To the American Cancer Society: Fill in the Blanks

In April, I wrote that the American Cancer Society (ACS) is withholding important information on the health risks of smokeless tobacco use (post here). Here’s how the ACS can fill in the blanks on the missing information.

In 1997 the ACS published death rates among non-smokers and smokers from their Second Cancer Prevention Study (CPS II), which the organization promoted as “the largest and most recent prospective study of smoking and disease.” (Available here). According to ACS at the time, “relative risk estimates from CPS-II already have been used extensively to estimate smoking attributable mortality in the United States, Latin America, and nearly 50 other developed countries.”

CPS II involved monumental effort. In 1982, ACS recruited almost 1.2 million Americans, and collected information on smoking, smokeless tobacco use and other lifestyle factors. During the next six years, it meticulously recorded deaths among participants, so that it could determine to what extent smoking and smokeless use influenced death rates

Death rates among smokers from CPS II are the basis for the entire American anti-smoking crusade. For 20 years, this data has served as the basis for estimates by the Centers for Disease Control of how many Americans die from smoking. As seen in the table, smoking is responsible for a two- to three-fold increase in death rates for male smokers compared with nonsmokers.

All Cause Mortality Rates (Deaths per 100,000 per year) Among Men Who Are Nonsmokers, Cigarette Smokers and Smokeless Tobacco Users, 1982-1988
Age (years)	Nonsmokers Rate	Smokers Rate	Relative Risk	ST Users Rate	Relative Risk
35-39	73	219	3.0
40-44	94	304	3.2
45-49	152	427	2.8
50-54	221	679	3.1
55-59	368	1,084	3.0
60-64	673	1,824	2.7
65-69	1,097	2,885	2.6
70-74	1,847	4,665	2.5
75-79	3,441	7,322	2.1
80+	5,467	10,448	1.9

Let’s interpret just one line in the table. Over the six year period, there were 368 deaths among 100,000 nonsmoking men who were 55-59 years at the start of the study. In contrast, there were 1,084 deaths among 100,000 smokers -- 2.95 times more (rounded to 3.0). That is a big difference.

But the table is incomplete. The Cancer Society has never released death rates among smokeless tobacco users for the period 1982-88. ACS has this information, but it refuses to release it. I believe that ACS is withholding death rates from smokeless tobacco use because they are not significantly different from those for nonusers.

The FDA should be required to address this appalling information gap. The agency mandates that smokeless tobacco packages carry this warning, among others: “This product is not a safe alternative to cigarettes.” It is outrageous that the FDA lacks hard data to support the statement. Potentially life-saving comparable risk information is being withheld from smokeless tobacco users, smokers and the FDA by the American Cancer Society.

Good News You Never Knew About Life Expectancy in the U.S.

The National Center for Health Statistics in May released final data on life expectancy and deaths in the U.S. for the year 2007 (read it here). It is an extraordinary report, because it further documents that Americans continue to live longer and healthier lives, year after year.

Compared with 2006, the age-adjusted death rate from all causes declined 2.1% in 2007. This is an extraordinary single-year decline, and it was driven by impressive reductions in five of the top 10 causes of death, as noted in the table.







Top Ten Causes of Death, and Percentage Change from 2006 to 2007

Cause of Death	Percent Change From 2006
1. Heart Diseases	- 4.6
2. Cancer	- 1.3
3. Stroke	- 3.2
4. Respiratory Diseases	+ 0.7
5. Accidents	+ 0.5
6. Alzheimer’s Disease	+ 0.4
7. Diabetes	- 3.4
8. Influenza/pneumonia	- 9.0
9. Kidney Diseases	None
10. Blood Infection	None

Heart disease, accounting for about one-quarter of all American deaths, declined almost 5% in 2007, and stroke deaths dropped by over 3%. Deaths from cancer were down over 1%, and there were impressive declines for diabetes (-3.4%) and influenza/pneumonia (-9%). These aren’t just one-year wonders; declines have been occurring for 20 to 30 years.

Chances are that you knew nothing about these incredible statistics. That’s because the federal government and most health organizations cast every health issue as a crisis. They argue that Americans are in poor health and are being killed by obesity, as well as chemicals in our food and in our environment. They portray our health care system as ineffective. They don’t want you to know the truth: death rates for most major diseases continue to plummet.

The long-term decline in smoking is playing a role, especially in the impressive reductions in heart disease, cancer and stroke rates. But many Americans are also eating healthier foods, and using preventive medications like aspirin and statins (that lower cholesterol levels) to reduce risks. And the health care system is providing ever-improved treatments.

I offer the following example to illustrate that the decline in American death rates over the past couple decades is truly astounding: let’s compare 2007 with 1987. In 2007, the nation’s age-adjusted death rate for all causes was 760 deaths per 100,000, and a total of 2,423,712 Americans died. Just twenty years earlier, the age-adjusted death rate was 970, about 28% higher than 2007 but still far lower than in previous decades. If the 1987 rate had been effective in 2007, there would have been 669,000 more deaths!

The average life expectancy at birth for the U.S. population in 2007 was the highest in history at 77.9 years, an increase of 0.2 year over the 2006 number. In other words, every American gained almost 2½ months of life expectancy in just one year! This is irrefutable evidence that our health and social system, despite its limitations, has sustained remarkable advances in the prevention and treatment of most life-threatening diseases, extending and improving the lives of millions of Americans.