Do you inhale? Capitalism and your Health by Northsylvania

(2 pm. – promoted by ek hornbeck)

True to form as usual

A purely free market system has one glaringly obvious flaw: if a company’s first responsibility is to its shareholders. In a system based on quarterly earnings, business decisions are only based on the effects of a product on the customer, or even society as a whole, if they impact the bottom line in the short term. This is why, to one extent or another, the excesses of free market capitalism are restrained through regulation. The only brake on corporate malfeasance in a case where the interests of business and society are diametrically opposed is the regulatory arm of the government.

Unfortunately, the interests of the government can be swayed by massive amounts of money, either through tax revenue or through campaign contributions to individual representatives. Sometimes the welfare of society and its constituent members are ignored, even in a supposedly representative democracy. A number of examples can be made here, from the lack of attention to global warming due to the interference of Big Oil, to the current state of the banking system.  This diary examines something both universal and intimate: the government’s ambiguous role in preventing long-term diseases such as cancer, and regulating triggers that might cause it. It is not a critique of the current US health care system, or even Obama’s modification of it, but an overview of how good health over the life of an individual is certainly not of primary importance to industry and in some cases, not of interest to the government either.

Many speculative discussions have arisen in this forum over the past several years concerning carcinogens in the environment and the food supply. Some of these are  controversial enough that they will not be covered here except tangentially. Instead I will use as a case study a substance whose toxicity is so well understood by the general public that there is no argument that its use and cancer are correlated. Nonetheless, because of the vast amounts of money produced through its sale, its carcinogenic nature was first ignored and then debated well past the point when it had become obvious to those in the medical profession, government regulators, and consumers. That subject is, of course tobacco, or more precisely the vast quantity of it consumed by cigarette smokers.

The Camels are coming

Cancer is by nature a stochastic disease, meaning that certain circumstances increase the probability but do not guarantee a specific outcome. Cancer can be caused in different parts of the body by genetic predisposition, radiation, chemical irritation, or combinations of all of them. Because cigarette smoking often, but not absolutely always leads to lung cancer and other long term illnesses, and employment and other confounding factors can be involved, concrete proof that smoking was dangerous enough to society that it should be severely curtailed was only made clear in the U.S. after 1950. However, early experiments showed its dangers much earlier.

The first known study linking tobacco and cancer took place in 1900 when Anton Brosch  painted tobacco tar on the exposed skins of guinea pigs and observed epithelial proliferation. By 1919,

James Ewing, a pioneer in American cancer epidemiology, observed in his book Neoplastic Diseases that lung cancer, while rare, was seen most often in metal workers, weavers, and cigar makers. In the years before cigarette smoking became the most common way of taking tobacco, “The cumulative effects of the habits of the individual are seen in smokers’ cancer of the lip, pharynx, and larynx.” Later on at a 1926 conference of the American Society For the Control of Cancer (later the American Cancer Society), Ewing stated

Since the major forms of cancer are largely the result of human habits and bad habits, a certain intelligent reformation of the habits of the race (sic) must be accomplished before cancer prevention can show very tangible results.

In the meantime cigarette production had become big business, supporting large corporations in the U.S. and UK. Buck Duke, the first American cigarette baron, was the first to recognize the capabilities of the newly invented Bonsack mechanised cigarette roller, which could reliably produce 120,000 cigarettes in ten hours. This revolutionized production, changed popular culture, and made Duke a very wealthy man.

The pressures created by the invention of the Bonsack machine led not only to the widespread use of cigarettes as America’s favored form of tobacco, but to the modern era of mass-market advertising and promotion.

The advertisement for Old Mill cigarettes from 1910 is visually typical of the era, but emphasises the lifestyle consumption that is often the defining feature of mass

marketing. The heavy promotion of cigarettes was counterbalanced by the efforts of social activists of the Progressive Era, who fought for more stringent rules on tobacco use. During the early part of the twentieth century, many states attempted to regulate both the sale and consumption of cigarettes. In 1901, only Wyoming and Louisiana were not in the process of considering anti-smoking legislation.  While the scientific experimentation was only preliminary, popular sentiment was strongly against public smoking. Buck Duke’s American Tobacco fought back through obvious, and in the case of Indiana unsuccessful, bribery attempts of state legislatures. More subtle means were employed as well. The 1890 edition of the U.S. Pharmacopoeia listed tobacco as a drug, but in later editions it was notably absent. When the Food and Drug Act was passed through Congress in 1906, part of the legislative wrangling involved in achieving a “greater good” was the exclusion of tobacco as a regulated substance. Non-smokers were beginning to feel that the government was turning against them. In a 1911 letter to the New York Times, Dr. Charles Pierce writes.

The right of each person to breathe and enjoy fresh and pure air–air uncontaminated by unhealthful or disagreeable odors and fumes is a constitutional right, and cannot be taken away by legislatures or courts, much less by individuals pursuing their own thoughtless or selfish indulgence.

From Here to Victory It’s Chesterfield

Aside from corruption, why might governments have been complicit in ignoring the majority of their constituents? The answer is money. As early as 1868, tobacco revenue was the main source of income for the U.S. government. As late as 2009, the expansion of SCHIP was able to cover dental and mental health programs for children by increasing excise taxes from $.39 to $1.01 per pack of cigarettes. Even this moderately progressive initiative balanced the welfare of the deserving poor (children) against that of the undeserving poor (the majority of smokers who are low income).  

