Editorial

America’s new cancer: History repeats itself

Long after Doll and Bradford Hill convincingly showed that lung cancer is caused by cigarette smoking, the denizens of the tobacco industry established campaigns of disinformation to confuse Joe Public into believing that this etiological association was merely incidental.

They cited a broad range of ridiculous — or sometimes partly credible — explanations for the association.

Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
Derek Raghavan

For example, they claimed smokers predominantly came from areas that were exposed to radiation; also used alcohol, and it was the alcohol that caused lung cancer; had genes that caused lung cancer, which parenthetically also drew them to smoking; and were exposed to carcinogens — such as asbestos or solvents — at work, and the carcinogens solely caused the cancer.

It also was suggested that Agent Orange, radon, sunlight, inhaled aerosols and a host of other spurious causes were responsible.

We have since learned most of these arguments were bogus and disingenuous, fortunately leading to record-breaking judgments after dozens of litigations against the leaders of the tobacco industry and their companies.

History is littered with sad, silly and similar bait-and-switch explanations that confound logic but are used by the unethical to excuse their culpability for a range of cancers — for example, those who run tanning booths and list a range of spurious causes for the epidemic of skin cancers arising from their trade. Or consider the nonsense that was claimed in decades past about the lack of association of industrial dyes and solvents with bladder cancer — and the epidemic of bladder cancer adjacent to the Great Lakes in the period before the great clean-up occurred.

The list of false claims and advertising on these topics is endless.

It is worth remembering that, addressing the seminal work on cigarettes and lung cancer, Austin Bradford Hill defined criteria that could logically produce causality — namely, the strength of the association, consistency, temporality, dose dependency, biological mechanism, coherence, experiment and analogy.

‘The true cause’

So why I am reminding the august readership of this cancer broadsheet of these facts?

I write on this topic because, in the United States, once again we are being fed a line of malarkey by prominent leaders who know better on the causes of the latest cancer sweeping the nation — in this case, more a societal rather than biological one.

Only 18 months after my editorial on the tragedy at Marjory Stoneman Douglas High School in Parkland, Florida, where a gun-toting maniac killed so many children, we have been witness to the further spread of America’s new cancer — the rise of mass shootings via the use of rapidly repeating weapons, mostly (but not exclusively) associated with bigotry, white supremacism and the unchecked political impact of the National Rifle Association.

As I write this editorial, I am reflecting on the events of the last 48 hours in El Paso, Texas, and Dayton, Ohio, closely on the heels of the loss of life in Gilroy, California. I am sickened by the number of leading politicians who are attempting to divert attention from the true cause — lack of gun reform — by blaming video games, mental illness, social disorder and blah, blah, blah. As a physician, I am particularly offended by the attempts to blame mental illness as the crucial cause, which reflects the worst of demagoguery.

There is no doubt that these factors are germane to the issue, but addressing one key item certainly will have the biggest impact on fixing the problem.

If one considers the association of the rapidly increasing incidence of this societal cancer vs. the likely explanations, absence of gun reform — reflecting lack of political courage — most perfectly meets Bradford Hill’s criteria:

A social responsibility

You all know that I believe physicians have a social responsibility as societal leaders of high intelligence, resources and impact.

We continue to allow our professional bodies to bleat ineffectively, issuing position statements for our medical journals, but without taking any steps ourselves.

Find your representatives
Find your senators

It is time to start to lobby actively, in the same way that we have taken strong clinical stances against smoking, tanning booths, industrial pollution, etc.

With elections looming, and a House that is focused on producing solutions to gun violence, it is time to lobby our senators — particularly those who have held up bipartisan legislation on this topic for years in order to protect their gun-lobby ratings.

Without wishing to confound two related issues, we should show courage and stand up as a profession against racism and the emerging culture of violence in our nation, which seems so heavily directed against the minorities who have done so much to strengthen life in the United States.

If we do nothing, all we have to lose are more children, young parents and our way of life.

For more information:

Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, is HemOnc Today’s Chief Medical Editor for Oncology. He also is president of Levine Cancer Institute at Atrium Health. He can be reached at derek.raghavan@atriumhealth.org.

Disclosure: Raghavan reports no relevant financial disclosures.

