACTILITY
VAGINA CANCER
VASOSPASM
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Vt:[tTIGO
VINCENTS DISEASI's
VISUAL ACUITY DECREASE
VISUAL S1iARCii YI:Rl'OlUmCE
VITAMIN B12 A11SJItP1'ION DFCitEASE
VITAMIN C ABSORPTION DEC1t1iASE
VOCAL• COR_n CAINCER
VOCAL CORD CIiANCES
VOCAL CORD LEUKOPLAKIA
VMEF.'LING
.
page 15

I can document in ever,/ case, that each of these diseases, ctcs
bas boen alleged to be associnted with tobacco use . The number of
conditions allegedly l i.nked to smoking are themselves proof of the
absurdity of the Inany anti-tobacco claims . This is because of some
fairly esoteric, but well establxshed, scientific pr.incipJ.es, which
even the 1964 Surgeon General's Report made its own, (8, see also
„ e .g. 59), and also because -- in my judgment - common sense indicates
,
that if tobacco were really the cause of all these ailments, people
would have long ago stopped smoking . Now, of course, not all the
anti-tobacco scientists cl .aim that all . these conditions are caused
by smoking . However, the most important aniong these diseases include
the diseases alleged to be together responsible for most deaths of
our post-World War Ix world, at least for the developed countries,
such as the United States and Europe . These most important &rou s
of diseases are agai.n lj.sted here :
Table 3 . Most Important Grou _s of Di~seases_AlleRed to be Associ~^ted
k'ith~Satoki .n&
CORONARY HEART DISEASE AND OTHER DISEASES OF THE HEART
ANI) CIRCULATORY SYSTEM .
CHRONIC OBSTRUCTIVE RESPIRATORY li1SEASES, SUCH AS CHRONIC
BRONCH1TxS, ENiPtiYSEMA, ETC .
LUNG CANCER AND OTHER CANCERS OF THE RESPIRATORY SYSTEM .
OJ.'tIF,R CANCERS, SUCH AS CANCERS OF THE DXGESTT .VE SYS;'EM, ETC .
EFFECTS ON PREGNANCIES, THE UNBORN FETUS AND THE NEWLY fiORN .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
x'a~e 16

There is no question - i .•L . , tbere is no controversy, that all
thes :: diseases occur in non-smokers and also did occur prior to the
widespread use of cigarette smoking . So, there are no really serious
clai.ms that cigarette smoking is THE, 3., e . , only cause for any or
for all these, diseases, even thotlF,h some of the more violent•, anti.-
tobacco advocates seem to claim differently, especially in front of
non-scientific audiences . Therefore, what the controversy or contro-
versies are all about is as to whether or not cigarette smoking is
the major cause or a major cause of al .l., of some, or most of these
diseases .
The rest of my discussion w ;.11 deal, of necessity all too
briefly, with some of the aspects of a few of these diseases .
Fxcept that toward the end, again very briefly, I wi :l al.so discuss
some of the components of cigarette smoke .
VIx . _ASSOCIATION ANU~CAUSATION_ XN I-iU ."1AN llTS.F_.ASES ~- nEFINXTIONS s
DIFFXCUITTES,wAND _;:ALI.AC7FS .
Now, we will discuss why the allegations that smoking causes
certain diseases are unproven . Therefore, we have to have a clear
notion on what conditions are necessary to establish an unequivocal
cause and effect relationship between a "cause" and its effect, as
manifested by a disease . 7n a ve~~ much oversimplified manner,
two conditions are necessary ; and .i.t is absolutely i .mperative and
axiomatic that ROTH conditions are fuif:illed . Or to put it dif-
ferently, one of these conditions is not enough : 1) There must
be an unequivocal. epictemi.ologicaXl l ink, i, e . , associa tion, between
the alleged cause and the more or less widespread occurrence of the
disease . llowever., in anci by itself, an epi .demiologieal link i .s
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 17

i
only just that - a link - or an asaoc3 .ation, and by itself can, never
prove correlation or causation . 2) What i.s equally necessary is to
uncover the biological pathway or mechanism through which the alle ged
cause produces the disease, either In man or in a sui .table animal
niodel. . No satisfactory mechanism has been described for any disease
alleged to be associated wi.th smoking . Nobody knows the causes of
cancer or of heart disease, etc . This is one of the major reasons
why the allegations against srnoking are controversial .
Why is it that an epidemiological association does not and
can never prove a cause and effect relationship? It is essentially
because there are at least three alternatives to the allegations
that any activity ; such as smoking, is the major cause, or one of
a number`of causes of a disease, such as lung cancer : V1 : The
association may be pvrely coincidental . #2 : Both the alleged
cause and the disease may be due to a conunon factor, e .g ., heredity
or psychological prof.iles,causi.ng both the disease and the smoking .
f3 : The disease may be the primary factor and the .alleged cause
the secondary factor, i .e ., the presence of a certain disease
causes a person to smoke .
In the past, there have• been many statistical associations
which were firmly, but falsely, believed by most : medical sci.enti.sts,
at that time, to be causal . . For example, it was shown that .scurvy
occurred chiefly in people who ate meat salted for the purpose of
preservation . It- was, therefore, believed that such salty meat
was the cause of scurvy . Now we know better . We know it was nnt
the salty meat that these people ate that was thee cause of scurvy,
but a lack in their diet ox fr: sh vegetables zand fruit and other
sources of vitzimi .n C .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 18
.
i

,.~~ \, .
.
.
A second example - at one tin~e it was "stati.sti.cally proven",
that a}alaria came from the so-called "night air" of swampy areas .
. The very name of the disease shows that : malaria means "inala aria",
two Italian words which mean bad .3ir . Today we unequivocally know
better . We know that malaria i.s' caused by the pre .;ence of a para-
site in the red blood cells transmitted to man by mosquitoes .
' In general, it can be said that today the problems of the
cause and effect relationships have been solved for most diseases
similar to malaria, which is just one of the many infectious
diseases, and most diseases, such as scurvy, which is just one of
many nutritional deficiency diseases . Also, most such diseases
are now curable .
Therefore, these conquests of medical science have had the
fortunate effect, especially since the end of World War Xl', that
deaths due to such diseases have been radically diminished, both
in absolute numbers, as well as - to an even larger extent - as
percentages of "total mortality", i .e ., the sum of all deaths .
This obviously means, just by pure arithmeti .c, that the percentagcs
of the total mortality of the Incurable chronic diseases have
increased . These percentages are further increased, because people
die older, thanks to the conquest of these i .nfectioas and deficiency
• diseases ; most of the cnroni .c di sease fatalities and "new cases"
only occur in older peo, :le . *I:n the WesterhWorld at l east, most
people die from diseases, niany of which are the chronic diseases,
which have .been alleged to be associated with smoking .
linny scientists, even medical sci entists, have continued to
postulate the sarie relatively simple rriechani snis for these chronic
http://legacy.library.ucsf.edu/tid/amu69d00/pdf

i
diseases that had been proven for the infectious and deficiency
c1Lscases . However, this is almost surely wrong, because these
chronic diseases have r.uch much more, and currently often inex-
tricab:y, complex cause and effect rel .ati .on ships . Wi.th most
infectious and deficiency diseases there i_s one, and only one,
causal factor, and the effect, i . .e ., the disease, ~1l .ways occurs
whenever conditions are favorable, i . .-e ., the .patient's defenses
are weak, etc .
Also, •the time span beween the occurrence of the "cause"
in the,patient and the occurrence of the disease is short, a
few days or weeks or months, or at most a handful of years . on
the contrary, the factors involved in the chronic diseases are
multiple . They interact, etc . Many factors are net known . xn
addi_tion, they take many years, often decades or more, to mature .
Attempts to determine causes involves the use of very sophisticated
mathematical techniques or are often impossible with our current
knowledge . The gap in level of necessary sophistication between
determining the etiology of a di .sease like tuberculosis on the one
hand, and lung cancer on the other hand, is much wider than the
gap in level of sophistication between understanding one of the
principles of Archimedes, i . .e ., leverage on the one hand, and
Einstein's atomic physics on the other hand .
VIXY . STATISTICS 0'rl SMOKTNG_ AND HEALTH_- LUNG CANCER AND GENF :RAI.
MORTALITY .
1. . Generai Connients .
"The case against smoking is based almost entirely on references
•frUm stat :i.stics", (9) . Thi squote from the latest (1974) vpamphlet,
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 20
6

