In 1964 the notorious Council for Tobacco Research (CTR) began to fund a young epidemiologist at Yale University named Alvan Feinstein PhD. During the course of his long and illustrious career, Feinstein received more than two million dollars in research funding from CTR and also received undocumented amounts for consulting and legal and legislative testimony.. Feinstein became a highly influential individual; considered by many to be the ‘father of American epidemiology’ and one of the three pillars of evidence based medicine.

Feinstein’s work relevant to lung cancer overdiagnosis (LCOD) consists of four articles published in the late 1980s describing his investigations on ‘post-mortem surprise’ lung cancers. Although he did not use the term overdiagnosis in these articles, the first mention of LCOD occurred in a publication from the Mayo Lung Trial and citing Feinstein. Feinstein’s research has subsequently been cited consistently by tobacco industry expert witnesses in multiple medical monitoring lawsuits and is routinely cited in scholarly publications on putative LCOD. Later research from Duke University - also from authors with undisclosed tobacco industry conflicts of interest- cloned Feinstein’s necropsy surprise research that has also been used in courtrooms by tobacco industry lawyers.

Objectives Special Project #1 was invaluable to Philip Morris and other tobacco companies in defending themselves against medical monitoring lawsuits attempting to compel them to pay for lung cancer screening of their former and current customers.

Method Search of documents relevant to the topic among the papers contained in the Tobacco Document library at the University of California San Francisco. https://www.industrydocuments.ucsf.edu/tobacco/

Results The tobacco industry played a major role in fostering the idea that there is a substantial ‘reservoir’ of undiagnosed lung cancers in the U.S. population that is unlikely to cause sysmptoms or kill.

Conclusions The tobacco industry has played an important role in promulgating and disseminating the false idea that many lung cancers are non-lethal. Few people involved in policy decisions on population lung cancer screening are aware of this enormous conflict of interest.