‘War on Tobacco’ heeft geen effect gehad
De ‘Oorlog tegen Tabak’ wordt al gevoerd sinds 1964. Er werden gouden bergen beloofd, maar is er een effect te merken na veertig jaar? Dertig jaar is de maximale tijd die nodig is om te bepalen of er effect van een ingreep op dit gebied te meten is.
Een gepensioneerd Amerikaans farmaceutisch chemicus had alle tijd om de effecten, aan de hand van onafhankelijke gegevensbronnen, op een rijtje te zetten en ontdekte dat al die overheidsdollars voor niets zijn geweest.
In statistical studies of smoking, when data exist conflicting with accepted theory, they are ignored. It’s bad enough that accepted principles of science are abandoned; it’s bad enough that smokers are being financially penalized for scientific principles that don’t exist; but even worse, we don’t alleviate suffering from these smoking related diseases while we bear the hardship of the War on Tobacco.
TIME TRENDS ON SMOKING AND HEALTH AND THE VALUE OF THE WAR ON TOBACCO
by David Kuneman
ABSTRACT: Most scientists believe a change in prevalence of a health risk behavior in a population will manifest itself between ten and thirty years after the change takes place. Since 1964, the War on Tobacco has caused one of the largest changes in health behavior of a population ever known, over a relatively short period of time. It is now past the time when we have a right to expect profound changes in the health profile of Americans due to the War on Tobacco. This article examines the smoking behavior of various American birth groups, identifies the years when smoking related disease should occur based on the age of these birth groups, and concludes no significant health profile changes have occurred that can be credited to the War on Tobacco. Further, it is concluded that no cost savings treating tobacco related disease have been realized. Comparisons are made to the health profiles of Europeans who have had no War on Tobacco which confirm our War on Tobacco is worthless. Literature is cited that predict our young generations of Americans can also expect no health bonanza from the War on Tobacco.
The author is a retired pharmaceutical chemist who noticed no improvement in health of Americans while accessing the medical literature during his career. His personal health profile does not include any smoking related diseases, and he believes anti tobacco activists and public health officials have diminished the quality of his life more than any tobacco company.
I have been compiling smoking rates and smoking related disease rates gathered over the last thirty years by government agencies. Time trends of most medical conditions blamed on smoking are stationary or rising even as the prevalence of smoking declines. The data I am about to present should be of interest to anyone concerned with claims smoking rates are a major health cost to society. I have compiled as much of this data as possible from Statistical Abstracts of the United States (SAUS) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results ( SEER) Program. The SEER Program is a scientifically selected population-based registry of 9 geographic regions within the United States used to identify and quantify our overall health trends. These are widely regarded as the best data available. The tables below present these data. The smoking rate data in some tables are inserted by me for the convenience of the reader, and not part of the original database cited. Birth group refers to birth year plus or minus five years. Thus, for example, birth group 1905 refers to those born from 1900 to 1910.
Identification of years when most smoking related disease should strike.
I have obtained historical (cigarette only) smoking data from J. Harris, J. Nat. Cancer Inst. , Vol. 71, #3, Sept, 1983, p473 of the birth groups of Americans old enough to be in the smoking related disease risk group between 1973 and 1998.Current smoker at age 60, birth year 1925, data were extrapolated by me because these are 1985 data and Harris published during 1983. Harris concluded male smokers born 1905 +5 and females born 1925 +5 smoked the heaviest lifetime dose. By birth group, male smokers peak cigarette use was actually males born 1925 during 1953, but they began quitting much earlier in their lives than prior birth groups and smoked almost exclusively cigarettes; their lifetime consumption was less than 1905 males. Harris reported the mixing of cigarettes with other tobacco products was more common among earlier male birth groups. I also conclude the 1905 male birth group smoked the heaviest lifetime dose because males born 1905 inhaled more tobacco combustion products: first, they also smoked more cigars, ( Table I ) second, they smoked more unfiltered cigarettes which were most popular before the 1950s when these males were already in middle age. The plain fact is when a filter cigarette is smoked, one can see tar build up in the filter. This is tar that is never ingested by the smoker. Studies consistently claim unfiltered cigarettes are more dangerous than filtered. Third, they arrived at the age of smoking inception during the 1920’s when smoking was very popular and acceptable, and fourth, they were already average age 59 when the first Surgeon General’s report was published in 1964, supposedly too late to benefit much from the rash of quitting that followed. At the time of Harris’ publication, cigars were thought to be less risky than cigarettes which was the official explanation why males who lived during most of the 1800’s never suffered from lung cancer. When cigar smoking again gained popularity during the 1990’s, reports that cigars are indeed as hazardous as cigarettes began appearing. If true, then males born 1905 ( smoking both) ought to be most at risk from smoking related disease. However, these recent cigar reports never gave a satisfactory explanation why lung cancer was extremely rare before 1930.