published by the Tobacco Institute, trade associ .ation of the U . S .
(, :Earette Industry, states a trui sr,i. Therefore, the .1rl;uments pro
and con must ptand or fall on the issuo. of statistics .
2 . General ?det:hodolo8i .ca1 tWc_aknesses and Lack of RePresenta- .
tiveness of the Most Tmportant Stati.stical . Studies .
The statistical arguments against smoking are largely basec: on
7-8 large so-called "prospective" stuqies, evaluated in the 1964
Surgeon General's Report . The first such study, published by Doll,
dealt with British doctors (10) . It is to this date stil7l thf:
second most importani: one . Three others involved AmeYican (11)(12),
or Canadian (13) veterans, another involved California men (14)
subject to higher than usual alleged occupational risks of developing
lung cancer . All these share a serious shortcoming - the populations
ar.e highly selected and do not represent the population at large .
Other studies were purposely designed - albeit unsuccessfully, as
shoWn below - t.o be more representative . These include the two
studies of American men and women,, directed tinder the aegis .of the
American Cancer Society - and specifically one of its vice-presiuents,
Dr, Cliyler Nammond (15) (16) . The second Anteri_c .n Cancer Society study
cited is probably the most important of all, because it is a pros-
pective study involving about a million people• (16) . There is also
a large sc.ale Japanese . study, which is difficult to evaluate, because
only very little has been published in scientific journals, in
sufficient detail for it to be properly scrutini .zed . Most of the
data have only been presented at scientific meetings (e .g . 17) .
Since we can only briefly discuss these 3_nvest:igatAons, we
must confine ourselves to the big Hammond study involving about a
n,il.lxon people ; and to the Doll study .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 21

.
h
<
Regarding all these st .~t,ist•ics, even the 1964 Surgeon General .'s
l:eiyort conceded "they vary also in the extent to which they are free
from methodological weakness" (18) . In other words, they alll have
methodological weaknesses, it is only the degree of weakness which
is different . Further on the Surgeon Gens:ral's Report says : "i .n
nl.l. studies, death rates forr non-smokers are markedly below those
of U . S . wt,itG males in 1960 . Even the smokers of one pack of cigar-
ettes or more dai .ly have death rates that average sl.ightly below the•
white male fi8ure" (19) . 1'hi.s is shown in the following table .
Table 4 . Age-Adjusted Death Rates per 1,000 Man-Years for Non-Smokers,
Study
British Doctors
Men in 9 States
U . S . Veterans
California
Occupational .
California Legio
Canadian Veteran .
Men in 25 States
3 . Ages 50-69
Smokers, (Cigarettes only - Age 35 ond over), by Amount
;;moked in Seven Studies and for U . S . White Males . (95)
Non-
Smokers
15 .8
114 .4
12 .0
Less than
]I pack
Current Smokers of
cigarettes only
1I pack
or more
23 .2
1 .2 7 .1.
23 .9
11.8.0
16 .3
24 .2
219 .2
U .S . White
Males, 1.96
22 .9
122 .6
22 .9
1 .22 .6
22 .9
22 .9
22 .9
2 . These figures may be too ]ow by about 1 .7 percent, since the person-
years used i.n the computati.on included some contribution by wen who
had not been fully traced .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
P .1~,['. 22
f.

In other words, following Ghe shaky logic of the Americam Cancer
Suci.ety, if you are an American mnl .e and want to live longer than
average and still enjoy smolcing one pack of cigarettes ox more per
clay, the thing to do is finagle somehow to get enrolled in one of
the Society's surveys .
3 . WeaZanesses and Paradoxes of the liamriiond Study .
The following figure shows how different the llammond popula :-
ti.on is as to age composition compared to the U . S . population at
large, which it is supposed to resemble . It is difficult to
imagine wider discxepanci-es . I:t is easy to see that there is a
colossal over-representation of men between 45 and about 59 ; as it
happens this is the age of peak incidence of lung cancer and other .•
allegedly smoking associated dzseases,(20) .
20
S
. AcS AkIts
0U.S. rm ;te ML$1
e U . S . 7n+ks
3S•39 l0-44 4S-49 50-54 SS•SO c0 e4 15•e1 70-71 7S•71 i0-IS
AGL
F3~ure.~3 . Y Comparzson of ACS and U . _ S ;_Populations : Percentage
Uistr.ibuti.on by
Age . (20~
The age distribution of ACS males in 1960 comes from Ha7rmiond .
Comparable figures for a population of U . S . males between the .
oFes of 35 and 85 were computed from tables given in the 1960
U . S.. cen ;;us report .
, PaFe 23
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
i

There is also a wide disqrepancy regarding the physicul
characterist-ics of the two populations as, for examp]e, the
following table shows, which describes the heights of these
two populations . Again, it is very difficult to imagine any
two populations which are more wi'dely different, (21) .
Table 5 . Comparison of the ACS (Ilanunond) and 11. S . PopuJ.ati.ons :
1'ercentage Distribution by Height . (21 )
xnche s
Population Under 66 66-67 68-69 70-71 Over 7 2
ACS- Males, 8 .57 18 .89 26 .37 29 .30 16 .8 7
Ages 45 - 7 9
U. S . Males 27 .57 36 . 67 2.6 . 29 13 . i4 5 .75
Ages45- 7 9
+ Figures for the U . S . population were derived from National Center
for Health Statistics .
One of the strongest objections that can be made against all
these statistical studies is, that, even though they deal with
diseases whict-, are knoitini to be associated with many, many factors,
they focus only on one element, namely smoking . Therefore, Dr .
Hammond, in"his study, tried to meet this criticism by studyin g
some other factors .
Let me just show you otle Hammond table, which deals with the effect of
the consumption of fried foods, (22) . Now, t,t,►is table r.eally 'proves'!,
that the more fried foods you eat, the longLer you ]i .ve . Asyyou cer► se e
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
1'age 24

t:his q11plies both tonon-s_»o{cers and to smokers .
7abl.e 6 . Age- Stanciard3.zed Death Rates pc:r 100,000 Man-Years for
Fried Food
Various Croups of Men, Aged 40-69 . Men who never Smoked
Regularly Compared with Men Currently Smoking .20 or more
Cigarettes a T)ay, at Time of Enrol .lment .e F;xcerpted from (22) .
Definiti.on of Subgroup
Never Smoked
Regularly
A8e-Srandard3.zed
Death Rate s
Cigarettes 20+a
day
None 1., 208 2,57 3
1-2 times a week 3,004 1,694
3-4 times a w. ek 642 1,?14
5-9 times a week 781 1,520
1 -15 times a week 722 l., 524
154- times a week 702 1,39 9
Now, if there is any one element in our daily diet which is
being castigated, as being suspect almost to the same extent as
swoking is castigated, it is fat consumption . People are urged
to reduce fat consumption to extend their lifespan, in the same
vein as they are urged to stop smoking ; or at least smoke onXy
low "tar" - ni_cotine cigarettes . Now, this clearl.y means - at
least to those who believe in the most cherished dogmas of con-
venti.onal medical wisdom - that eia .t:her result must be wrong, i .e .,
ei_ther,tbe conclusions of liarrinond regarding smoking are not valid,
or the implications regarding fat consumption are not valid .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
PaRe 25
~
0
a
N
~
N

