Wednesday, August 17, 2016

Low-Tar Cigarettes Had Merit, Said American Cancer Society; So Do E-Cigarettes

E-cigarette opponents routinely claim that e-cigarettes benefit from industry-promoted consumer health misconceptions in the same manner that so-called light cigarettes soared in popularity years ago, when, it is alleged, marketers created a mythology about the relative safety of “reduced tar.”  In reality, there is more truth in those light claims than people suspect.

According to one heavily cited account (here), “In the late 1960s, tobacco manufacturers introduced ‘light’ or ‘low tar’ brands that yielded 7–14 mg tar per cigarette, compared to the 22 mg tar of the average cigarette sold at that time.   Later, ‘ultralight’ brands appeared, with tar yields below 7 mg per cigarette.  Today [in 2004], almost 90% of cigarettes sold in the United States are in these categories.  Better taste is not the reason why smokers buy light cigarettes.  They buy them because they have the misconception that smoking lower tar products reduces their risk of lung cancer and other tobacco-related diseases.  Advertisements for these brands carry the implicit and tempting message that switching to a light brand is an alternative to quitting smoking.”

This line – that safer cigarettes are a deception perpetrated by the tobacco industry -- has been repeated so often that it is considered gospel by the American public.  In fact, the scientific literature supports the relative safety claim and debunks the popular myth.

Research published in the 1970s documented that low-tar low-nicotine cigarettes were less hazardous than others.  Articles from the American Cancer Society in respected medical journals played a prominent role in shaping consumers’ positive perception of these products. 

In 1976 the Cancer Society published research (here) showing that light cigarettes were 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 for death rates and dates. 

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 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.”

The research findings were extensively reported on by the media (example here).

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.  Researchers looked for microscopic changes indicating that a cancerous tumor might have eventually developed if these men had lived longer.

Percentage (%) of Smokers Who Had Pre-Cancerous Lung Changes At Autopsy, According to the American Cancer Society
Smoking CategoryFull-Tar Smokers, 1955-60Light-Tar Smokers, 1970-77
Less than 1 pack per day2.60.1
1-2 packs per day13.20.8
2+ packs per day22.52.2

The results from this study are shocking.  In 1955-60, when most smokers consumed full-tar cigarettes, 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 per day, 13% had changes; this increased to 23% 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 low tar/nicotine cigarettes than among men who smoke the same number of high tar/nicotine cigarettes per day…”

Again, the results were widely reported by the national media, including the Wall Street Journal (here).  Cancer Society 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.”  Leffall noted that “the best way to escape the risk of lung cancer ‘is not to smoke at all…There is no safe cigarette.’”

By the 1980s, public health experts and cigarette manufacturers alike were optimistic about the prospects of a safer cigarette.  Manufacturers introduced products with even lower levels of tar, which they called ultra-lights. 

In 2004, Cancer Society researchers confirmed that smoking ultra-lights resulted in lower lung cancer rates than the full-tar cigarettes, but the rates for ultra-lights were the same as those for low-tar cigarettes (here).

The health advantages of light cigarettes over full-flavor brands were documented and promoted by the American Cancer Society in 1976 and 1979.  Optimism about low-tar brands was later reversed by another Cancer Society report, which did not acknowledge or cite the earlier studies. 

One fact is not debatable: The public health community conducted research that led to the promotion of light cigarettes as safer alternatives.  Therefore, there is no industry conspiracy template for anyone to employ against e-cigarettes.


Bill Godshall said...

Please note that prior to 1960, most smokers smoked non filtered cigarettes, which emit far higher tar levels than high tar filtered cigarettes.

And according to reports filed with the FTC, just 2% of cigarettes sold in 1967 emitted less than 15mg of tar even though filtered cigarettes accounted for 72% of all cigarettes sold that year.

So much of the differences found in that ACS study could be due to the sharp increase in sales of filtered cigarettes.

Regardless, subsequent research has confirmed that the daily smoking of low-tar cigarettes poses significantly higher disease risks than was found in the ACS study cited here.

In contrast, there is no evidence vaping imposes risks for respiratory, cancer or heart disease, and the evidence consistently finds vaping is far less harmful than smoking low tar cigarettes.

Anonymous said...

Bill, your very well versed on this subject. Do you have any other useful references for us considering the focused anti-vaping effort being lead by the gov and public health agencies?

R Davis said...

Great post! Besides potentially being a safer alternatives, light cigarettes can be used in the "switch down and quit" method described at In fact, I blogged at on how I used this method to quit. I also blogged at about how the government no longer releases information on the tar and nicotine content of cigarettes although I believe that they continue to obtain the numbers via testing.

As I state there, the FDA seems to feel that it is better that people have no information about the tar and nicotine content of cigarettes than that they have imperfect information by which they might be misled. This seems like a questionable policy to me, treating people like children who "can't handle the truth". I can see no reason why they cannot release the data along with prominent warnings that there is no safe cigarette, low-tar cigarettes may contain high levels of other dangerous chemicals, and that smokers may need to make some effort not to compensate for smoking a lighter cigarette by smoking more cigarettes or inhaling more deeply. In any case, it seems a big mistake to take taxpayer money to measure tar and nicotine content and then refuse to release the information. It forces responsible adults who wish to switch down and possibly quit to go to sites such as mine which contains 2007 data obtained via the Freedom of Information Act.