Table I ,Domestic Cigar Consumption, 5-year intervals, in Millions
| Per Capita Male/year over age 21* | ||||
| 5-Year Interval | Large Cigars/yr | Small Cigars/yr | Large Cigars | Small Cigars |
1920-1924 | 7,018.6 | 594.5 | 223 | 19 |
1930-1934 | 4886.1 | 286.5 | 130.5 | 7.5 |
1940-1944 | 5449.6 | 132.7 | 125 | 3.0 |
*Calculated from data from “Historical Statistics of the U.S”. House document #93-78 part1 and the Production of Tobacco, W.W. Garner, U.S. Dept of Agriculture, 1947.
Males, average birth years 1895 and 1905, reached the age of smoking inception when males smoked an average of 223 cigars per capita annually. Latter birth groups reached the age of smoking inception after cigar consumption began declining.
Another reason to believe male smokers born 1905 were the heaviest is due to their low quitting/ decade-after-age-30-numbers. These data in Table II are from Harris. We have been bombarded with claims substantial reduction of smoking related disease occurs when people quit before the disease strikes, and even quitting after the disease strikes can have benefits. Birth group 1905 males ought to have more smoking related disease because they smoked the most at age 50, and almost as much as 1895 males at age 60. The cigar issue doesn’t apply to female birth groups. Female birth groups 1915 and 1925 actually had somewhat similar smoking histories, both smoking 37% at age 50, but those born 1925 took up the habit earlier in their lives while the 1915 birth group smoked the most at age 60. Smoking at age 50 ought to be the most important parameter because most smoking related cancers occur after age 60 and claims are common that ten years after quitting, risk of cancer declines dramatically.
Based on age of these birth groups, smoking related disease incidences during 1973 occurred mostly among those born 1905 +5, during 1985 among those born 1915, and during 1996-1998 among those born 1925. The slightly longer time span, I have presented, between birth and expected incidences at later intervals is due to overall life expectancy increases occurring from 1970 to 1998.
( refer to J. Amer. Med Assoc., Feb9, 1994, p435, T5. Most smoking related cancers are diagnosed age 60 to 80, with peak age 70. Birth year overlap is about 25% over ten-year intervals )
Table II, Harris Cigarette-only Smoking Prevalence by Birth Group
| Quitting/decade | ||||
| Ave Birth Year + 5 | Ever Smoked | Smoker Age 50 | Smoker Age 60 | After Age 30 |
MALES 1895 | 50% | 50% | 50% | 0% |
1905 | 62% | 60% | 49% | 5% |
1915 | 68% | 59% | 44% | 9% |
1925 | 69% | 50% | 33% | 17% |
FEMALES 1895 | 12% | 12% | 11% | 0% |
1905 | 24% | 24% | 23% | 0% |
1915 | 38% | 37% | 31% | ~0% |
1925 | 42% | 37% | 25% | 7% |
From SAUS1992, T19&39 and SAUS 2000, T13, I obtained data from the U.S. Census Bureau, Current Population Reports, and have calculated percents of each birth group still living among those over age 60, of the same sex, during various decades. m= male, f= female NA= not yet age 60.
Table III, Percent of all Persons Over Age 60, by Birth Group
Birth Group: | 1895 | 1905 | 1915 | 1925 |
during1970’s | 31.3%m 33.4%f | 57.7%m 52.2%f | NA | NA |
during1980’s | 11.3%m 16.8%f | 31.4%m 33.3%f | 57.3%m 49.8%f | NA |
during1990’s | | 12.6%m 19.5%f | 33%m 34%f | 54.3%m 46.3%f |
during1999 | | | 13.8%m 18.6%f | 35.9%m 35.7%f |
Among those over age 60, the highest portion of persons are under age 70 during all years studied. Therefore one should expect smoking related disease patterns during any decade to be most dependant on smoking behavior of those born 60 to 70 years earlier. The reason vertical data total more than 100% is because our population over age 60 increased during the later years. The reason the 1999 horizontal data don’t total 100% is the 1935 birth group is then over age 60 and not included in this table. Male and female 1935 birth groups both smoked less than those birth groups shown.
