I dropped into the River this afternoon, and was told a sad story. One of the regulars said that someone he knew had just been given two weeks to live. She was only 39, and riddled with cancer.
'Imagine it,' he said, rolling his eyes. 'Two weeks to put your affairs in order!'
'It started in her throat,' he added.
'Was she a smoker?' I asked.
'No. She didn't smoke. And she didn't drink either.'
And I began wondering yet again what was causing all this cancer, if it wasn't smoking or drinking or any of the other 'lifestyle' risk factors. Sir Richard Doll claimed that 90% of lung cancers were caused by smoking. 60 years on, we still have no better idea.
Smoking was hit upon as a convenient culprit. And it's remained the prime suspect ever since. Over the subsequent 60 years, antismoking has grown up to become a lucrative industry. Yet all that was found in 1950 was that, in an era when most people smoked, most people with lung cancer were smokers. What a surprise! Various figures get bandied about on the prevalence of smoking back then. That 60% of men smoked. Or 80% of them. But in the British Hospitals study conducted by Doll and Hill in the late 1940s, and published in 1950, 98% of all the patients in the study - lung cancer or other - were smokers. And when the subsequent Doll and Hill British Doctors study began a year later, 87% of the doctors were smokers. From these two snapshots from that time, it rather looks as if 90% or more men were smokers back then.
Since then, smoking has been in steady decline. In half a century, it's fallen from something like 90% to 25% or less. But lung cancer rates kept on rising for most of that period.
If this might have suggested to some people that there might be something wrong with the smoking hypothesis, the response of the antismoking zealots was to vastly magnify the threat. Whereas Richard Doll and Ernst Wynder had largely dismissed any danger posed by secondhand smoke, the next generation of zealots seized upon it to extend and enhance the threat. Smokers weren't just killing themselves, but were killing everybody else as well. If lung cancer rates kept on rising as smoking rates fell, it was because secondhand smoke in the vicinity of smokers was just as lethal as firsthand smoke. And if never-smokers in smoke-free environments continued to get lung cancer, it could only be because they encountered the thirdhand residues of smoking on the walls of buildings or the clothes of smokers, and this residue was yet more lethal still. The more remote the threat of tobacco smoke became, the greater its toxic powers were multiplied so as to compensate.
There is a mediaeval mindset underpinning such a tenacious belief. A wicked witch has been casting evil spells upon people, and she is tried and burned. But the blight on their lives continues, and so suspicion falls on her previously unsuspected daughters. And they are tried and burned too. But the blight only grows worse. And so suspicion falls upon her house and her possessions, and they are burned too.
Another mediaeval belief is that sickness is a punishment for sin. Smoking, along with drinking and debauchery, had long been held to be a sinful practice. What more apposite than to discover that the sin of smoking was attended by an appropriately divinely ordained punishment, in the form of lung cancer?
In fact modern 'lifestyle' medicine is simply this ancient dogma renovated and re-branded for a new age. Words like 'sin' and 'punishment' are no longer employed. Its practitioners no longer brandish crucifixes and bibles. But the gist of its message remains the same: the patient is to blame for his disease.
Such mediaevalism may well be simply what always emerges when reason falters or fails. Medical rationality has yet to explain cancer and many other diseases. And while the bright fire of reason slowly advances, it pushes up against a surrounding darkness inhabited by the spirits and hobgoblins and witches and succubi of the mediaeval mind. For every patient scientist like Snow or Pasteur or Fleming, there are always dozens of Dolls and Godbers and Liam Donaldsons, the modern descendants of witch doctors with bones thrust through their noses, dancing ecstatically around their pinioned sacrificial victims. Unable to advance in reason, we fall back on superstition.
One might even say that other modern beliefs have a similar mediaeval structure. We are told that we are to blame for heating up the planet, and that we must repent and wear sackcloth and ashes, as a carbon penance for our sins, for otherwise a divine retribution of global fire will be upon our children and our children's children, yea even unto the seventh generation.
It was all present this afternoon at the River. After firsthand smoking as a cause of the unfortunate young woman's cancer had been dispensed with, the spectre of secondhand smoking was conjured up in its place. If it wasn't one form of smoking, it had to be another. Anything else was inconceivable.
'Who was that comedian who reckoned he'd got lung cancer from playing for years in smoky clubs?' the regular asked. 'The name's on the tip my tongue. Roy... Roy Castle!'
'Yes,' I replied, 'That was indeed his own wild guess how he got it.'
Banging on about the Smoking Ban
- The Mediaeval Mind