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.