During 1980, the males born 1905 , still alive, were average 75 years old, and females born 1925, 55 years old. Considering average life expectancy, ( 72 for males, and 79 for females), most of the heaviest male smokers were no longer alive to influence the incidence trend of smoking related diseases during and after 1980. This would leave only males born 1915&1925 who smoked 1% to 10% less at age 50 and 5% to 16% less at age 65 at risk for these diseases after 1980. After 1990, males and females born 1915 have less influence on smoking related disease incidences because they comprise only 33-34 % of all persons over age 60. Females, still alive, had steady smoking rates at age 50 and 60. Therefore we should expect peak smoking related disease incidences among males during the 1970’s and after 1980, declining incidences. Among females, rising incidences during the 1970’s and steady smoking related disease incidences after 1980.
There is, however, a reason to expect smoking related disease declines even earlier than 1980. IF claims are true smoking reduces life expectancy an average of 14 years, then all of the projections made above should have occurred 14 years earlier. Perhaps the average life expectancy numbers for males is composed of 70% never smoking males and males who quit before age 50, living to an average age of 76 and 30% at risk smokers living to an average age of 62. The overall life expectancy would still be age 72, but the smoking component would have died at average age 62, or average 1967 among those born 1905 and average 1977 among those born 1915. Those persons, still living, in the birth groups 1905-1915 during, 1980, and 1990 would then be mostly those who never smoked or quit early in their lives. This would leave only males, birth group 1925 and latter, who smoked less than birth groups 1905 and 1915 at age 50 and much less at age 60 alive to suffer smoking related diseases after 1980. Similar calculations for females, average life expectancy 79, yield average death age 69 for the smoking component, and by 1985, only the portion of the 1915 birth group that didn’t smoke is still alive instead of almost all the 1915 birth group and this would lead to declining smoking related disease among still-living women because their smoking exposure thereafter would be declining.
I have addressed an alternate approach to determine if smokers live an average 14 years less than nonsmokers. From SAUS, 1992,T199, I have obtained data from U.S. Centers for Disease Control, Office of Smoking and Health surveys of those aged 25-44 years-old during 1965, and aged 45-64 years-old, during 1985:
* during 1965, of those aged 25-44, 49.5% smoked and their quit ratio was 23.6%
*during 1985, of those aged 45-64, 31.6% smoked, and their quit ratio was 49.7%.
The definition of quit ratio is “percent of persons who ever smoked who are former smokers”. From this data, it is possible to calculate percent ever smokers of both surveys. Subtracting 100 from the quit ratio yields percent ever smokers who are current smokers. Dividing percent current smokers by percent ever smokers who are current smokers = percent ever smokers. I obtained: *for those aged 25-44 during 1965, 64.8% ever smoked.
*for those aged 45-64 during 1985, 62.8% ever smoked.
But, these are the same people, simply aged 20 years. IF many more of the ever smokers and current smokers than never smokers had died off before 1985, they would not have been able to participate in the 1985 survey and the 1985 survey results would have yielded much lower ever smoker results. As a consequence, I conclude the difference between 64.8% ever smokers during 1965 and 62.8% ever smokers of the same group, during 1985 proves smokers don’t die off 14 years earlier than nonsmokers. Perhaps, the two percent difference is due to smoking, but, as will be discussed later, this 2% could easily be explained by other risks more prevalent among smokers, such as blue collar or military employment.
Yet, according to the 1990 Surgeon General’s Report, “The Health Benefits of Smoking Cessation”, after ten years of abstinence, the risk of lung cancer is 30-50% of the risk of continuing smoking. Cessation also reduces the risk of cancers of the larynx, oral cavity, esophagus, pancreas, and bladder. Heart disease death is reduced 50% after only one year of abstinence. After quitting, stroke risk returns to ordinary levels after 5 to 15 years. With sustained abstinence, chronic obstructive pulmonary disease risk returns to normal, and peripheral vascular disease risk is substantially reduced. He also states death risk due to influenza and pneumonia is substantially reduced. Overall, those who quit before age 50, have one-half the risk of dying in the next 15 years than those who continue to smoke. Below, we will determine if that actually happened.
