Ben Goldacre
Saturday June 30, 2007
The Guardian
We live in troubled times, where scientific research – at least in popular forums like newspapers – is only ever critiqued by ad hominem attacks on the person who did it. Evidence showing that MMR is safe was rubbished, because some researchers once accepted a drug company pen; and similarly, when the MMR scare died in the popular imagination, it wasn’t because of the evidence, but because Andrew Wakefield was shown to have personally profited from legal cases and applied for potentially lucrative patents for the alternatives to MMR. It would have been less complicated if everyone had just looked at the data.
But how bad would someone have to be for you to completely disregard the findings from their research, simply on the grounds of who they were? An adulterer? A recipient of private consulting fees? How about a cold-blooded racist, homophobic mass murderer?
This Sunday a smoking ban comes into force. In 1950 Richard Doll and Austin Bradford Hill published a preliminary “case-control study” – where you gather cases of lung cancer, and find similar people who don’t have the disease, and compare the lifestyle risk factors between the groups – which showed a strong relationship with smoking. The British Doctors Study in 1954, looking at 40,000 people, confirmed the finding.
You wouldn’t know it, but the Nazis beat them to it. The Germans had identified a rise in lung cancer as early as the 1920s, but they had suggested – quite reasonably – that it might be related to exposure to poison gas in the great war. In the UK, Doll and Bradford Hill were wondering if it might be related to tarmac, or petrol. Then, during the 1930s, identifying toxic threats in the environment became an important feature of the Nazi project to build a master race through “racial hygiene”.
In 1943 two researchers, Schairer and Schöniger, published their own case-control study in the journal Zeitschuft für Krebsforschung, demonstrating a relationship between smoking and lung cancer almost a decade before any researchers elsewhere. It wasn’t mentioned in the classic Doll and Bradford Hill paper of 1950, and if you check in the Science Citation Index, the paper was referred to only four times in the 1960s, once in the 1970s, and then not again until 1988. In fact, it was forgotten.
It’s not hard to understand why: Nazi scientific and medical research was so bound up in the horrors of cold-blooded mass murder, and the strange puritanical ideologies of nazism, that it was almost universally disregarded, and with good reason. Doctors had been active participants in the Nazi project, and joined Hitler’s National Socialist party in greater numbers than any other profession (45% were party members, compared with 20% of teachers).
Figures on the smoking project included racial theorists, but also researchers interested in the heritability of frailties created by tobacco, and the question of whether men could be rendered degenerate by their environment. Research on smoking was directed by Karl Astel, who helped to organise the “euthanasia” operation that murdered 200,000 mentally and physically disabled people, and assisted in the “final solution of the Jewish question” as head of the office of racial affairs.
Earlier this year this paper ran a rather dismal news story in which criticism was made of Sir Richard Doll, suggesting that his impartiality was somehow affected simply because he had occasionally accepted finance from industry. But medical statisticians like Doll save lives on a scale that is incomprehensible to most people, on a scale in the millions, the polar opposite of the anecdotes the media love. What would it take for me to doubt Doll’s data? The man was a hero. If you showed me he was a cold-blooded racist homophobic mass murderer, I’d still read his papers carefully.
Please send your bad science to bad.science@guardian.co.uk.
jodyaberdein said,
July 5, 2007 at 6:24 am
OK perhaps I’m not making my self clear, or at least those adopting a freedom of choice stance seem to be remaining quiet over the addiction issue.
You could formulate an argument as follows:
Many smokers are addicted to smoking i.e. they suffer withdrawal symptoms upon cessation, they exhibit tolerence, smoking is prioritised as an activity, they allow damage to occur to themselves and others in order to continue smoking, and continue smoking despite this damage being in some cases patently obvious.
It is difficult to make a rational choice about a behaviour to which you are addicted, as you are both coerced by your own withdrawal symptoms and you have an inappropriate discounting of the costs of that behaviour.
If the goverment were to legislate to provide smoking areas this could be interpreted as collusion with this destructive behaviour, which may earn them a pretty penny more but would be difficult to defend ethically.
That should get the ball rolling.
quark said,
July 5, 2007 at 10:18 am
triangular.bread
In my experience smoking areas don’t work. A restaurant critic once wrote that “having a smoking area in a restaurant is like having pissing a area in a swimming pool” (or similar). Not only does smoke not stay in one place, but I’ve also had to argue with smokers who simply ignored the non-smoking signs.
This is not about prohibition – you may smoke as much as your like in your own home or outside.
triangular.bread said,
July 5, 2007 at 11:32 am
gee, a restaurant critic said it? That’s settled it, then.
