Public Health

It's Official: Dose Doesn't Matter—The Surgeon General Says So!


In 2006 I noted that Surgeon General Richard Carmona's description of the hazards posed by secondhand tobacco smoke was so hyperbolic that it made smoking seem safe by comparison. Last week his successor, Regina Benjamin, continued the shameless fearmongering with a press release warning that "exposure to tobacco smoke—even occasional smoking or secondhand smoke—causes immediate damage to your body that can lead to serious illness or death." The doctor in the sailor suit elaborates:

"The chemicals in tobacco smoke reach your lungs quickly every time you inhale, causing damage immediately," Benjamin said in releasing the report.  "Inhaling even the smallest amount of tobacco smoke can also damage your DNA, which can lead to cancer."…

Even brief exposure to secondhand smoke can cause cardiovascular disease and could trigger acute cardiac events, such as heart attack.

The press release, which accompanied the latest surgeon general's report on smoking, generated predictably panicky headlines like these:

Surgeon General: No Amount of Smoking Is Safe (WebMD)

Even a Puff of Tobacco Is Harmful, Report Says (The Washington Post)

Surgeon General Outlines Risks of Just One Cigarette (PBS)

Surgeon General Says a Whiff of Cigarette Smoke Can Hurt You (Los Angeles Times)

A Single Cigarette Can Raise the Risk of Cancer and Heart Disease (Time)

Surgeon General: 1 Cigarette Could Kill You (Fox News)

Just One Cigarette Can Be a Killer (The Sydney Morning Herald)

Here are a few follow-up questions these reporters might have asked:

1. What percentage of people who smoke just one cigarette die as a result? Has this outcome ever been observed in the world outside of surgeon general's press releases?

2. How would one establish a safe level of smoking? If it is impossible to falsify the statement that "no amount of smoking is safe," can it count as a scientific conclusion, as opposed to an article of faith?

3. If brief exposure to small amounts of secondhand smoke causes heart disease and cancer, why do these conditions take so long to develop in smokers?

4. Is there any difference in risk between a whiff of secondhand smoke or a single puff on a cigarette and a pack-a-day habit? How big is that difference?

5. How do the risks of "just one cigarette" compare to the risks of swimming, riding a bicycle, driving to work, or sitting in the sun?

Since the surgeon general did not address these questions, I'll let Michael Siegel, a physician and longtime anti-smoking activist who is a professor of public health at Boston University, assess her dire warnings:

It is simply not true that even brief exposure to secondhand smoke can cause cardiovascular disease….

The press release's assertion flies in the face of common medical sense. How could it possibly be that a brief exposure to secondhand smoke can cause heart disease? It takes many years for heart disease to develop. It takes years of exposure to tobacco smoke even for a smoker to develop heart disease. I estimate that it takes at least 25 years of exposure (based on the fact that very few smokers are diagnosed with heart disease before age 40).

So how could it possibly be that for an active smoker, heart disease takes 25 years of exposure to tobacco smoke to develop, but for a passive smoker, it only takes a brief exposure?…

Fortunately as well, inhaling the smallest amount of tobacco smoke does not lead to cancer. While the press release is correct in asserting that the tiniest amount of tobacco smoke can damage your DNA, it simply is not true that someone who inhales the tiniest amount of tobacco smoke may well develop cancer because of it. There is certainly no evidence to support such a statement.

Moreover, there is nothing in the Surgeon General's report itself which concludes that, or supports the assertions that a brief exposure to secondhand smoke can cause cardiovascular disease or cancer. These assertions basically come out of nowhere. They have been manufactured to create a sense of public hysteria, but they are unsupported by any science whatsoever.

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  2. Damn, I was using this report to justify my own cigarette consumption.

    I guess I can no longer blow smoke at people and claim I’m participating in the lower risk behavior.

  3. Does anyone take the Surgeon General seriously any more? Did they ever?

    1. A few of them have been fired for being honest about legalization. I can respect them.

      1. But they still weren’t taken seriously.

        1. Joycelyn Elders was taken very seriously by millions of teenage boys when she declared that wanking was cool.

          1. Isn’t she the Patron Saint of Libertarian Boys?

            1. No, she’s the mom that shat you into the world. Show a little respect.

          2. Like they needed encouragement.

          3. I believe that she invented masturbation.

      2. From the Strange but True files.

        C. Everett Koop told the Reagan administration “Nope. We looked and can’t find any evidence of psychological harm to women who’ve had abortions”.

      3. It’s the difference between burning leaves and burning leaves. One is eebil tobacky, the other is medicinal marijuana. Duh.

  4. It’s simple:
    If you get run over by a truck while smoking, it’s a ‘smoking related’ death.
    See how dangerous it is?