From the Tables I and III, it is possible to calculate composite smoking data of all those over age 60 during decades 1970,1980, and 1990 to prepare the following table which compares it to health outcomes that actually occurred during those decades. Bear in mind these composite figures are only accurate if smokers live as long as nonsmokers; otherwise smoking data would be lower.
Table IV, HEALTH-RELATED TRENDS DURING OUR HEAVIEST SMOKING YEARS
YEAR | 1970-73 | 1980 | 1985 | 1990 | 1996-98 |
MALES: ( born1905 are heaviest smokers) | | | | | |
composite ever smoking among those now over 60 | 51.5% | 58.4% | | 59.9% | |
composite smoking @ age 50 among those now>60 | 50.4% | 52.7% | | 46.3% | |
composite smoking @ age 60 among those now>60 | 44.0% | 40.6% | | 32.4% | |
life expectancy gains of preceding decade | | 1.9 | | 1.4 | 1.2 |
CANCERS, AGE ADJUSTED/100,000 (all) | 372 | | 439 | | 549 |
Lung | 73.8 | | 83.8 | | 69.8 |
Colon and Rectum | 53.2 | | 63.0 | | 51.7 |
Pancreas | 12.9 | | 11.3 | | 9.9 |
Oral Cavity and Pharynx | 17.5 | | 17.1 | | 13.6 |
Urinary Bladder | 25.6 | | 26.9 | | 29.0 |
Esophagus | 5.5 | | 6.3 | | 6.7 |
Larynx | 8.4 | | 8.7 | | 5.6 |
FEMALES ( born 1925 are heaviest smokers) | | | | | |
composite ever smoking among those now over 60 | 16.5% | 26.9% | | 32.4% | |
composite smoking @ age 50 among those now>60 | 16.5% | 26.4% | | 29.7% | |
composite smoking @ age 60 among those now>60 | 15.7% | 23.1% | | 22.1% | |
life expectancy gains of preceding decade | | 1.9 | | 0.6 | 0.4 |
CANCERS, AGE ADJUSTED/100,000 (all) | 292 | | 339 | | 416 |
Lung | 18.3 | | 35.3 | | 43.4 |
Colon and Rectum | 41.6 | | 45.4 | | 38.2 |
Pancreas | 7.8 | | 8.2 | | 7.7 |
Oral Cavity and Pharynx | 6.2 | | 7.0 | | 5.6 |
Urinary Bladder | 6.3 | | 7.9 | | 7.4 |
Esophagus | 1.8 | | 1.9 | | 1.6 |
Larynx | 1.3 | | 1.8 | | 1.4 |
CHRONIC COND, both sexes/1000 | | | | | |
Male/Female smoker, 45-64 years old , % | 39.3/30.7 | 33.4/29.2 | | 27.1/24.0 | |
Heart Conditions | | 75.4 | 82.6 | | 78.9 |
Hypertension | | 114.3 | 125.1 | | 107.8 |
Varicose Veins of Lower Extremities | | 27.2 | 30.6 | | 28.2 |
Chronic Bronchitis | | 36.1 | 49.7 | | 53.7 |
Asthma | | 31.2 | 36.8 | | 55.6 |
Chronic Sinusitis | | 145.0 | 139.0 | | 126.2 |
Cataracts | | 22.6 | n/a | | 26.7 |
OTHER DISEASES, both sexes/100,000 | | | | | |
Cerebrovascular disease hosp. discharge rates | 254 | | 384 | | |
Chronic Obstructive Pulmonary Disease | | | | deaths | increasing |
DAYS OF DISABILITY, both sexes | | | | | |
Overall Smoking Trend, age 26 and over | 39.1% | 36.9% | 32.8% | 29.8% | |
Work Loss Days | 5.4 | | | 5.6 | |
Bed Disability Days | 6.1 | | | 6.5 | |
Restricted Activity Days | 14.6 | | | 15.2 | |
Life expectancy gains, source:SAUS1992,T104; SAUS2000, T117
SEER cancer incidence data, source: http://seer.cancer.gov/csr/1973_1999/overview.pdf
Chronic conditions prevalence data, source: SAUS,1988,T172; SAUS,1992,T195;SAUS,2000,T220
Days of disability, source:SAUS,1992,T188
Male/Female smoker 45-64 year old data, source, “Health, United States”,2001, table 60
Overall Smoking Trend, age 26 and over source: SAUS,1992,T197
LIFE EXPECTANCY:
Selected Life Table Values
Source:SAUS1992,T104; SAUS2000, T117
