Collecting the biggest myths about tobacco/nicotine/smoking

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

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Comments

  • Kate  On July 26, 2010 at 9:56 am

    Great idea Dr Carl, I’ll definitely be following this discussion.

    One thing I’ve noticed a lot in the UK is claims that ‘harm reduction’ equal medicalisation. The RCP, ASH and the health services say that they support harm reduction but in practice, to them, that means closing the recreational nicotine market, bar tobacco.

  • Paul  On July 26, 2010 at 10:26 am

    That the nicotine in NRTs is a different beast than the nicotine in tobacco products or even e-cigs. An article on quitting tobacco will dismiss ecigs or smokeless forms will pose the question ‘is it safer?” and answer with “its still nicotine” which implies that you are no better off, and then ends with a suggestion to try pharmaceuticals.

  • Kate  On July 26, 2010 at 10:28 am

    Oh yeah forgot to say, a big nasty myth the cessation industry uses is that medical cessation drugs work. People who fail to quit just aren’t trying hard enough apparently and should keep on trying until they’re successful or dead.

    A quit and fail cycle is essential to keep the pennies rolling in. That’s why they have to close the recreational markets, that’s the main source of reduced harm products that work and break the cycle.

  • CMNissen  On July 26, 2010 at 6:01 pm

    Myth: Promoting THR in North America and Europe would be useless because it is not part of the culture there, and thus won’t be taken up (and the only reason Sweden has taken up ST use is because it is part of their culture).

    In reality, this is speculative and not actually a reason to not endorse THR. In fact, admitting that ST use is related to culture should actually be considered a reason TO endorse it. Culture is changeable and socially-derived, unlike something genetically inherited. People change their habits in accordance to new information.

  • Iro Cyr  On July 26, 2010 at 10:22 pm

    In my opinion the biggest myth out there is the ”no safe level” mantra whether it has to do with smoking, smokeless, or second hand smoke. This soundbite is used deliberately to mislead and frightens some people to the point that it makes them petrified of even one whiff of SHS. Some perspective is definitely required to bring everything back to proportion.

    The other myth is the no. of deaths caused by tobacco. In Canada they now adjusted this down to 37,000, in the states it’s around 440,000 but they only come up with these statistical figures by lumping smokers and former smokers under the same category as outlined in the SAMMEC methodology. Worse yet, is considered a former smoker anyone who has smoked at least 100 cigarettes in their lifetime and no longer smokes. No distinction of how long they have quit and how old they were when they died. And is considered a smoker anyone who has smoked at least 100 cigarettes and still smokes everyday or on some days. No distinction of how long ago they started and what ”some days” represents.

    So in essence, anyone who has ever smoked 5 (20’s) packs of cigarettes in their lifetime and passed away from pancreatic cancer for instance, no matter at what age, is computed as a smoking related death in their estimates. This is totally insane. If the definition changes even further to include anyone who has breathed in 10 whiffs of SHS in their lifetime, every one who passes away from any of the 20 attributed to smoking illnesses will be considered a victim of tobacco! It’s absurd.

    Thank you for your initiative.

    • rothenbj  On July 29, 2010 at 2:05 pm

      Iro, you hit my two favorites, but I’d like to add to “no safe level” the equal myth of “product x is not a safe alternative to smoking” That mantra drives me crazy and smokers back to cigarettes. I haven’t read anyone in the “health” industry or in the commercials come forward and state “Warning Chantix is not a safe alternative to smoking”.

  • Jonathan Bagley  On July 27, 2010 at 5:20 am

    The reduction in life expectancy due to smoking. ASH UK often makees meaningless statements such as “smokers die up to ten years earlier”. More precise claims like “smokers die on average six years” earlier are possibly true but misleading. Smoking is associated with poor diet, heavy drinking, lack of exercise, stress, mental illness. David Spiegelhalter, Professor of the Public Understanding of Risk at Cambridge University, has a life expectancy calculator on his website on which smoking, alcohol, poor diet and lack of exercise (note: not obesity) are each given equal weight; so, for me at 53 years old, each knocks three years off my future life expectancy (in fact I’m only guilty of one and a half).
    I think the “no safe level” mentioned above is very dangerous because it gives moderate or heavy smokers less incentive to cut down. The anti tobacco industry must know this and should question its attitude.

