A critical reassessment of the evidence bearing on smoking as the cause of lung cancer.
A critical reassessment of the evidence bearing on smoking as the cause of lung cancer.
复制标题
对吸烟导致肺癌的证据进行严格的重新评估。
DOI：
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发表时间：
1975
影响因子：
12.7
通讯作者：
T. Sterling
中科院分区：
文献类型：
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作者：
T. Sterling
由于人口统计数据在很大程度上使人们相信吸烟是肺癌的一个原因，也许人们应该首先问人口调查和统计研究如何有助于了解肺癌或任何癌症的可能复杂的原因？这个问题是基本的，因为它包括吸烟作为可能的前因之一，但并没有忽视涉及其他因素的丰富证据。如果现有的人口研究确实清楚地表明吸烟是肺癌的主要原因，那么额外的大规模和昂贵的人口调查来发现其他原因可能是不必要的。另一方面，如果这一一般性结论是不可接受的，那么可以为一项更具包容性的人口研究奠定基础。一般认为，现有证据已证实吸烟是肺癌的主要原因。本报告致力于探讨这一信念--不是为了激怒或取悦，而是为了剖析和分析。由于采取分析的态度，可能难以避免的印象，这篇论文的重点是在关键的一面。关于吸烟和肺癌的大量研究既有优点也有缺点。虽然批判性的分析往往会指出不足之处，但这并不意味着过去的研究都没有价值。恰恰相反：许多有能力的研究人员非常仔细地研究了这个难题，并收集了宝贵的数据，他们的分析为了解人类疾病做出了重大贡献。批判性分析为评价广泛使用的研究方法和分析程序提供了一个客观的框架，但不幸的是，它没有挑出个别的优点或缺点，也没有强调这些科学家的工作如何丰富了我们的知识。考虑到这些局限性，还有一个迫切需要密切分析关于吸烟影响的统计研究和人口调查。不幸的是，主要基于动物研究的常规程序越来越不足以确定任何消费产品或广泛污染物的毒性。持续的人口调查可能是监测大型社区健康状况和保护人们免受其许多活动副产品的不利影响的主要方法。吸烟和健康人口研究为如何进行此类调查提供了一个模式。如果这一模型是无效的，并可能导致误导性的结论，正如许多受人尊敬的统计学家和科学家所声称的那样，那么，从长远来看，如果不公布这一模型的缺点，可能会造成不可估量的损害。
Since population statistics have contributed significantly to the belief that cigarette smoking is a cause of lung cancer, perhaps one should start by asking how population surveys and statistical studies can contribute to the understanding of the possibly complex causes of lung cancer or, in fact, any cancer? This question is basic since it includes cigarette smoking as one of the possible antecedents but does not ignore the rich evidence implicating others. If it is true that existing population studies clearly indicate that cigarette smoking is the major cause of lung cancer, then additional large and expensive population surveys to uncover other causes may not be warranted. On the other hand, if this general conclusion is not acceptable, then the groundwork may be laid for a much more inclusive population study. It is generally believed that existing evidence has established that smoking is a major cause of lung cancer. This report has undertaken to probe this belief - not to provoke or to please, but to dissect and to analyze. Because one adopts an analytical attitude, it may be difficult to avoid the impression that the focus of this paper is on the critical side. The voluminous research on smoking and lung cancer contains many good as well as bad points. While a critical analysis tends to bring out inadequacies, this should not be taken to imply that none of the past studies are of value. Quite to the contrary: many able investigators have studied this difficult problem with great care and have gathered valuable data, and their analyses have significantly contributed to the understanding of human disease. A critical analysis offers an objective framework for evaluating widely used research methods and analytic procedures but, unfortunately, without singling out individual good or bad points or emphasizing how the work of many of these scientists has enriched our knowledge. Bearing in mind these limitations, there is yet one other pressing need to closely analyze the statistical studies and population surveys of the effects of smoking. Unfortunately, conventional procedures based largely on animal studies are becoming increasingly inadequate for determining the toxicity of any consumed product or of a widespread pollutant. Continuing surveys of human populations may be the major method for monitoring the health of large communities and protecting men from the untoward effects of the byproducts of his many activities. The smoking and health population studies form a model on how such surveys may be conducted. If this model is invalid and possibly leads to misleading conclusions, as many respected statisticians and scientists have claimed, then incalculable damage may result in the long run if the shortcomings in this model are not made public.