Males gained the most life expectancy /decade (1.9years) from 1970 to 1980 while most of the heaviest smoking component born 1905 were still alive and most at risk from smoking related diseases. Females also gained 1.9 years/decade life expectancy 1970-1980 but most of their heaviest smokers were not yet at the age where smoking related disease would strike and influence life expectancy. If past smoking history were an important determinant, males would have experienced the lowest life expectancy gains during the 1970’s. If quitting by age 50 cut the risk of dying in half over the next 15 years, males would have experienced increased life expectancy gains during the 1990’s because their smoking at age 50 had declined from 52.7% to 46.3%. The data do fit the predictions made by the Surgeon General for females, as their smoking at age 50 and 60 increases, their life expectancy gains diminish in the subsequent decade, but when combined with male data, life expectancy gains do not relate to quitting before age 50 or 60. Males and females are realizing declining life expectancy gains per decade despite ever fewer of them continuing to smoke. According to SAUS, 2001,T191, only 14.6% of males, and 11.5% of females over age 65 smoked during 1990. Yet during the 90’s, we witnessed the lowest life expectancy gains of all.
Females with increasing smoking exposure, gained 3.0 years of life expectancy from 1970 to 1998, males, with declining smoking exposure, gained 4.5. Overall, the influence of smoking patterns after age 50 is obviously of little importance on remaining life expectancy. With this dramatic change, males ought to have fared much better than females. Further, females have always had a higher life expectancy and this is a disadvantage when comparing net gain with males. Finally, most of these males at age 50 were employed, and tend to have more hazardous occupations than females. The odds a male dies due to an accident are twice those of a female. SAUS 2000, T705 indicates fatal accidents at work declined from 21/100,000/yr during 1960 to 4/100,000/yr during 1998. For reference, lung cancer kills about 50/100,000 Americans annually. The extra 1.5 years of life males gained past age 50 vs. females could easily be explained by improved workplace safety alone. We should expect males to attain proportionately more life expectancy based on this accident data. All deaths due to accidents and violence declined from 101.9/100,000 white males and 42.4 white females during 1970 to 77.3 white males and 33.2 white females during 1998. According to a study published in the Journal of Drug Issues, 1993, 62% of prison inmates smoke. Because criminals are much more likely to die of violence than the rest of us, it is highly plausible some of the excess mortality attributed to smoking is actually due to the lifestyle of criminals. The Chicago Tribune reported Mar. 21, 1997 that smokers who attend church regularly have 4 to 7 times lower risk of high blood pressure than smokers who do not. It also reported church-going smokers have the same risk of high blood pressure as non-churchgoing nonsmokers. It is obvious the lifestyle of criminals is a health risk, and that they smoke more than the general population causes some of this risk behavior to be falsely attributed to smoking. Together, accidents and violence represented 5% of all deaths in 1970 ( about the same as lung cancer) and therefore strongly influence overall life expectancy; particularly since accidents and violence are not age dependant. Accidental and violent deaths are mostly male and had they not declined, the male life expectancy increase between 1970 and 1998 ( 4.5 years) would have probably been similar to females ( 3.0 years). This similarity would rule out the possibility the female data do fit predictions made by the Surgeon General. The different male and female life expectancy gains between 1970 and 1998 are explained by factors other than smoking.
