July 22nd, 2010

frank_davis4

Fashion

I've been surfing the web (again). And I rediscovered Aberrant today:

Julian Whitaker, MD( October 1995) "Since 1950, the incidence of all cancers in people between the ages of 50 and 60 years has increased by 44%, with even higher increases in some of the more deadly forms of cancer. Breast and colon cancer went up 60%, prostate up 100% and testicular cancer for men between the ages of 28 and 35 went up 300%. Lung cancer has gone up 262%, an increase that is obviously not related to cigarette smoking, because over the same period the number of people smoking cigarettes dropped from 50% to 25%..."

These huge increases in the incidence of cancer reminded me of the 2002 Swedish study Cancer Trends During the 20th Century, which I first came across 4 or 5 years ago. cancer trendsAt left are a couple of graphs from it, which show the incidence of of various cancers. The figures are, I believe, not age-adjusted: which should mean that they're the raw figures for Sweden rather than the massaged ones.

What's striking about almost all the varieties of cancer is that, from relatively low rates up until about 1945, they start climbing in an almost straight line, and keep on rising. This applies also to lung cancer. And assuming that the prevalence of smoking in Sweden had been falling after 1945 much as it had in the rest of the Western world, it said that the incidence of lung cancer had kept on rising while the prevalence of smoking was falling - which strongly suggested that something other than smoking was causing lung cancer, and perhaps all other cancers as well.

What had happened in 1945 that might have led to this sudden change? My suspicion was that it might have been the atmospheric testing of nuclear weapons, which began in 1945. I supposed that perhaps radioactive fallout from these tests had been scattered all over the world, perhaps mostly in the Northern hemisphere. And it had got into people in one way or other, and played havoc.

But any number of other things started happening in 1945, as WW2 ended. Cancer is mostly a disease of old age, and it may well have been that before the latter half of the 20th century people simply weren't living long enough to die of it, and were instead dying of tuberculosis or flu or any number of other communicable diseases. But while it seems plausible that lung cancer and skin cancer might be caused by breathing in or coming into contact with radioactive particles in the environment, it seems harder to explain breast cancer or prostate cancer in this way. And anyway to the best of my knowledge there isn't much of an enhanced risk of getting cancer if you live in post-war Hiroshima.

My current favourite hypothesis is that cancer is caused by Human Papilloma Virus (HPV), largely because HPV has been found in most cases of cervical cancer, and also in many cases of other cancers, including lung cancer. It's also an explanation that fits in with the 'classical' medicine which has been so successful over the past century with so many other diseases. It would also make cancer a 'normal' sexually-transmitted disease. If so, WW2 might have seen HPV spread by infected military personnel all around the world from its source of origin, to become a global epidemic. Increased civilian travel over subsequent decades, and increasing sexual freedom would have spread the virus further. If smokers tend to get cancer more often, it's probably because smoking is sexy.

It's really rather surprising that smoking is still widely regarded as the cause of lung cancer. But back in 1950, when young Richard Doll was working on the London Hospitals study, and finding that 99% of lung cancer patients were smokers, it must've looked like an open-and-shut case. Same also with the British Doctors study, which began being published in 1954. 87% of the doctors were smokers. And smoking is very plausible as a cause of lung cancer: people inhale the smoke into their lungs.

But Aberrant reports a similar study to the London Hospitals study carried out in 1995

On May 23, 1995, the Associated Press(US) reported on a study made by Dr. Gary Strauss. Strauss analysed 685 lung cancer patients seen at Brigham and Women's hospital in Boston(Mass) between 1988 and 1994. He found that 59% of the patients were non-smokers at the time their cancers were diagnosed. Of these, 8% of the entire sample had never smoked; 51% had smoked at one time but had given it up. Of the 51% who had quit, nearly one fourth had been off cigarettes for more than 20 years. On average, the former smokers had been off cigarettes for six years. Lung cancer is not always diagnosed in non-smokers, because doctors aren't necessarily looking for it. Currently, according to the CDC, 25% of the (US)population are smokers. In the study years (1988-1994), the percentage was as high as 30%. Thus, purely on the basis of demography, we would expect between 25 and 30% of the sufferers from lung cancer, or for that matter, hangnails or acne, to be current smokers. 41% of the cases studied by Strauss were current smokers. Given the role of detection bias (doctors more likely to diagnose lung cancer in smokers than non-smokers), the 41% figure suggests that the lung cancer risk for current smokers may be little or no greater than for non-smokers.

So, coming up on 50 years later, non-smokers outnumber smokers among lung cancer patients. It's not just detection bias that should be taken into account. The prevalence of smoking is found by asking people whether they're smokers or not, and in an antismoking age where people may not wish to confess to be smokers, figures like 25% or 30% are almost certainly an underestimate of the true prevalence of smoking. It would appear that there is little or no risk of lung cancer from smoking.

