It may seem paradoxical that the robust identification of one of the most important environmental causes of disease of the 20th century occurred in a totalitarian state. The first case-control study of smoking and lung cancer originated in Nazi Germany in 1939 and found that heavy smoking was strongly related to the risk of lung cancer. Such research occurred against a backdrop of considerable official concern in Germany on the health damaging effects of smoking. Dr Leonard Conti, the Reich health führer, established the Bureau against the Dangers of Alcohol and Tobacco in 1939.1 In 1942 the Institute for the Struggle against the Dangers of Tobacco was established at the University of Jena, where a second case-control study of smoking and lung cancer was carried out.2 This was a convincing investigation in which the authors showed a sophisticated understanding of the potential biases that could distort epidemiological …