CANCERS:
According to http://seer.cancer.gov/csr/1973_1998/overview.pdf , Table I-3 , the percent change of lung and bronchus cancer incidence between 1950-1998 was 248 % / for colon and rectum, 0.6% / pancreas, 13.7% / oral cavity and pharynx, -40% / esophagus, -2.7% / larynx, 20% / and urinary bladder, 53.8%. During 1950, the average birth year of those at risk was 1885. According to Harris, only 33% of these males and 3% of these females ever smoked during their lives and by 1950, only 25% of these males, and about 2% of these females still smoked. The heavier smoking 1895 birth group ( table II) was only average 55 years old, still too young to influence this data much. As already discussed, those most at risk during 1998 had much higher exposure to smoking. Considering these dramatic differences in smoking behavior, any cancer due to smoking ought to be much more prevalent during 1998. Only cancers of the lung/bronchus , oral cavity and pharynx, pancreas, urinary bladder, and larynx fit this pattern. We can immediately eliminate cancers of the colon and rectum, oral cavity and pharynx, and esophagus as being dependant on smoking behavior of birth groups. Below, data are presented in more detail for each of the 1905, 1915, and 1925 birth groups for the years when their cancer would be most likely to occur.
If smoking contributes substantially to the incidence of these cancers, one would expect males peak incidence during the 1973 period when Harris’ heaviest lifetime male smokers were still alive, and of age where these cancer most often strike. If the smoking component of Harris’ heaviest smoking males lost an average of 14 years of life expectancy, then these peak incidences would have occurred during the 1960s. Male lung and laryngeal cancers peak incidence rates occurred between ten and twenty years after they should have ( 1985) if past smoking history is any measure of vulnerability . Another way to examine this data is to compare the different smoking histories of males diagnosed with lung and laryngeal cancers during 1973 and 1996-98. Males born 1905 and diagnosed in 1973 only quit 5%/decade after age 30. Males born 1925 and diagnosed in 1996-98 quit 17%/decade after age 30. Yet both birth groups had the same lung, and colon-rectal cancer rates. Cancers of the esophagus and bladder are still increasing while lifetime exposure to smoking continues to decline. This eliminates bladder cancer, which had been previously included from the 1950-1998 data. Only cancers of the pancreas and larynx survive all comparisons but lung cancer will be considered still included because of the strong correlation with the 1950-1998 data and a proximate correlation with the 1973-1996-98 data. For females, steady incidences of these cancers would be expected after 1980 while half of the 1915 and almost all of the 1925 birth group were still alive, and this assumes smoking females’ life expectancy is 69 due to 14 years diminished life expectancy. If female smokers live as long as nonsmokers, then female incidence trends should be peaking now. However, conclusions male pancreatic and laryngeal cancer are related to smoking history, are contradicted by declining female pancreatic and laryngeal cancer trends from 1985 to 1998. ( They should have been steady.) Despite smoking much less, females born 1905 had slightly more pancreatic and the same laryngeal cancer rates during 1970-73 as females born 1925 during 1996-98. It can be concluded birth group 1925 females who were the first to have measurable quitting after age 30 did not benefit relative to 1915 females. ( Table II). The more detailed analysis presented here, continues to support the conclusion from the 1950-1998 data that cancers of the colon-rectum, oral cavity-pharynx, and esophagus are not related to smoking behavior of birth groups. The parallel trends of male and female incidences of most of these cancers, including the “all” cancer data, are striking, even though their historical smoking patterns are quite different. Some early evidence suggests female lung cancer has peaked, but this can only be correlated with their past smoking behavior if we assume no diminished life expectancy and then we can’t explain why their laryngeal cancer rates declined after 1985. More years have to pass before we can reach any firm conclusions concerning females, but it is clear substantial quitting between male birth groups 1905 and 1925 did not benefit the latter and save society costs of treating any of their cancers, except possibly, of the lung, larynx and pancreas.
Davis, et. al. J. Amer. Med. Assoc. Feb. 9, 1994, p 434 took a broader approach and found the same trends, using a log-linear Poisson model. “ Successive birth cohorts of women have experienced dramatic increases in smoking-related cancer, with women born in the 1920s and 1930s developing six times more cancer than women in the baseline birth cohort 1888 through 1897. Although the explosive rise in smoking-related cancer appears to have peaked, the relative risk for the most recent cohort in Fig. 4 is still about 5 (RRc, 4.93; 95%CI, 3.83 to 6.37). Among men, the incidence of smoking-related cancer increased with birth cohort to the point where rates for men born 1923 through 1932 were about 40% greater (RRc, 1.39, 95%CI,1.00 to 1.94). than for men born 1888 through 1897. In the more recent birth cohorts of men, however, these rates have decreased. For instance, men born in the 1940s had roughly the same risk of developing smoking-related cancer as men born around the turn of the century.”
