Medicine: Smoking & Cancer (Contd.)

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After years of bombarding each other with flat denials and unflattering recriminations, the two sides in the smoking-and-lung-cancer controversy came close to sense-making agreement last week. Previously, evidence has usually been offered at one-sided meetings—either by those who indict heavy cigarette smoking as the principal cause or by those who put the blame for lung cancer's explosive increase on general atmospheric pollution. Last week authorities from both schools met in San Francisco under auspices of the University of California* the Tobacco Industry Research Committee put up $28,000 toward expenses.

A New Zealand general practitioner, Dr. David F. Eastcott, might have been speaking for nearly everyone present when he declared: "The incidence of lung cancer is complexly determined and cannot be related solely or principally to a single factor. Tobacco smoking plays a part. Atmospheric pollution plays a part." Trouble is, he complained, that the evidence incriminating heavy cigarette smoking is "compact" (and hence easily grasped), while that indicting air pollution is diverse and various.

Dark Satanic Mills. In the Down-Under dominion's heavily industrial Hutt Valley (pop. 80,000), Dr. Eastcott found conditions for his inquiry as neatly laid out as in a laboratory experiment. By excluding Maoris, he dealt with people almost entirely of British extraction. Under socialized medicine, all got the same health care. Their smoking habits were essentially the same. All were living where the wind is strong and almost continuous, so that air pollution is negligible. But some had been born and raised there, while others were immigrants who had spent the first part of their lives in smoke-shrouded Britain.

The death rate from lung cancer among both men and women, Dr. Eastcott found, was 30% higher among the British-born, and 75% higher among those who emigrated to New Zealand after age 30. No such discrepancy appeared with cancer in other parts of the body. Moreover, though New Zealanders (native and immigrant alike) smoke even more heavily than stay-at-home Britons, the dominion's lung-cancer death rate is still lower than the old country's. Concluded Dr. Eastcott: "Something happens to the Britisher in his native environment that increases his susceptibility to lung cancer . . . I regard this as the long shadow of those dark Satanic mills."

Public & Personal. Most surprising was the extent to which the University of Southern California's Dr. Paul Kotin agreed. Previously, Pathologist Kotin had minimized the importance of smoking, emphasized public air pollution. This time, though he piled up more scientific data to convict public air pollution, Dr. Kotin also plumped for multiple causation. He doubted, he said, that heavy cigarette smoking or "personal air pollution" plays a "primary role" in causing lung cancer, but he granted that it may be guilty as a fellow criminal. The researchers still differed in their theories of sequence: Dr. Eastcott thought British air pollution sets the stage for smoking to damage the lungs and perhaps lead to cancer, while Dr. Kotin thought smoking sets the stage for the air pollution villain.