  • Tony Palazzolo  On July 27, 2010 at 6:04 am

    The myth that nicotine is far more addictive than heroin.

  • Ann W.  On July 27, 2010 at 6:28 am

    I would like to offer up this myth for consideration.

    “Unless smokers quit, up to half of all smokers will die from their smoking, most of them before their 70th birthday and only after years of suffering a reduced quality of life.
    http://www.health.gov.sk.ca/questions-smoking

    “Abstract | On the basis of current consumption patterns, approximately 450 million adults will be killed by smoking between 2000 and 2050. At least half of these adults will die between 30 and 69 years of age, losing decades of productive life.”
    http://www.cghr.org/publications/NatureReview_tobacco%20Sept%202009.pdf

    “One in two long-term smokers will die prematurely as a result of smoking – half of these in middle age. One quarter will die after 70 years of age and one quarter before, with those dying before 70 losing on average 21 years of life.3 It is estimated that between 1950 and 2000 six million Britons and 60 million people worldwide died from tobacco-related diseases.4”
    http://www.ash.org.uk/files/documents/ASH_107.pdf

    “About half the deaths from smoking happen before the smoker reaches 70 years of age. These smokers lose an average of 22 years of life. Older persons (70 and over) who die because of smoking lose an average of 8 years of life expectancy.”
    http://www.smoke-free.ca/pdf_1/TOBACCOINCANADA2003.pdf

    But when you get to the detail breakdown of how the deaths were estimated, it’s a different story.

    http://www.ccsa.ca/Eng/Priorities/Resea … fault.aspx
    click on the detailed report second link on the right
    “The Costs of Substance Abuse in Canada 2002” was released in April, 2006
    (note: we did not look at a literal body count but on well-documented economic theories and assumptions,)
    The study estimated:
    – 37,209 deaths attributed to smoking.
    – Passive smoke caused 831 death
    – 14 cancer deaths and 41 cardiovascular disease deaths for the age group 15-29.
    – Cervical cancer; 19 deaths are listed in the 70-79 age group and 17 deaths in the over 80.
    – 32% of these smoking related deaths occur over the age of 80
    – 30% between the ages of 70 – 79

    can 62% of these deaths over the age of 70 that are attributed (but not an actual body count) to smoking really be called premature or preventable?

    and if my math is correct that only leaves 38% or an estimated 14,139 deaths under the age of 70 attributed (but not an actual body count) to smoking out of a smoking population estimated at just under 6 million.

  • Carl V Phillips  On July 27, 2010 at 7:46 am

    Everyone,
    Thanks for the great input. Please keep them coming.

    Here are some thoughts on your thoughts (in case you wanted to add, clarify, disagree, etc.).

    Kate, I will have to think about whether the attempts to co-opt the meaning of “harm reduction” qualifies as a myth, per se. I agree it is a nasty problem, and I already put it into a report I am writing thanks to your reminder. Anyone have an opinion about whether to call it a myth?

    Paul, I think I might generalize/tangent yours into “nicotine is a major health hazard”. Question: Do you see a lot of claims that pharma nicotine (or e-cig nicotine) is somehow different (other than in dose)? I am not so familiar with those.

    Kate 2, Good one about pharma not working as well as claimed. I will generalize it into something about “we have proven good methods for promoting abstinence” and then roll in a combination of failure rates and side effects.

    Catherine, That is a good one that I definitely would have included a couple of years ago. Does it seem like they are still flogging that one? The more generic version is “almost no smokers are interested in harm reduction”, which is clearly not true based on a mountain of evidence. Can we document that this is still being seriously claimed, thought?

    Iro, The “no safe level of ETS” point can be rolled into the general point about the risk of ETS. I will do that.