But rather than surrender the dogma that smoking causes lung cancer, and conclude that smoking poses little or no risk, the medical establishment has decided that smoking must be even more dangerous than they had hitherto supposed, and that even the tiny amounts of tobacco smoke in secondhand (and now thirdhand) smoke are lethal. Smokers are not just killing themselves, but everyone else as well. The menace of SHS was invented to preserve the established orthodoxy, just as it was coming under threat, much in the same way that extra epicycles were added to the paths of the sun and the planets around the Earth in order to preserve the geocentric Ptolemaic universe.

Part of it may be professional pride. If smoking doesn't cause lung cancer (which it almost certainly doesn't), then the medical profession are going to have egg all over their faces some day soon. Secondhand smoke, and now thirdhand smoke, are ways of delaying that awful day.

But it may also be that "lifestyle medicine" - which is eugenics in disguise - is much more about creating a "fit" and "healthy" society than it is about curing disease or making people well. And this health and fitness is really mostly the appearance of health and fitness. "Healthy" people are defined as being people with lean, slim, muscular bodies rather than waddling fat people or spindly thin people. It's really just an aesthetic ideal. Smoking is an unsightly and filthy habit. It's a sort of blemish on the perfect society. As also is drinking, as drinkers stagger around singing and drunk and throwing up. Not nice. The utopia of the eugenicists is one that is filled with wiry, non-smoking, teetotal joggers. Beautiful people. It's a world from which ugliness of any kind will have been expelled. In its pre-war Hitlerian variant, people were also ugly if they had big, hooked noses like stereotype Jews. And they were beautiful if they were blonde. 50 years on, blonde still is beautiful.

Lifestyle medicine really has much more in common with fashion in clothing or architecture or art than it has with science and reason and classical medicine. It's post-modern medicine. Or maybe post-normal medicine. There's nothing rational about it, because there's nothing rational about fashion. Lifestyle medicine is a sort of tyrannical Weightwatchers, where the personal goal of being slim and fit and attractive has been universalised, and absolutely everybody must become slim and fit and attractive. The tyranny of lifestyle medicine is the tyranny of fashion. Giving up smoking is a fashion statement, much like wearing chinos or three-piece suits or Reebok trainers. It shows you're in with the in-crowd. It shows that you're cool, or hip, or whatever.

But fashion is very ephemeral. What's fashionable one day is unfashionable the next. Women are usually far more aware of this than men. Aesthetic tastes change, and often change very suddenly.

When I was in Barcelona back last November, I took an inventory of the little bars and cafes dotted around the district where I was staying. From memory (I don't have the documentation to hand) there were about 26 of them, of which just 3 were non-smoking. My idea was that, when I next went back, I'd count how many the impending total smoking ban had wiped out. In the event, no such ban was imposed, so they're probably all still in business.

But one thing I noticed about the 3 non-smoking cafes was that they were aesthetically completely different from the other 23 smoking bars. They were all hyper-clean and hyper-modern and largely devoid of decoration. They were also largely empty of customers. The smoking bars were all quite different, and very often quite different from each other. They were all much more relaxed. One of my favourites, I noticed one day, had a coat rack made of upturned goats' hooves. Some of them were so tiny that they only had one table inside. The oldest and quirkiest had plain wooden tables on a stone floor in an ill-lit room. The non-smoking bars were a bit like stark, plain, white-washed Methodist chapels. And the smoking bars were more like Catholic churches with their little bits of sculpture and art (posters rather than Stations of the Cross). And I suppose that being a Methodist or a Catholic used once to be a "lifestyle choice", and you were real cool, real chic, if you belonged to the progressive Methodist in-crowd, and you weren't a stick-in-the-mud, blinkered Catholic with your holy water and your patron saints. Freedom of religion is freedom of fashion. It's the right to wear dirty torn jeans and grubby T-shirts. And smoke cigarettes. Like me.

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Apart from Aberrant, I also found out that Jredheadgirl (aka Juliette Tworsey) has her own blog. She's only been writing it for a couple of months or so, she told me today. And very nicely written it is too. I love it when angry smokers mouth off about smoking bans. Particularly when they're real pretty, and talk like truck drivers. And smoke.

Her band, Firebug, is coming to England next week. And I'm beginning to think that I'd like to see her play that big yellow electric guitar of hers. She's playing 3 or 4 gigs before going back to the Hell That Is California. One of them is in Swindon, which isn't an impossible distance away. Stuck down here in Devon, my social life in complete ruins after the smoking ban, I never see anybody. I'm beginning to wonder whether to climb into my car and sprint up the motorway, just so that I can see and listen to someone who's on my side. What you say? Should I stay or should I go?

PS. I'm going. Firebug tour dates and locations can be found here. I'm not sure whether I need to book to get into Riff's Bar in Swindon. Does anyone know?

PPS: On smoking and lung cancer, read this too.