Lies and the Health Nannies Who Tell Them

"Some people think smokeless tobacco (chewing tobacco and snuff), pipes, and cigars are safer than cigarettes," says a pamphlet from the National Institute on Aging. "They are not."

Some people think you can rely on authoritative-sounding health information from the federal government. You can't.

Let's start with the basics. Smokeless tobacco, as the name suggests, does not involve smoking. Therefore smokeless tobacco users are not exposed to the toxins and carcinogens generated by combustion. You might think this difference would make smokeless tobacco a lot safer than cigarettes, and you would be right.

Cigars and pipes do involve smoking, of course, and therefore are more hazardous than oral snuff or chewing tobacco. But they differ from cigarettes in two important ways that affect health risks: Cigar and pipe smokers typically do not inhale, so they do not expose as much of their bodies to combustion products, and they typically smoke less than cigarette smokers. These differences show up in much lower tobacco-related disease rates among cigar and pipe smokers.

These facts are familiar to anyone who has looked at data on tobacco-related health risks, which ought to include federal officials who dispense advice about tobacco-related health risks. If the people responsible for the NIA pamphlet simply did not know what they were talking about, that would be embarrassing enough. But the misstatements in the pamphlet appear to be part of a deliberate strategy to scare people away from tobacco products by falsely implying (or, in this case, asserting) that they are all equally hazardous. In print, in congressional testimony, and in comments to the press, public health officials routinely blur the distinctions between tobacco products, because they've concluded that the public can't handle the truth.

[Thanks to Brad Rodu for the tip.]

Comments

[grylliade]

Sheesh. I don't know how many times I've had people bitch at me for smoking a pipe. "It's just as dangerous as smoking cigarettes! You might not get lung cancer, but you'll get mouth cancer! I could show you photos of pipe smokers who got mouth cancer -- then you'd quit!" Things like this will just encourage them. No matter how many times that I tell them that pipe smoking just isn't as risky as cigarette smoking, they just reiterate that there is risk. Now at least some of them will quote this stupid pamphlet, and I'll have to deal with more idiots.

BTW, anyone know where I can get hard numbers on the relative risks? I've read time and again that it's less risky, even in official government reports, but I've yet to see exactly how much less risky. I'm thinking that I've seen that it's at least ten times less likely to lead to cancer, but I'm not at all certain on that. I'd like to have some good, hard numbers to quote to people who tell me that the risk is just as high.

[nobody]

Also, a decent handmade cigar is all tobacco. No paper, no added chemicals, nothing but whole leaf and long filler. A "natural" product, you might say. Heh heh.

[garym]

I wonder how the National Institute on Aging would feel if the cigarette companies started quoting them as saying that cigarette smoking is no more dangerous than using smokeless tobacco. No doubt they'd have a fit. But that is what's implied by their statement.

Also, I notice that the "no-additive" cigarettes which run full-page ads in _Reason_ have a presumably mandated warning, saying that lack of additives doesn't mean a safer cigarette. This implies that additives don't mean a more dangerous cigarette. But I don't imagine the cigarette makers are allowed to say so.

[Brian]

From Wald and Watt, Brit Med J 314(7098):1860-1863 (1997):

"OBJECTIVE: To estimate the extent to which cigarette smokers who switch to cigars or pipes alter their risk of dying of three-smoking related diseases-lung cancer, ischaemic heart disease, and chronic obstructive lung disease. DESIGN: A prospective study of 21520 men aged 35-64 years when recruited in 1975-82 with detailed history of smoking and measurement of carboxyhaemoglobin. MAIN OUTCOME MEASURES: Notification of deaths (to 1993) classified by cause. RESULTS: Pipe and cigar smokers who had switched from cigarettes over 20 years before entry to the study smoked less tobacco than cigarette smokers (8.1 g/day v 20 g/day), but they had the same consumption as pipe and cigar smokers who had never smoked cigarettes (8.1 g) and had higher carboxyhaemoglobin saturations (1.2% v 1.0%, P 0.001), indicating that they inhaled tobacco smoke to a greater extent. They had a 51% higher risk of dying of the three smoking related diseases than pipe or cigar smokers who had never smoked cigarettes (relative risk 1.51; 95% confidence interval 0.96 to 2.38), a 68% higher risk than lifelong non-smokers (1.68; 1.16 to 2.45), a 57% higher risk than former cigarette smokers who gave up smoking over 20 years before entry (1.57; 1.04 to 2.38), and a 46% lower risk than continuing cigarette smokers (0.54; 0.38 to 0.77). CONCLUSION: Cigarette smokers who have difficulty in giving up smoking altogether are better off changing to cigars or pipes than continuing to smoke cigarettes. Much of the effect is due to the reduction in the quantity of tobacco smoked, and some is due to inhaling less. Men who switch do not, however, achieve the lower risk of pipe and cigar smokers who have never smoked cigarettes. All pipe and cigar smokers have a greater risk of lung cancer than lifelong non-smokers or former smokers."

If I did the math right (I did it really quick, so feel free to double check me) that means that current cigarette smokers have a relative risk of 2.8 for those three causes of death compared to pipe/cigar smokers who never smoked cigarettes habitually. That means that if you only smoke a pipe or cigars, your risk of dying of one of the the three main tobacco-related causes of death is about 1/3 that of cigarette smokers.

[GoonFood]

Ah, but now to the real question! What is the relative risk (compared to a normal smoker) of dying from one of the three associated smoking diseases if you never smoked cigs but instead smoke cigars that have been hollowed out and filled with cannabis? I'm guessing it is higher than a normal cigar smoker because you actually inhale (unless you are an elected official).

[Jacob Sullum]

According to the 1979 surgeon general's report, "Pipe smoking seems to have a slight effect in increasing overall
mortality....It can be concluded that some risk exists from smoking cigars and pipes as they are currently used in the United States, but for most
diseases this is small compared to the risk of smoking cigarettes as they are commonly used."

Table 32 (on page 2-35) gives mortality ratios for pipe smokers (compared to nonsmokers) from four studies. They range from 1.05 to 1.19, compared to 1.54 to 1.86 for cigarette smokers. Tables 33 and 34 on the following page break down the data from two of these studies by amount smoked.

The 1979 report is available at http://profiles.nlm.nih.gov/NN/B/C/M/D/.

For information on cigar risks, see the National Cancer Institute's 1998 monograph Cigars: Health Effects and Trends and Carlos Iribarren et al., "Effect of Cigar Smoking on the Risk of Cardiovascular Disease, Chronic Obstructive Pulmonary Disease, and Cancer in Men," New England Journal of Medicine, 340:3 (June 10, 1999), pp. 1773-1780.

I discuss these sources in my columns at http://reason.com/sullum/042298.shtml and http://reason.com/sullum/062399.shtml.

[grylliade]

Thanks a lot to Brian and Jacob Sullum! *grins* Now I can be even more effec -- well, who am I kidding. The information will just be dismissed as produced by "corporate shills," even if it's really from the surgeon general. But I'll feel better, certainly. Thanks again!

[cigars]

Sure they are going to link cigars and pipes to cigarettes. The government funds tobacco growers and studies against tobacco at the same time, while the politicians smoke their cigars. Kind of hipocritical isn't it. Cigars are definetly safer than cigarrettes but sure they can cause cancer. That's nothing new about cigars. It was just another way to get more anti cigars propaganda out with a washington spin. Since the boom in cigars they have been working on tarnishing the stigma of cigars. It worked for a while but it seems that smoking cigars is on the rise again.