Wednesday, July 14, 2010

Who Said Light Cigarettes Are Safer? The American Cancer Society

On June 22, Congressman Henry Waxman wrote a commentary (here) in The Hill’s Congress Blog celebrating the first anniversary of his legislation giving the FDA regulatory authority over tobacco. He noted, “Today new regulations take effect banning the use of the terms ‘light,’ ‘mild,’ and ‘low-tar,’ from tobacco advertising, labeling, and marketing. These terms were designed by the industry to mislead consumers, who often think - incorrectly - that products that carry these labels are less dangerous than other tobacco products.”

This line – that safer cigarettes are a deception perpetrated by the tobacco industry -- has been repeated so many times that it is considered gospel by the American public. In fact, the medical and scientific literature makes this a prime example of historical revisionism, if not pure myth.

Research published in the 1970s documented that low-tar low-nicotine cigarettes were less hazardous than others. Contrary to Mr. Waxman’s assertion that “these terms were designed by the industry to mislead consumers,” articles in respected medical journals reveal that the American Cancer Society played a prominent role in shaping consumers’ positive perception of these products.

As I have previously blogged, in 1976 the Cancer Society published research (here) showing that light cigarettes were indeed safer. In 1959-60, over a million people were enrolled by the Cancer Society in a prospective epidemiological study of cancer risk factors. Smokers were classified according to nicotine-tar content, high (2.0-2.7 milligrams nicotine and 26-36 mg tar) or low (less than 1.2 mg nicotine and less than 18 mg tar); detailed records were obtained about the number and dates of deaths.

The study revealed that the death rate from all causes was 16% lower among smokers of low nicotine-tar cigarettes than among smokers of high nicotine-tar cigarettes. Similarly, low nicotine-tar smokers had a 14% lower death rate from heart attacks and a 26% lower rate from lung cancer. The Cancer Society authors concluded that “total death rates, death rates from coronary heart disease, and death rates from lung cancer were somewhat lower for those who smoked ‘low’ tar-nicotine cigarettes than for those who smoked ‘high’ tar-nicotine cigarettes.”

This study was extensively reported on by the media.

In 1979, Cancer Society investigators published a study in the New England Journal of Medicine, confirming the 1976 lung cancer findings (abstract here). This study examined the lungs of 211 men who died in 1955-60 and 234 men who died in 1970-77. It looked for microscopic changes indicating that a cancerous tumor might have eventually developed if these men had lived longer.

Smoking Category% Pre-cancer, 1955-60% Pre-cancer, 1970-77
NonSmoker 00
Less than 1 pack per day 2.60.1
1-2 packs per day 13.20.8
2+ packs per day 22.52.2

The results from this study are shocking. In 1955-60, when filter or light cigarettes were rare, 2.6% of men who smoked less than a pack per day had pre-cancerous changes in their lungs. Among men smoking 1-2 packs, 13 percent had changes, and this increased to 23 percent among those smoking over 2 packs per day. But in 1970-77, when, according to the report, “a large proportion of smokers have deliberately selected brands with reduced tar and nicotine,” the percentage of smokers in every category who had pre-cancerous lung changes was very small.

Cancer Society researchers concluded: “The evidence from this study is consistent with evidence from epidemiologic studies indicating that death rates from lung cancer are lower among men who smoke the same number of high tar/nicotine cigarettes per day…”

This study appeared in the New England Journal of Medicine, one of the most prestigious medical publications. The results were widely reported by the national media, including the Wall Street Journal.

According to one article (here), ACS president LaSalle D. Leffall Jr. issued a harm reduction message, saying that “findings of the new study suggest a way for smokers to reduce their lung cancer risk by switching to low tar-nicotine cigarettes if they find it impossible to quit entirely.” To his credit, Leffall also noted that “the best way to escape the risk of lung cancer ‘is not to smoke at all…There is no safe cigarette.’”

American smokers made a large-scale transition from full-flavor to light cigarettes almost 50 years ago; the public health impact remains a highly debated topic even today. One fact is not debatable: The marketing of light cigarettes was not entirely an industry-driven conspiracy. The health advantages of light cigarettes compared with full-flavor brands were documented and promoted by the American Cancer Society in 1976 and 1979.


Anonymous said...

Isn't there a case in Canada at the moment about the Canadian government designing smoking products with tobacco companies? They were supposed to reduce harm but didn't apparently and the government involvement was an endorsement of the product.

The RIP cigarettes designed by lobbyists are going to bring interesting cases too. If the new technique of puffing more to keep them lit is proved to be more harmful then the lobbyists and legislators may have to justify in court the basis for forcing smokers to use their design.

Unfortunately recreational nicotine markets are being closed worldwide to protect the cessation industry which relies on tobacco and medical markets. Not many people seem to realise that the potential for genuine non-tobacco harm reduction products is being wiped out.

Anonymous said...

"The RIP cigarettes designed by lobbyists are going to bring interesting cases too. If the new technique of puffing more to keep them lit is proved to be more harmful then the lobbyists and legislators may have to justify in court the basis for forcing smokers to use their design."

Interesting that you mention this as I have been thinking about the light and mild "compensation" theory that many of the anti tobacco groups have written about.

Now wouldn't an indoor smoking ban also cause a smoker to inhale more and inhale more deeply, as they stood outside, then when they used an ashtray?

Anonymous said...

This is about a recent Canadian court case and shows that tampering with design is nothing new for governments:

"Whatever the views consumers had about light and mild back when those products were on the market were really the result of the claims and the information provided by the federal government."

Anon, this is what Dr Laugensen of Health New Zealand says about smoking RYO:

"Whereas a smoker of factory-mades lets a lot of the smoke go up in the air, these roll-your-own smokers suck like crazy and don't let so much be wasted," Dr Laugesen said yesterday. "They're getting more value out of the tobacco - and more harm."

A study that compared smoking of roll-your-own and factory-made cigarettes showed rollie smokers:
* Inhaled 28 per cent more smoke per cigarette.
* Took 25 per cent more puffs.
* Puffed for six seconds longer per cigarette.
* Increased their carbon monoxide level by the same amount.

I believe that the RIP engineering will replicate the technique of RYO smoking - frequent puffing is required to keep the cig lit. As you say, technique may also be affected by environment changes too.

As taxes go up more people swap from filter cigarettes to RYO. Government manipulation of the tobacco market appears to cause a lot more harm than simple education with reliable facts.

I suppose it's not called 'tobacco control' for nothing - control being the operative word and profit the main driver (at least for the people running the lobby groups). They can't contribute to a solution to the perceived problem so settle for profiting from prolonging it.