Simi.lar plus addi.tion .,1 criti : isms could be levol.esl against al7l
other studies .
IX . TNI: RF;I .A'1'TON 13);7.WIa;N DIAGNOSTIC CRRORS AND TI)L D'r,GRI:r OF ALLEGED
7NC.Ri.AS), OF LUNG CANCI :R, WITN SOMI ; COMM1 ;NTS ON RT:CE-NT D):CRI?ASrS OI'
LUNG CANCER .
Now, another of the questionable and indispc .nsahle towlctations
of the srnoking-lung cancer hypothesi .s is the claim that there has been
a truly tremendous increase of lung cancer following the advent of
cigarette smoki_ng . Ilowever, this claim is very much subject to doubt,
because the correct diagnosis of lung canc-,r is very difficult and
was only feasible - by means other than autopsy - with any degree of
certainty, in comparatively recent years. •
There can be no doubt whatsoever - .?nd this is also generally
conceded by most knowledgeable scienti .sts' - that the increase in lung
cancFr has been greatly exaggerat :ed . Because of this lack of suitable
methods of diagnosis, l.ung cancer was mis-diagnosed as "consurnpt.ion",
or as tuberculosis, or some other respirat -,ry ailment., or pneu«ionia,,
or God knows what . The only point which is at dispute is the extent
of this mi .s-diagnosis, or the ext :ent: of this increase or the lack of
increase . I can only refer you here, among numerous other examples,
to the many publications by the late Dr . Uosenblatt of Ncw York
Medical Col.lege and Nr•a Yor k C,1_t_y's Doctors Nospi .tnl, (?.3 .. .
This problem still prevails even today . Lung cancer, i.n the
most up-to-date medical. centers of the United States and Europe, for
example - if it occurs in non-smokers, i_s not searched for di_af ;nos-• .
ti.cal .].y at all., or to a much lesser extent than in smokers . This
was indicated, for example, in 3_974, by Dr . Feinstci .n of Yale
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
1'£1 ge 26

University, in connection wh nc cases later found to have lung cancer
at two New Haven hospitals, (21s) (25) . The following table sunmari.zes
his data .
Table 7 . Cigarette Smoking and Non-pre--wor tem hiagnosis in Patients
with Lung Cancer at Necropsy . (25)
Amount of
Cigarette
Smoking
Rate of
Non-Ui_agnosi.s
Tniring Life
Unknown 16/43 (37°l,)
None 17/45 (38%)
Light
(!1/2 ppd)* 8/ 41 (20%)
Moderate
(71/2 'Ca I pPd) 28/203 (14%)
2teavy
( :;-1 :5~ 2 ppd) 24/241 (10%)
Extreme
( ~ 2 ppd) 9/81 (11%)
TOTAL 102/654 (16%)
~ ppd - packs per day
Another example - as recent as 1971 - this time from Europe - at
no less prestigious an institution as one of the oldest universities
in the world, the Psithological Anatomic Institute of the University
of Vienna, it was shown that almost 50% of all lung cancer was mis-
diagnosed - 507, or 205 missed diagnoses, out of a total of 414 . Of
t:h4se, in 122 cases there was lung cancer, but it was not diagnosed
during t.hc lifetime of the victims, (26) . The table on the following
page has been excerpted from that paper .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf

.
University, in connection -t,ith
nt two New llaven hospitals,
his data .
Table 7 . Cigarette Smoki ::8
with Lung Cancer at Necropsy . (25)
Amount of
Cigarette
Smoking
Unknown
None
Light
(! 1/2 ppd)*
Moderate
(>-1/2 -4 1 ppcd)
lIeavy
( ;;-1 ~ 2 ppd)
Extreme
(>- 2 .PPd)
TOTAL
~ ppd - packs per day
cases later found to have 1un8 cancei
(24)(25) . 1he following table summarizes
and .Non-pre-mortem Diagnosis in Patients
Rate of
Non- Di.af;nosis
1)urin8 Life
16/43 (37%)
17/45 (38%)
8/41 (20%)
. 28/203 (i4%)
24/241 (1 .0%)
9:/81 . (11%)
102/654 (16°l0)
Anot:her example - as recent as 1971 - this time from Europe - at
no less prestigious an institution as one of the oldest universities
xn the world, the Pathological Anatomic Institute of the University
of Vienna, it wF~s shown that almost 50% of all lung cancer was mis-
diagnosed - 507., or 205 missed diagnoses, out of a total of 414 . Of
these, in 1.22 cases there was lung cancer, but it was not diagnosed
during the lifetime of the victims, (26) . The table on the following
page. has been excerpted i:rbtn that: paper .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page ^00

Table 8 . Incidence and Site oi pi .ignosed nnd Undinl;tiosed Carci.nomas
(Translated and Excerpted from (26) )
.. .... ... .._•,..-. .. .~ .~. ..- .. ......_~ . .~_. ..~... ...,. . _ .. .... .~.. . ~ . ~.-~ w _...... ... .. . ...~,..~ ~.._.._
Organ
W- --- _ - -_.
Adrenal
Liver
;Gallbladder,and biliary tract
i
Pancreas
Large intestine
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lung ;
. . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . .
Etc .,
Urinary bladder and urinary tract
Etc .
Esoph?gus
Etc .
Larynx
Pharynx
Etc .
1"otal
xn 1955, Gzlli_am, a scientist of the U . S . National Cancer
lnsti.tute, (27, see also 2.8),stated : "lf as few as 27. of the
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Yage 28
~
1+
N
u a
.~ ..
LJ ~
4l N
U O
A1 ~ Cn
4,9
Ip U Gi
61
50 •
68
15
49
• 44
63
14
2
52
88
92
94
. . . . . .
50,0
. . . . . . . . .
205 49 .5
. . . . . . . . . . . . . . .
12
6
5
1
(100,0)
(80,0)
66,1
64,3
(1916)
(12,0) .
2701 188~ 814 30,2
I '

deaths in persons 35 years of age and older, that were attri.boted
to other respiratory diGeases, were in fact due to cancer of the
lung, the recorded increase in white males since 1914 woula be
fourfold instead of twenty-six fold" . Now, there is very little
question that in the pn .,st the errorr in diagnosis was many tLmes
2% . Dr . Gi.lliam, in his paper, personally,conc] .uded that there
~~as a real incr.ease in lung cancer, because lie assumed that the
diagnostic error rta3 not large . He also stated : " . . . unless it
can be showm that errors in di.agnosing lung cancer as other res-
piratory diseases, occurred more frequently iii niales than in females
and more frequently in the older than in the younger age groups, al .ll
of the recorded increase between 1914 and 1950 cannot be attributed
to faul ty certification of deaths" . In my judgment - and it is
only a judgment - it is probable that these conditions did prevail,
becausce lung cancer occurs much more frequently in males than in
females, therefore, in the~past, the diagnostic error was proba-
bly greater ; also, lung cancer occurs much more frequently in older
people than iin younger people, so again, in the zst, the diagnos-
tic error could very' possibly have been greater .
In conclusion, it is almost certain that the increase in lung
• cancer is much less than claimed . There is at least the possibility
` that it is spurious altogether .
You probably have heard or read in the "media" in tecent weeks,
that lung cancer is decreasing, at least in men, or that at least
the rate of increase has been decreasing . Now, th3.s hng been
attributed by oui adversaries to the increasing use of filter tip
cigare.tt:es and other cigarettes with lowered "tar" and nicotine .
, .- .

llowever, these decre.ase :, wcru'prectictecd more than 20 years ago,
w.~en these technological and markc~tinp, dc~velopn,ents could not be
anticipated . One of these predictions was made by the same Dr .
Gil.liam, whom we have just discussed, (28) . The same decrease
was predicted by Dr . Lees of Great Britain, based Jn different
considerations . Dr . Lees has developed the "wave theory of cancer
incidence" . Iiis thr.sis is that the secular ticend of each cancer .•
rises and falls in a predictable wave, .the rise and fall affecting
the youngest ages and then working through to the oldest . .When the
wave i.s risi_ng, the numbers at the younger ages predominate and
thc average age at death in a single year . is low . As the cancer
wave goes over its peak, the converse become true, (29) . We shall
come back to the hees theory later on when we will discuss "peak
xncidence" .
X .SOME OTHER PARADOXES ON LUNG CANCER .
There are many other paradoxes which do not jibe with the
simplistic allegation that cigarette smoking causes lung cancer .
xn the interest of brevity, we can merely enumerate a few of these
paradoxes, without discussing them in any detail .
Forr example, there is lack of correlation between the inci-
dence of lung cancer in various coum tries throughout the world
and the per capita consumption of cigarettes . For example, lung
cancer incidence is highest in England and Scotland, and much
lower in the U . S . ,but per capita cigarette consumption in the
United St.ates is far higher than in Great Britain . Similar
discrepancies occur from other cou2ttries, such as for exaizipl .e,
Sweden and Norway, Austria, etc . I am citing rn17.y one iecent
study, and it has been selected because Dolll is one of the authors,
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page '0 0
~
N
N ~
N
_J