  5. One of the very few joys that I will get out of ObamaCare is vigorously mocking the Smoking Nazis as the government takes away all the stuff that they like (and makes them fat)…and then I’ll fight to save the stuff they like too.

  6. 4. Is there any difference in risk between a whiff of secondhand smoke or a single puff on a cigarette and a pack-a-day habit? How big is that difference?

    And if he says none, then doesn’t that mean anyone who has ever walked past a smoker might as well just start lighting up a pack a day?

    1. I’m seriously thinking about taking up smoking again based on this study. If the damage is already done, fuck it.

      1. Like Johnny Dangerously’s mother when he gets her an ashtray for her birthday: “I’ve been thinking of takin’ up smokin’…this clinches it.”

    2. I was once on the same planet as a smoker. Does this mean I’ll get cancer?

      1. No, you’ll be dead from new ice age greenhouse effect global warming climate change new ice age before then.

      2. You already have it.

  7. The science is settled!

    Fucking do-gooders.

  8. Man, the homeopaths are gonna be pissed!

    1. What do you mean? They’re completely vindicated!

  9. Obama has really topped Bush in the “crazed wingnut appointee” contest. If you would have told me that 3 years ago, I’d have said he’d come close but I’d never dream he’d blow past by such a wide margin.

    It’s pretty obvious that the only people who want these positions anymore are psychotic.

    1. Yeah, it seems like every day there’s some new plan to control the populace even further, at a rate that makes GWB’s look glacial. But I don’t think it’s so much Obama appointees; I think that his presidency and the ramming through of Obamacare has emboldened the ultra-nannies of all stripes and TEAMs, and they’re going for everything they can get right now.

      1. America today is so fucked up and off its kilter that if MASH got a reboot, Major Burns would be cast as the hero.

        1. America today is so fucked up and off its kilter that MASH would get a reboot.


        2. People already think Dwight Shrute is the hero in The Office.

  10. The doublespeak is strong with the Surgeon.

    -Even brief exposure to secondhand smoke can cause heart disease and can trigger heart attacks. –

    -But “this report makes it clear – quitting at any time gives your body a chance to heal the damage caused by smoking,” Benjamin said. “It’s never too late to quit, but the sooner you do it, the better.” –

    Even small amounts of second hand smoking can cause long term damage. But your friend can quit smoking and avoid long term damage. Makes sense, no?

    1. Fucking filters, how do they work?

      1. Magic… powered by ground up unicorn horns.

        1. funny, I thought unicorn horn was for male enhancement. This damn bottle lied to me!

    2. Consider the source.

  11. “The whole aim of practical politics is to keep the populace alarmed, and hence clamorous to be led to safety, by menacing it with an endless series of hobgoblins, all of them imaginary.”

  12. With this announcement, the phrase “jumped the shark” comes to mind.

    Does anyone take anything these idiots say seriously, anymore?

    … Hobbit

    1. Some do.

      In Santa Clara county a month or so ago, the esteemed supervisors made a law that outlawed smoking in multi-housing buildings, apartments and condos. They apparently watched those commercials that show smoke wafting through the ventilation and killing small babies with the nefarious smoke.

      I always figured it’s probably unhealthier to live in LA than to live wiht a parent who smokes.

  13. Remember kids, smoking does have its benefits – namely reducing the number of kanker sores you get. Seriously. Look it up.

  14. Cigarette smoking killed my mom, my uncle and my brother. All from cancer caused by smoking. This post seems to be trying to excuse smoking as something innocuous. It isn’t. Pure f*cking evil.

    1. This post seems to be trying to excuse smoking as something innocuous.

      This claim is as utterly unsupported as the Surgeon General’s complete fabrication above.

      Come on Bill, as sorry as I am for your tragic loss, it really doesn’t excuse such an intellectually lazy or dishonest post.

    2. Is there any way you’d be willing to take up smoking?

      1. I intend to start (resume) smoking on my 80th birthday (presuming I make it) just to piss “them” off.

        … Hobbit

      2. Didn’t you listen to the Surgeon General? He lived with them, so it’s only a matter of time before it gets him too. And his dog. And the lady across the hall. And the mailman. And anyone else within 1/2 a mile. And of course, the squirrels.

    3. I don’t think crying wolf is going to help much. If you make claims that seem completely full of shit, then some people are going to question whether you’re right about more sensible claims like “smoking a lot increases your cancer risk”. I can’t think of anything Big Tobacco would like more than for anti-smoking activists to be regarded in general as wild-eyed lunatics. For all I know, they’re encouraging these kinds of statements.

      1. Personally when I read anti-smoking messages, all I hear in my head is cartoon Rob Reiner complaining about dirty smokers and stuffing food in his mouth.

