Number of words: 311 A “drug,” in bare conceptual terms, is any substance that can produce an effect on the physiology of an animal. Drugs can be simple molecules; water and salt, under appropriate circumstances, can function as potent pharmacological agents. Or drugs can be complex, multifaceted chemicals— molecules derived from nature, such as penicillin, … Read more

Number of words: 548 Genes encode proteins, and proteins often work like minuscule molecular switches, activating yet other proteins and inactivating others, turning molecular switches “on” and “off” inside a cell. Thus, a conceptual diagram can be drawn for any such protein: protein A turns B on, which turns C on and D off, which … Read more

Number of words: 146 Of the twenty thousand genes in a cancer cell, Weinberg reasoned the vast majority were likely normal and only a small minority were mutated proto-oncogenes. Now imagine, for a moment, being able to take all twenty thousand genes in the cancer cell, the good, the bad, the ugly, and transferring them … Read more

Number of words: 535 Papanicolaou secured a research position at Cornell that may have been just as surreal as carpet selling: he was assigned to study the menstrual cycle of guinea pigs, a species that neither bleeds visibly nor sheds tissue during menses. Using a nasal speculum and Q-tips, Papanicolaou had nonetheless learned to scrape … Read more

Number of words: 772 Edell’s case, filed in 1983, was ingeniously crafted. Previous cases against tobacco companies had followed a rather stereotypical pattern: plaintiffs had argued that they had personally been unaware of the risks of smoking. Cigarette makers had countered that the victims would have had to be “deaf, dumb and blind” not to … Read more

Number of words: 601 In the early summer of 1967, Banzhaf dashed off a letter to the Federal Communications Commission (the agency responsible for enforcing the fairness doctrine) complaining that a New York TV station was dedicating disproportional airtime to tobacco commercials with no opposing antitobacco commercials. The complaint was so unusual that Banzhaf, then … Read more

Number of words: 1,187 If Clarence Little had not been discovered by the tobacco lobbyists in 1954, then they might have needed to invent him: he came preformed to their precise specifications. Opinionated, forceful, and voluble, Little was a geneticist by training. He had set up a vast animal research laboratory at Bar Harbor in … Read more

Number of words: 270 In a case-control study, risk is estimated post hoc—in Doll’s and Wynder’s case by asking patients with lung cancer whether they had smoked. In an often-quoted statistical analogy, this is akin to asking car accident victims whether they had been driving under the influence of alcohol—but interviewing them after their accident. … Read more

Number of words: 750 To understand the Bailar-Smith analysis, we need to begin by understanding what it was not. Right from the outset, Bailar rejected the metric most familiar to patients: changes in survival rates over time. A five-year survival rate is a measure of the fraction of patients diagnosed with a particular kind of … Read more

Number of words: 147 In the history of medicine, no significant disease had ever been eradicated by a treatment-related program alone. If one plotted the decline in deaths from tuberculosis, for instance, the decline predated the arrival of new antibiotics by several decades. Far more potently than any miracle medicine, relatively uncelebrated shifts in civic … Read more