If You Don’t Know What I Died of,
Why Are You So Sure I Had It?

In 1959 Heasman and Lipworth surveyed reports from 75 hospitals of the National Health Service in England and Wales. [41] They compared the doctor’s diagnoses made in the patients’ lifetime with the results of post-mortem examinations.

For cancer of the lung they found that doctors had diagnosed 338 cases when the pathologists found 417; in only 227 cases did doctors and pathologists agree.

In fact, 33% of cases diagnosed as lung cancer were not, and 46% that were supposed to be something else were actually lung cancer.

If you are dealing with errors of this kind, figures become meaningless, and Doll and Hill merely state that they sought confirmation of the cause of death from the doctor who certified the death and, when necessary, from the consultant to whom the patient had been referred: they do not mention any post-mortems except very briefly, and curiously inconclusively: “in more than half the deaths (56%) there was histological, cytological, or necropsy [post-mortem] evidence together with x-ray or bronchoscopic confirmation”, and “necropsy evidence or histological or cytological...” [42]

That the position on certification of the cause of death is still [in 1992] unsatisfactory is shown by a publication of the Government Statistical Service, POPULATION TRENDS. [43]

It states: “This paper has identified some aspects of the processes” [by which details on deaths are collected]. “Its findings cause concern because some certifiers may not fully understand...there must always be some concern as to the accuracy with which cause of death information is provided...”

Probably...may well be...estimated...

It is not surprising that Philip Burch, whose letter on the “World Cancer Burden” has been quoted above [16], in the article in the IRCS Med. Sci., also quoted [17], quotes the Royal College of Physicians thus: [44] “It is not possible to give a precise estimate of the proportion of these excess deaths among smokers which are caused by smoking.” Then they do give a rather precise estimate: “at least half”. Burch remarks that this seems to be arbitrary.

They conclude the section on deaths:

“It would not be unreasonable to attribute to cigarette smoking 90% of the deaths from lung cancer...These probably conservative assumptions lead to an estimate...it can be reasonably assumed that...may well be due to cigarette smoking”, [my emphasis].

This is not the language used by people who are perfectly sure of themselves. Nevertheless, in THE BIG KILL, a publication of the Health Education Council (the predecessor to the Health Education Authority), the very exact figure of 77,774 deaths a year from smoking-related diseases is given. [45]

Burch comments that the fact that figures that have been reasonably assumed, estimated and so forth are so confidently quoted as exact to the last unit: “is not without a certain whimsical charm”.

Further on he adds: “the calculation of the annual toll to the nearest death from percentages rounded to the nearest five betrays a certain innocence.”

Ignore The Facts

K.A. Brownlee makes what could be a significant remark: “the way it [the Surgeon General’s 1964 report - and we have already seen these reports behaving oddly - see notes 12 & 24] claims the facts are in conformity with [a particular criterion] is to ignore the facts.” [46]

A.R. Feinstein, a distinguished clinical epidemiologist and an expert medical statistician, says epidemiologists “can obtain and manipulate the data in diverse ways that are sanctioned not by the delineated standards of science, but by the traditional practice of epidemiologists.” [47]

Use Rubber Numbers And
Blame The Victim

Professor Samuel Epstein says: [48] “...questionable are claims by the NCI and ACS that overall cancer survival rates have improved dramatically in recent years. These claims, based on rubber numbers [my emphasis], according to one prominent critic, ignore factors such as...earlier diagnoses of cancer, resulting in apparently prolonged survival even in the absence of any treatment; and the ‘overdiagnosis’ of essentially benign tumours...”

“Even the very modest funding for cancer prevention is largely directed to endorsing...[the] blame the victim concept of cancer causation.”

Epstein went on to describe a 1981 report by Doll & Peto dealing with causes of cancer in the USA. The study was sponsored by the Office of Technology Assessment, which was “apparently unable to find any US experts with a knowledge of cancer, and so selected British lifestyle advocates. To reach their misleading conclusions...Doll and Peto excluded from analysis people over the age of 65 and blacks, just those groups with the highest and increasing cancer mortality rates.”

Epstein baldly called this “manipulation”, and it is difficult to see what else he could have called it. He also pointed out that they had claimed that occupation was responsible for some 4% of cancers, which he called a “wild 4% guess”. This was matched by “guesstimates”, he said, that diet was determinant in some 35% of all cancers.

Bruce Ames, says Epstein, “is a geneticist who, in the 1970s, developed bacterial assays for mutagenecity...the predictability of his test is now recognized as similar to that of flipping a coin.”

Flip A Coin...

