Robert N. Proctor

Tobacco and the global lung cancer epidemic.

Tobacco is the worlds single most avoidable cause of death. The World Health Organization has calculated that the 5.6 trillion cigarettes smoked per year at the close of the twentieth century will cause nearly 10 million fatalities per year by 2030. Lung cancer is the most common tobacco-related cause of cancer mortality, with one case being produced for every 3 million cigarettes smoked. How was the global lung cancer epidemic recognized, and what can we expect in the future?

The history of the discovery of the cigarette–lung cancer link: evidentiary traditions, corporate denial, global toll

Lung cancer was once a very rare disease, so rare that doctors took special notice when confronted with a case, thinking it a once-in-a-lifetime oddity. Mechanisation and mass marketing towards the end of the 19th century popularised the cigarette habit, however, causing a global lung cancer epidemic. Cigarettes were recognised as the cause of the epidemic in the 1940s and 1950s, with the confluence of studies from epidemiology, animal experiments, cellular pathology and chemical analytics. Cigarette manufacturers disputed this evidence, as part of an orchestrated conspiracy to salvage cigarette sales. Propagandising the public proved successful, judging from secret tobacco industry measurements of the impact of denialist propaganda. As late as 1960 only one-third of all US doctors believed that the case against cigarettes had been established. The cigarette is the deadliest artefact in the history of human civilisation. Cigarettes cause about 1 lung cancer death per 3 or 4 million smoked, which explains why the scale of the epidemic is so large today. Cigarettes cause about 1.5 million deaths from lung cancer per year, a number that will rise to nearly 2 million per year by the 2020s or 2030s, even if consumption rates decline in the interim. Part of the ease of cigarette manufacturing stems from the ubiquity of high-speed cigarette making machines, which crank out 20 000 cigarettes per min. Cigarette makers make about a penny in profit for every cigarette sold, which means that the value of a life to a cigarette maker is about US

Three Roots of Human Recency

10 000.

Nazi Science and Nazi Medical Ethics: Some Myths and Misconceptions

Conceptions of human antiquity have changed dramatically over time, with recent evidence (and opinion) pointing to the relative recencyca. 105 years agoof language, kindled fire, compoundtool use, and a number of other presumed signs of human symbolic intelligence. A concomitant change has been the dehumanizing of early hominids, a transformation visible in the separate sciences of archaeology, paleontology, and molecular anthropology. Understandings of humanity have changed in response to discoveries in these fields but also in response to struggles over how to understand race, brutality, and the oldest tools (Acheulean handaxes, for example). Conceptions of hominid and racial diversity have often been intertwined, and one impact of racial liberalism after World War II seems to have been a delay in the recognition of fossil hominid diversity, in consequence of fears of excluding one or another nowextinct hominid from the Family of Man. Racial resonances still complicate theories of human origins, as evidenced in the tendency to celebrate the exodus from Africa (Out of Africa: Thank God!). Temporal compression can be seen as a cultural artifact, and different conceptions of evidentiary prudence can be found in debates over the humanness of early hominids. Given the inherent arbitrariness in saying when they became us, the question When did humans become human? must also be seen as, among other things, a moral one.

The Changing Public Image of Smoking in the United States: 1964–2014

We often hear that the Nazis destroyed science and abandoned ethics. That was the view of Telford Taylor in his opening statement at the Nuremberg “Doctor’s Trial” of 1946–1947, where he stated that the Nazi doctors had turned Germany “into an infernal combination of a lunatic asylum and a charnel house” where “neither science, nor industry, nor the arts could flourish in such a foul medium” [1]. Similar views were expressed by Franz Neumann, author of the 1942 treatise Behemoth, the first major analysis of how the Nazis came to power [2]. Neumann predicted “a most profound conflict” between the “magic character” of Nazi propaganda and the “rational” processes of German industry, a conflict the emigre political theorist believed would culminate in an uprising on the part of engineers to combat the irrationalist regime. Such an uprising, needless to say, never materialized. It would be comforting to believe, of course, that good science tends to travel with good ethics, but the sad truth seems to be that cruelty can coexist fairly easily with “good science.” There is a convenience of sorts in the myth: it makes it easy to argue that “Nazi science” was not really science at all, and therefore there is no ethical dilemma. One needn’t talk about the ethics of Nazi medicine, since there was no legitimate medicine to speak of. Nazi science in one swift blow is reduced to an oxymoron, a medical non-problem.1

