Smokescreen

Jacob Sullum | March 1, 2000

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In the study, researchers led by Carlos Iribarren, an epidemiologist with the Kaiser Permanente Medical Care Program in California, tracked about 18,000 men–1,546 cigar smokers and 16,228 nonsmokers–from 1971 through 1995. Overall, the cigar smokers were about twice as likely to develop cancers of the mouth, throat, and lungs; 45 percent more likely to develop chronic obstructive lung disease; and 27 percent more likely to develop coronary heart disease.

As Iribarren and his colleagues noted, these risks are modest compared to those seen in cigarette smokers. Depending upon the study, cigarette smokers are four to 12 times as likely as nonsmokers to develop mouth and throat cancers; eight to 24 times as likely to develop lung cancer; nine to 25 times as likely to develop chronic obstructive lung disease; and 1.5 to three times as likely to develop coronary heart disease.

Furthermore, smoking-related diseases were concentrated among the heaviest cigar smokers in the Kaiser Permanente study. For those smoking fewer than five cigars a day–three-quarters of the sample–only the difference in heart disease risk (20 percent) was statistically significant. Iribarren et al. did not ask the subjects about inhalation, which has been linked to higher risks in other studies, and they did not consider men who smoke less often than daily–who represent about nine out of 10 cigar smokers, according to recent survey data–as a separate category.

Probably because the researchers themselves made it clear that cigars are not nearly as hazardous as cigarettes, the coverage of this study was more accurate than the coverage of the NCI monograph. Stories in The New York Times, The New York Post, The Washington Post, and Time noted the difference in risk. But the most refreshing story ran in The Hartford Courant, under the appropriately reassuring headline, "Cigars’ Dangers Relatively Low/Moderate Users Face Only Slightly More Health Risks Than Nonsmokers." The Courant’s Hilary Waldman, who is completing a master’s degree in public health and therefore knows something about statistics and epidemiology, reported the risks found in the study but was careful to put them into perspective. For example, she quoted a local cardiologist who said: "If someone tells me they’re smoking one cigar a day, it would be hard for me to jump up and down and say you’re killing yourself and be intellectually honest. You are increasing your risk a little bit."

Waldman says the Courant received complaints from readers who thought the story (especially the headline) was "irresponsible," but her colleagues were supportive. Though she has no particular interest in cigars, she says the study was an opportunity to show how the paper could improve its health coverage by calmly and accurately reporting research findings instead of hyping them. "I knew the minute I saw the study exactly how it would be spun," she says. "‘Cigars are as deadly as cigarettes’: I heard the TV news do that. The [New England Journal of Medicine] article didn’t say that; the article said specifically that cigars are not as bad as cigarettes, although they contain the same toxins. And then they [the TV news] went ahead and said that cigars were as dangerous as cigarettes. That was just wrong."

In a similar vein, UPI reported that "new findings give more weight to warnings that cigars can be at least as hazardous as cigarettes." Elizabeth Manning, the stringer who wrote the UPI brief, says she did not spend much time on it and probably relied on press material from the journal or from Kaiser, rather than the study itself. But The New England Journal of Medicine does not issue press releases, and the Q&A sheet that Kaiser distributed to reporters explicitly notes that cigars are less dangerous than cigarettes. Manning says her gloss on the study was "consistent with what I’ve seen in the press....What the press seems to be reporting is that cigars are as dangerous as cigarettes."

At one point, Robert Pitofsky, the chairman of the Federal Trade Commission, seemed to believe this, too. In an April 1998 comment to The Washington Post, he misinterpreted the NCI monograph as saying that "regular cigar smoking is roughly as dangerous as cigarette smoking." By contrast, when the FTC issued its recommendations for federal warning labels on cigars last July, he said, "We now know, based on the findings of the National Cancer Institute, that cigars, like other tobacco products, pose serious health risks."

The significance of Pitoksky’s backpedaling did not register with everyone. "Federal regulators say they want to correct misperceptions that cigars are less dangerous than cigarettes," the Associated Press reported. Similarly, New York Times reporter Stephen Labaton cited "a widespread misperception that cigars are safer than cigarettes." And in case you didn’t get the point, Labaton added that "studies by the National Cancer Institute and others" have shown that "cigar smokers face increased risks of heart and lung diseases and that cigars are therefore not safer than cigarettes." These errors represented backsliding for both A.P. and the Times, since the Times had run an accurate A.P. story about the Kaiser study the previous month. On the other hand, the Reuters and Washington Post stories about the FTC’s recommendations both noted the lack of evidence that occasional cigar smoking is harmful.

It’s not surprising that some reporters continue to overstate the hazards of cigars, since their sources have not made much of an effort to clear up the matter. One of the cigar warnings proposed by the FTC nicely illustrates the artful evasiveness of public health officials who seek to shape people’s behavior rather than inform them: "Cigars are not a safe alternative to cigarettes." This warning, which was also the NCI’s take-home message when it released its monograph, assumes that people currently think cigars are risk-free. Yet the FTC itself reports, based on survey data, that "consumers generally are aware that cigar smoking poses health risks."

Meanwhile, public health officials continue to exaggerate those risks. "It’s a very dangerous habit," Surgeon General David Satcher told Reuters last August. By any reasonable definition of "very dangerous," this is simply not true of cigar smoking as it is commonly practiced. Satcher has also complained that the absence of federal warning labels "implies cigars are different [from cigarettes] and don’t carry the same risk." They are, and they don’t.