Monday, January 27, 2014

Rest of the Story Author Takes it Under the Chin for Suggesting that Filtered Cigarettes Pose Slightly Lower Lung Cancer Risk

Once again, I was attacked by my colleagues, including two co-authors of the 2014 Surgeon General's report, for having the nerve to suggest that lifelong smokers of filtered cigarettes may have slightly lower lung cancer risk than lifetime smokers of non-filtered cigarettes.

Remember that I did not argue that a smoker switching from a non-filtered to a filtered cigarette brand will reduce her cancer risk. It may be that vigorous compensation offsets the impact of such a change. However, I do believe that the scientific evidence supports the contention that all else being equal, a lifelong smoker of non-filtered cigarettes faces a slightly higher cancer risk than a lifelong smoker of filtered cigarettes.

While the attacks were mostly personal, and not worthy of expounding here, the shred of substance was that more recent studies which compared lung cancer risks of successive cohorts of smokers have found increased risk among more recent cohorts. From these studies, the Surgeon General's report - and these co-authors - conclude that filters must convey an increased risk of cancer.

This argument is fallacious, I believe, because there are many things that changed from one cohort to the next. The introduction of cigarette filters is only one such change. To assume that any observed changes in cancer risk from one cohort to the next must be attributable to one particular change - the filter - is not appropriate, in my view.

Instead, I think that studies which specifically compare lung cancer risk between lifelong smokers of filtered vs. non-filtered cigarettes during the same time period are most informative regarding the relative cancer risks of these products. And multiple studies along these lines, including recent studies, have reported a slightly decreased risk associated with lifetime smoking of filtered vs. non-filtered cigarettes.

These studies are simply ignored by the Surgeon General's report and by my colleagues who have attacked me. It would be one thing if there were no evidence for my opinions, but it's hardly appropriate to attack an individual for expressing an opinion that is backed up by scientific studies.

This issue is particularly important because based on the arguments of these authors, the FDA should ban filtered cigarettes in order to protect the public's health. But in my opinion, such a move could be disastrous because it would result in a dramatic increase in tar delivery and possibly carcinogen dose, potentially leading to an increase, rather than a decrease in cancer.

The Rest of the Story

What is most disturbing to me about this story is that there is clearly no room for a difference in opinion in the tobacco control movement about certain dogmatic elements of the field. You can't express disagreement without facing personal attack, no matter how well you support your argument with scientific evidence. Like a religion, you can't challenge the gospel-like nature of movement's mantra without being viewed as a heretic.

Fortunately, I'm used to this treatment, so I'm not going to be bullied into backing down. I believe that a lot is at stake here, because a wrong move on the part of the FDA in banning filtered cigarettes could literally lead to an increase in cigarette-related deaths.

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