Timeless Knowledge from an Insightful Mathematician

 

I recently read on X (Twitter) a tribute to the book, “A Mathematician Reads the Newspaper,” by John Allen Paulos. 

The author is a professor of mathematics at Temple University, and his bio, here, is impressive.  The book, still in print and available on Kindle, was originally published in 1995.  More importantly, it remains relevant today, especially, as the reviewer put it, if you want to “become smarter and a better consumer of information who will not fall into [the] many traps of the media.”

I don’t recall having contact with Paulos, but his tome includes these two insightful paragraphs:

“More than 400,000 Americans die annually from the effects of smoking, but there is some intriguing evidence that the number could be drastically reduced by the widespread use of smokeless chewing tobacco.  Professors Brad Radu [sic] and Philip Cole recently published a note in Nature in which they claimed that the average life expectancy for a thirty-five-year-old smokeless tobacco user would be fifteen days shorter than that for a thirty-five-year-old smoker.  This is in contrast to 7.8 years lost by smokers.  The authors estimate that a wholesale switch to smokeless tobacco would result in a 98 percent reduction in tobacco-related deaths.

“Since a small amount of tobacco lasts all day, tobacco companies would likely oppose smokeless chewing tobacco.  There has already been strong opposition to it from some antismoking groups because of an increase in the risk of oral cancer (which is much rarer than lung cancer, emphysema, and heart disease).  I suspect that another reason is a certain misguided sense of moral purity – not unlike opposing the use of condoms because, unlike abstinence, they’re not 100 percent effective.  If the numbers presented here are confirmed, however, recommending a switch to smokeless tobacco for those smokers (and only those) who can’t quit would seem like sound public policy.”

Paulos has a knack for interpreting numbers, and he understands the “misguided sense of moral purity” that has dominated tobacco policy – and killed millions of smokers – for nearly 30 years.

 

 

*Nota bene: Phil Cole and I never claimed that a “wholesale switch” to smokeless would result in a 98 percent reduction in smoking-related deaths, as that would not have accounted for residual deaths from former smoking among those switchers.  Rather, we based the 98 percent reduction on the following premise: “If, instead of smoking, smokers had used smokeless tobacco.”  It is a subtle but crucial distinction, but it does not detract from the huge risk reduction available to individual smokers who switch.

 

Menthol Cigarettes & Race: FDA Shades the Facts

 

The FDA announced on April 29 its decision to ban menthol cigarettes, saying it had “strong scientific evidence” that the action would “reduce tobacco addiction and curb deaths.”  It claimed that “menthol increases the appeal of tobacco” and makes cigarettes “more addictive and harder to quit by enhancing the effects of nicotine.”  The agency, however, failed to explain why menthol cigarettes, despite such appeal, are favored by fewer than 30% of American smokers. 

Media coverage of the ban featured the claim that menthol cigarettes “disproportionately addict – and kill – Black Americans,” as the Washington Post headlined a story that contained this statement: “Black men have the highest rates of lung cancer in the United States, according to the Centers for Disease Control and Prevention.”

In 2018, I answered the question, “Who smokes menthol cigarettes?” using the 2015 National Health Interview Survey (NHIS), which was the last CDC report on the number of menthol smokers.  Although federal officials claim that menthol cigarettes pose an existential threat, they only collect information about them every five years in the NHIS, their main instrument for tracking smoking.

The 2015 NHIS found 10.7 million menthol smokers; 61% were white and 32% were Black.  Here is a further breakdown of race and gender, from highest to lowest numbers:

Table 1. Number of Menthol Smokers in the U.S., NHIS 2015
Race/Gender	Number (millions)
White women	3.8
White men	2.7
Black men	1.8
Black women	1.6
Others	0.8
All	10.7

If menthol cigarettes addict and kill smokers, these numbers reflect the victims’ race and gender distribution.

Let’s look at lung cancer mortality rates (LCMR) and numbers of deaths from the CDC’s most recent five years of data.  The rate is the number of deaths per 100,000 population per year (among persons 45+ years), so it’s the best way to compare different-sized groups.  The number of deaths is related to both the rate and the size of the group.

Table 2. Age-adjusted LCMR (per 100,000 persons per year) and number of deaths from lung cancer, 2012-2016
Race/Gender	LCMR	Deaths
Black men	184	49,578
White men	151	371,140
White women	102	306,234
Black women	93	35,158
Others	*	22,434
All		784,544

*Various groups with different LCMRs

While Black males have the highest lung cancer mortality rate, it is not because they smoke menthol; it is because they smoke more than white men and women, and especially Black women.

Mitch Zeller, director of the FDA’s Center for Tobacco products, played the menthol ban as a race issue: “For far too long, certain populations, including African Americans, have been targeted, and disproportionately impacted by tobacco use.” [Federal officials always say “tobacco” when they mean “smoking’?] 

The numbers prove Zeller is wrong.  While he asserted that Blacks “have been targeted,” far more whites than Blacks smoke menthol.  Zeller claimed that Blacks have been “disproportionately impacted,” but while Black men have the highest lung cancer death rates, Black women have the lowest, at about half the rate of the former.

It’s Too Early to Prove Absolute Safety, But Smokers Shouldn’t Wait to Vape

Tobacco opponents say that we’ve had too little experience with e-cigarettes to know whether they are safe.  While it is true that we don’t yet know the health consequences of long-term use, that should not discourage smokers from switching. 

We know that smoke contains high levels of thousands of agents, many of which are toxic or carcinogenic.  In contrast, e-cigarette vapor contains water, propylene glycol and/or vegetable glycerin, nicotine, flavors and perhaps a few contaminants at minuscule levels.  None of these – with the exception of buttery flavors (here) – are linked to any specific disease.  This difference alone justifies encouraging smokers to switch to e-cigarettes.

In the case of cigarettes, the effects of long-term use were not apparent for 20 years.

As I discuss in my book, For Smokers Only, smoking prevalence increased substantially around World War I (1914-1918).  The first clinical report of an increase in lung cancer and the suggestion of a link to smoking was published in 1939 by Alton Oschner and Michael Debakey in the journal Surgery, Gynecology & Obstetrics (68: 435-451, 1939).  “Until recently,” they wrote, “[cancer] of the lung has been considered a relatively infrequent condition.  However, recent studies demonstrate that [lung cancer] is one of the most frequent [cancers] of the body.”  But they acknowledged, “…it is controversial whether the increase in [lung cancer] is apparent or real.”  Oschner and DeBakey described 79 previous cases and presented seven cases that they had seen.

German pathologist Dietrich Eberhard Schairer and colleague Erich Schöniger published perhaps the first epidemiologic case-control study of smoking and lung cancer in their native language in 1943. Now considered a groundbreaking study, it was republished in English by the International Journal of Epidemiology in 2001 (reference here).  They confirmed “the [earlier] report of Müller [1940] that non-smokers rarely get lung cancer whereas heavy smokers get it more frequently than average.”

The smoking-lung cancer link did not appear in mainstream medical literature until 1950, when studies by Ernst Wynder and Evarts Graham (Journal of the American Medical Association, here), and by Richard Doll and Austin Hill in the (British Medical Journal, here) were published. 

While the strong link between smoking and lung cancer was not discovered for decades, today’s advanced surveillance techniques may detect a vapor-linked problem sooner.  It should be noted, however, that evaluating the effects of vaping will likely be complicated by the fact that most vapers already have smoking histories.

Smokers shouldn’t wait to vape.