    Iro and Johathan 1, The no safe level point as applied to smoking dosage is an interesting one. You are quite right that this it is claimed that there is no value in just cutting back and that it is clearly wrong, so it definitely qualifies. Is it “top ten” material, though? I guess it has practical importance both because it discourages healthy behavior and from the perspective of anti-THR propaganda that says “many switchers still smoke a little, so THR does not work”.

    Iro and Johathan 2, Sigh. That is the really tough one that requires a lot of work. I have never made a careful complete study of the basis for claiming that the current number of deaths is X and related statistics. I have seen plenty of important flaws in the calculations, of course, and the fact that the core data and calculations are kept more secret than Afghanistan War intelligence reports means we should definitely assume they are grossly flawed even beyond what we can see. I might finesse this one a bit and make the myth (which is definitely one of the biggest) something like “the widely reported figures are good estimates of the toll from smoking”. I might roll it in with the even more absurd future projections point from my original post.

    Tony, Excellent one. That is one that has occurred to me before but I did not think of it when staring my list. Here is my take on it (chime in if you have something different): Addiction is barely defined (at best) and no definition includes a quantification or even ordering. Thus, it is utter nonsense from the start to call one thing more addictive than another — there is simply no such beast. As for why people claim that, it basically comes down to rates of relapse (higher for those who quit smoking) and the quit rate among those who try to quit (whatever that means) (lower for smokers). My very scientific assessment of that is: Well, duh! Some smokers are motivated to quit by scattered social pressure and the prospect of dying exactly 6 years earlier (sorry :-); some heroin users are motivated to quit because it completely dominates how they live their life and might kill them this year, and often recently almost did kill them. (Note: This is not every user. There are many functional careful long-term users and everything in between.) So “more addictive” becomes “the net benefits of quitting are not nearly as high”. Then after quitting, the heroin user likely changes his lifestyle radically and cuts ties with those most closely associated with using (including suppliers), while the ex-smoker is still living basically the same life and continues to have easy access to starting again. The first of these can be seen as evidence that smoking is not so bad after all, while the second could be seen as evidence that easy supply is dangerously tempting, but neither of them has anything to do with “more addictive”.

    Comments encouraged.

    –Carl

  • Ann W.  On July 27, 2010 at 4:00 pm

    Carl, to add to my suggest that “Unless smokers quit, up to half of all smokers will die from their smoking, most of them before their 70th birthday and only after years of suffering a reduced quality of life.” should be including in the list of myths, I offer you further evidence.

    Projected Smoking-attributable Mortality in Canada, 1991-2000
    Larry F Ellison, Yang Mao and Laurie Gibbons
    http://www.phac-aspc.gc.ca/publicat/cdic-mcc/16-2/c_e.html

    I will use the figures for the 60-64 age for Canadian males as an example.

    From chart 5 of smoking-attributable deaths for Canadian males age 60-64
    Per/100,000 is 1,292.1

    Total Population for 2000 (1) for Canadian males 60-64 was 614,659 divided
    by 100,000 x 1292.1 equals the Smoking-attributable deaths of 7,946.

    The total deaths for Canadian males age 60-64 in 2000 was 7,607.(2) This
    leaves a short fall of 339 deaths.

    To this short fall I also have to add the deaths that in no way could be
    considered smoking related such as:
    Accidents (V01-Z59)(YV5-YO6) 188
    Intentional self-harm (suicide) (X60-X84, Y87.0) 121
    Assault (homicide) (X85-Y09, Y87.1) 10
    Diabetes mellitus (E10-E14) 252
    Chronic liver disease and cirrhosis (K70, K73-K74) 208

    Now bringing the short fall over 1,000.

    I have tested each of the age groups and the figures don’t appear to be
    close to plausible under the 80-84 age group.

    When I forwarded this problem to Dr. Mao, one of the authors of the study and Robert Semenciw, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, both agreed that something was wrong.