(30) . }lowever, ar-_ny oth-,r old and recent references could be
]i.sted .
Another anomaly : since the smoke travels through the rest
of the respi r. .ztory system before reaching the lung, one would
expect, that there should be similar increased incidences in can-
cersof the pharynx, larynx, trachea, etc . }lowever., this is not
the case . Ume would also expect lung cancer to occur in both
lungs, however, this again is not the case and lung cancer occurs
only in one lung . Cases of ]ung cancer in both lungs or the
trachea are extremely rare, (31) .
One would also expect that the age of peak incidence of
lung cancei would occur earl-ierr in smokers and earliest in the
most heavy smokers . Nowever, this is nc', the case, and the peak
age of incidence occurs at the same age, r.egardless whether we
have lvng cancer in smokers or in non-smokers, and is also inde-
pendenL of the amount smoked and the starting age of smoking .
Since, except for the last :.,few years, the antount of cigarette
smoking has increased and the starting age of smoking has decreased,
one would expect that the peak incidence age would decrease, however,
the exact opposite is the case, i .e ., the peak•age of incidence has
i.ncreased, i .e ., people get lung cancer at an older age than ten
years ago, . (32) (33) . •
This argument regarding peak incidence age is all the more
striking, because in some lung cancers,which have been alleged to
"be,associated with industr i_al exposures, this peak age does not
occur at`.yearlier ages ; this was ::hown, among others, by }tuc :per, (34) .
,
Agai_n; this was •also predi_cted by Lees on the basis of his
cancer wavc- theory, which states that each cancer rises and falls
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 31
i

., .
in a predictable wave over a•peri.od of many years, (35) (36) .
/
Some, but certainly not all, of the statistical studies also
show some anomalies regarding inhalation . For example, the famous
study by Do13l showed that smokers who inhal .ed had lower i.ncidences
than non-i.nhal.ers, (37), this was confirmed in a La1l . paper pub-
Xi.shed as recently as December 25, 1976 (37a) . Some'simil.ar ].a--k
of correlations were found in at : least two other studies, and
commenting on .thi.s, the 1.964 Surgeon General.'s Report stated :
" . ., there is no immediate expl .anai:i_on for this apparent discre-
pancy", pancy", (38) . These brave words were published in January of 1964,
now more than 13 years later we are still waitinb for this "immedi-
ate explanation" .
As mentioned, additional paradoxes cou] .d be
what we have said wil .l. have to suffice .
discussed, but•
X1 . SOME LIMITED COMMENTS ON STATISTICAL DATA ON CHRONT_C_ RESPIRATORY
DISEASES ANl) HEART AND RF.LATF.D DZSF.ASES :
The arguments against'al7 .eged causal relationship.between
cigarette smoking and chronic respiratory diseases are as strong
or weak - whichever one's point of view - as those against lung
cancer .
On the chronic respiratory diseases, I wil .7ft only, more or less
at random,•cite as examptes, two papers among many studies and argu-
nvants which could be discussed . One shows (39), that it is totally
tnijustified to claim that emphysema, is a new disease, which concurred
with the advent: of cigarette smoking . The same paper also shows that
the alleged increase of emphysema may welll be an artifact due to
earlier faulty dis ati;noses and for other reasons, (39) . The sec ond
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 32 %D
ro ~
:
• ,~~

example is a study which c'. ; :n}r,nst:ratas the strong genetic collst'it :u-
t•9.ont,1 impact on these chronic respiratory di .seises, (40) .
Coronary•heart disease and other diseases of the cir-culatory
system are the greatest cause of mortality, at least in the Western
World . There is a general concensus that these diseases are multi-
factorial, which means that there are a great many fictors which
allegedly affect or may affect or are in some way associated with
their occurrence and outcome . 1'tie factors are called "risk factors" .
Depending on definitions, there are, at l .east, a dozen such alleged
risk factors, including smoking .
One of the many striking arguments, wlui_ch can be made against
the alleged causal association between coronary heart disease and
smoking, has bee:1 stated, •only about a year ago, by H . 1: . Russek, . .
one of the most famous U. S . cardiologists, (1f1) : "At the present
time throughout the world, there is wide accc:ptance of the view
that high cholesterol, elevated blood pressure, and cigarette smoking
are the most importart risk factors in the etiology of coronary
heart disease . Largely unquestioned, however, has been the repeated
finding that these factors are completely absent in more than half
of alll the new cases of coronary heart disease'encountered in
clinical practice ." Quoting further from that same very recent
study : "For example, although more than 100,000 American physicians
have allegedly given up smoking and no segment of our society is
more aware of the potential dangers of hypercholesterolemia and
hypertension than are members of the medical profession, there has
been no significant change either i .n l ongevi ty or in average age
at death from coronary heart disease an-,ong doctors in the Ui.it.ed
St-ates over the past 20 years (Table I) ." Vae table on the fol-
?owing page has been taken from that study, (41) . . .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf

