Measuring the Health Hazards of Tobacco: Commentary

By Lopez, A. D. | Bulletin of the World Health Organization, January 1999 | Go to article overview

Measuring the Health Hazards of Tobacco: Commentary


Lopez, A. D., Bulletin of the World Health Organization


"We therefore conclude that smoking is a factor, and an important factor, in the production of carcinoma of the lung". With this cautious statement, and an equally prudent remark on the evidence for a dose-response relationship, which while "admittedly speculative", none the less suggested that "... the risk of developing the disease increases in simple proportion with the amount smoked", the case was launched against tobacco as a leading cause of disease (1). Almost five decades and thousands of scientific studies later, the extraordinary individual risks of smoking are now well established in populations where the habit is widespread, and are no longer a question of substantial scientific uncertainty.

But this has not always been the case, and certainly was far from accepted wisdom in 1950 when Doll & Hill published their study. Indeed, not long after its introduction into Europe at the end of the fifteenth century, tobacco was thought to have medicinal value! While some undoubtedly found the smoking of tobacco disagreeable, such was its social acceptability that when King James I of England published a vigorous attack on the habit in 1603 (Misocapnus sire de abusu tobacci lusus regius), it was "read widely, dutifully praised, and generally ignored" (see ref. 2, page 98).

The evidence that tobacco was harmful began to accumulate during the 19th century, much of it relating to cancer and the use of clay pipes. As the incidence of lung cancer among men began to rise in the first decades of the 20th century, several epidemiological (case-control) studies were carried out in Britain, Germany, and the USA to explore the reasons for the observed increase. For various reasons, these studies failed to establish unequivocally the role of tobacco in producing lung cancer. Even the laboratory evidence was far from convincing, and "in 1950 ... was still not thought to support a significant role for smoking in cancer in either Britain or the USA" (see ref. 2, page 91). Indeed, at that time" general atmospheric pollution from the exhaust fumes of cars, from the surface dust of tarred roads, and from gas-works, industrial plants, and coal fires" was suspected as being the major cause, along with tobacco (see ref. 1, page 739).

The situation changed dramatically in 1950 with the publication of five major case-control studies (four carried out in the USA (Schrek et al. (3) , Levin et al. (4), Mills & Porter (5), and Wynder & Graham (6)) and one in the United Kingdom (Doll & Hill (1)), all of which revealed a close association between smoking and lung cancer. These studies were methodologically more rigorous than previous case-control investigations, and two studies in particular (those by Doll & Hill and by Wynder & Graham) were particularly noteworthy in view of the numbers of cases they studied (over 600 in each instance), their differentiation of risk by amount and duration of smoking, the exclusion of ex-smokers (whose risks of lung cancer are intermediate between current and life-long nonsmokers), and the careful consideration of possible selection bias and sources of confounding.(a)

While Doll & Hill's findings about the strength and nature of the association between smoking and carcinoma of the lung were widely accepted when they were published by the medical and scientific community, their conclusions as to cause and effect were not. The significance of the study was, as Doll himself remarked almost 50 years later, that the "... idea that smoking might be an important cause of disease had, however, been raised as a serious possibility and a great deal of research into its effects was initiated in many countries" (see ref. 2, page 97).

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Measuring the Health Hazards of Tobacco: Commentary
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.