    “Ann, Yes, except for perhaps age 85+, the age-specific rates of smoking
    attributable deaths in Table 5 appear too large. I do not know if the high
    rates are related to the projection. Dr. Mao will raise this issue with
    the other authors.
    – Robert”

    “In response to your request, I have discussed the issue with the senior
    author of the article, Mr. Larry Ellison. Since the work was done 16-17
    years ago, the original calculations were no longer available for
    examination. Nevertheless, Larry has checked the methods and data sources,
    and has assured me that the methods are sound and peer reviewed, and that
    the data sources are reputable.

    Since the estimations are based on projected parameters, Larry and I felt
    it is important to discuss with you the principles and applications of the
    projection. For this piece of work, the projections were based on three
    assumptions: 1. the mortality trends would continue in the 1990’s, as they
    had in the 1970/80’s; 2. smoking prevalence rates would continue in the
    1990’s, as in the 1970/80’s; 3. the relative risk of mortality associated
    with smoking has not changed. Any estimations based on projected
    parameters will not be valid if any of the projection assumption were
    violated.

    Although we have taken no time to conduct a detailed evaluation, we judge
    that the discrepancies between the estimated values and what you have
    observed, likely resulted from a projection assumption violation or a
    combination of the violations, in particular the mortality rate reduction
    in major chronic diseases and the smoking prevalence rate decrease
    observed in males. It worth noting that the projections are done for each
    province and than aggregated to the national total. In some provinces,
    small numbers could cause large data variation and increase the likelihood
    that the projected values will differ from the true values.

    Please feel free to e-mail me or call me for questions and clarification. If it is more convenience, you may provide me you phone number, so I can call you and discuss the issue more.
    – Yang Mao”

  • Iro Cyr  On July 27, 2010 at 8:52 pm

    Carl, this is going to be a long post. I hope I don’t put you to sleep midway 😉

    Here are my sources for the super inflated mortality rates:

    From: http://apps.nccd.cdc.gov/sammec/methodology.asp

    The smoking-attributable fractions (SAFs) of deaths for 19 diseases where cigarette smoking is a cause are calculated using sex-specific smoking prevalence and relative risk (RR) of death data for current and former smokers aged 35 and older.

    And when we go into the glossary of terms at: http://apps.nccd.cdc.gov/sammec/Help/glossary_hp.asp here’s what we can read for the definitions of former and current smokers:

    Former Smokers
    Individuals who have smoked at least 100 cigarettes over their lifetime but who do not now smoke.

    Current Smokers
    Individuals who have smoked at least 100 cigarettes over their lifetime and who now smoke every day or some days.

    This looked so absurd to me, especially that they tell us that risk for heart disease will start decreasing almost immediately and lung cancer risk drops by 50% 10 years after one quits smoking,(1) that I wanted to make sure I was understanding it correctly, so I asked Dr. Siegel. Here’s what he replied:

    ”Iro,
    This is an absolutely legitimate criticism of the SAMMEC system. You’re right: the percentage of former smokers is entered into the equation, but it doesn’t differentiate by amount smoked. The ideal system would account for individual lifetime smoking histories, but that would be far too complex. What you should know, however, is that there was a study done in Oregon to compare the estimates from SAMMEC with actual doctor-certified death certificates noting if smoking was a cause of death. The results showed a remarkable similarity between the two estimates. So there is some validity for the use of the SAMMEC estimates, although it is very important to acknowledge that they are just that – estimates.
    Michael Siegel | Homepage | 03.28.09 – 11:40 am | #”

    Now about the Oregon study comparing death certificates with the SAMMEC estimates. Apart from the obvious that doctors actually base their opinion (whether tobacco would have caused the death) on the CDC literature itself therefore their opinion could be just as biased and/or faulty, there is a particularity with the Oregon death certificates in the sense that it was the first state to add a special section on whether the physician felt that tobacco contributed to the death of the deceased. I came across a study that concludes that adding that section to the death certificates motivates physicians to declare that the death was caused by smoking and that smoking related death reporting has risen due to that (2). I do not think that it is a coïncidence that they used Oregon as their state of choice to compare it to the SAMMEC estimates. The 37,000 in Canada, the 440,000 in the USA and the xxx no. of deaths attributed to smoking in every country that uses SAMMEC as a reference should definitely make the top 10 myths! (3)

    (1) Excerpt confirming what I was suspecting, from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1747540/pdf/v010p00161.pdf After quitting smoking, the risk of death from the 27 underlying causes of death falls at different
    rates for the different diseases, and SAMMEC 3.0 does not take into consideration the length of time since the individual quit smoking.