So you think it impossible to make adequate facilities for smokers and non-smokers in the same venue? Well, I think it is possible – no matter what Matthew Norman might have said.
Here’s an idea: rather than ban smoking in alll pubs, ban smoking in 1/2 of them, chosen by lottery. That way everyone could be happy, no? A blanket ban says that giving non-smokers a chance to enjoy refreshment in pubs is not the real reason for the ban; rather, some bansturbators hate the idea of smoking. It’ll be the street next, then in cars, then at home. Just watch.
Smeone mentioned powers reserved to local authority discretion. Well, no such powers have been reserved in Scorland AFAIK – and in Glasgow, believe me, we’d know all about it. Very few exemptions have been permitted (prisons, oil rigs and, interestingly enough, the palace of Westminster).
Anyway, I’m going to carry on smoking, not only because i enjoy it but also because it annoys all the right people – the dominies, the puritans and the nosy parkers most of all.
stever said,
July 5, 2007 at 3:10 pm
Why Transform supports the smoking ban:
transform-drugs.blogspot.com/2007/07/why-transform-supports-smoking-ban.html
a couple of reasons why i am slightly rueful about the ban:
1. now you can smell all the stale beer in the carpets, and old men farting.
2. we wont ever be able to have dutch style coffee shops
triangukar bread – that last comment of yours in teetering into troll territory.
your not banging the liberty drum. The legistlation is. if you want to smoke you can, just not in other peoples faces. nd if you want to consume nicotine you can wherever you like, just not cigarettes.
triangular.bread said,
July 5, 2007 at 3:58 pm
stever:
how is liberty served by restricting adult choice like this? How is liberty served by making smoking in pubs a police matter, rather than one of manners or private discretion of a licensee?
stever said,
July 5, 2007 at 7:29 pm
Its just not that clear (silk) cut.
The liberty of the pub staff, and of non smokers to be in a smoke free environment should be prioritised because:
– non smokers do not have the same options (smokers can go to a non smoking pub and not smoke, non smokers cannot go to a smoking pub and avoid smoke)
– non smokers are not imposing their antisocial drug use on others
Furthermore, as I have outlined:
– nicotine users have a range of smokeless products as options (patches, inhgalers, gum, snus, snuff, bandits, chewing tobacco etc) which are not banned. There liberty to consume their drug of choice is not infringed merely one particularly antisocial mode of administering it.
– liberties have to be wieghed against social costs. In this case a minor infringement of liberty will result in a massive social gain.
– in practical terms most establishments will be able to have an outside area where people can smoke. Where the ban has been introduced compliance has been very good, and police enforcement is very rarely needed.
– cigarette and tobacco smoking use is not being banned – if it was i would object strongly. You will still be able to smoke in the street, in parks, in the country side, in your own home and on private property. vioolating the ban is also a civil offence (£50 fine) rather than a crimainl one, like the possiesion of cocaine or ecstasy (7 years in prison). Its really just sensible public health regulation: A move that has massive proven benefits, majority support even before its introduced, and overwhelming popular support where introduced.
in a years time youll love it and wonder what the fuss was all about.
jodyaberdein said,
July 5, 2007 at 10:33 pm
Re 72:
I’m not sure I’m communicating very well today. I certainly didn’t think I was making a direct recommendation on prohibition, merely suggesting that addiction distorts choices and providing tacit support for distorted damaging choices might not be a good thing.
Regarding it being easy to give up smoking, I’m not so sure everyone would agree. The Royal College of Physicians has an excellent report on smoking, in which can be found this paragraph:
The evidence reviewed in this section demonstrates that the onset of certain conditions such as lung cancer, a heart attack or pregnancy provides the motivation for a higher proportion of smokers to try to succeed in stopping smoking than would otherwise have been the case. However, even after developing a serious smoking related illness which threatens loss of life or limbs in the immediate future, the majority of smokers are unable to stop smoking completely in the year after their condition is diagnosed. This remains true when medical advice and nursing support are provided, and when the smokers make determined attempts to stop smoking. When considered in conjunction with the other available evidence on the role of nicotine in tobacco smoking, this provides convincing evidence that many smokers suffer serious ill-health not through personal choice, but because they are, and remain, dependent on the nicotine they obtain from tobacco.
Which is certainly compatible with my experience of seeing amputees glumly puffing away outside the hospital doors. Are they exercising their free will and all just happen to be nihilists? Apparently not if you actually ask them what they think: the office of national statistics in England routinely find around 70% of smokers express the desire to give up smoking.
