LETTERS to Thousand Tons Were Shipped in 1948, Followed the USA* J Epidemiol Community Health: First Published As 10.1136/Jech.51.2.208 on 1 April 1997
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20828ournal of Epidemiology and Community Health 1997;51:208-214 ship tobacco, free of charge, into Germany Table 2 Lung cancer mortality (age adjusted) as part of the Marshall Plan. Twenty four per 100 000 inhabitants in West Germany and LETTERS TO thousand tons were shipped in 1948, followed the USA* J Epidemiol Community Health: first published as 10.1136/jech.51.2.208 on 1 April 1997. Downloaded from by another 69 000 tons in 1949. The net cost West Germany USA THE EDITOR to the US government was around 70 million dollars; the benefit, at least for American 1952 1990 1952 1990 tobacco firms, was a gradual shift in German Men 22 49 25 75 tobacco tastes from the traditionally favoured Women 4 8 5 32 Cigarette smoking and black tobacco to the milder, blond Virginian health promotion in Nazi blend (the latter was also purportedly more All figures are age adjusted. Sources: Deutsches popular among women).' Krebsforschungzentrum (Nicholas Becker) and the American Cancer Society. Germany Two other factors may be mentioned, both of which indicate that tobacco consumption SIR - I have followed the exchanges between may have been somewhat higher than is in- Brenner and Davey Smith et al with inter- dicated in official figures. The first is that, by the 1930s and est, 123 given that I am presently writing a contrast with later years, cigarettes in the expect the tobacco policies of In 1952, the annual book-length history of Nazi cancer research immediate postwar period were often smoked 1940s to have borne fruit. cancer among German and policy, with a special focus on Nazi to- down to the very end. Discarded cigarette rate ofdeath from lung women was a mere 4 per 100 000; that same bacco policy. Davey Smith et al are correct butts were gathered and smoked, and one has was to say that the Nazis implemented strong to conclude that the amount of tar, nicotine, year, the mortality rate for German men the mortality rate anti-smoking policies; it is not quite true, and ash inhaled per cigarette produced or 22 per 100 000. By 1990 had climbed to only 8 per 100 000, however, to state that these policies were smuggled was significantly higher than in less for women increased to 49 implemented "with little success".2 While per desperate years (cigarette butts contain a dis- while the rate for men had capita smoking increased in the first six years proportionately high quantity ofharmful sub- per 100 000 (see table 2). In Germany today, from lung cancer than from of Nazi rule, smoking actually declined rather stances). Such things can be important in more men die of Among women, by dramatically during the war and immediate calculating the cancer consequences of the any other kind cancer. postwar period (table 1). tobacco habit.6 contrast, lung cancer is still in third place, colon The differ- The second factor is that many Germans behind breast and cancer. in cancer mortality between the grew their own tobacco for home use or ence lung Table I Cigarette consumption, per capita per sexes is so great that, if this particular differ- year trade. The Tobacco Research Institute in Forchheim actually promoted backyard to- ence were somehow to vanish, most of the Year Germany USA bacco cultivation in the 1940s, providing de- difference in overall cancer mortality between would also disappear. tailed instructions for how to grow and cure men and women 1930 490 1485 we the relatively slow rise your own.7 Home cultivation continued after How can explain 1935 510 1564 female cancer mortality in Germany, 1940 1022 1976 the war, and popular memory records many of lung 1944 743 3039 with that of the United States? a soldier returning home from the east to by comparison 1950 460 3552 I would suggest that Nazi efforts to discourage 1955 866 3597 transform gardens being used to grow ve- 1960 1280 4171 getables into tobacco plots. women from smoking, together with the the war and postwar 1963 1523 4345 It is difficult to say how much home cul- shortages imposed by tivation, the black market trade, and the poverty, combined to slow the rate of rise of Sources: "Rauchen: Wie Gut", Der Spiegel, January female smoking and (therefore) the rate of 22, 1964; 61 and the Economic Research Service, smoking of discarded butts added to overall US Department of Agriculture. American figures cigarette consumption. It is unlikely, however, rise of female lung cancer mortality. are for persons 18 years and over. it is possible to calculate how many per capita that even all of these factors combined made Indeed, women's lives may have been saved by what- up for the shortages imposed by the collapse of the German tobacco trade. Recall that ever caused