Tuesday, February 11, 2014

Anti-Smoking Advocate Incorrectly and Irresponsibly Tells Public that Smoking Half Pack Per Day is No Better than Smoking Two Packs Per Day

According to Dr. Stan Glantz - a leading tobacco control researcher - cutting down substantially on the amount you smoke has no health benefit. Thus, according to Dr. Glantz, smoking two packs of cigarettes per day is no more harmful than smoking a half pack per day, for example.

Dr. Glantz's comments on the lack of health benefit in cutting down on one's smoking come in response to one of the reported benefits of electronic cigarettes: that they help many smokers to cut down substantially on the amount they smoke. Glantz writes: "Dual users, who simultaneously use both products, are unlikely to see much, if any, health benefit because of the continued cigarette use, even if daily consumption drops." In other words, if you are still smoking, there are no benefits from cutting down on the amount you smoke thanks to e-cigarettes.

This is actually an important point because in published studies of the efficacy of electronic cigarettes, they reportedly helped more than half of smokers to either quit completely or cut down the amount they smoked by 50% or more. Thus, electronic cigarettes - even dual use - results in a substantial decline in cigarette consumption for the majority of users.

The Rest of the Story

The truth is that Dr. Glantz is simply wrong. He is not a medical doctor and therefore has no personal experience treating patients upon which to draw. As a physician, I can testify to the fact that when smokers substantially reduce the amount that they smoke, they experience immediate and significant health benefits.

The major problem with Dr. Glantz's argument is that he is considering only smoking-related mortality. The literature he cites deals with mortality only. However, there is more to life than simply its length. The quality of life is also important (although apparently not for smokers, according to Glantz). And cutting down the amount you smoke substantially improves the quality of life by reducing respiratory morbidity.

You see, there is no question that huge reductions in cigarette consumption improve respiratory symptoms. My patients who were able to cut down substantially on their smoking experienced immediate improvements in their ability to exercise and were able to enjoy life more because they could do more things without getting short of breath. Research confirms that respiratory symptoms improve when smokers are able to cut down the amount they smoke by at least 50%.

Long-term, there is a significant reduction in lung cancer risk associated with cutting the amount one smokes. The study that Glantz cites as showing no health benefits of smoking reduction actually found a 34% decline in lung cancer risk associated with smoking reduction.

One thing that is true is that there are no cardiovascular benefits to smoking reduction. The reason for this is that the adverse cardiovascular effects of smoking saturate at a low level of exposure. However, with carcinogenic effects as well as lung disease, there is a well-recognized dose-response relationship between exposure and disease risk. Therefore, substantial smoking reduction has no cardiovascular benefit but it does lower lung cancer risk and respiratory morbidity.

But there is another important factor that Glantz is forgetting. In the existing studies, the smokers examined had simply cut down on the amount they smoked without substituting another source of nicotine. Therefore, they were highly likely to be compensating by inhaling much more heavily on the cigarettes that they smoked. In contrast, when dual users of e-cigarettes and cigarettes cut down substantially on their smoking, they are doing so by substituting non-tobacco, nicotine cigarettes. One would expect much less, if any, compensation. Thus, the studies that Glantz cites are not quite as relevant as they would otherwise be.

A final, important benefit of smoking reduction is that it helps facilitate the possibility that a smoker will subsequently be able to quit. It reduces the level of smoking addiction. It is easier to quit from a level of 5 cigarettes per day than it is to quit from a level of 30 cigarettes per day.

The rest of the story is that it is inaccurate to tell the public that there are no benefits to substantial reduction in cigarette consumption.

But why is it irresponsible?

It is irresponsible because this advice basically tells smokers: "If you are unable to quit completely, there is no point in your trying to reduce the amount you smoke. If you are a 3-pack per day smoker and cannot quit completely, then you should just keep smoking 3 packs per day. Don't try to cut down to 1/2 pack per day because it will have no benefit."

If this was advice given by Glantz to a smoker he was treating, it would represent malpractice. Instead, it is what I consider to be public health malpractice.

There is no question that the best advice to smokers is to quit completely. But for those who are unable to do so, the use of electronic cigarettes to try to quit is sound advice. Clearly, if they quit completely with electronic cigarettes, they have accomplished a huge task in terms of improving their health. But even if they are still dual using, they may have substantially improved their health. And, they may have made it easier to quit completely at a later time.

But the truth is much too inconvenient for zealots who have adopted an abstinence-only, quit-or-die mentality. The lives and health of smokers are expendable when compared to the principle that addiction is evil and smoking is immoral. So when the truth gets in the way, anti-smoking fanatics simply lie.

1 comment:

Blogger said...

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