I have already commented on how and why the Surgeon General's statement that brief exposure to secondhand smoke causes heart disease and lung cancer is unsubstantiated and inaccurate, and suggested that the statement was not appropriate because it is not supported by the science. Here, I argue that the statement is also inappropriate because it could well have an adverse impact on the appreciation of the health risks of smoking and benefits of smoking cessation among smokers.
The Rest of the Story
If, as the Surgeon General stated last week, a "brief" exposure to secondhand smoke is enough to cause heart disease and lung cancer, breathing secondhand smoke for even a short time "sets the cancer process in motion," even a short time in a smoky room can "cause a deadly heart attack," and breathing secondhand smoke briefly can "have immediate harmful effects...potentially increasing the risk of a heart attack," then why should smokers quit smoking?
I'm quite serious about this question. From the perspective of a smoker hearing the message that even a brief exposure to secondhand smoke may set the cancer process in motion, then is there any real point (assuming that the smoker believes the Surgeon General) to quitting smoking?
So far as I can tell (from the scientific evidence), a brief exposure to active smoking is not enough to cause heart disease and lung cancer. Actively smoking for a short time does not set the cancer process in motion. A short time smoking does not cause a deadly heart attack, and actively smoking for a brief time does not immediately increase the risk of a heart attack. It takes many years of smoking before one can get heart disease or lung cancer and before one's risk of a fatal or non-fatal heart attack increases.
But apparently, for secondhand smoke, many years of exposure are not necessary. It is so hazardous that even a single brief exposure puts you at increased risk of heart disease and lung cancer. In fact, the cancer process is already set in motion, suggesting that there may be nothing you can do to stop it.
Thus, what the Surgeon General is asking us to believe is that in many ways, secondhand smoke is far more hazardous than active smoking.
Jacob Sullum picked up on this in his column today, pointing out that since the Surgeon General's press release claims that "even brief exposure to secondhand smoke...increases risk for heart disease and lung cancer" and since "among smokers, these diseases take many years to develop," therefore "if you get your health tips from the surgeon general, you'd start smoking a pack a day as a protective measure."
This is obviously a joke, but it actually follows quite logically from the Surgeon General's press release and the well-appreciated fact that smoking-related cardiovascular disease takes years to occur.
Since many smokers spend time in environments where they are exposed to secondhand smoke, it would not be unreasonable to expect that they would continue to have significant secondhand smoke exposure after quitting smoking. If they are led to believe that this secondhand smoke exposure is actually worse than their own active smoking, does it really provide much of an incentive for them to quit?
And it seems to me that the suggestion that a brief exposure to secondhand smoke sets the cancer process in motion may lead people to believe that quitting smoking (or even avoiding secondhand smoke) is a worthless endeavor, because the cancer process has already been put in motion. It makes it seem like there is nothing you can do once you've been exposed. And since all of us have already been exposed at least briefly to tobacco smoke, what's the exact point of limiting our exposure? After all, the cancer process is apparently already in motion.
I believe that the Surgeon General's public statements inaccurately implied a lack of reversibility of the impact of brief exposure to secondhand smoke. If that brief exposure is enough to increase your risk of heart disease and lung cancer, then it is entirely unclear that you can protect yourself by avoiding further exposure. Apparently, it's too late. You're already at increased risk!
This message is, then, not only inaccurate, but counter-productive in terms of promoting smoking cessation and improved health. It is essentially a message that all of us are already at increased risk of heart disease and lung cancer, simply by virtue of having been exposed briefly to secondhand smoke. The message really comes down to the fact that it's too late. Our risk has already gone up. So what good is it to avoid exposure to secondhand smoke or to quit smoking now?
By overblowing and distorting the science on the reversibility of the acute cardiovascular effects of secondhand smoke, I believe that the Surgeon General's statements have done a disservice to the interests of protecting the public's health. I think these messages have distorted the public's understanding of the risks of active and passive smoking (among those who believe them). And if people have to discount the Surgeon General's statements in order not to be misled about health risks, isn't that an unfortunate state of affairs?