‘1-10 sigaretten per dag kunnen extra gezond zijn’

De discussie naar aanleiding van het Enstrom&Kabat rapport, dat in Mei 2003 in de British Medical Journal verscheen, woedt nog steeds door op de BMJ-site.

Vandaag werd een nieuwe bijdrage in de discussie geleverd die een overzicht geeft van onderzoeken waaruit blijkt dat het roken van één tot tien sigaretten per dag juist positieve effecten heeft.

Meerokers zouden eigenlijk blij moeten zijn met de incidentele blootstelling aan tabaksrook. Het komt hun gezondheid ten goede…

Various recent letters in conjunction with the Enstrom and Kabat debate focus on the antismokers’ claim that a safe threshold of environmental tobacco smoke (ETS) exposure does not exist. There is no experimental or epidemiologic evidence to prove such an assertion, which is not only against common sense but also incompatible with many reports of safe thresholds for active smoking.

Antismokers like to edge that ETS is more toxic than what smokers themselves experience, but the claim is spurious because smokers are also exposed to ETS far in excess of any nonsmoker. Evidence of a no effect threshold around 3-4 cigarettes smoked daily emerge from the statistical analysis of epidemiologic dose gradients in active smokers (Gori & Mantel, 1991). The finding is supported by two official and massive national surveys in the USA and in Australia, which found that smokers of less than 10 cigarettes/day enjoyed overall better health than nonsmokers ( Wilson 1967, Australian Bureau of Statistics 1994).

A 34 year follow up of the US Framingham study reports that for smokers of less than 10 cigarettes/day lung cancer rates were not elevated, and cardiovascular diseases were less than in nonsmokers (Freund et al, 1993). Similarly, a 22 year follow-up of the British Doctors study found that rates of lung cancer mortality and ischemic heart disease were the same in nonsmokers and in smokers of 1 14 cigarettes/day. Mortality from all diseases was slightly lower in smokers of 1 14 cigarettes/day (Doll et al., 1980). To these reports one should add the evidence that moderate pipe and cigar smoking are not associated with increased risks of lung cancer and other diseases (U.S. Surgeon General, 1964).

A large cohort study of white women in Maryland reported threshold effects for lung cancer and cardiovascular diseases (Bush and Comstock, 1983). The Western Collaborative Group Study also reported clear threshold values for cardiovascular diseases, especially after adjustment for type A personality confounding (Jenkins et al., 1968). Many more studies support the notion that smoking less than 10 cigarettes/day is unlikely to adversely influence lipidemic cardiovascular risk factors, and the official US National Cholesterol Education Program only lists smoking of over 10 cigarettes/day as a possible risk factor for cardiovascular disease (NCEP, 1988).

The list could be quite longer, but what’s here should be enought to make the point.


Australian Bureau of Statistics (1994): 1989-90 National Health Survey: Lifestyles and Health Australia. Australian Bureau of Statistics. Canberra.

Bush TL, Comstock GW (1983): Smoking and cardiovascular mortality in women. Am J Epidemiol 118:480-488.

Doll R, Gray R, Hafner B, et al. (1980): Mortality in relation to smoking: 22 years’ observations on female British doctors. Br Med J 280:967-971.

Freund KM, Belanger AJ, D’Agostino RB, et al. (1993): The health risks of smoking. The Framingham study: 34 years of follow-up. Ann Epidemiol 3:417-424.

Gori GB, Mantel N (1991): Mainstream and environmental tobacco smoke. Regul Toxicol Pharmacol 14:88-105.

Jenkins CD, Rosenman RH, Zyzanski SJ (1968): Cigarette smoking. The relationship to coronary heart disease and related risk factors in the Western Collaborative Group Study. Circulation 38:1140-1155.

NCEP (1988): Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults. Arch Int Med 148:36-69.

U.S. Surgeon General (1964): Smoking and health. Report of the advisory committee to the Surgeon General of the Public Health Service. U.S. Department of Health, Education, and Welfare. Public Health Service Publication No.1103., Washington, DC.

Wilson RW (1967): Cigarette smoking and health characteristics. United States – July 1964 – June 1965. Public Health Service, National Center for Health Statistics, Series 10, No 34. Public Health Service Publication No. 1000. US Department of Health, Education and Welfare, Washington, DC.

Competing interests: Competing interests: I was director of the Smoking and Health Program of the US National Cancer Institute, for which I received the US Public Health Service Superior Service Award. In becoming a critic of official allegations, I received occasional support from the tobacco industry. In matters of tobacco and health I sought in vain other support that might equally come without strings attached.

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    Albert Einstein

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