Tobacco policies in Austria during the Third Reich.

BACKGROUND: The anti-smoking stance taken by Adolf Hitler, coupled with Nazi support for research on smoking and lung cancer and campaigns to discourage smoking, have encouraged pro-smoking groups to equate tobacco control activities with totalitarianism. Previous work has described the situation in Germany. OBJECTIVE: To examine the situation in Austria, also part of the Reich after 1938. DESIGN: Iterative analysis of documents and reports about the situation in Austria in the 1930s and 1940s, supplemented by a review of Reich legal ordinances, party newspapers, health behaviour guidelines issued by Nazi party organisations and interviews with expert informants. RESULTS: In contrast to the situation in Germany where, albeit to a much lesser degree than is commonly believed, some anti-smoking policies were adopted, the Nazi authorities in Austria made almost no attempt to discourage smoking and the Austrian tobacco company worked closely with the Nazi authorities to ensure that supplies were maintained. CONCLUSION: Especially when looked at in the Austrian context, the much-cited link between anti-smoking policies and Nazism is a gross over-simplification. This purported link should not be used to justify the continued failure to act effectively against smoking in Germany and Austria.     

Mortality league tables: do they inform or mislead?

OBJECTIVE--To examine certain methodological issues related to the publication of mortality league tables, with particular reference to severity adjustment and sample size. DESIGN--Retrospective analysis of inpatient hospital records. SETTING--22 hospitals in North West Thames health region for the fiscal year 1992-3. SUBJECTS--All admissions with a principal diagnosis of aortic aneurysm, carcinoma of the colon, cervical cancer, cholecystectomy, fractured neck of femur, head injury, ischaemic heart disease, and peptic ulcer. MAIN MEASURES--In hospital mortality rates adjusted by disease severity and calculated on the basis of both admissions and episodes. RESULTS--The numbers of deaths from specific conditions were often small and the corresponding confidence intervals wide. Rankings of hospitals by death rate are sensitive to adjustment for severity of disease. There are some differences that cannot be explained using routine data. CONCLUSIONS--Comparison of crude death rates may be misleading. Some adjustment for differences in severity is possible, but current systems are unsatisfactory. Differences in death rates should be studied, but because of the scope for manipulating data, this should be undertaken in a collaborative rather than a confrontational way. Any decision to publish league tables of death rates will be on political rather than scientific grounds.