Political epidemiology of case-control studies (1926-1950)

The political epidemiology of case-control studies developed in this paper aims at comparing the contexts of German studies regarding the relation of tobacco to lung cancer published during the height of Nazi power with that of English and American case-control studies on the same topic published in 1950. In Germany, the political context was opposed to tobacco and willing to condemn its potential deleterious effects. Two studies comparing cases of lung cancer with "normal" ones accurately concluded that tobacco was a cause of lung cancer. They were not the first to do so; they were poorly designed and most likely were produced to legitimate the Nazi project, which used the fight against tobacco as a means of racial engineering and militarization of the German society. In contrast, in 1950, English and American epidemiologists had to overcome obstacles in order to publish their own findings about the tobacco-lung cancer connection, based on much larger samples. The English case-control study conducted by Doll and Hill was methodologically robust, but it contradicted the good image of tobacco in democratic societies and the strength of the pro-tobacco lobby. But, because of the quality of the work, the English and American studies served to obtain the official acknowledgement that tobacco is a cause of lung cancer.