{"text":[[{"start":6,"text":"In these pages, and in my last book, I’ve written about the lessons we should learn from Richard Doll and Austin Bradford Hill’s investigations in the 1950s into the link between cigarettes and lung cancer. There is one lesson I failed to draw."}],[{"start":20.95,"text":"I wrote that in 1954 the British epidemiologists Doll and Hill “marshalled some of the first compelling evidence that smoking cigarettes dramatically increases the risk of lung cancer”. That is not untrue, but neither is it the whole truth."}],[{"start":37.099999999999994,"text":"Two pathologists, Eberhard Schairer and Erich Schöniger, published a study of “lung cancer and tobacco consumption” well before Doll and Hill took up the question. Schairer and Schöniger began by noting that lung cancer, a rare disease in the 19th century, had shown a “pronounced increase”, and then dismissed the plausible-seeming idea that the cause was vehicle exhausts. Lung cancer was on the rise in rural areas just as much as urban, they noted, adding that “the male gender is much more frequently afflicted . . . than the female,” yet “both genders are exposed to almost the same degree” to exhaust fumes. "}],[{"start":72.75,"text":"More plausible, they suggested, was that cigarettes were to blame. Schairer and Schöniger sent out questionnaires to the families of people who had died from cancer, and also to living men in their fifties (at peak risk of lung cancer), enquiring about their smoking habits. They found a strong correlation between being a heavy smoker and developing lung cancer, but no such link between smoking and stomach cancer. "}],[{"start":98.4,"text":"Schairer and Schöniger never pretended to have the last word on the subject, they thought their findings were not certain but “only likely”. It was a small study and there are question marks over the survey methods used. But decades later, Richard Doll himself described the study as “percipient” and “important” even if it fell short of decisive proof."}],[{"start":118.85000000000001,"text":"Why, then, is the study not better known? The overwhelming weakness in Schairer and Schöniger’s study is simple: they were German, writing in German, and they published in a German scientific journal in 1943. The immediate consequence is that Doll and Hill didn’t see it. Copies of the study didn’t reach the UK at all during the war."}],[{"start":139.65,"text":"But the problem for Schairer and Schöniger was not a language barrier or a failure of scientific communication because of the strictures of war. It was that their entire enterprise was fatally tainted by association with the Third Reich. Doll notes that in postwar West Germany, the study was ignored and that “interest in the effects of smoking waned, as a reaction to the anti-smoking policies of the Nazi government”."}],[{"start":164.35,"text":"Those policies are striking indeed. Hitler was a vegetarian — a fact so well known as to have become a punchline — but he was also a non-smoker. Nazi anti-tobacco activists were fond of pointing out that Mussolini and Franco also abstained, while Churchill, Roosevelt and Stalin all smoked heavily. Nazi cartoons depicted grotesque caricatures of Jews and dark-skinned people drinking and smoking, connecting two Nazi obsessions: their fear of racial impurity and their fear of impure substances such as alcohol, tobacco and processed food. Some of the Nazi ideas about health, clean living and being ever vigilant about toxins feel unnervingly fashionable."}],[{"start":203.7,"text":"The Third Reich pursued its promotion of healthy lifestyles with some good old-fashioned public health messaging with an overtone of “do it for the good of the nation” that is probably much more sinister with the benefit of hindsight. Inspiring posters pointed out that healthy Aryan women drank apple juice and did not smoke so they could produce healthy babies, while hard-working men could save so much money from quitting smoking that they could buy a Volkswagen."}],[{"start":229.89999999999998,"text":"For chief propagandist Goebbels, there was a risk of taking this campaign against smoking too far. Many teachers smoked, and doctors, and for that matter many senior Nazis, including Hermann Göring. The propaganda ministry feared that a hardline wartime campaign against smoking would inevitably fail and the government would look foolish."}],[{"start":249.84999999999997,"text":"Yet Hitler clearly felt quite passionate about the issue. In 1941, Karl Astel, a professor of medicine as well as a prominent racial hygienist, established the Scientific Institute for Research into the Hazards of Tobacco at Friedrich-Schiller University in Jena. Hitler sent a telegram of congratulations and 100,000 Reichsmarks from his personal office, a substantial sum. "}],[{"start":273.7,"text":"Astel was a strong supporter of Hitler as early as 1923, and received the “Golden Badge of Honour” for being one of the early members of the Nazi party. He was intimately involved in organising the Holocaust and even more closely associated with the murder of 200,000 disabled people. Shortly before the end of the war, and presumably contemplating being tried for war crimes, he killed himself. "}],[{"start":296.7,"text":"Astel also funded Schairer and Schöniger’s research. So how complicit were Schairer and Schöniger themselves in the evils of the Third Reich? We know little about Schöniger, but we do know that Schairer joined several Nazi organisations, including — along with 10 million others — the Nazi party. "}],[{"start":314.25,"text":"In an obituary essay, Schairer’s son declared that his father “never was a member of the resistance and he was not a hero” but that he was a “liberal person” who regarded the Nazi manifesto as “inhuman”."}],[{"start":326.55,"text":"While it is only natural to want to know what Schairer and Schöniger thought and did about Hitler, that has very little to do with what they thought and did about the link between cigarettes and lung cancer. Their research was important and should have been influential, but it was ignored."}],[{"start":343.2,"text":"At a distance of more than eight decades it’s easy to shrug; we figured out the link between cigarettes and cancer a few years later, after all. But the delay was real and deadly, especially in West Germany itself."}],[{"start":357.2,"text":"Historian Robert Proctor, author of The Nazi War on Cancer, speculates that in postwar Germany the Nazi campaign against tobacco delayed “the development of effective tobacco measures by several decades”. Public health campaigners and epidemiologists have always had powerful enemies in the form of Big Tobacco. But who needs an enemy if your loudest cheerleader is Adolf Hitler?"}],[{"start":380.34999999999997,"text":"For all our lofty aspirations to scientific rigour, we are social creatures, heavily influenced by the beliefs of those we admire and those we despise. But even those we despise are not deluded about everything. The Nazis were so monstrously wrong about so many things that it is hard to imagine that they were ever right. Life is rarely that simple. "}],[{"start":404.04999999999995,"text":"Find out about our latest stories first — follow FT Weekend Magazine on X and FT Weekend on Instagram"}],[{"start":416.79999999999995,"text":""}]],"url":"https://audio.ftcn.net.cn/album/a_1777365839_5748.mp3"}