A new TV ad sponsored by the California Department of Health Services shows a yuppie in a suit holding a cigar. "Say, Chad," the narrator asks him, "any idea how many cigarettes you'd need to equal the nicotine in that big fat stogie?"
After Chad repeatedly guesses wrong, the narrator says, "No, Chad, you'd have to smoke more than 70." Seventy cigarettes appear in poor Chad's mouth.
According to the Sacramento Bee, "the television spot…points out that smoking cigars poses the same health risks as smoking cigarettes." That's a fair interpretation of the ad's implicit message. The problem is, the message isn't true.
As a monograph released this month by the National Cancer Institute confirmed, cigar smokers face hazards far less serious than cigarette smokers do, primarily because they inhale less smoke. The attempt to obfuscate this point is part of a public health strategy intended to scare people away from cigars and put an end to the recent fashion for stogies.
Consider the California ad, which creates the impression that smoking a cigar is like smoking three and a half packs of cigarettes. That is not true even in terms of nicotine delivery–according to the NCI report, a premium cigar typically yields about as much nicotine as a dozen cigarettes, not 70–and it certainly is not true in terms of health risks.
In an American Cancer Society study cited by the NCI, men who smoked a cigar or two a day were only 2 percent more likely to die than nonsmokers, a statistically insignificant difference. By contrast, the mortality rate was 69 percent higher for men who smoked a pack of cigarettes a day and 88 percent higher for those who smoked more than that.
As a group, cigar smokers get oral and esophageal cancers almost as often as cigarette smokers. But they face much lower risks of lung cancer, coronary heart disease, and chronic obstructive pulmonary disease (emphysema and bronchitis)–the three main smoking-related causes of death.
The NCI emphasizes that the risk from cigars increases with the amount of smoking and the degree of inhalation. Cigar smokers who inhale deeply face measurably higher risks of heart disease and emphysema (though still not as high as those faced by cigarette smokers), and the risk of lung cancer for a five-cigar-a-day smoker who inhales approaches the risk for a pack-a-day cigarette smoker.
The important point, however, is that cigar smokers typically do not inhale, and they tend to smoke occasionally. Hence enthusiasts such as Cigar Aficionado publisher Marvin Shanken are correct to say that smoking cigars in moderation–with moderation defined by the way most cigar smokers actually behave–seems to pose little or no health risk.
Yet the NCI monograph implicitly criticizes Shanken for reassuring cigar smokers. Although the data it presents show he's basically right, the report downplays the fact that the hazards of cigars pale in comparison with the hazards of cigarettes. "Cigars are not safe alternatives to cigarettes," says NCI Director Richard Klausner, skirting the issue.
That spin showed up in press coverage of the report. "Smoking cigars can be just as deadly as smoking cigarettes," an Associated Press story began. This is true only in the sense that a dead cigar smoker is just as dead as a dead cigarette smoker. The same article said the NCI monograph was "intended to equate dangers posed by the two products."
It's easy to see where reporters get such ideas. This is how Michael Eriksen, director of the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention, described the hazards of cigars in a May 1997 New York Times story: "Tobacco is tobacco is tobacco." The Times itself went further, asserting that cigars pose "higher risks than…cigarettes."
Last February, the addiction specialist Jack Henningfield, who contributed to the NCI monograph, told The Wall Street Journal "it will help explode some of the myths about cigars," including the idea "that they are relatively safe." Later in the story the Journal referred to "the widespread misconception that cigars are safer than cigarettes."
In their zeal to drive people away from cigars, tobacco's opponents may inadvertently drive them toward cigarettes. Based on what he's heard, our friend Chad might reasonably conclude that a pack-a-day habit is no worse than an occasional cigar. And you thought they couldn't advertise cigarettes on TV.