    (2) Excerpt from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448502/ Conclusions. The addition of a tobacco-associated-death check box on Texas death certificates significantly increased reporting of tobacco use contributions to mortality.

    (3) Excerpt from another study I came across about smoker centenarians that reveals something very interesting about the estimated number of cigarettes required before and if one contracts cancer and kind of defeats the ”no safe level of smoking” at least when it comes to cancer: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448502/
    ”The average number of smoked cigarettes per day is quite low,less than 10 cigarettes, so that the total average number of smoked cigarettes is 158,045,well under 280,000 which is considered the cut-off point in many studies of when tumors are noticed”.

  • Elaine Keller  On July 28, 2010 at 9:56 am

    How about the myth that nicotine abstinence has nothing but positive effects on health? Smoking cessation tirggers a much bigger weight gain than they were claiming for all those years. The lung cancer rate for former smokers is 60% compared to 20.9% for current smokers and 17.9% for never smokers. http://www.lungcanceralliance.org/press/documents/WomenandLC2010_000.pdf
    Numerous research projects in the past have shown a jump in the rate of hypertension among former smokers (compared with continuing smokers) about one-year post-cessation, and recent research shows an increase in diabetes. Is it possible that all these negative effects can be avoided by simply switching to a safer form of nicotine intake?

  • CMNissen  On July 28, 2010 at 12:24 pm

    Hi Carl,
    Yes, that thought crossed my mind after I posted my suggestion. When I think about it, I don’t think I have seen the claim too recently – at least, nothing sticks out in my head. I will keep my eyes open in the future. Perhaps the e-cig phenomenon has killed that myth. There also seems to be more anti-snus propaganda around… so perhaps they’ve accepted that people actually want to use it!

  • Carl V Phillips  On July 28, 2010 at 7:14 pm

    Hi again.

    Catherine, please go ahead and see if anyone is still making that claim — it is worth a bit of time to check.

    Elaine, That is a good point. I am not sure I buy into the claim that lung cancer risk increases, but the weight gain is certainly real. I will need to check on the hypertension result — hadn’t heard that one. (If you want to send some references that would be great. Otherwise I will have Catherine or Paul do it.). I will need to decide, however, if this is its own myth or if it is one of the many subsets of “there are no benefits from using”. That one might get too big if everything that fits is included.

    Ann and Iro, thanks for the analysis and details. I think the quantitative claims about the effects is definitely one of the myths. I am leaning toward phrasing the myth as: “the commonly repeated quantitative claims about the toll from smoking are accurate” or something (suggestions?).

    Paul and Catherine, that one is going to take more work because it is far enough away from my core work that I don’t already know what to say about it. So when it fits in, could you try to collect (from what I, Ann, and Iro wrote and whatever you can think of) one studies, analysis, thought, etc. on this point. It is easy to argue that projections and overly-precise claims are absurd. Also, massive adjustments like the Canadian one are great evidence (they go from claiming it is exactly X and then say “oh, wait, we were wrong, it is Y — but now we are sure it is exactly Y, unlike before when we told you we were right but were not”). So are major flaws in the calculations like those pointed out above. As for research that contradicts the standard claims, we will have to be careful to do a systematic search rather than just picking one contradictory claim.

    This looks like it will come together really well. Still open to other inputs. Also, if those of you who have contributed would like to be acknowledged by name in the paper, please send me (you can email it) the fully name you prefer I use if it is different from your login name (or, if you would not want to be acknowledged, tell me that). You can email one of us rather than posting if you want.

