Brad Rodu’s latest post reminds me of a long-simmering paper I wanted to write, about the top 10 (give or take) myths in the realm of nicotine use. Rodu wrote about how at the time that ostensibly lower risk (“light” etc.) cigarettes were widely introduced in the 1970s, the public health research and advocacy community supported them as being a worthwhile improvement. This contradicts the favorite current tale told by anti-tobacco activists (particularly the extremists who are trying to prevent harm reduction efforts), that efforts to reduce the risks from cigarettes were nothing a plot by the manufacturers to trick the public and undermine the public health advocates. Actually there are really two separate myths here: One is that the public health community was not integrally involved in supporting efforts to find and promote lower risk cigarettes, and the other is that the technical innovations did not lower the risks of smoking at all.
(Aside: Rodu’s post focuses on the American Cancer Society. I think it is reasonable to say that back then, in the 1970s, the ACS’s tobacco branch deserved credit for being about public health.)
I would say that one or both of these is definitely in the top five myths. Number one, I would say, is the claim that smoking (nicotine delivery in general) provides no benefit and that people do it exclusively because they are addicted (which is necessarily defined circularly for this purpose). I am posting this to collect others’ inputs on what should be on the list. I encourage other interested bloggers (etc.) to repost the question — I think this is a great candidate for community authorship.
Some others that occur to me to put on the list:
-Low risk nicotine products (e-cigarettes, smokeless tobacco) post substantial risks. They likely pose some risk, but it is too small to measure. The claim that these product cause great risks is such a flat contradiction of the evidence that it almost does not qualify as myth (merely as utter ignorance of simple facts) but because it is so important, I am inclined to include it.
-Low-risk product X is lower risk than low-risk product Y. It is widely claimed by anti-THR activist that pharma products are lower risk than smokeless tobacco, and some activists on the pro-THR side have started to claim that e-cigarettes are lower risk than ST. There is no basis for either of these claims. The best evidence that pharma and e-cig products are low risk is the extensive epidemiology we have about smoke-free nicotine delivery (i.e., about ST). We extrapolate from ST to the other products, and do not have independent evidence about the others. So no comparison is possible. There are a few things in ST and largely absent from the other products that might cause harm, but there is not actually any evidence that they do cause harm. And there are other characteristics that could cut the other way.
-Second hand smoke (ETS) poses a major health threat that contribute a substantial fraction of the deaths caused by smoking -and- Exposure to trivial amounts of ETS poses a measurable health risk. Undoubtedly ETS causes some health risks, but the evidence clearly does not support claiming its toll is nearly as high as the conventional wisdom says. (Note that I am not including “third hand smoke” on this list at the moment because I do not think that it is an important enough myth to be promoted to the list, and gets talked about mostly as a source of ridicule toward those who embrace it. But I could be persuaded I am wrong about this.)
-Smoking is the leading “preventable” cause of premature death. This one is a myth not because of the basic message, but because of how it is spun. It is reasonable to say that smoking is the leading voluntary cause of premature death, but those who like to make the claim also like to insist that it is not really voluntary, creating a conundrum for them. So they came up with “preventable”, but that phrasing does not stand up to scrutiny. If “preventable” means “we know how to make it go away” then why is that no one has implemented the fix. Of course, no one knows how to make it go away, but think they can figure it out. But if “preventable” merely means “we can imagine someday putting an end to it” then why be so unambitious: cancer death, heart failure, and even DNA transcription errors certainly seem preventable by that standard. If “preventable” merely means “the individual who is exposed could choose to prevent it” then we are back to the word “voluntary”.
-Smoking will kill X people in region Y by year Z. Do people seriously think anyone can predict social trends, wealth trends, rates of “competing causes” (other diseases), and medical technology so well that they can estimate this to better than an order of magnitude? Seriously?
Ok, your turn. To clarify, I am not looking for normative claims that might be objectionable, legitimate open questions, or simply dumb statements, but positive claims that are:
(a) widely repeated and believed, to the point that they are “fact”,
(b) potentially influential in some way, and
(c) clearly either false, meaningless, or ridiculously overly-precise once you take a look at the evidence.
– Carl V. Phillips