    4. This post seems to be trying to excuse smoking as something innocuous.

      And here I thought it was trying to refute the ridiculous assertion that “Inhaling even the smallest amount of tobacco smoke can also damage your DNA, which can lead to cancer.”

    5. Well Bill, I guess I should be dead by now. Both my parents smoked, My ex wife smoked 2 packs a day (we were married for 33 years) and I occasionally smoked a pipe and cigars up until about 10 years ago. I’m now 67 and in excellent health other than slightly elevated blood pressure, which my doc says is normal for a man my age. No one in my family died of smoking related illness.
      Apparently some people are more susceptable to cigarette smoke than others.

    6. So in other words, you mom killed herself, your uncle killed himself, and your brother killed himself.

      Unless the cigarettes coerced their way way into their mouths, they were people responsible for their own actions.

      Perhaps they were trying to kill themselves because they were so ashamed of a relative such as yourself.

      1. More likely, it was their inferior genes that killed them. Bill should be happy he has survived with all the untermensch blood running through his veins.

  15. Chantix works.
    Granted I had vivid dreams to the point where I had difficulty discerning them from reality, and in March I was driving around with my windows down (and taking lots and lots of courtesy walks at work) thanks to a constant flow of air coming out of my ass, it did help me quit smoking.

    1. For Christ sake! Smoke

    2. So, you were the crop duster in my cubicle farm…

  16. Don’t underrate this current Surgeon General of the moment.
    Just check the facts and see how much the last one made from his famous pronouncement.

  17. “even the smallest amount of tobacco smoke can also damage your DNA”

    This could be useful. If I leave a little DNA behind when committing a crime, then I should buy a cigartte and take just a small puff to “damage” my DNA. Then the crime lab won’t be able to match my new damaged DNA to the old undamaged DNA and they’ll never catch me.

    Sure I’ll die from cancer but that won’t happen for another 25 years.

  18. this guy told me that if a baby touches cigarette smoke wood nymphs come and take it and leave a fake baby in its place that never stops crying and is always hungry.

  19. how could it possibly be that for an active smoker, heart disease takes 25 years of exposure to tobacco smoke to develop, but for a passive smoker, it only takes a brief exposure?

    I’m more sensitive to smoke than is an active smoker. It’s like how I mind smelly hair and burns in my clothing more than does an active smoker.

    1. Don’t worry you’ll die of concern cancer way before the lung goblins get to you.

    2. I am more aware of these things also but being aware of the smell doesn’t increase your chance of cancer.

      Second hand smoke hysteria is the second biggest scam against the American people. The biggest was Obama running on Hope and Change.

    3. Again, your sensitivity is because of inferior genes. In order for the world to heal itself, people like you have to die off naturally instead of being kept alive artificially.

  20. Do you know who else was an anti-smoking advocate?

    No really, he was.

    1. Really, I was.

  21. Every time I see a really good blog post I do a few things:1.Share it with all the relevant

    it in all my common sharing sites.3.Be sure to return to the website

  22. Kinda off topic, but I wonder how prez Obama and soon to be speaker of the house again Boehner (sp?) get their cigs and where do they smoke them? I’m guessing they don’t drive to the 7-11 to buy them or even step outside of a govment office building to light them up.

  23. From the report:

    Through multiple defined mechanisms, the risk and severity of many adverse health outcomes caused by smoking are directly related to the duration and level of exposure to tobacco smoke.

    The headline the Jacob Sullum gets from this…

    “It’s Official: Dose Doesn’t Matter?The Surgeon General Says So!”

    1. Also from the press report:

      “Even brief exposure to secondhand smoke can cause cardiovascular disease and could trigger acute cardiac events, such as heart attack.”

      I’d say the headline is justified, if tongue-in-cheek.

    2. Every pack of cigarettes sold in the US has a printed label on its side saying everything that has been said and can be said about smoking cigarettes or being around those who smoke. There are taxpayer funded advertisement campaigns sponsored at every level of government to get the message out.

      When do we get to stop paying government employees, with their luxurious pensions and medical benifits, for repeating this information?

  24. Off topic:

    You Reason bitches need to give us some book recommendations before Christmas.

    it is to late now…but next year this needs to be done.

    A top ten or each reason staff contributor…what ever.

    Reading through the NYT top books list was tedious and unfruitful. Luckily I saved The war at the end of the world off of your recommendations as well as A world lit only by fire which has sat in my amazon cart for two years.

    Don’t leave me hangin next year cuz no man should ever have to go to the new york times web site.

    1. Skippy Dies


  25. I know right, who gives a fuck, just blow your tobacco smoke in a baby’s face, they can’t prove it causes cancer.

    Seriously you knobs will defend anything if someone in government tells you not to do it.