    –Carl

  • Elaine Keller  On July 28, 2010 at 10:08 pm

    J Hypertens. 2010 Feb;28(2):245-50.
    The association between smoking and hypertension in a population-based sample of Vietnamese men.
    Overall, however, current smokers were not at higher risk of hypertension than never-smokers (prevalence ratio = 1.08, 95% CI 0.70-1.68), and ex-smokers were more likely to be hypertensive than either never-smokers (prevalence ratio = 1.81, 95% CI 1.07-3.06) or current smokers (prevalence ratio = 1.67, 95% CI 1.25-2.23), similarly adjusted.
    http://www.ncbi.nlm.nih.gov/pubmed/19829145

    J Intern Med. 2004 Feb;255(2):266-72. Related Articles, Links

    Changes in blood pressure and body weight following smoking cessation in women.

    Incidence of hypertension (> or = 160/95 mmHg or treatment) was significantly higher in quitters [adjusted odds ratio (OR): 1.8; CI: 1.4-2.5] when compared with continuing smokers (OR: 1.3; CI: 1.07-1.6) and never smokers (reference). CONCLUSION: Over a long follow-up, weight gain was approximately 3-4 kg higher in quitters when compared with continuing smokers or never smokers. Although the differences in blood pressure increase were moderate, smoking cessation was associated with an increased incidence of hypertension.
    http://www.ncbi.nlm.nih.gov/pubmed/14746564

    Hypertension. 2001 Feb;37(2):194-8.

    Effects of smoking cessation on changes in blood pressure and incidence of hypertension: a 4-year follow-up study.

    The adjusted relative risks of hypertension in those who had quit smoking for /=3 years were 0.6 (95% CI 0.2 to 1.9), 1.5 (95% CI 0.8 to 2.8), and 3.5 (95% CI 1.7 to 7.4), respectively, compared with current smokers. The trends for increased risk of hypertension for longer periods of smoking cessation were observed in subgroups of those who maintained weight as well as those who gained weight after smoking cessation. The adjusted increments in both systolic and diastolic blood pressure were higher in those who had quit for >/=1 year than in current smokers. These trends among weight losers, as well as gainers and maintainers, were similar. We observed progressive increases in blood pressure with the prolongation of cessation in men, although at this time the mechanism remains unknown and must be clarified. This study implies that the cessation of smoking may result in increases in blood pressure, hypertension, or both.
    http://www.ncbi.nlm.nih.gov/pubmed/11230270

    Prev Med. 1991 Sep;20(5):602-20.

    Smoking cessation and change in diastolic blood pressure, body weight, and plasma lipids. MRFIT Research Group.

    Cigarette smoking cessation was examined for its impact on diastolic blood pressure, weight, and plasma lipids in 3,470 special intervention males in the Multiple Risk Factor Intervention Trial. More quitters (35%) became hypertensive than nonquitters (27%, P less than 0.01), although the groups had similar baseline diastolic blood pressure levels. Weight gain subsequent to cessation probably contributed to this excess incidence of hypertension in quitters.
    http://www.ncbi.nlm.nih.gov/pubmed/1758841
    —————
    Ann Intern Med. 2005 Mar 1;142(5):313-22.

    Incidence of type 2 diabetes in the randomized multiple risk factor intervention trial.

    Blood pressure was treated more intensively in the special intervention group than in the usual care group. RESULTS: 11.5% of the special intervention group and 10.8% of the usual care group developed diabetes over 6 years of follow-up (hazard ratio, 1.08 [95% CI, 0.96 to 1.20]). The special intervention-usual care hazard ratio for diabetes was 1.26 (CI, 1.10 to 1.45) among smokers (63%) and 0.82 (CI, 0.68 to 0.98) among nonsmokers (37%). These estimates differed significantly (P = 0.0003). Weight gain after smoking cessation and the use of antihypertensive drugs may have counterbalanced the beneficial effect of the lifestyle intervention for the special intervention group smokers, while the lifestyle intervention was beneficial among nonsmokers.
    http://www.ncbi.nlm.nih.gov/pubmed