Long after Doll and Bradford Hill convincingly showed that lung cancer is caused by cigarette smoking, the denizens of the tobacco industry established campaigns of disinformation to confuse Joe Public into believing that this etiological association was merely incidental.

They cited a broad range of ridiculous — or sometimes partly credible — explanations for the association.

Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
Derek Raghavan

For example, they claimed smokers predominantly came from areas that were exposed to radiation; also used alcohol, and it was the alcohol that caused lung cancer; had genes that caused lung cancer, which parenthetically also drew them to smoking; and were exposed to carcinogens — such as asbestos or solvents — at work, and the carcinogens solely caused the cancer.

It also was suggested that Agent Orange, radon, sunlight, inhaled aerosols and a host of other spurious causes were responsible.

We have since learned most of these arguments were bogus and disingenuous, fortunately leading to record-breaking judgments after dozens of litigations against the leaders of the tobacco industry and their companies.

History is littered with sad, silly and similar bait-and-switch explanations that confound logic but are used by the unethical to excuse their culpability for a range of cancers — for example, those who run tanning booths and list a range of spurious causes for the epidemic of skin cancers arising from their trade. Or consider the nonsense that was claimed in decades past about the lack of association of industrial dyes and solvents with bladder cancer — and the epidemic of bladder cancer adjacent to the Great Lakes in the period before the great clean-up occurred.

The list of false claims and advertising on these topics is endless.

It is worth remembering that, addressing the seminal work on cigarettes and lung cancer, Austin Bradford Hill defined criteria that could logically produce causality — namely, the strength of the association, consistency, temporality, dose dependency, biological mechanism, coherence, experiment and analogy.

‘The true cause’

So why I am reminding the august readership of this cancer broadsheet of these facts?

I write on this topic because, in the United States, once again we are being fed a line of malarkey by prominent leaders who know better on the causes of the latest cancer sweeping the nation — in this case, more a societal rather than biological one.

Only 18 months after my editorial on the tragedy at Marjory Stoneman Douglas High School in Parkland, Florida, where a gun-toting maniac killed so many children, we have been witness to the further spread of America’s new cancer — the rise of mass shootings via the use of rapidly repeating weapons, mostly (but not exclusively) associated with bigotry, white supremacism and the unchecked political impact of the National Rifle Association.

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As I write this editorial, I am reflecting on the events of the last 48 hours in El Paso, Texas, and Dayton, Ohio, closely on the heels of the loss of life in Gilroy, California. I am sickened by the number of leading politicians who are attempting to divert attention from the true cause — lack of gun reform — by blaming video games, mental illness, social disorder and blah, blah, blah. As a physician, I am particularly offended by the attempts to blame mental illness as the crucial cause, which reflects the worst of demagoguery.

There is no doubt that these factors are germane to the issue, but addressing one key item certainly will have the biggest impact on fixing the problem.

If one considers the association of the rapidly increasing incidence of this societal cancer vs. the likely explanations, absence of gun reform — reflecting lack of political courage — most perfectly meets Bradford Hill’s criteria:

A social responsibility

You all know that I believe physicians have a social responsibility as societal leaders of high intelligence, resources and impact.

We continue to allow our professional bodies to bleat ineffectively, issuing position statements for our medical journals, but without taking any steps ourselves.

Find your representatives
Find your senators

It is time to start to lobby actively, in the same way that we have taken strong clinical stances against smoking, tanning booths, industrial pollution, etc.

With elections looming, and a House that is focused on producing solutions to gun violence, it is time to lobby our senators — particularly those who have held up bipartisan legislation on this topic for years in order to protect their gun-lobby ratings.

Without wishing to confound two related issues, we should show courage and stand up as a profession against racism and the emerging culture of violence in our nation, which seems so heavily directed against the minorities who have done so much to strengthen life in the United States.

If we do nothing, all we have to lose are more children, young parents and our way of life.

For more information:

Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, is HemOnc Today’s Chief Medical Editor for Oncology. He also is president of Levine Cancer Institute at Atrium Health. He can be reached at derek.raghavan@atriumhealth.org.

Disclosure: Raghavan reports no relevant financial disclosures.