So it is on figures based on diagnoses that can be wrong in 190 out of 417 cases, on manipulated data, on guesstimates and wild guesses and rubber numbers, on predictability compared with that of flipping a coin, on estimates with a certain whimsical charm and innocence, that these frightening conclusions are based.

Smoking Kills, If You Think So....

But this does not look so funny when you read Eysenck’s report on a survey carried out in Heidelberg. [49] A sample of 528 men who smoked were asked whether they, as smokers, were convinced that they would be very likely to develop lung cancer, heart disease, or other smoking-related disease? Of those who answered “yes” 72 admitted that their views were taken from information in the media, and this group had an almost three times higher death rate at the end of 13 years than those who were not so influenced.

Fear, in fact, as has been known ever since there has been any civilised study of disease, kills. What do those who help to spread that fear, with their rubber numbers, really think about it?

You’re Dying, And We Told You So

The “blame the victim” concept causes untold suffering to victims and their families. It is bad enough to have cancer without being sanctimoniously told that it is your own fault, especially if you have a suspicion that it isn’t, as many sensible people, perhaps an increasing number, have.

Examples Of What Can Go Wrong

To quote J.P. Vandenbroucke: [50] “Often I have wondered why medical opinion was so suddenly and massively swayed into accepting the lung cancer - smoking hypothesis in the late 1950s and early 1960s, as described very well by Burnham. The original case-control studies by Wynder & Graham and by Doll & Hill are still used in a famous epidemiologic exercise (according to oral tradition in the Netherlands, it was originally drafted by Dr M. Terriss), where they serve as examples of what can go wrong [my emphasis]: biassed ascertainment of exposure, selection of cases and controls from different source populations, poor ascertainment of ‘caseness’, etc. Moreover, these studies were preceded by a good many others...[which] had not succeeded to move acceptable medical and public opinion by one iota. Although a convinced nonsmoker myself...I am afraid that the sudden and total acceptance of smoking as a cause of lung cancer, up to the point that a present-day epidemiologist puts his reputation at perilby treating the subject too lightheartedly, is a phenomenon that belongs rather to the sociology of medical science.”

 

A Strong Emotional Force...

There have been a number of theories put forward to account for this. Most require a certain “grassy knollism”. There is one, however, that requires nothing more than a weary knowledge of human nature. There are something like 880 associations and institutes in the USA alone that are devoted to anti-smoking programmes, and another 700 or 800 organizations engaged in research on smoking.

At the 1990 World Conference on Tobacco and Health in Australia (the official information on which spoke glowingly of the night-life available, [51]), Stanton Glantz, known, no doubt proudly, as “the anti-smoking activist”, who runs cigarette-quitting seminars and develops anti-smoking regulations for profit, said: “...the main thing the science has done on the issue of ETS, in addition to help people like me to pay mortgages, is it has legitimized the concerns that people have that they don’t like cigarette smoke [his grammar, not mine]. And that is a strong emotional force that needs to be harnessed and used. We’re on a roll, and the bastards are on the run.” [52]

It is no longer "politically correct" to persecute people for their race or their religion or their sexual preferences, at least in the Western world. But there are people who must persecute somebody, and if they can get their mortgages paid by it, so much the better.

The smoker is often a quiet and cheerful person, and the witch-hunter is not: his habits demand noise, and he is usually strangely miserable (as H.L. Mencken said, the puritan has “the haunting fear that someone, somewhere, may be happy”).

And if the smoker is suffering from some disease that can be put down to smoking, with the aid of wild guesses and rubber numbers, so much the better. Increase the bastard’s misery as much as you can.

Postscript:

Since 1992, when this paper was originally written, more examples of epidemiological finagling have turned up. Three are included here:

A report from Australia [1989-90 National Health Survey Lifestyle and Health Australia, Australian Bureau of Statistics, Catalogue No. 4366.0, Ian Castles, Australian Statistician] was published in February 1994. It showed that smokers had on the whole little or no worse health than non-smokers, and better health than ex-smokers.

This, you would think, was rather sensational news, coming as it did from a government that is almost Californian in its anti-smokerism, yet apart from two articles in the quality press (one by Professor Eysenck and the other by Lord Wyatt), no-one seems to have taken any notice of the report at all.

Two similar studies, with similar conclusions, have been published, one in France [CREDES study 1988-90, described in Tabac L’histoire d’une imposture, by Bertrand Deveaud & Bertrand Lemennicier, published by Jacques Grancher, Paris, (1994)]; and one in the US, [Cigarette Smoking and Health Characteristics United States, July 1964-June 1965, National Center for Health Statistics/Series 10 Number 34].

