The Famous and Fatally Flawed Surgeon General Report on Smoking
Well I decided to put up a few choice bits about the problems with the anti-tobacco position along with plenty of my own commentary which I hope will generate a bit of thinking among a few here.
To start with let review what the often mentioned but never read Surgeon General Reports these quotes come from the great book “In Defense of Smoking” Lauren Colby
“ The 1964 Report was issued by a committee of ten "scientists", picked from a list of 150 scientists and physicians, heavily weighted towards government agencies and large organizations active in public relations, with a low representation from the scientific community. There were no statisticians on the panel, although statistical expertise was essential to a proper analysis of the epidemiological studies, which formed a large part of the "evidence" which was studied. In 1965, a prominent statistician, K.A. Brownlee, of the University of Chicago, wrote a scathing review of the Report, pointing to many discrepancies in the statistical data. I will refer to that later 17 .
Prior to the writing of the Report, numerous experiments had been conducted, attempting to induce lung cancer in laboratory animals by painting their lungs and trachea with cigarette tars, forcing the animals to inhale vast quantities of tobacco smoke, etc. All of these experiments failed, miserably! Consequently, at page 165 of its Report, the Committee was obliged to concede that "Bronchogenic carcinoma has not been produced by the application of tobacco extracts, smoke, or condensates to the lung or the tracheobronchial tree of experimental animals with the possible exception of dogs".
The phrase "possible exception of dogs" related to a single experiment, of which the Committee wrote that "this work has not yet been confirmed". To this day, it remains unconfirmed and it remains true, to this day, that despite hundreds of experiments18, nobody has been able to induce a single cancer in lab animals by exposing them to ordinary tobacco products or smoke.
Other researchers attempted to induce lung cancer in lab animals by using nasty combinations of industrial strength carcinogens. They used mixtures of ozonized gasoline and mouse-adapted influence viruses; polycyclic aromatic hydrocarbons, directly applied to the lungs of rats; mixtures of benzo(a)pyrene and iron oxide dust; radioactive cerium; and beryllium oxide. Even with these noxious brews, the results were not entirely successful. For one thing, some of the experimenters reported "distant metastases", i.e., tumors occurring in sites far from the lungs (which makes me wonder whether the "treatments" had simply weakened the animals' immune systems to the point at which cancers were springing up spontaneously throughout their bodies). Moreover, not all the animals got sick. For example, two out of ten rhesus monkeys injected with beryllium oxide developed cancers but 8 did not.”
The crux of what has been explained rests upon two matters. First, the panel tasked with composing the report was the product of an active effort to form a group pre-disposed to be influenced by political pressure which should say a lot about the credibility of the panel. Those of the readers who have dealt with large bureaucracies (be they public or private sector) are undoubtably aware that committees dealing with regulatory matters are typical composed with the purpose affirming a pre-determined position rather then honestly examining a given issue. A decent treatment of the Surgeon General’s panel can be found by consulting the following: Brownlee. K.A. (1965), A Review of "Smoking and Health", J. Amer. Statist. Ass. 60, 722-739.
Secondly I will draw the reader back to the critical matter that - "Bronchogenic carcinoma has not been produced by the application of tobacco extracts, smoke, or condensates to the lung or the tracheobronchial tree of experimental animals with the possible exception of dogs" In short, efforts to produce lung cancer via massively concentrating tobacco products within the confines of empirical testing failed. In and of itself, such a revelation would have resulted in the production of a report showing something other then the claim that smoking tobacco causes lung cancer.
Instead, what happened is that a panel ill-suited to statistical analysis sought to force data into supporting a pre-determined position that tobacco consumption represented a great social evil that needed to be suppressed, heavily taxed and demonized via an intensive program of public indoctrination.
The supposedly scientific basis for such public policy came from quasi-empirical studies lacking the reproducibility found in the controlled environs of a laboratory. Returning to Colby we learn that:
“ The animal experiments having failed, the Committee was left with retrospective studies and prospective studies. Retrospective studies are studies in which cancer patients are interviewed about their smoking habits and compared with another group of controls from the general population, whose smoking habits are likewise identified. In prospective studies, a population is sampled, their smoking habits are ascertained, and they are then followed for a number of years, to determine who develops the disease.”