    1. I assume you must be under 30, because once upon a time, that’s exactly how it was. Second hand smoke was unavoidable whether you had a smoker in your family or not. If the SG is right, then most of us should have been dead by now.

    2. noyou, this post is so embarrassingly moronic it makes me cringe for humanity.

      Firstly, if I take your initial facetious statement at face value, it falls flat because if they can’t prove it causes cancer, then wtf are we talking about in the first place?

      Secondly, why do we have to jump all the way from questioning a government report about smoking to blowing smoke in babies’ faces? Isn’t there room for questioning the government? If we don’t blindly accept gov’t propaganda then we’re baby killers?

      Thirdly, the article doesn’t defend smoking — it challenges a gov’t report that is full of hyperbole at best, and is down right propaganda at worst. It’s called CRITICAL THINKING. Try it.

      Fourth, “… you knobs will defend anything if someone in government tells you not to do it….” If I take your assertion at face value, then perhaps a solution might be for the government to stop telling us not to do stuff… hmm? (stop — I might get excited)

      1. Really nice response.

      2. It’s called CRITICAL THINKING. Try it.

        Life feels more like a Zombie Movie every day. The moaning outside is getting louder….

        “Braaaaiiinnns…..Smoke-freeeeeeee Brraaaaaaaaiiiiiiinnns!”

    3. Let me guess…. Noyuo is a liberal…. right? Those macaroons will believe anything.

  26. Another question…

    How does a single “dose” of second hand smoke compare to sitting behind a dump truck spewing diesel exhaust?

    1. Better buzz from the cig. The diesel exhaust will just give you a headache.

  27. Meh. Get back to me when the headline is:

    “It’s Official: Size Doesn’t Matter?The Surgeon General Says So!”

    1. That’s what she said…or tried to, at least.

  28. This, and the preceding article, give a lie to Obama’s claim about science based decision making.

    Instead it’s another chorus of “If we don’t have evidence to support our policies, we’ll just make shit up”.

    Damn, where have I heard that song before?

  29. God – the place is haunted. Ghosts are coming through the walls.

  30. so here is the link to the actual report if anyone is interested.

    I didn’t read the whole thing, but it looks like a synthesis report where they take a bunch of studies and then draw conclusions from them. This is always a bitch, because you aren’t provided with the methodology of the studies and understanding the methodology is very important to understanding the studies.

    1. Maybe it was a meta-analysis, as in, I never meta-analysis I didn’t like.

    2. SKR: A successful health administration:
      They knew the media and its audience would fall for this – and they achieved what they set out to do.

  31. How long before they outlaw camp fires and charcoal barbecues?

    1. Native Americans owe us reparations for all the tobacco deaths.

    2. I remember learning in one of my biology classes after the sun and smoking, charcoal is estimated to be the number three cause of cancer.

      No cook out is safe!

  32. Hitler was passionately anti-smoking, and offered any member of his inner-circle a gold watch if they quit smoking.

    No joke.

    So these anti-smoking zealots really are Nazi’s.

  33. The anti-smokers are guilty of flagrant scientific fraud for ignoring more than 50 studies which show that human papillomaviruses cause over ten times more lung cancers than they pretend are caused by secondhand smoke. Smokers and passive smokers are more likely to have been exposed to this virus, for socioeconomic reasons. Their studies are all based on nothing but lifestyle questionnaires, so they’re cynically designed to falsely blame ETS for all those extra lung cancers that are really caused by HPV.

    They commit the same of fraud with every disease they blame on tobacco, and exclude every piece of evidence that contradicts their lies, such as the fact that death rates from heart disease have declined just as much among smokers as among non-smokers, so not even their claims about active smoking are credible.

    Most of their corrupt “studies” were funded with our tax dollars. For the government to sponsor fraud in order to deprive us of our liberties is automatically a violation of our rights to the equal protection of the laws, of the same nature as if the government purposely threw innocent people in prison. And spreading lies about phony health risks is an act of terrorism, like calling in a phony bomb threat. Furthermore, out of all the hundreds of billions of dollars the government has looted from smokers, not one cent has ever been used to protect smokers’ rights. This government is in violation of its duty to uphold the Constitution!

  34. KPres, there’s more to the Nazi connection than that. Anti-smoker Richard Doll attended the lectures in Frankfurt of the SS radiologist Professor Hans Holfelder in the 1930s. The first lifestyle questionnaire studies were done in Nazi Germany, and the American Cancer Society enthusiastically embraced their pseudo-science along with the Nazis’ anti-smoking persecution. And they’ve been brainwashing the public for the last seven decades with the Big Lie that lifestyle questionnaire studies that ignore the role of infection are legitimate science. The Nazis could hide behind the excuse of ignorance, but the anti-smokers CANNOT!

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