Table 9 . Deaths iii U . S . r'h~,sicx .nns (JAMA) (41)
Jan .-
April
Jan .-
April
Jan .-
April
--- -_.~.. . . .~.... .~.. . ._..
Jan .- Jan .-
April Apri.l.
1955 1965 1967 7_970 1974
_~_~_. _ _ . . _ . ..~ .. ._. _ .~.
Average age at death 69 .6 68 .9 69 .6 67 .2 ~ 68 .4
Average age, coronary
deaths only (70 years 61 .0 60 .8 60 .6 - 59.4 60 .5
Total number of deaths . 1,148 7_ y 091 13,251 1_, 01;5 ] .,159
.
Its another example, of many, studies that show that smoking does not
cause chronic: heart disease, I shall again, more or less at rundom,
cite the very important study, conducted under the aegis of the
American Neart Association, and directed by A . Keys of the University
of Tii.nnesota, compari.ng coronary heart disease in seven count .ries, •
involving almost 13,000 men . Tt showed no relationship between
cigarette smoking and coronary heart disease, (!F2) . Keys concluded
.Lhat : "Cigarette smoking cannot be involved as an explanation" and
documented that statement by the figure on the next page, which is
reproduced from that study .
Figure J . Percentage of }icn in the Keys' American Neu•t A .csocizt9.on Study,
}te~~?1z~•]y Srinlc:ng at Lcast ]0 CiVlret .tes Xveiy Day .
The l.e"'gths of the narrow solid bars are proporti .onal to the qge-
standzrdized CIID incidence xates ~~mong n-ien .Citp_free tit entry .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
~~~
,

©
.. ' ~ ,
Ci_guxe 6. M.LN 4D•59. '!. StAGttlrlG > 11.) CIGr3tElTCS/ MY
•.1 . . ...,.-7 .r- ..._. ~, f'^'
1 = i r' ., y:. . .......~ ... .-.•. . ...y. .... . . . . .-• ~
:- .:J
59'4,JAPAN
GREECE
Q9'G, YUGOSLAV.A
~A3•/., 1TAL'1
4•1'L, NfTHFRLANCS
.-151'!. US RY
•rn~ ~.~. .• .~• : v. .~ N ..,~~wav ..,~;t`' .•^_'F;.S
. • :.w4~b
tM--•W.1;SCk 1D BARS 5t10\Y CIiD 1`CiD•'cNCE RATE
In my judgment, Ci.galette smo'tCing, ~~hicli is t1 :J :>O4J .Aa}4d sta~ :st~r~~.ly
wi.t'a these cardiovascular diseases, is .a symptom ratherr than a
cause, and let me also remind, you once again, that association does
' not mean causation .
31
There are a great many other uncertainties regarding cardio-
vascul.ar risk factors . For exainple, the overc•ffielminb majority of
the medzca7. estab].ishment believes, that cholesteroll is one of the
rrzai_n culprits . . However, there are some very serious objections
against that particular do8ma, as was, for example, pointed out a
f~,.w weeks ago by Dr . McMi chael of University Co7 .lege Hospzta]., .
•hondon, and in the studi_es czted by him, (43) . Other conclusions
questioning the traditional cholest-eroll dogma, have been reported
.•_ _• . .
I
(i.n the New York Times of January 18, 1977, (43a) .
X1X . THE ALTCI:N/1TxVI: I,tPT.ANATION - 'i11F. CONSTxTUT'70NAT, HYPOTIIESTS .
I have reported that the statists_cal_ studies show an association
between cigarette smoking and ) .un8 cancer, etc . 11gain. I stress that
association does• not meai: causntionr I have .-elso reported that the
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
. pr, ge 35
ti
.

associations show many weahnesses . Nevertheless, these associati ons
tre consistent, and they are reported from most of the populations
studied . They simply cannot be i.gnored, because there are too many
studies .
When I discussed above why an association betweer. an alleged
cause and a disease does not mean causation, I mentioned the alter-
native that both the alleged ca•asation and the disease may be due
to a common causal factor, possibly psychological or biological,
which would cause both smoking and the disease . This explanation
is whit is called the constitutional. hypothesis . The cor.stitu-
tiona7l bypothesis is based, •umong other reasons and findings, on
a great deal of evidence suggesting that smokers are different in :
many important x•espects from non-smokers . liowever, a few brief
examples have to suffice .
Smokers generally are more communicative . They are more
creative than non-smokers - more energetic, (44), more volatile ;
(45) . They drink more black coffee and l•iquor, (46) . They,
marry more often, (47) . They prefer spicy or salty foods in
preference to blander uiets, (48) . They participate in more
sports, (49) . They change jobs more often, (50), evidencing,
perhaps, what one researcher has described as the smokers' search
, "for aims and purposes",
As children, they were more independent, (52) . As adults they
are more outgoi_ng, (53) . They differ in family background as well .
They are more likely to have parents with heart disease and hyper.-
teasion, (54) .
The constitutional hypothesis suggests, that these differences
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 36

include, as one vital di£ference, a greater propensity on the part
of some smokers to suffer from di .seases with which sii,oki.ng is nsso-
ciated, regardless of smoking habit . Stated differently, the
consti.t-utional hypothesis postulates that many of the people who
have a genetic, :L .e . her.edi ..tary, predisposition towards acquiring
these diseases also have a propensity to want to smoke, but these
people acquire, or are prone to acquire, the disease regardless
of whether they smoke or not . Stated as its briefest, this hypo-
thesis says : "Tt is the smoker and not the smotci .i~" .
Dr . Yerushal.my, whose work I will be discussing very shortly,
used almost these very words in his concl .usions on his pregnancy
studies, (55) . He concluded : " . ., the evidence appears to support
the hypothesis that the higher incidence of low-birth-weight infar .ts
is due to the smoker, not the smoki_ng" .
Please remember, that I have not said that al l_ smoker. s, *or even
all heavy smoker•s-, have this propensity to take sick with one or .
more of the diseases with iahi .c,1 smoking has been associated . In
other words, most smokers do not die "too ear7 .y" from allegedly
"smoking related" causes .
There is a great deal of evidence, that straight genetic pre-
disposition is involved for a11l the important aiseases allegedly
associated . with sinoki .ng . The references on this are simply too
many to even cite selectively . I shall ., therefore, mention only
tvro authors providing evidence for genetic. factors in lung cancer,
I3urch and Tokuhata, (56)(57) .
In qui_t-e arother field, the iate Dr . Yerushaimy from the
lhiiversity of Califer•nia and the Kaiser Foundat.ion Research
xnsti tute, -,?orki_ng on the rel .at•ionshi_p of mothers' ci_garci:te
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
j
.r
. Ii .
FL
~' .
t
~
~
~!.
. ;t
cn t i
n~ ;t
F.~ge 37 ~ ~
s f
,• : .
t~

smoking and the 1ow-birth-weight of infants, founcl that the incidence
of: 5.ow-birth-wei.ght infants born to future smokers during the period
before they started to smoke is as high as the incidence for infants
of n:others all of whose pregnancies occurrc~d during periods of
smoking . The incidence of low-bi.rth-weight for infants born to
future smokers during periods before they started to smoke was
significantly higher than that of i .n.fznts of mothers who never
smoked . Striking also was the finding that i~ast• smokers during the
period before they quit smoking gave birth to relatively few low-
birth-weight infants . The i .ncid .-~nce was significantly lower than
for infants whose mothers smoked during all the pregnancies . There-
fore, even while they smoked, women who subsequently quit smoking
differed in their reproductive experiencu from continuous smokers .
(58, see also e .g . 59). "
Additione?, powerful evidence for the constitutional hypothesis
has come from a whole series of twin studies . Let me recall that
identical twins have ori_gi.nated from one egg cell ., i .e ., they have
in all .points common genetic make-up ; while non-identical twins,
which have originated from two eggs, are genetically just as dissimi .-
lax as brothers and sisters in general . For e:kample, several workcrs
have .i.ndependently assembled data showing thaf identical twins more
frequently have the same smoking habits as have non-identical twins,
(e .g . 60, 61, 62., 62a) . Some evidence of a genetic basis for the '
smoking habi.t has also come from non-twin studies of some biological
parameters, (e .g . 62b, c) d) .
Other studies reported arn excess mortality among smo,cing dis-