He then goes on to describe how carefully cherry picking studies which seemed to support the anti-tobacco position the panel hoped to show a scientific consensus supporting the anti-tobacco position was beyond question. Yet even with such shoddy methods the panel failed to provide sustenance for their position. Rather what was discovered was that:
“Then, at page 116 of its Report, the Committee made the following curious observation. Citing a paper by Berkson 20 , the Committee said, "The death rate in the complete population (3.000) was 42% higher than the respondent death rate. The non-smoker death rate was over 38 times as high among non-respondents as among respondents (60.1221/1.553), whereas among smokers it was only 1.8 times as high. [Berkson's] calculations referred to an early year of the study, in which the differential entry of ill persons among smokers and non-smokers are likely to be most marked. Further, as we interpret his writing, the example was intend ed as a warning against the type of subtle bias that can arise whenever a study has a high proportion of non respondents, rather than a claim that this numerical estimate of the bias actually applied to these studies".
Thus, the Committee was confronted with what should have been a red flag: a finding that the death rate amongst non responding non-smokers was 38 times as great as the rate amongst responding non-smokers, whereas the death rate among non-responding smokers was only 1.8 times as great as the death rate among corresponding respondents. It is apparent, even to a layman, that such a major discrepancy could greatly skew the results of the surveys. Yet, the Committee brushed the point aside, saying, in substance, that it didn't think that Berkson meant what he wrote!”
At this point the panel that composed to report could be seen by even a casual observer to be utterly lacking in intellectual honesty and competency. Anyone attempting to support such a ridiculous position as that taken by the panel in an introductory social science methodology course would be justifiably flunked.
Colby goes on to point out that the panel had no explanations for the far lower cancer rates among cigar and pipe smokers despite the fact that cigar and pipe tobacco has far higher quantities of benz(a)pyrene which is commonly viewed as a carcinogen that naturally occurs in tobacco. In fact, a key study upon which the report heavily depended upon found pipe and cigar smokers having a longer life expectancy then non-smokers. Rather then allow such facts to influence it’s position the panel noted, then ignored them in the report they composed.
Later, a great deal of time is spent discussing that cigarette smokers are disproportionately drawn from the low socio-economic rungs of society and as a result, numerous variables that clearly influence morality figures make it difficult to see how tobacco consumption or any other variable could be weighted as a risk factor within the confines of prospective and retrospective studies done by statistical neophytes. Among the factors mentioned (but not addressed) by the panel are that people from low socio-economic groups are more likely to be afflicted with: hazardous occupations, higher exposure levels to hazardous fumes and chemicals, a worse diet, higher obesity rates and tend to receive less medical care and lower quality care. While the panel noted that socio-economic status may have been a weakness within the study they chose not let that little detail temper the conclusions reached.
Colby noted correctly that the panel completely overlooked the matter of detection bias which is covered as follows:
“ While the Committee did, in fact, acknowledge the possibility of bias due to SES, it appears to have overlooked entirely another important source of bias. That is detection bias. Remember, everybody enrolled in the studies knew what was being studied, and their doctors knew that, also. Thus, everybody was waiting with baited breath for the smokers to develop lung cancer. I will discuss the role of detection bias in more detail in the next chapter. It should be noted, however, that the methodology followed in the SG's studies was calculated to exaggerate the possibility of detection bias, because the researchers were concentrating heavily upon the hypothesis that smoking causes lung cancer.
In the British Doctor's study, for example, all deaths in which lung cancer was a contributing cause were classified as deaths from lung cancer, even though the direct cause of death may have been something else (Report, page 101). It is interesting, in that regard, that the British Doctor's study was the one which purported to show the highest risk for lung cancer, from smoking 24 .
The British Doctors study in question (Doll and Hill, in 1956) which is often cited by the panel and anti-tobacco lobbyists as well as it’s 1991 follow up is virtual case study of how not to conduct research. "The original case-control studies by Wynder and Graham and by Doll and Hill are still used in a famous epidemiologic exercise....where they serve as examples of what can go wrong: biased ascertainment of exposure, selection of cases and controls from different source populations, poor ascertainment of caseness, etc..." From page 427 of Invited Commentary: How Much Retropsychology?, by J.P. Vandenbroucke, Department of Clinical Epidemiology, Leiden University Hospital, American Journal of Epidemiology, Vol 133, Number 5, March 1, 1991, (pages 426-7).
Yet somehow, we never heard about these issues from the media , the government or the anti-tobacco establishment which just shows that science is often used to carry water for those with public policy agendas to persue. Yet even more startling is the admission by Doll himself in 2001 that his study was designed as a propaganda tool to promote an anti-tobacco agenda. Nonetheless, the Doll study and the Surgeon Generals report it props up is still viewed by the public, media and government as proof of the pernicious threat posed by tobacco consumption to this day.
In the end I can see the great benefit that Surgeon Generals Reports to the anti-tobacco lobby depends upon it not being read by anyone with the least degree of mythological literacy. Instead, it serves as an effective tool to deceive an ignorant public when cited by media and government sources actively disdainful of academic honesty.
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