This last is particularly noteworthy because it came at the start of the anti-smoker movement in the US, and though its tone generally is commendably fair, it does make the most of such figures as seem to support the "PC" case. Nevertheless, it is interesting in that it is one of the few such studies that takes into account the amount smoked, and shows that people who smoke what anybody would call heavily have more problems than those who smoke moderately or not at all, which indeed is what one would expect. It is reasonable to assume that the 40-60 a day smoker has more problems to start off with ...

Numbers of reasons have been given for the tragedy of “Cot Death”, or Sudden Infant Death Syndrome. Dr Sydney Segal of Vancouver told the Winnipeg Free Press on 2nd February 1992: "There isn’t any prime cause. SIDS is just where a child dies suddenly for no cause that we know". This seems to be the verdict of numerous other authorities.

However, in the last few years at least one cause has been definitely established. This is the advice given in Britain by doctors and midwives to put babies to sleep on their stomachs. This had been questioned almost as soon as it became medically orthodox, in 1971, but it was continued until 1991, when a campaign led by a television presenter (no medical authority, but who had tragically lost her own baby), finally induced the medical profession to change the advice. Then the rate of "cot deaths" dropped by 60%.

The deaths had been running at 1,500 a year. Over twenty years, the medical profession had been responsible for the deaths of rather more than 1,500 babies. [The Times and The Daily Telegraph, 30 March 1993].

What has been the reaction of the profession to this clear demonstration of its culpability? Dead silence, and a further attack on smoking mothers.

The medical profession has continued to blame smoking in mothers for these deaths. Three months after the damning reports on the lethal effects of the above-described medical advice, the Royal College of Physicians stated that 365 infant deaths a year had been "associated" with maternal smoking. This 365 represents approximately 27% of the total that they gave of 1,326 cot deaths a year (their figures were presumably compiled before the campaign to put babies to sleep on their backs had got under way).

Yet according to the official figures published by the Office for Population, Census, and Surveys (OPCS) 29% of women in this country smoke. It is likely that this number is higher among women of child-bearing age, since smoking is commoner among the young. The compilers of this report, therefore, have neglected the first rule of statistics: coincidence is not causality. It is not even coincidence, since on their own figures the number of women who smoke who have lost their babies by "cot death" is slightly less than the national average; indeed, proportionately slightly more such deaths occur in the children of non-smoking mothers.

And not a word of apology from anyone. Indeed, the Health Minister, Mrs Bottomley, described the whole affair as “a triumph” for her department. It is to be hoped that she meant the correction, not the original deadly mistake.

One more example of what gets foisted upon the public in the interests of the anti-smoker industry:

The scientists and civil servants of the US Environmental Agency, working on Environmental Tobacco Smoke, or “passive smoking”, have produced a report so flawed, so statistically dishonest, so altogether ridiculous that even its own members have blenched. Two internal EPA documents by its own Environmental Criteria and Assessment Office suggest that the “EPA process and report was badly conceived and argued, that the alleged ‘causal’ connection between lung cancer and ETS was overstated, and that the evidence does not support a Group A carcinogen classification for ETS.

“It is clear from the way in which the EPA has handled the ETS issue that the anti-smoking movement is aware of, if not directly involved in, using corrupted science in the pursuit of its public-policy agenda” [Dr John C. Luik, Through the Smokescreen of “Science”: The Dangers of Politically Corrupted Science for Democratic Public Policy: FOREST publication, 1994].

The EPA, in fact, could not have produced its result without using what the EPA official responsible for the risk assessment herself actually described as “fancy statistical footwork” ... [Science, July 31, 1992].

Or as an understandably anonymous “prominent epidemiologist” remarked to Professor Alvan Feinstein: “Yes, it’s rotten science, but it’s in a worthy cause. It will help us get rid of cigarettes and become a smoke-free society.” [Professor Alvan Feinstein, in Toxicological Pathology, 20 (2), pages 289-303].

There are risks in lying, even about smoking, as the subsequent furore about this report has shown, and the EPA would surely not have been insane enough to take those risks if there had been any genuine evidence at all. If there had been any real evidence of the dangers of passive smoking, it would not have been necessary to use fancy statistical footwork or rotten science.

But the corollary to this is surely more important than the collapse of the case on “passive smoking”, which no-one with any sense really believed in.

How can we trust any work by official institutions, with their scientists, doctors, and civil servants, on any other subject, including, of course, that of the dangers of actual smoking?

After the shameful scandal of the EPA report the onus is on the anti-smokers to prove that the rest of their work is not as corrupt, as much “rotten science”, as that on ETS. We are waiting to hear from them.


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