Furthermore even the tobacco companies realised early on that addiction would open them to serious culpability, hence the first admission that nicotine was most likely addictive only came from a tobacco company in 1997.
www.rcplondon.ac.uk/pubs/books/nicotine/
www.statistics.gov.uk/downloads/theme_health/smoking2006.pdf
triangular.bread said,
July 6, 2007 at 12:39 am
Jody:
You know, I have the right to make choices you don’t approve of. You can deplore them all you want, and tut about my lack of foresight or perspicacity. To which I say: mind your own beeswax.
You ever think that your glum amputees are enjoying one of the few pleasures left to them? If you’ve had a leg chopped off, it’s not going to magically grow back if you quit.
Here’s something that may be news for you: non-smokers die every day. You’ll eventually die; so will I; so will everyone reading this. And we all have the absolute right to decide how we head towards that terminus.
jodyaberdein said,
July 6, 2007 at 6:52 am
re 81:
OK I think this is as far as I can go with this point. Regarding rights and choices, I’m not sure I was doing any deploring. What I was doing was trying to expolore whether freedom of choice is limited by addiction, and suggseting it was as clearly the majority of people end up exhibiting behaviour that is both self damaging and contrary to their stated preferences. Again I’m sorry that tutting was thought to be going on. I certainly don’t think that foresight is an issue I’m not sure nicotine dependence goes hand in hand with reduced insight into the problem, if anything the contrary is true.
Regarding glum amputees, heart attack survivors and dialysis patients, I actually think quite a lot about them as I meet them evey day in the course of my work. It may well be so that they enjoy the pleasure of a cigarette whilst contemplating whether their below knee will turn into an above knee or full hind-quarter, but as I said, most of them state a desire to stop the habit and yet continue. I don’t deplore them or their habits for this, you wouldn’t last long in this trade with that level of moronic morality. I do deplore that they can’t act on their wishes though.
Regarding non smokers dying, of course they do, just on average much later and less often of lung cancer. Regarding ‘non-smokers die too’, I think that Bill Hicks had quite some insight into his addiction at least. It comes as part of the sketch where he thanks his audience for their support, ‘yeah Bill’s gonna lose a leg!’ he quips. And he died young of pancreatic cancer, not a way I’d choose to go personally, and interestingly not a way most smokers would choose to go either.
stever said,
July 6, 2007 at 10:38 pm
triangle – your repeating yourself, and just trolling now.
Robert Carnegie said,
July 8, 2007 at 10:37 am
Central Station: if you’re referring to the taxi rank under the canopy, I believe that you’re on railway property there. Railway stations went non-smoking before the ban. For one thing, every time there’s a terrorist bomb they take away all the litter bins. It may also apply to “The Hielan’man’s Umbrella”, the road underpass below Central’s upper train tracks. Or in each case perhaps it’s because there’s a roof.
Did we sort out “Godwin’s Law”? I’m not sure it really bears. Goodwin’s Law, on the other hand, probably refers amongst geeks to computer journalist Rupert Goodwin.
en.wikipedia.org/wiki/Godwins_Law gives a reasonable account as far as I can see (I understand Godwin protested its use to decide the winner of an online debate, but that’s memetics for you), or you could call it something like “The Nazis: An Exemplum In Sophistry”. Obviously, if you set out to discuss the Nazis or something that they did, that’s one exception.
RS said,
July 10, 2007 at 2:30 pm
“as for nazi research, at a slight tangent, i think the profits from sales of Mein Kampf are held in trust, supposedly to benefit jewish charities, but because the money comses via such a dubiious source they refuse to spend it, so it’s just gathered interest for 60 years….”
Superburger, I think you’ll find that the profits have been distributed for at least some of the versions (www.newstatesman.com/200106250039), with much of the rest of the profits taken by copyright holders (governments or publishers).
raygirvan said,
July 12, 2007 at 3:30 am
triangular.bread > Read the following … tinyurl.com/27bezm
Love the picture. Get orff moy laand!
teej said,
August 1, 2007 at 1:00 am
Apologies for joining this conversation late. I just think it would have been nice if the government had shown some imagination when legislating on this smoking thing. Could they not at least have tried something other than an outright ban first? Someone pointed out that there was no market for non-smoking pubs. The government could have at least tried to create one with, for example, tax breaks for non-smoking pubs/tax increases for smoking pubs.
Also, does anyone have reliable figures on how much the NHS spends on smoking-related illnesses compared to how much smokers pay in tax? I’ve heard it both ways but, if smokers pay more than they cost, this will have a negative effect on public health. Just a thought.
Yeah ok I admit it I’m a dirty horrible smoker. Oh yeah and I drink too much. Is there a doctor about?
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