cordant non-i.de,iti_cal twins . However, no simi.larr excess was found
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 38
I

ir, identical twins . This was, found, for er.amPle, by F1 ;iberg, (63) .
Similar results were reported by Lundmnn, (64), and by Liljefors,
(65), and by Do Faire, (66) .
Commenting on alll these findings, Do Faire stated : "It mly
well be that cigarette smoking only rc,*fl .ects a certain constitution
and that smokers and non-smokers are self-selected groups ." (66)
Some quite di.fferent evidence for the inheritance of the desire
to smoke was reported a few months ago under t.he title : "Re]ation
of parent:al'hi_st-ory of coronary heart disease to risk factors in
young adults . The Framingham Offspring Study," as follows : "Com-
pared to mal,~ offspring of those without CiiD, a significantly
hi.ghcr proportion of male offspring of young C1ID victims smoked
cigarettes . This excess occurred independently of the age of the
offspring and detpite the offspring's apparent knowledge of his
father's coronary event ." (67)
In my oini judgment at least, the constitutional hypothesis
does not require genetic mechanisms in Che strict scientific sense
of that term . . Tt can also involve psychological or psychosomatic
predispositio:ls which are well set in a person's early life, very
rnuch pzi or to 'the onset of smoking .
At this point, a cautionary note might be worth making . A
more or less reasonable argument can be put forth against many of
the paradoxes and fallacies, which I have, and will . be, citing
against the alleged casua' hypotheses . However, in a very impor-
tant respect, it is the multipl^icity of these fallacies, which
make the smcking ar:d health controversy a controversy .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 39

XI X x . I1NIiMAL 1?XPT:1t7MENTS . •
1 . General . Comment . :; .
Except for epi.demi .ol.ogical statistics, animall studies are
most fr.equently ci .ted by those who allege that there are cause
and effect relationships between cigarette smoking ancd lung can-
cer or other diseases .
But, it is a fact that, in spitc : of hundreds and hundreds .
of experiments and millions of doll .ar.s of expendit-ures, nobody
has been able to produce these diseases, in forms analogous to
human diseases, experimentally in animals, using cigarette smoke
iti a manner reasonably simulating human smoking, with respect to
quality and quantity . Because of 'Lhe need for brevity, we can
only discuss, and very cursorily at that., what is called cancero-•
€enesis, i .e ., the production of cancer in anima] .s .
?. . Skin Pai_ntin-8--
T.et us first examine skin painting experiments . Xn,these
experiments, cigarette "tar" - about which more l .ater - is
painted onto the shaved skins of mice or other rodents . There
it has been appropriately said that these experiments involve the
app:lication of "the wrong inaterial, i.n the wrong form, in the wrong
concentration, to the wrong tissue, or the wrong animal ." The
"wr.ong materi.al" which is used is "tar" or "smoke condensate",
which is nothing which the smoker smokes, but an artifact, as we
shalll describe below when we will be brie~ly discussing ingredients .
"Xn the wrong concentration" : i_t has been calcul.ated that the
afi oUllts of tobacco "tar" used correspond to a dail .y (! ) human
consumption of about 50 to 100 thousand cigarettes . The "wrong
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 40

Cissue", because the "t :ar" is applied not onto the respiratory
tissue, but to the skin of mice and othcx• rodents .
3 . ~ The S^~oki.n~ Iicarles .
11owever, the most notorious work is that of the so-called
smoking beagles . This is now large] .y discredited and only •rarely
ci.t-ed, even by its authors, Auerbach, iianuuond and others, and
their sponsors, the American Cancer ' Society . It would have been
very easy to devote al.l or at least half of my "allotment" to
the cri.ti ..que of the Auerbach study, but a few highlights will
have to suffice .
The data were first not announced in the customary manner,
which is in a sciontifxc journal or in a scientifi .c meeting where
such findings are submitted by the autilor.s to the scrutiny of
their scientific peers . But they were announced in a press con-
ference and in a news release i n February, 1970, (68) .
• Subsequently, the manuscript was submitted to two prestigious
medical journals but both refused to publish it . The second journal
had gone to great lengths and had asked 18 expert reviewers for
their opinion and 17 recommended a~ainst publishing it . Finally,
almost a year after the initial" news release, agreatl .y chan&ed manu-
,
script was accepted within a few days, in a journal where, inter-
est3.ngly enough, one of the authors of the study served on the .
editorial board, (69) .
7.'he beag7 es did not smoke through their oral . cavity, but the
ci_Farette was inser.tc,d, through a ; urgical operation, directly below
the heaci in±o the trachea . In other words, the upper respiratory
system, whex-e .a substant-i.a1 part of the smoke is absorbed in man,
was by-passed by those dogs .
Page 41
A I
http://legacy.library.ucsf.edu/tid/amu69d00/pdf

Also, some very emi.n-nnt pathologists have strongly questi .onod
whether the lesiona proJuced •Ln the lungs of these dogs were really
comparable to human lung cancer as claimed .
There was further very justified criticism that the controll
animals used in these experiments were inadequate . For example,
there were no sharn-~smoking dogs, i .e ., there were no dogs subjected
to the same treatment as smoking dogs, but withouC exposure to
cigarette smoke .
There was also an unusually high incidence of tumors, though
not of tumors claimed to resemble human lung cancers, in al1. of those
dogs, including 25% .of the dogs nbt exposed to smoke at all .
Also, shortly after the original results were announced, the
Tobacco Institute,i_n this country,asked the data to be submitted
for an impartial review by a panel of independent scientists .
IIowever, the American Cancer Society steadfastly refused, and
stated that they would submit the dat :a neither to a committee
chosen by the Tobacco Instittrte nor to any other groups, (70)(71) .
Al.so, at the time of'publ_ication the authors promised that
fur-therr data on lung cancers in the surviving beagles would be
forthcoming, but to date, almost seven years after the initial
announcement, these have not been paba-i_sred - at 1, :~ast not to my
knowledge .
4 . 1,i.fespan_Ext:ending~Effect~of Cigarette Smoking _on Iiamsters .
Scientists from - of al.l. places - the Research I :nstitut.e of
the German Cigaret-te Industry have claimed to have produced cancers
in the larynx -- but not the ]ungs - of hamsters inhaling cigarette
smoke . Althout,h they started with about Ii,000 ~ :nin-1als, they pro-
duced only a handful of hamsters with changes in th :- larynx, whi.ch
they c1ai.-med to be carcerous, (72) ; howev.er, other scientists
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
1?a ~e ~i 2
U
a
G
0~
N

s:
disagreed with their intc,cpretations . Ilere again, the nmounts of
smoke i.nvolved were equivalent to several thousand cigarettes per
day in a man . But also, in my judgment, the hamsters larynxes were
not really exposed to smoke, but were exposed to something identi-
cal or very similar to "tar", because of the inevitable heavy
condens.ation of the inhaled smoke within the very narrow confines
of the hamster larynx . The very fact that the findings were Yiot
publ i.ci xed by the anti-smoking lobby in the U . S ., neither when
the data were published here in 1973 in the Journal of the Nati_onal
.Cancer Xnstitute (72),nor before, is additional evidence of the
very limited significance of these experiments .
However, there are also other experiments which show opposite
results . Recently, one of the most prestigious American scientific
institutes, i .e ., the Battel_le Institute, ha, published some data of
experiments, which were not in any way financed by the U . S . Tobacco
industry, but on. the contrary, were paid for by the U . S . Govern-
ment, (73) . These experiments showed that hamsters i_nhaling
cigarette swoke lived significantly lo~er than hamsters which did