Why ban the sale of cigarettes? The case for abolition

Tobacco use behaviors in the U.S. have changed significantly over the past century. After a steep increase in cigarette use rates over the first half of the 20th century, adult smoking prevalence rates started declining from their peak reached in 1964. Improved understanding of the health risks of smoking has been aided by the U.S. Surgeon Generals Reports, issued on a nearly annual basis starting in 1964. Among the many forces driving down smoking prevalence were the recognition of tobacco use as an addiction and cause of cancer, along with concerns about the ill effects of breathing secondhand smoke. These factors contributed to the declining social acceptance of smoking, especially with the advent of legal restrictions on smoking in public spaces, mass media counter-marketing campaigns, and higher taxes on cigarettes. This article reviews some of the forces that have helped change the public image of smoking, focusing on the 50 years since the 1964 Surgeon Generals Report on smoking and health. Cancer Epidemiol Biomarkers Prev; 23(1); 32–36. ©2014 AACR.

“Everyone knew but no one had proof”: tobacco industry use of medical history expertise in US courts, 1990–2002

The cigarette is the deadliest artefact in the history of human civilisation. Most of the richer countries of the globe, however, are making progress in reducing both smoking rates and overall consumption. Many different methods have been proposed to steepen this downward slope, including increased taxation, bans on advertising, promotion of cessation, and expansion of smoke-free spaces. One option that deserves more attention is the enactment of local or national bans on the sale of cigarettes. There are precedents: 15 US states enacted bans on the sale of cigarettes from 1890 to 1927, for instance, and such laws are still fully within the power of local communities and state governments. Apart from reducing human suffering, abolishing the sale of cigarettes would result in savings in the realm of healthcare costs, increased labour productivity, lessened harms from fires, reduced consumption of scarce physical resources, and a smaller global carbon footprint. Abolition would also put a halt to one of the principal sources of corruption in modern civilisation, and would effectively eliminate one of the historical forces behind global warming denial and environmental obfuscation. The primary reason for abolition, however, is that smokers themselves dislike the fact they smoke. Smoking is not a recreational drug, and abolishing cigarettes would therefore enlarge rather than restrict human liberties. Abolition would also help cigarette makers fulfil their repeated promises to ‘cease production’ if cigarettes were ever found to be causing harm.

Learning from Philip Morris: Japan Tobacco's strategies regarding evidence of tobacco health harms as revealed in internal documents from the American tobacco industry

Historians have played an important role in recent tobacco litigation, helping the industry with its defence of “common knowledge” and “open controversy”. Historians re-narrate the past, creating an account for judges and juries that makes it appear that “everyone has always known” that cigarettes are harmful, meaning that smokers have only themselves to blame for their illnesses. Medical historians are also employed to argue that “honest doubts” persisted in the medical community long past the 1950s, justifying as responsible the industry’s longstanding claim of “no proof” of hazards. The industry’s experts emphasise the “good science” supported by the industry, and ignore the industry’s role in spreading doubts about the reality of tobacco hazards.

Expert witnesses take the stand.

Japan is in the midst of a rapid increase in tobacco-related disease mortality, following the rapid growth of smoking after WWII. Stomach cancer was the countrys leading cause of cancer death for most of the 20th century, until lung cancer took over this position in 1993. Cigarettes are the major cause of lung cancer in Japan, but the countrys leading manufacturer, Japan Tobacco, two thirds of which is owned by the Japanese government, continues to question whether tobacco is a major cause of disease and death. Japanese courts do not have the power to subpoena a companys internal records, which has made it difficult to document Japan Tobaccos strategies concerning tobacco and health. Our interpretation of online archives of internal documents from American tobacco companies, however, is that Japan Tobacco has long known about the potential health risks involved in smoking and has sought to obstruct effective tobacco control. Beginning in the mid-1980s, these efforts were often co-ordinated with American tobacco manufacturers. The documentary evidence shows that cigarette manufacturer Philip Morris in particular assisted with and sometimes also supervised Japan Tobaccos actions and statements on smoking and health. In one instance, data gathered for an article published by the Japan Public Monopoly Corporation (Japan Tobaccos predecessor) were deliberately altered to lower the reported value of a hazard indicator (nicotine concentration in the air). International collaboration has made it easier for companies such as Japan Tobacco to develop effective anti-antismoking strategies. Evidence of such global industry collaborations might grow as lawsuits begin to be filed in other nations.

Nazi Biomedical Policies

Historians of science can play an important role in US public health litigation.