the dramatic reduction in smok- Cigarette consumption German domestic tobacco production in the ing in Germany over the period 1940-50. We here in the realm of From 1940-50, German per capita cigarette immediate postwar period was only a tiny are obviously moving but it is perhaps worth noting consumption fell by more than half, from fraction of prewar production, that much of speculation, that more women would have died of 1022 per person to 460 per person. The the home grown variety was eventually sold many cancer had German rates continued to decline is notable, given that in the US over to tobacco companies (and therefore counted lung grow as rapidly as they did in the United this same period cigarette consumption nearly in official sales statistics), that post war rations http://jech.bmj.com/ States. As we can see in table 2, American doubled, from 1976 per person to 3552 per were only about a fifth of the early wartime women's lung cancer mortality rates increased person. rations, and that women, even after the war, factor of six between 1952 It is important to recognise, of course, the continued to receive half rations.6 Recall also by more than a and 1990. German women's rates, by con- possible sources of bias in such figures. In that, at 100 marks or more per pack and in trast, doubled. Had the German rate both the German and the American case, the a time of extreme poverty, American brands only increased as rapidly as the American rate, numbers indicated are domestic sales figures were more often traded than smoked. Taking 20 000 more women would have died recorded for taxation purposes (both there- into account, we should probably roughly such things did die. One could fore exclude production for export). In the conclude that the decline in tobacco con- than actually plausibly are reasons official argue that whatever prevented German on October 2, 2021 by guest. Protected copyright. German case, there several sumption was real - though it is difficult to from as rapidly as records may have underestimated actual to- sort out the contributions of Nazi women taking up smoking separate American women eventually prevented the bacco use in the immediate post war period. policy and the coincident pressures of the war lung cancer deaths of some 20 000 German For one thing, official statistics could not and post war poverty. Tobacco consumption take into account the flourishing black market in several other European nations declined women. trade in foreign tobacco. American cigarettes from 1940-50. ("Amis") were highly prized in the post war Fertility period, with single cigarettes selling for as One further correction to the comment article much as 5 or even 7 marks (compared with Gender differences by Davey Smith et al. Martin Gumpert, the several pfennigs for German brands). To- The Nazi anti-tobacco campaign was not gen- emigre author of Heil Hunger, is quoted to bacco smuggling was rampant: in 1949, an der neutral: women were much more ag- the effect that German birth rates did not estimated 400 million American cigarettes gressively targeted than men. When tobacco increase, despite Nazi pronatalist pro- found their way into Germany every month. rationing was implemented early in the war, paganda. In fact, Germany's birth rate of As late as 1954 two billion Swiss cigarettes - women received only half rations. Two thirds jumped dramatically in the first few years 1000 in 1933 to a quarter of that country's production - were of all tobacco supplies were diverted into the Nazi rule (from 14.7 per estimated to have been smuggled into Ger- military for the duration of the war. It is 18 per 1000 in 1934), probably due to the was many and Italy.4 therefore not surprising that German women optimism with which the new regime Smuggling was fostered by the fact that born in the periods 1911-20 and 1921-30 greeted. The birth rate continued to climb German cigarette manufacturing had sunk to show a much lower lifetime prevalence of until about 1940, by which time German only about 10% of prewar levels, mainly due smoking than subsequent birth cohorts.' women were having more babies than Eng- to the inability to secure raw tobacco from Equally intriguing is the fact that female age land and France combined.8 Fascism is per- outside Germany. Shortages remained so adjusted lung cancer rates in Germany are haps more complicated and seductive than severe that American authorities decided to low for the period 1952-90, when one would many of us like to think. Letters to the editor 209 ROBERT N PROCTOR paring countries with very different long term cohort and at each age group lung cancer Department of History, attitudes and behaviours relating to cigarette mortality rates are higher in Germany than Pennsylvania State University, J Epidemiol Community Health: first published as 10.1136/jech.51.2.208 on 1 April 1997.