The government has been complicit in promoting cigarette consumption for other reasons as well, including a perception that smoking enabled soldiers to fight better. After WWI, virtually an entire generation of U.S. soldiers returned home as tobacco addicts. Those who had objected to cigarette rations had been pronounced traitors. General Pershing himself said,

You ask me what we need to win this war. I answer tobacco as much as bullets. Tobacco is as indispensable as the daily ration; we must have thousands of tons without delay.

During WWII they were also included in soldiers’ rations. Service personnel were not discouraged from smoking, and cigarettes excluded from rations, until 1975. Even during the first Gulf War, the military assisted tobacco companies by transporting cheap cigarettes to the front. It has only been since 2010, when the Defense Department became fully aware of the cost to them, not because of VA treated long-term illnesses, but because efficiency studies show it handicaps troop readiness and individual productivity.

What were scientists doing to prove or disprove the dangers of smoking? After early experiments, the only scientists that continued to carry out experiments, with the full support of their government, were Nazi scientists. Hitler was vehemently anti-smoking for rather suspect reasons, some of which were racist: he thought tobacco was

the “the wrath of the Red Man against the White Man, vengeance for having been given hard liquor”. The role of women in Nazi Germany also played a role. Smoking was considered to age women prematurely, contaminate their breast milk, and make their children sick through passive smoking, a term the Nazis coined. Nonetheless, the first epidemiological studies linking smoking and lung cancer were accomplished there, and that was because they were government supported.

This…is the L&M moment

In the U.S., it was only after 1946, when lung cancer rates and their attendant health costs, had tripled, that serious experimentation took place. The first survey studies were done by Morton Levin and Evarts Graham and were published in JAMA in 1950. In the same year Richard Doll and Bradford Hill published similar findings in the British Medical Journal. In 1953, the Washington University School of Medicine and Sloan Kettering supported an experiment very similar to the 1900 Brosch study, though better documented, by Wynder, Graham, and Croninger, and

published in Cancer Research. The methodology and apparatus used were elaborate, and the conclusion inescapable. Mice treated with cigarette tar developed cancer at about the same point in their lifespan, and in about the same percentages as had been observed in humans:

This corresponds roughly with the fact already noted that in the human about 30-35 years of smoking are required for the production of bronchiogenic carcinoma.

Meanwhile competing narratives were being promoted. Findings in W.C.Heuper’s 1954 study, “Environmental Causes of Lung Cancer”, which examined carcinogens other than cigarette smoke, were cherry picked by cigarette industry lawyers, and sent to science and editorial writers.

As a result of the distribution in the U.S.A., articles questioning a link between smoking and cancer sprouted. In some press accounts, the Hueper story took precedence over the reports of Drs. Hammond and Wynder.

Other industry supported scientists published studies such as “Heavy Smokers With Low Mortality and the Urban Factor in Lung Cancer Mortality”, further confounding the issue.

However, by 1957 the Surgeon General distributed the report “Joint Report of Study Group on Smoking and Health” and formally declared a link between smoking and lung cancer in the scientific annals of the U.S. Government. However, scientific and legislative policy could be very different. Indeed, government price support of tobacco continued until 1985.

At least two important influences on U.S. tobacco policy have been in play, which may have encouraged those in government who were knowledgeable of scientific literature correlating tobacco and cancer to turn a blind eye: the vast amounts of money generated by domestic use and export of cigarettes, and the promotion of the national interest, especially during wartime. If you subtract 30-35 years from 1953, the year of Wynder et. al.’s study, the result is 1915-1920, exactly the time frame when Buck Duke’s mass produced cigarettes became a part of the popular culture through advertising and the influence of returning WWI American Doughboys. One could say that serious scientific research in the U.S. trailed initial studies by 50 years, because this kind of research wasn’t popular in certain quarters. It did not pay to know these things for sure.

Science discovered it- you can prove it. “No Unpleasant After-taste” Always Buy Chesterfield

All of this is past history. Scientific evidence, governmental policy regarding those findings, and popular perception are all on the same page, so why write about the more obscure parts of a rather sordid history? As mentioned in the introduction, other controversies have come to replace that of smoking and other long-term health risks have yet to be assessed. Some journalists, notably Nicholas Kristof of the New York Times, writes about endocrine disruptors in the environment. Others have investigated other issues, in both prominent and obscure forums, from meat production and industrial farming to the processing of wild caught fish, that challenge our assumptions of what constitutes a healthy lifestyle.

Sifting through the chaff can be incredibly difficult and time consuming and often there is no overwhelmingly right answer. However, the example of tobacco shows us that gold standard scientific research can lag far behind initial findings if what is perceived to be the national interest is at stake. In short the government often supports research, and if it is in the government’s interest not to know, they won’t bother finding out. Even when overwhelming evidence is produced, commodities will remain on the market, if what is perceived to be “the greater good” conflicts with the well being of individuals. At times, any semblance of concern for public health goes by the wayside when enough money is involved. Teacherken’s excellent diary, “Who knew that carcinogens had their own lobby in Washington?” calls out another Kristof article “The Cancer Lobby” about chemical industry lobbyists, and their tame congressmen such as Denny Rehberg of Montana, who are part of an effort to roll back regulation on formaldehyde and asbestos. Capitalism’s weak point, the pursuit of short-term profit in the face of long-term harm, infects all of society, from the ethics of supposedly neutral scientists to the questionable morals of those we elect to represent us. Some tend to look back on the Progressive Era as a golden era of citizen activism and good government, and in many ways it was, but even then the huge concentration of capital in a few hands such as Buck Duke’s could set back the cause of public health by 50 years. The biggest threat to your health is often vast quantities of someone else’s money.