Tobacco and Public Health - TCSC Indonesia

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THE GREAT STUDIES OF SMOKING AND DISEASE IN THE TWENTIETH CENTURY
and Public Health 1957), and by cancer societies in Denmark, Norway, and Finland
(United States Public Health Service 1964). The evidence at the time included
early reports from the cohort studies (Doll and Hill 1954, 1956; Hammond and Horn
1954, 1958a, b), additional case-control data (Doll and Hill 1952; Kouloumies 1953;
Linckint 1953; Gsell 1954; Randig 1954; Kreyberg 1955; Schwartz and Denoix 1957;
Segi et al. 1957), and experimental evidence that prolonged application of condensates
of tobacco smoke induced skin cancer in rabbits and mice (Wynder et al. 1953, 1955;
Sugiura 1956; Engelbreth-Holm and Ahlmann 1957; Guerin and Cuzin 1957;
Croninger et al. 1958).
Counterarguments to the idea that smoking caused lung cancer grew increasingly
implausible in the face of the evidence that had accumulated by the late 1950s. The
hypothesis proposed by R. A. Fisher, that some underlying constitutional factor predisposed
smokers to both smoking and lung cancer (Fisher 1957, 1958, 1959) did not
explain the temporal increase in lung cancer in the population, nor the decrease in
lung cancer in persons who stopped smoking. Berkson’s contention that the hospitalbased
case-control studies were biased by the differential effects of illness on enrollment
(Berkson 1955) was countered by the stability of the association between
smoking and lung cancer during longer follow-up of the British Doctors Study (Doll
and Hill 1956). The lack of specificity whereby smoking was associated with multiple
diseases (Berkson 1958) was also not considered strong evidence against causation,
because of the complex mixture of chemicals in tobacco smoke (Doll 1998b).
The scientific consensus that tobacco smoking caused lung cancer became even
stronger after 1960, with the publication of reports from the World Health
Organization (1960), the Royal College of Physicians of London (1962), and the
Advisory Committee to the United States Surgeon General (US Public Health Service
1964). In 1962 the Royal College of Physicians concluded, ‘Cigarette smoking is a cause
of lung cancer and bronchitis and probably contributes to the development of coronary
heart disease ...It delays healing of gastric and duodenal ulcers’. The 1964 Report
of the Advisory Group to the Surgeon General in the United States (US Public Health
Service 1964) was particularly influential, according to Doll, because of its thoroughness
and because its members had been individually vetted by the tobacco industry to
exclude those who had publicly expressed views on the topic (Doll 1998b). Based on
independent analyses of seven published and unpublished prospective studies, and
review of 29 retrospective studies of smoking and health, the report stated, ‘Cigarette
smoking is associated with a 70 percent increase in the age-specific death rates of males
and to a lesser extent with increased death rates of females’. It concluded:
Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette
smoking far outweighs all other factors. The data for women, though less extensive, point
in the same direction. A relationship exists between cigarette smoking and emphysema, but it
has not been established that this relationship is causal: Male cigarette smokers have a higher
death rate from coronary artery disease than non-smoking males. Although the causative role of