The Nazi War on Smoking

November 5, 1999

Recently, we have been bombarded by a series of articles and TV documentaries, extolling the war against smoking conducted by authorities in Nazi Germany. These articles praise the Nazis for their foresight and vision, in "discovering" that smoking causes lung cancer (as well as nearly every other disease known to man).

All of this stems from a book, written by Robert N. Proctor, entitled "The Nazi War on Cancer". In the book, Proctor goes on and on, raving about the great work the Nazis did in finding a cure for cancer: i.e., the abolition of tobacco smoking. In page after page, Proctor describes and praises the work of the Nazi scientists. He is, however, long on hyperbole and adulation and short on descriptions of any real scientific studies, until we get to page 194, where we are told about "an exquisite piece of scholarship" by one Hans Muller who, in a paper published in 1939, finally "proved" that smoking causes lung cancer. Let's take a look at this "exquisite piece of scholarship".

What Muller did was to send a questionnaire to the relatives of deceased lung cancer victims. The questionnaire read as follows:

"1. Was the deceased Herr_____ a smoker? If so, what his daily consumption of cigars, cigarettes, or pipe tobacco? Please be numerically precise in your answer!

2. Did the deceased smoke at some point in his life and then stop? Until when did he smoke? If he did smoke, what was his daily consumption of cigars, cigarettes or pipe tobacco. (Please be precise!)

3. Did the deceased ever cut down on his smoking? How high was his daily use of tobacco products, before and after he cut back? (Please be precise!)

4. Can you say whether the deceased was ever exposed to polluted air for any length of time, either at work or off the job? Did this unclean air contain smoke, soot, dust, tar, fumes, motor exhaust, coal dust or metallic dust, industrial chemicals, cigarette smoke, or similar substances?"

Muller's paper does not state exactly how many questionnaires were sent out but he advised that 96 "cases" were obtained - 86 males and 10 females (which seems strange, since the questionnaire, by its express language, referred only to males). Anyway, the 86 males were divided into five classes: extremely heavy smoker, very heavy smoker, heavy smoker, moderate smoker, or non-smoker. The same was done for a group of 86 "controls" of the same age as the cases.

Proctor tells us that the results were "stunning"; the lung cancer victims were more than six times as likely to be extremely heavy smokers as the controls. 16% of the healthy group were non-smokers as opposed to 3.5% of the lung cancer victims. The lung cancer victims smoked a total of 2,900 grams of tobacco per day; the healthy controls smoked only 1,250 grams.

While Proctor may have considered this to be an "exquisite piece of scholarship", I demur. To me, it is a piece of trash. Why?

Well, for starters, we don't know how Muller selected either the lung cancer victims or the controls. Since he didn't tell us how many questionnaires he sent out, he was free, if he wished, to select from the questionnaires that came back, and cull out "faulty" questionnaires, just as do election judges in Chicago, when picking which ballots to be accepted or rejected. Furthermore, he was free to select his controls - the healthy people - on any criterion he might choose.

Even more important, Muller compared apples with oranges. He compared the recollections of relatives concerning the smoking habits of the deceased lung cancer victims, with the recollections of living people concerning their own smoking habits. That is a "no-no". Whenever the survivors of dead people are asked about the deceased's smoking habits, they always exaggerate those habits. In Germany in the 1930's, as in the U.S. today, a virulent propaganda campaign was underway, blaming smoking for lung cancer and almost every other disease known to man. Thus, when Hermann's widow was asked how much he smoked, her natural tendency was to visualize Hermann with a deadly cigarette in his mouth and respond, "He smoked a lot".

A reverse bias existed, for the healthy controls. Propaganda Minister Goebbels had been saturating the German press with advertisements and articles, suggesting that smokers were nearly as bad as Jews. Thus, when the living people were asked about their smoking habits, a strong bias existed to minimize the amount that they smoked. Simple conformity dictated that a Good German, like his leader, Adolf Hitler, didn't smoke or at least, didn't smoke very much - and the Germans were a very conformist people.

At the end of his book, Proctor cites figures, provided by the American Cancer Society and some German group called "Krebsforschungszentrum", purporting to show that the lung cancer death rate in West Germany in 1952 was 22 per 100,000 population in men and 4 for women, compared to 25 for men and 5 for women in the U.S. By 1990, allegedly because of the delayed effects of the successful Nazi efforts to eliminate smoking, especially among women, the German rates were 49 for men and 8 for women, while the U.S. rates were said to have climbed to 75 for men and 32 for women. We are told that these figures are "age adjusted".

I'm always a little suspicious of figures released by the cancer societies, because they have an ax to grind, and I'm especially suspicious of figures which are adjusted, when I'm not told exactly how the adjustment was made. Fortunately, we have the means to test these figures. If, as the anti-smokers claim, the elimination of smoking leads to the elimination of all sorts of diseases ranging from lung cancer to emphysema, and if, as they also claim, it takes anywhere from 25 to 45 years for the effects of youthful smoking to take their deadly toll, it follows that in Germany, where tobacco was in very short supply during and after World War II, and where women were virtually forbidden to smoke, the beneficial effects of smoking cessation should be reflected in a significant improvement in life expectancy. They are not.

To the contrary, according to a 1987 database, West German women had a life expectancy of 78 years, compared to 79 for their free smoking sisters in the United States, while German men had a life expectancy of 71, as compared to 72 for their brethren in this country. In neighboring Switzerland, which remained neutral during the War and where tobacco was never in short supply, the comparable life expectancies for women and men were 80 years and 73 years, respectively.

So the notion that doing away with smoking leads to an elimination of disease and a longer healthier life is scarcely born out by the German experience. In particular, it is not born out by the life expectancies of German women, which turn out to be less, 42 years after the War and 37 years after the end of the tobacco shortage in Germany, than those of women in the United States who smoked freely during the same time when smoking was either banned for German women or unavailable to them because of shortages of tobacco.