  • Iro Cyr  On July 28, 2010 at 10:31 pm

    Carl,

    You mean : ”“the commonly repeated quantitative claims about the toll from smoking are INaccurate” not ”accurate” as you have typed, I hope 🙂 I can’t think of anything much better, but if I do I’ll let you know. Well…maybe “the commonly repeated quantitative claims about the toll from smoking are inaccurate computer generated estimates” ? Many (if not most) people believe that they are real body counts taken from death certificates or hospital records and I believe that it should be spelled out that they’re not, right in the title.

    You can use my name as it appears on the screen. Just don’t add a Mr. before it. I am female 🙂

  • Ann Welch  On July 28, 2010 at 10:45 pm

    INaccurate” not ”accurate” – lol – nice catch Iro.

    Carl, you have my permission to use my full name. It’s not like anyone at Health Canada or the anti smoker groups don’t already know it.

  • Elaine Keller  On July 29, 2010 at 8:40 am

    Yes, if you include my submission, feel free to use my name. BTW, I realize that anecdotal evidence isn’t really evidence, but everyone that I know who had normal BP and quit all use of nicotine after age 50 was on blood pressure medication within 18 months after stopping. I’m 64, using an e-cigarette, and so far have dodged the hypertension bullet. I think this is an area that deserves a little research. Does sustained nioctine maintenance prevent weight gain and postpone the development of hypertension?

  • Iro Cyr  On July 29, 2010 at 11:55 am

    The benefits of smoking:

    Elaine’s hypertension observation. It is documented at least for pregnant women:

    http://www.ajog.org/article/S0002-9378%2899%2970384-4/abstract

    Prevents restenosis after heart surgery
    Prevents restenosis of peripheral arteries after surgery
    Prevents atopic disorders (could very well be part of the reason allergies has increased dramatically ever since smoking has decreased)
    Strongly suspected to prevent Alzheimer’s, Parkinson and Tourette’s syndrome
    Low carbon monoxide levels such as in cigarettes prevents blood clogs that can save lives
    Enhances cognitive functions, concentration and memory (mental health patients self-medicate with smoking)
    Prevents and/or alleviates symptoms of ulcerative colitis (ulcerative colitis has increased proportionately to smoking prevalence decreasing)
    Suppresses appetite (decrease in smoking prevalence partly contributes to the obesity problem)
    Stimulates bowel movement
    Controls glucose levels (which may very well be one of the reasons that diabetes has sky rocketed proportionately with smoking prevalence decreases)
    Has the dual benefit of relaxing and stimulating depending on the need of the moment. (The smoking paradox).
    Supplies low amounts of niacin. Nicotine when combusted, produces nicotinic acid aka as niacin. And heating the nicotine may well be the reason that e-cigarettes are more effective than any pharma product that only offer nicotine in its original form.

    Each and everyone of these benefits is scientifically (or at least epidemiologically) documented. If you would like to elaborate on any or all of those benefits and you don’t have the documentation, please let me know and I will look up the references for you.

  • CMNissen  On July 29, 2010 at 4:06 pm

    Further to the point re: diabetes and weight gain, Dr. Rodu had a posting on this back in January with some good links off it: http://rodutobaccotruth.blogspot.com/2010/01/quitting-smoking-increases-diabetes.html

  • Iro Cyr  On August 27, 2010 at 12:01 pm

    Hello Carl,

    Although I indicated otherwise, I do not want my name mentionned in your paper. Use the info anyway you wish, I don’t need to be credited for it.

  • Ann Welch  On August 27, 2010 at 12:23 pm

    Carl, considering that Paul’s latest post has almost created the “biggest myth about tobacco/nicotine/smoking”, I do not want my name associated in any form with your organization and hereby retract permission to use my name in your paper.

    Feel free to use any information that I posted but I don’t want to be credited with it.

    Sincerely

    Ann Welch

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