Lauren A. Colby
Chapter 04, The U.S., A Smoking Laboratory
|© 1996, Lauren A. Colby. Version 2.0
HTML-version by Kees van der Griendt
Many people believe that the current concern over smoking and health began with the publication of the first Surgeon General's Report, in 1964. Not so!
As early as 1952, the American Cancer Society, frustrated by the inability of medical science to find a cure for cancer (or even find the root causes of the disease), began pointing an accusing finger at smoking. In that year, the ACS began a study of a group of volunteers allegedly to find out whether smoking was related to lung cancer but actually, to prove that it was. They had the support of the Surgeon General at that time, Dr. Leroy E. Burney, who, in an article in the Journal of the American Medical Association, opined that cigarette smoking causers lung cancer and that cigarette smoking is 7 times worse than cigar smoking and 3 times worse than pipe smoking.
In the following pages, I will be discussing the relationship (if any) between smoking and lung cancer. Before doing so, however, it needs to be pointed out that, despite the claims of the anti-smoking movement, there is no "pandemic" of lung cancer in the United States. In the United States, there are about 2,140,000 deaths from all causes, each year. Of these deaths, less than 120,000 are from lung cancer 3 . Thus, despite what you may have read or heard, lung cancer is not a common illness.
According to the Surgeon General's Report, releasedin 1964, cigarette consumption in the United States was 50 cigarettes per capita per annum in 1900; 138 in 1910; 1965 in 1930; 1828 1940 and 3322 in 1950. In 1961, according to the Report, cigarette consumption reached a "peak" at 3986. In that year, according to the Report, 68% of all males in the United States over the age of 18 were smokers 4 .
The interesting word in the "Report" is the word "peak". By 1964, when the Report was issued, the ACS campaign against smoking was already taking hold, and consumption was already declining. By the time period 1986-88, according to the figures published in the Oxford Atlas of the World, which I've previously cited, it was down to 2020 cigarettes per capita per year, or just slightly over half the peak rate achieved in 1961. A Surgeon General's Report, issued in 1980, reported that in 1965, 51.1% of adult men smoked and 33.3% of women. According to the same source, the figures in 1979 were 36.9% for men; 28.2% for women 5 . According to the CDC (Centers for Disease Control), 26.5% of all Americans were smokers in 1992. Of these, 22.1% were regular smokers, while 4.4% were occasional smokers.
There are approximately 180 million Americans over the age of 18. Assuming that the average smoker smokes a pack a day (20 cigarettes), we can calculate annual per capita cigarette consumption by taking 26% of 180 million to get the number of smokers (which equals 51 million), multiplying by 365 days to get the annual consumption of all 51 million smokers and dividing by 180 million to get the per capita annual consumption. This gives a result of 2069 cigarettes per annum per capita, which is very close to the number supplied in the Atlas 6 .
The United States, therefore, has been turned into a giant laboratory for the evaluation of a cigarette/lung cancer link. If, in fact, cigarettes do, in fact, "cause" lung cancer, we should see a decrease in the LCDR's over the time period between 1961 and the present, corresponding to the approximately 50% decline in cigarette consumption, and the comparable decline in smoking. The problem is, we don't!
The Statistical Abstract of the United States, published by the Commerce Department, 1993 Edition, gives statistics for cancer death rates in men and women during the time period from 1970 to 1990. Unlike the international statistics, reported in the previous chapter, the figures in the Statistical Abstract are not percentages. Rather, they represent the number of deaths per 100,000 of population. Where the figures refer to a particular age group, they refer to the number of deaths per 100,000 population in that particular age group. Thus, the figures are automatically "age adjusted" 7 .
It turns out that in every important age grouping, LCDR's have increased, steadily, between 1970 and 1990, notwithstanding the decline in smoking! Here are the figures from the Satistical Abstract:
|For Men||For Women:|
|Age Group||1970||1980||1990||Age Group||1970||1980||1990|
|85 +||215.3||386.3||538.0||85 +||56.5||96.3||142.8|
Particularly interesting are the figures for women. They show dramaticincreases in LCDR's, in the key age groups where lung cancer is most prevalent, notwithstanding a steady decline in smoking rates.
The most obvious interpretation to be given to these figures is simply that the decline in smoking has not produced any decrease in LCDR's and that, in fact, in most age categories, the LCDR's have gone up. The anti-smoking people have an answer to everything, however, and, to combat the obvious implications of the statistics, they have developed a new theory: the "incubation period" theory. According to that theory, lung cancer is caused by smoking, and there is an "incubation period", variously given as 20 years, thirty years, or some other number, during which cancer develops in the lungs of smokers. According to this theory, the dramatic increase in LCDR's in women simply confirms that smoking causes lung cancer, because women began to smoke more recently than men, and the effects are just starting to show up in the figures.
There are a number of problems with the "incubation period" theory. The first is simply that, contrary to the assumptions advanced by the proponents of the theory, women are not newcomers to smoking, in America. A Gallup poll, taken in 1944, revealed that 36% of the women in the U.S. over the age of 17, smoked" 8 . In 1959, the Department of Agriculture estimated that 47% of the overall population of the U.S., over the age of 14, smoked, and that men smoked an average of 24 cigarettes per day while women smoked 19" 9 . I have found no reliable statistics for female smoking earlier than 1944" 10 , but would remind the reader that in films, books, etc., the female "flapper" of the 1920's was usually depicted with a cigarette in her mouth, often in a long white holder. Anyway, various surveys, taken between 1955 and 1985 and cited in International Smoking Statisticsshow female smoking rates as low as 27% and has high as 37%, with the latest surveys (1985) at 25% or 28% (according to which survey you believe). The notion that women were shy abstainers from tobacco use until recent years simply is not supportable.
A second, even more serious problem for the "incubation period" theory is that the statistics for LCDR's in women just don't add up when compared with the overall cancer death rate in women, i.e., the rate of death from cancers of all kinds, combined. According to the Statistical Abstract, that overall cancer death rate, age adjusted, has remained practically constant over the years. In 1970, it was 108.8; in 1990, it was 112.7. But how is this possible, given the dramatic rise in LCDR's in women?
To answer that apparent paradox, we must remember that we're talking death rates, notrates of incidence of disease. The death rate in females from heart disease has declined significantly in recent years. Here are the rates, by age groups, for ischemic heart disease (the major killer in that category):
Furthermore, medical science has made considerable progress in curing some of the kinds of cancer which afflict women. Thanks to pap smears and mammography, cancers of the genital organs and breast can now be detected early and often successfully treated. Thus, more women are living to the ripe old age where lung cancer usually strikes. Progress has also been made in prolonging the lives of lung cancer victims through chemotherapy, which may well account for the slight reduction in lung cancer rates in younger women (and men). The anti-smoking crowd, however, refuses to even consider these factors. They are committed to the belief that if smoking were just prohibited, disease, of all sorts, would be practically eliminated. When the statistics fail to show that the drastic decline in smoking has brought about a corresponding decline in LCDR's, the anti-smokers simply postulate longer, and longer "incubation" rates for lung cancer (forgetting, by the way, that on that theory, there also has to be an "incubation period" for the disease in the thousands of non-smokers who develop lung cancer!).
Next Chapter (5): The U.S.: Some Studies That Went Wrong