not smoke . Futhermore, for sham-smoking hamsters, i .e ., hamsters
which were subjected to the same smoking procedures as a smoking
hamster, but without cigarettes, the longevity was intermediate .
Now, . in i-ay judgment, these Battelle experiments have ; from the
point of view of human smoking, as little - or as niuch - validity
as the skin painted mice or the smoking beagles . However, there
is an American exp3-essi_on that says : "what is sauce for the goose is
sause for the gander ." Let us adopt for the sake of argument the
shaky logic of i :1ie anCi_-ci.garette scientist:s t:ho cl.aim, on the
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 43
t

,
basis of producing skin cancer by paintini ; the backs of mice with
robacco "tar", that cigarettes are dangerous to our health . By
the sarne k9.nd,o£ logic, one could claim that one should smoke
cigarettes because they make you live longer .
The need, for brevit :y makes it impossible to eren discuss
animal experiments related to heart disease, chroni .c-respiratory
di.sease, etc ., except to state that the short-comings and failures
in these areas are even greater than for cancer .
Talking about carcinogenesis experiments with tobacco smoke,
the Surgeon General's Report states : " . . . the results of a number
of such assays present a pu .zli_ng anomaly", and, a few paragraphs
later the i eport states : " . . . assessment of al]l conceivable syner-
gistic effects presents a gi .ganti c problem for exploration", (74) .
7.'hese words are still true today .
XXV. SMOKE CONSTITUENTS
Before closing, a few words need to be said about smoke
constituents and their alleged involvement in the diseases associated
with smoking .
l . "Tar" .
Let us first review what is fal seXy called "tar" or "smoke
condensate" . This is a complete artifact which no smoker smokes .
It is applied in animal experiments after i .t has been collected
isi a cold trap by condensation of cigarette smoke at extremely low
temperatures ; it is rather obvious that no smoker smokes in that
fashion .
Tables on "tar" and nicotine are published in the U . S . and
in other countri .es . 7n these cases, "tar" mea ;is the "total parti--
cul.ate matter", which in the natural cigarette smoke strearn is
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 'f4
O
O
P
N

t ,
carried as fine particles ii : suspenvion ; it is then collected on
p fil :.~er as a dense precipitate, or in some countries on an
electrostatic precipitator . Here again no smoker ever experiences
it in that form .
2 . Nicotine .
Regarding nicotine, I shall be happy to confine mysel .f•to
Quate from the Surgeon General's Report : " . . . the cha-onic toxf .-
ci.ty of nicotine in auanti.ties absorbed fro:n smoking .and other
methods of tobacco use is very low and probably does not repre-
::ent a si gnificant heal th pcoble :n",(75) . Nothi ng has happened
since 1964, which would induce one to alter that evaluation .
For example, in a paper pub] ..ished a few weeks ago, on Pecember
17, 1976, Dr . Gori of the National Cancer Institute has stated :
. I . ., no chronic toxic effects have been clearly and consistently
attributed to ni coti.ne" , (76) .
3 . Carbon Monoxi._de .
--lrately, some of the gaseous components of smoke have been
mentioned ln t'ne public media i_ri efforts to incriminate cigarette
smoking . The most important of these is carbon monoxide . It is
zmquesti.onable, that smokers.have in their blood, higher concen-
trations of carbon monoxide than non-smokers . trocaevex, unless a
smoker continues to smoke uninterruptedly during the day and does
not go to bed and continues smoking d ;2ri.ng t:he night, this carbon
monoxide significantly decreases in the blood rather rapidly .
The main defect of the misleading claims on the alleged chronic
effects of carbon monoxide is that they are based on pure specula-
ti_on, "deri_ve_c'. from acute exposure to reLati.vel.y high concent2'ati.ons,"
(69) .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 45
t

\V _ /
Also, n]most all the' i.nves ::i8at,ions involvittf; low-level effects
of carbon monoxide use conti.nuoua administration of set levels of
carbon monoxide . This is fundamentally different from the smoking
situation which involves i .n''ermittent exposure, i .e ., exposure to
carbon monoxide interspersed by more frequent and longer lasting
exposure to ambient ai.r .
Furthermore, the ievels in smok ;;, s, of even more than a pack
a day, are probably not biologically significant . As an example,
7I would like to ci .te findings on automobile tunne3l workers which
are exposed to much higher and' less intermittent carbon monoxide
levels than sniokers ; even in these workers no signi ficant long-
term effects of carbon monoxide could be shown, (78)(79) . In
another study it was reported that some of the biological effects
of carbon monoxide and other smok : components - possibly nicotine
counterbalance each other ; this work ieas done by Dr . Aronow of
the University of California, a vehemently anti-tobacco researcher,
(80) .
Farenthetically,'there are also some data-with rats claiming
to show that the carcinogenic activity on mouse skin of a chemical
compound, called . benzo(a)pyrene, allegedly the most important
carcinogenic constituent of cigarette smoke, is inhibited by
nicotine, (81) .
~i ._v llydro~en Cyanide~
Another gaseous component : of tobacco, which has been cited in
vff.orts to incriminate sniolci .ng is hydrogen cyanide . Nere again,
the arnolants in smoke are bi.ol_ogica'lly insi_gni ficant . In addition,
a large portion of this does not reach the respi .z•at:ory, system where
it supposedly is doi .ng its damage, but is absorbed in the oral cavi .t :y .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 46
~

~~ Nitr.o~en oxides
other gaseous components of smoke l;te called "nitrogen oxides" .
This refers to a mixture or two chemical compounds, one called
nitrogen oxide, (or nitrogen monoxide) and a second compound called
nitrogen dioxide . By convention, that is to say, by a more or less
arbitrary agreement, analyti .cal. chemists express this mixture o£
nitro~en oxides as nitrogen dioxide only . However, tobacco smoke
contains either infinitesimal amounts or -no nitrogen dioxide ; all,
or nearly all of the "nitrogen oxides" in tobacco smoke Is nitrogen
oxide, a gas N.rhich is innocuous biologically, even in relatively
large quantities .
The chief reason why nitrogen dioxide is alleged to be dele-
terious is, because it could theoretically'combine with some other
tcbacco or smoke constituents, which are called amines, and form
coMpounds, which are called nitrosam =nes, which have been showtn
in many animals to cause a variety of cancers . The odd thing about
this is that, so:ne years ago, one of the most famous and vehement
tobacco antagonists, Dr . Wynder, has added a compound to tobacco,
called nitrate, which has as a consequence to increase the amount
of nitrogen dioxide in smoke . lie has alleged that the smoke from
tobaccos treated with nitrate, i .e ., which should increase airy
yield of nitrosamincs in the smoke, was less carcinogenic to ani-
mais than that .from regular tobaccos . This means, if anything,
that the minimal lesser amounts of nitrogen dioxide, which may or
may not be present in smoke from regular tobaccos should not have
any carcix~ogen :.c effect .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 4%
It,

XV . THf; END : VITAMIN C IS DAidGl:[t01iS TO YOUR 11RALTtI .
We have now come to the end of the formal presentation, except
I want to come back to a point T raised earli .er, to 1.llust-rate the
controversial nature of many sci .entific findings . I have said above
that most re;;ular components of food products, even vitamins,' have
been alleged to cause cancer or othe- diseases . Now, the latest
wrinkle in studies on the genesis of cancer s is to equate cancer
causing activity with the ability of a ehemicall compound to cause
an inheritable change, technically called a mutation, in micro-
organisms, such as bacteria, etc . Recently a very well respected
researcher in Canada has shoim Vitamin C to cause st- :h mutations,
i .e ., the equivalent of cancer, (82) .
