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P. O. Box 127 0uray, Colorado 8~@27 June 8, 1972 Mr. Donald K. Hoel ShooK, Hardy, aitchell ~ Bacon 915 Grand Avenue Kansas City, iissouri 6@106 Dear Don: Your recent telephone call re the imminence of Peters v. Brown and Williamson prompts me to send a few disconnected thoughts. (1) The observation on ~ letter to you of December 17, 1971 concerning H~mmond's December 1971AAAS paper I considez, to believe to be of signifigance, but what I still have no i@ea. The essential point of that letter rather gets lost in the detail, but it is ~ha~ whereas the overall death rate of H~mmond's "Nw~er Smoked Regularly" remains • nchanged as the period of observation changes from the first three years to the second three years, in contrast the death rate for th~ lO-lO, 20-39, @0+ ~igarettes a day group rises. As you know, it is "traditional" for a pros- pective survey to show a rise in death rate after the first few d~, ~his always being attributed to the non-particip- ation of the sick or about-to-be-sick. We see this tradit- ional behavior in Hammond's lO-19, etc. cigarettes a day smokers, but not in his never smoked regularly. In my letter of December 19 I attempted to produce hypothes~e to er~lain this observe±on, without success, and I still have no success, but I memtion it again here as this may be one point at which one might attempt to r~ise reasonable doubts about HRmmoz~'s sampling procedure. (2) As you Enow from my letters of ~arch 12, ~arch 27, and April 7 to Mr. ~atrick McLarney, I am no~ overwhelmed with happiness at the possibilities of refut- ation of Condic~ ~oore. In particular, it is noteworthy tha~ Moore's sample does not show the usual facture ~hat those who discontinue smoking were, when ~hey were smokers, relati~y ifght smokers. This usual observation is satis- factory as it is consistent with th~ constitutional hypoth- esis. One migh~ turn Moore's observation around against him, and imply that since his result here is not consistent with the usual one obtained on much lar~er samples, ~herefore there must be something wrong with his sample. (3) I presume ~hat you must have gotten opinions from physicians speaialists in this field as to the reasonableness of Moore's fantastically high ~ercentage of persons continuing to smoke.

(4) You will note in. my letters to ~r. Patrick icLarney that there were several places where I explore possible refutation of ioore but find that actually he ~ives data which show that the possible explanations are in fact not tenable. However, he does not discuss adequately, nor give data from which one could examine for oneself, the possibility that X-ray treatment may be confou::ded with smoking and this is one of his most serious weaknesses. (5) It is well accepted now that "double blind" procedure is almost essential for sound clinical trails. In a "double blind" trial the treatments must be assigned at ramdom to the patients and the results assessed by a person ignorant of which ~r~atment each patient received. We do not have a precise analogy here, but the same idea is implicit in my comment that if the person administering the "treatment" (namely the sermon against cigarette smoking) was mware of the prognosis, and did not put his heart into his sermon with those patients that he regarded as hopeless cases, then we would immediately generate biased results. Note that we cannot assert that this K~ppened, merely that it m~ght have happened. (6) ~oore~uses a reference to Doll~Jones- Pygott to z.efute the interpretation of his results in terms of the constitutional hypothesis. The Doll-Jonesm Pygott paper is very important as it is the only genuine randomized experiment that I know of, and the only hope refuting it is to assert that I know of no way of achiev¢ing their claim _. "The individual treatments were, however, allocated in such a way that the group of patients given any one treat- ment and the group of patients not given it contained equal m,~mhers of patients given each of the other treatments " (Jeepers~) -a~ simultaneaouly having satisfactory randomizat- iSn. To say that I don't know how to do it and therefore there is Do possible way of doing it is a rather drastic assertion very difficult to maintain. It is curious that the 1964 "SMOKING AND ~.~LTH" makes no reference to this paper in the parts around page 190 where they sre attempting to dispose of the constitutional hypothesis. This omission is remarkable as this paper, in my opinion, is the strng~st argument Cney cculd he. re usee.

Howler, one cannot _ace firm infermmces about this ommission: it could as well be from incompetence as from deep understanding. The only place this paper is referred to is on page 3~7, in a section on peptic ulcer, and strangely the authors of t~is section do not sound impressed: "In view of the probable existence of other factors which may have concommitantl~ been introduced in the approach to the smokers , and the complex nature of the healing process, it is ee~ difficult to interpret this observation". Note that the Surgeon General's Committee uses the word "probable". I thir~ tha~ from tae ~ractical point of view, this is sufficient ~o dispose of Doll-Jones-pygott. I ~hink that ~hese are all ti~e thoughts that occur to me at this time. Perhaps ~ou would be so Eood as to pass this lette~~ on to ~. ~c~arney: I realize that ! should have made him a co~y. S inc ere ly K. A. Brownlee