As partofitsroleinthecontroloflungcancer the American Cancer Society disseminates the known facts derived fromresearch concerning the causes of this disease. When the spotlight has been focusedon tobacco in response to such researchfindings, Dr. Little has deflected the lightto “¿�many,many substances that we all useor are exposed to from day to day.―andto “¿�manyvariablesin human habits.environments, and constitution—hormonalinfluences and many other factors.― Thisleads naturally to the suggestion that thetobacco industry should support researchon air pollution and that the automotiveindustry direct its attention to cigarettesmoke. Neitherwants to incriminateitsown product; products of both have already been seriously incriminated.

The medical profession and the publicmust decide whether the partially allocated research appropriation of $2.2 million, of which so much has been made.has been more valuable as a fraction oftheadvertisingbudgetsoftheparticipatingtobacco firms or as a sincere effort to discover any harmful effects of tobaccosmoke.

Dr. Little and spokesmen for the innocence of tobacco have repeatedly deniedproof of a causal relationship betweensmoking and lung cancer.They can demand “¿�proof―with impunity, for overwhelming evidence can fall short ofmathematical proof. However, publichealth measures are usually based on overwhelming evidence.

Dr. Rutstein's letter (p. 46) was dispassionate—his questions concise and direct.Dr. Little announced that he would reply“¿�constructively.―In his statement (p. 49)he did not refer to either Dr. Rutstein orany of his specific questions. He essentially restated his reply of July 1957 to theSurgeon General's statement (p. 44). andreferredto contraryopinionsof “¿�anumber of distinguished statisticians,― naming

only Berkson who had shown that it wouldhave been theoretically possible for thefindings of one (Hammond and Horn,1954) of the many statistical studies tohave resulted from sampling bias. Fourstatisticians have pointed out the weaknesses of Berkson's arguments.

Knowledge of the relationships of cigarette smoking to lung cancer has gone farbeyond the statistical association and thedemonstration of carcinogenicity for animals. Much of the pathogenesis of lungcancer has been worked out. Some of ithas been reviewed by the Study Group onSmoking and Health (p. 57). In otherareas of research epidemiologic, experimental, and pathogenetic methods all playa role in studying the causes of humandisease. One gets the impression that theyare unacceptable here. It would be interesting to know, as a starting point, whatDr. Little does accept of this evidencewhich “¿�claims―to establish a relationship.It would help, too, if he would state precisely what kind of information he requires before he will be satisfied thatsmoking is a major cause of lung cancer.

The credulous public tends not to distinguish between expert opinions andopinions of experts outside their own specialties. Many do not even distinguish between fact and opinion. Have the tobaccointerests and the public press capitalizedon thesefactsby making theissue“¿�controversial―?

The challenge to the tobacco industryis not how courageously it can fight accumulating evidence, hut how bold and imaginative it can be in helping to solve themost seriousproblem ithas ever facedand one of the most serious problems inpublic health today. An early solutioncould be found through cooperation between industry and independent medicalresearch.____ DeanF.Davies,M.D.,Ph.D.

ACS Administrator for Researcison Lung Cancer,

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II. What Can One Think?