Another researcber from the U . S . Department of Agriculture
has claimed, last year, that,in rats, Vitamin C can induce an
excess of cholesterol . His conclusions were as follows :
seems likely that an excessive intake of Vitamin C increases the
risk of coronary heart disease", (83) .
XVI . CONCLUSION
Summing up, I would like to remind you of what I have been
trying to show you : It would be irresponsible to claim that
ci.garette smoking can be exonerated of suspicion as a possible
health bazard,•P.owever, I hope I have been able to convince you
that there are many contradictions, i .nnun-jerable doubts and count-
less unanswered questi_ons - and there are many others I did not
even have the chance to touch upon - regarding the efforts to link
smoking to various c'iscases . THE SMOKING AND 11I;ALTil CONTROVERSY
IS A CON1'ROIjEE:SY .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
rc?f!,e 48
ti
4
a

, ' .
}S? 13LIMRAI'llY
1 . Newberne, P . M., Cancer Detection Prevention 1, 129-173 (1976)
2 . Ilriyf 1i.ck, L ., New Engl . Jour . Med . 295, 1.302-08 (Dec . 2,1976)
3 . Bearings before the U .S .Senate Conuni.ttee on Commerce, Part 1 .,
p .34, see also pp . 41.9 and 455 (1965)
4 . King James I of England, A Counterbl.aste to Tobacco,London 1604
5 . Karbecke, R ., A Defence of Taba :•co, London 1602
6 . "Smoking and Uealth", Report of the Advisory ConmAttee to the
Surgeon General of the Public 11ea1th Service,U .S .Dept . H .E .W .,
387pp .(1964), below quoted as "Smoking and llealth",etc .
7 . "The Health Consequences of Smoking - A Report tc the Surgeon
Genera1 :1971" U .S .Dept . H .E .W ., 458pp (1972)
7A . Hearings before the U .S .Senate Committee on Commerce, etc .,
"Public Health Cigarette Amendments of 1971" e .g . pp .459 etc .,
pp .727 etc ., (February 1972)
8 . "Smoking and Ilealth", et;c ., p . 184 (1964)
9 . '!'he Tobacco Institute, "The Ci.garette Controversy", 13pp (1974)
10 . Do11, R . ; 11111, A .B ., Brit Med .Jour . 1956i_f, 1071-81 (1956)
1.1 . Dorn, 11 . F ., Proc .Soc .Statist . Sect .Amer . Statist .Assoc . 1958,
34-71 (1958) t
12 . Buell, P ., et al ., Cancer 20, 2139-47 (1967)
13 . Best, E . W . R., et al, Can .Jour .Publ .Health 52, 99-106 (1961)
14 . Dunn, J . I: ., et al, Amer .Jour .Publ .Health 50, 1475-87 (1960)
1. 5 . Hamniond , E .C . ; Horn, ' D . ; Jour .Amer .Med . Assoc . 1.66,
, 1159-72 ;
1294-1308 (1958) .~W
-16 . Hammond, E .C ., Natl .Cancer Inst .Monograph No .19, pp .1.27-204 (1966)
17 . Hirayama, T., Proc . 11th Intern .Cancer Congr . 3, 26-35 (1975)
18 . "Smoking and Health", etc ., p . 94 (1964)
19 . l:bi.d ., p . 95 (1964)
20 . Ste rling, T . D ., Amer . Jour . P .ebl .l-lealth 65,, 939-53 (1975),
especially p.940 __ .
21 . Sterling, T . D ., ibid ., especially p . 941
22 . Hammond, I: . C ., Jour .P7atl .Canccr xrist . 32 , 1161-88 (1964) ,
.,
espccially p . 11.72 _
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
U
O
~
P
N
~
r

1,
23 . Roscnblatt, M . I3 . , Me .: . Counterpoint, 1969, 29-39 (March 1969)
~4 . reinstcin, A . R ., Wells, C . K ., C]in .Res . 22, 55a (1974)
25 . l'einstein, A . R . ; Wells, C . K . Trans .Assoc .Amer .Physi.c3ans 87,
180-85 (1974)
26 . Banki, N . ; Krep]er, R ., Wiener K1in :Wochenschr . 83 (1), 1-5
(Jan . 8,1.971)
27 . Gi.lliam, A . G ., Cancer 8, 1130-36 (1955)
28 . Gilliam, A . G ., Milit .Med . 116, 1 .64-73 (1955) ; see also :
Gilli.am, A . G . , Cancer .14 (T3)' 622-28 (].961.) and
Rosenblatt, M . R . , 23 . supra
29 . Lees, T . W ., Smoking and Lung Cancer, 1959, The Darien Press,Ltd .,
I:dinburgh, Scotland
30 . Armstrong, B . ; Doll, R ., Int:ern .Jour .Cancer 15, 617-31 (1975)
31 . Langston, M . S ., Ilear.ings before the U .S .Senate, Conanittee on
Labor, etc ., "Cigarette Smoking and Disease," pp .45-55 (1976)
32 . Beicher, J . R ., Brit .Jour .Dis . Chest 69, 247-58 (1975)
33 . Belcher, J . R ., Thorax 30 (2) (1975)
34 . }lueper, W . C ., Occupationall and Environmental Cancers of the
Respiratory System, pp .24-25, Sp :-inger Verlag, New York (1966)
35 . Lees, T. W .,•Lancet i, 1116-1 .117 (1965)
36 . Lees, T . W., Lancet ii, 443 (1965) ^
37 . Doll, R . ; Hi1 .1, A . B ., Brit .Pied .Jour . 1964, 1460-67 (1964)
37a . Dol.1, R . ; Peto, R ., Br. it,Med .Jour• . 1976i.i, 1525-36 (Dec .25,1976)
38 . "S*noking and IIcalth", etc ., p . ? 88 (1964)
39 . Rosenblatt, M . I3 . , Bu1.1 .N .Y, Acad . Sci . 48, 823-41 (1972)
40 . Van der Lende, R . ; et al. .', Bronchitis~ III 3, 52-79 (1970)
41 . Russek, 11 . X . ; Russek, L . G ., Psychosomati.cs 17, 63-67 (1976)
42 . I:eys, A ., Amer .Heart Assoc . Monograph, No .29 x, 186-95 (1970)
43 . Mct•ii.chael, J ., Lancet 3.i., 569 (Sept .1, 1976)
43a . "CheTtlical Carriers of Cholesterol Casting Light on Coronaries
PulZle", New York Times, Tuesday, January 18, 1977
44 . }ieath, C . W . , Arch . Interna2 M,2td . 1.01, 377-88 (1958)
`I45 . 'iiiomas, C . R . , Ann .Int•e?'rial 1•ied . 53 (4) 697-718 (1960)
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 50

46 . rLatara r.zo, J . 1) . ; Saslow, G ., Psychological Bull . 57 (6)
493-513 (1960 )
47 . Lil.? enfel.d, A . M. , Joui .Nat1 .Cancer Inst . 22 (2) 259-82 (1959)
48 . I'errin, M. J., et .al ., Brit .Med .Jour . 1961, 387-88 (Feb .11, 1961)
49. Lilienf.eld, A . M., supra .
50. Ibid .
51 . Neath, C . W., supra .
52 . Stew*arf, L . ; Livson, N., Jour .Consult: .Psychol . 30 (3) 225-29
(1966 )
53 . McAr.tb ;~.r, C., et . al ., Jour .Abnonnal Psychol . 56 (2) 267-75
(1958 )
54. Thomas, C . B., Jour .Chron . 1)iseases 7(3) 198-208 (1958 )
55. Yerushalnry, J . , Amer .Jour .Obstet .Gynecol . 1 .1.2, 227-84 (1972 )
56. Burch ; P . R. J . ,1he Biolqgv of Cancer, A . New Approach,
Med . Technol . Publ . . , Manchester, Y~916 `~TexCbook)
57. Tokuhata, G . K., Chapter 13, Cancer of the Lung, IN :
H. T. I.y»cli, Cancer and Genet:ics, pp . 213-32, C .C .Thornas,
publisher, Sprxn~ii.c~d, Irl ., l.gl5
58. Yerushalmy, J . , Aiiier .Jour .Obstet : . Gynecol . . 1 .1.2 (2) 277-84 (1972)
59: Yerushalmy, 'J ., Amer .Jour .Epidemi.ol. 93 (6) 443-56 (1971 )
60. Fisher, R ., Nature 182, 596 (1958)
61 . Friberg, L., et al ., Brit .Med .Jour . 1.959i 1040-42
62 . aaschou-Nielsen, E ., Dan .Med .Bull. . 7, 82-88 (1960)
62a. Todd, G . F. ; Mason, J . X . ,Ileredi.ty 13, Pt jF : '[}17- 444 ; (1959)
62b. Conteri.o, F . ; Chiarelli, B ., Neredity 17 : 347-359, (1962 )
62c. Carney, R . E . ; I'eldman, . H ., Psychol. .Rep . 261-262, (1969)
62d . Deutscher S . ; Ili.ggi.ns, M .W ., Amer_ .Rev .Resp .Dis .102(2) :180-189(1970)
62e . Brackenra.dge, CJ ., et al., Clin . Genet- . 3(5) : 341-346, (1972 )
62f . Brown, B . B. ,"Additional. Characteristics I!.T;G Differences
Between Smoker.s and Non-Sinokers" C:hapter 5 in W . L . Dunn,Jr .
Smoking Behavior : Motives and Incentives 67--81. (1.973 )
63. Friberg, L ., et al, Axch . I?nviron .Health 27, 294-304 (1973) .
611 . Ltindnkan, T . ; Blomstrand, It ., Acta 1 fed . Scand .Suppl. 455, '''
pp . 1-75 (1966)
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 51
cQ
a
~
J

65- Li1jefors, I ., 11cta ~ :cd, Sccind . Sup>>1 . 511 ., pp .1-87 (1970)
66 . DeFaire, U ., Acta Med . Scand . Suppl . 568, i>p .65-79 (1974)
67 . F'einlea.b, M . ; et al, Circulation suppl .1Z, No .200,
p .52 (Oct . 1976)
68 . Amer .Cancer Soc ., News release, Feb . 5, 1970
69 . Auerbach, 0 ., F: .C .Ilannnond, et al . ; Ar.ch . F,r.viron .Nealth 21,
754-68 (] .970)
70 . New York Times, May 9, 19 70
71 . New York Times, June 11, ] .971.
72 . Dontenwill, W ., et al ., Jour .Natl .Canccr 7nst . 51, 1781-1807 (1973)
73 . Wehner, A . P ., et al .•, Arch .Environ .Ilealth 31, 146-53 (1976)
74 . "Smoking and Health, " etc . p .58-59 (1964)
75 . Ibid ., p .76
.76 . Cori, C . B ., Science 194, 1243-46, (December 17, 1976)
77 . 1`heodore, J ., et al ., Jour .Occupat .Mea . 7.3, 242-55 (1971)
78 . Sievers, R . F., et al, Jour .Amer .Med .Assoc . 118, 585-88 (1942)
79 . Hickey, R . J ., et a1, Jour .Amer .Med .Assoc . 232, 486 (1975)
80 . Aronow, W . S ., et a1, • Ci.rculation' 53, 340-47 (1974)
81 . Weber, R .P ., et a1, Science 184, 1081-82 (1974)
82 . Stich, 11 . F . ; et al, Nature 260,, 722-24 (1976)
83 . Kievay, L . M, Fed .Proc . 34 (3) 899 (1975) . .
http://legacy.library.ucsf.edu/tid/amu69d00/pdf
Page 52
0