Lung cancer has been one of the most important epidemics of the twentieth century. Late-nineteenth-century physicians and surgeons rarely diagnosed lung cancer and, even though techniques for making the alternative and more frequent diagnosis of tuberculosis were only partly developed at that time, it is unlikely that they were failing to make the diagnosis and much more likely that lung cancer was a medical rarity at that time. Now lung cancer is, in all probability, the commonest cancer in the world, with nearly 700.000 cases per year. In the United Kingdom, it accounts for 25 per cent of cancer deaths.The epidemic has been especially damaging. The disease strikes down men who are still economically productive and have dependent families. Sadly, the outlook for a patient diagnosed as having lung cancer remains one of the most dismal of all cancer diagnoses. Whereas the surgeon may hope to cure a third or a half of all of the patients whom he treats for other common cancers, the situation is quite different with lung cancer. When the diagnosis is made, no more than one quarter of patients have a disease that can be removed by surgery. Even when surgery is carried out and it seems that the cancer has been removed, only about one quarter of those patients are cured. Overall, less than 10 per cent of patients will be cured by surgery.Other means of treating lung cancer have been equally unsuccessful. Radiotherapy has been applied vigorously in a wide range of doses and with a wide range of schedules for the last fifty years. Although the treatments have become simpler and safer, and in many ways more sophisticated, very few patients are cured by radiotherapy alone. The introduction of drugs for the treatment of lung cancer in the 1960s gave rise to great hope for the group of patients with a sub-group of very dangerous cancers known as small-cell lung cancers. Combinations of drugs have proved capable of producing frequent remissions for this group of lung cancer patients. The disease shrinks readily away when the drugs are used and, during the 1970s and 1980s, intensive research was directed to using this effect and trying to turn it into lasting remissions and cures. Such efforts have, however, been met with disappointment. Patients with small-cell lung cancer can usually expect remissions as a result of these combination chemotherapies, but very few are cured.The scale of the epidemic of lung cancer is illustrated in Figure it. The disease started to increase in the 1920s and 1930s and achieved its present epidemic proportions during the 1950s and 1960s. The number of deaths due to lung cancer is however, beginning to show signs of a significant reduction. The graph shows the death rate against the number of cigarettes consumed; we must now accept that this indicates the clearest and most important explanation of this century’s lung cancer epidemic.There is an indisputable and strong link between lung cancer and smoking. In fact, almost all lung cancers are attributable to smoking and, if the smoking habit were dropped, lung cancer would revert to its former status as an infrequent diagnosis, of concern only to the individual patient and doctor. Instead, it remains one of the most overwhelming public-health issues facing the world as it moves towards the twenty-first century.*37\194\4*

Empty calories, which are usually not well hidden, offer little or no nutrition for their caloric content. For example, a tablespoon of peanut butter may have about 100 calories, but it’s a great food—it’s tasty, has little or no cholesterol, is high in nutrients, and isn’t expensive. A piece of candy may have the same 100 calories, but it offers your body nothing but sugar. Those are empty calories. Most junk foods consist of empty calories, which is why eliminating them can make such a dramatic impact on your waistline. Liquor consists of empty calories; most desserts are filled with empty calories.When you are counting calories, you do not have the budget to waste anything. To make your calories go as far as they can, eliminate as many empty calories as possible. Allow yourself (or your man) no more than 100 calories a day for liquor (if he drinks); 100 for a snack (if snacks cannot be eliminated); and 150 for dessert—I don’t think desserts should be eliminated.Look for hidden calories in these foods:• fruits• fruit juices• meatsLook for empty calories in these foods:• candies and sweets• chips, pretzels, etcetera• desserts• sauces, dressings, and toppings• refined-flour products• packaged meats• soft drinks*63/243/1*

QuackeryThe word ‘placebo’ was used by Geoffrey Chaucer as long ago as 1340. His use refers to a psalm that begins ‘Placebo domino in regione vivorum’ (‘I will please the Lord in the land of the living’). He uses the word in mockery because it was the first word in prayers for the dead which were said by priests and friars who pestered the populace for money to sing these prayers. The derisory use of the word is similar to the phrase ‘hocus-pocus’, which is derived from ‘Hoc est corpus’ (‘This is the body’), which are the first words of the Mass. By the seventeenth century, the word had been adopted by doctors for inactive medicines that greatly impressed their patients. In 1628, Burton writes in the Anatomy of Melancholy: ‘There is no virtue in some remedies but a strong conceit and opinion’. In 1807, President Thomas Jefferson wrote in his diary: ‘One of the most successful physicians I have ever known has assured me that he used more bread pills, drops of coloured water and powders of hickory ash than of all other medicines put together. I consider this a pious fraud.’ Jefferson expresses here a strict division between fraudulent placebos and medicines that were believed at the time to act by a rational mechanism. That division continues to this day, with therapy being judged either a placebo or true.A tiresome and expensive artefactIt is required by law that a new drug be proven superior to a placebo. This perpetuates the separation of true versus imagined. The placebo response was taken by the drug companies as a meaningless error to be dissected out and discarded while attention is monopolised by the powerful action of the therapy, which did not depend on what the patient thought about it. Some therapies, such as surgery, were assumed to be so powerful and dominant that it was not only unethical but ridiculous to test for a placebo component to explain the success of the therapy. This is dualism in practice, as therapy is assumed to readjust body mechanisms while mental processes are assumed to be irrelevant. In this atmosphere, it is not surprising that the placebo response was not studied until very recently. Similarly, it was not considered likely that a patient’s response might be a combination of physical and mental process. This led to the very mention of a placebo trial being taken as a hostile questioning of the logic on which the therapy was based. This hostility is shared by enthusiasts both for academic and for complimentary medicine.The reality of the sensesEveryone assesses their own sanity by cross-checking senses with objective reality and with what other people say. We have special words for mismatches, such as hallucination, delusion, madness and drunkenness. We trust our senses. Pain appears to us as the sensation provoked by injury. A trusted, impressive physician prescribes the very latest analgesic for your pain and the pain disappears. Later, you learn that you were a guinea-pig in a trial and you were in fact given a blank tablet. You are angry, cheated, embarrassed and shaken. I have responded to placebo trials and I am always mortified and ashamed of myself. The pill could have had no action on the reality of my injury and yet my sensation changed.Given these three reasons, it is no wonder that the placebo is an unpopular topic. Some physicians think that anyone who responds to a placebo did not have a ‘real’ pain: they are wrong. Some physicians think that a placebo is the same as no treatment: they too are wrong. Some think that only weak-minded suggestible people in minor pain respond: they are wrong. Even physicians respond to placebos! The placebo response is a powerful and widespread phenomenon. Let us therefore examine it, using four examples.*61\219\2*