From Harris, females born 1895 ever smoked 12% ,smoked 11% at age 60 and 10% at age 70. Females born 1925 smoked three times as much and, according to Davis, had six times as much smoking related cancer. Males born 1895 ever smoked 50%, smoked 50% at age 60, and 37% at age 70. Males born 1925 ever smoked 69% , smoked 33% at age 60 and much less at age 70. Although smoking more when they were young, males born 1925 quit to levels below the 1895 birth group by age 50 and still suffered 40% more cancer. Among these male and female birth groups, smoking related cancer is obviously out of sync with smoking history. Then how can we correlate their smoking histories with the costs of treating these cancers?
CHRONIC CONDITIONS:
Statistical Abstracts of the U.S. publishes data on selected chronic conditions, but unfortunately the NHIS warns data collected prior to 1979 cannot be compared to latter data because the data collection procedures changed in 1978. We cannot compare data when the heaviest male smokers were still alive (1970s) with data obtained while the lifetime male smoking exposure was declining. We can do this for females because their peak exposure birth groups were mostly still alive during 1980. Hence the combined data should reflect progressively declining male exposure to cigarette smoking, and steady exposure among females. IF smoking shortens life expectancy 14 years, then all data below should be declining. I inserted age 45-64 smoking rates because alternately, these data can be compared with that prevalence data to assess how current smoking influences these conditions instead of the past smoking histories of Harris’ heaviest smokers during the years leading up to the prevalence data. Claims are common that quitting smoking results in a decline of 50% for heart disease after only one year. Then, a decline of 4% current smoking between 1973 and 1985 should have resulted in less heart conditions and hypertension by 1985, and a decline of 9% smoking between 1973 and 1996 should have resulted in even lower prevalence by 1996. Examining current smoking behavior of each gender has little or no effect on the prevalence of conditions at the same year, or latter years. A decline of these conditions due to most of Harris’ heaviest smoking males dying before 1980 is also not indicated.
It is noteworthy that despite 45-64 year old males smoking 12% less and 45-64 year old females smoking 7% less during 1998 than 1985, the prevalence of heart disease is higher in 1996. Hypertension is down slightly, but better drugs exist now to fight this condition. Chronic sinusitis is improving and it seems reasonable smoking can aggravate this condition. Asthma and chronic bronchitis clearly bear no past or present historical relationship to smoking. Varicose veins of the lower extremities has not changed. Overall, the Surgeon General’s promises don’t seem to be holding up for these chronic conditions and no cost savings have been realized treating fewer of these chronic conditions.
OTHER DISEASES:
Some other diseases are blamed at least in part, on smoking, but incidence or prevalence data are not reported in the references cited above. I have identified other sources the interested reader might wish to review.
Cerebrovascular disease hospital discharge rates are rising, from 254/100,000 persons in 1970 to 384/100,000 in 1985. (http://www.cdc.gov/mmwr/preview/mmwrhtml/00001370.htm) The authors report it’s prevalence is difficult to ascertain. Again, with fewer of Harris’ heaviest male smokers still living in the 1985 population, and less current smoking among those 45-64 years old, one should expect a decline of this disease. This decline could be partially offset by increased smoking of females, at age 50 and age 60 (10%)in the birth groups at risk in 1985, but not to the extent that an overall rise of 130 discharges would result. But that offset would have been modified somewhat by a decline of 4% among males over age 60 in 1980. With a 6% overall average smoking exposure increase at age 50 and 60 among those now over age 60 during 1980, the 1985 data show a 51% increase in CVD relative to 1973, or 45% more of an increase than we would expect if CVD rates were smoking-dependant. Modern claims are that CVD risk declines rapidly after quitting smoking. Smoking had declined from 41.2% to 39.3% for 45-64 year-old males and from 33.4% to 30.7% for 45-64 year-old females between 1973 and 1980. Although ever-smoking status of at risk females was increasing, current risk as measured by current smoking was declining for both males and females. Allowing 5-years for this supposed lower risk to be realized, (1985) one can simply not explain why actual CVD occurrence was 51% higher.
Chronic Obstructive Pulmonary Disease death rates and hospitalizations are increasing, but mild to moderate COPD decreased from 1971-1975 to 1988-1994 among those over 55 years of age. Among other groups, rates have been stable. (www.cdc.gov/mmwr/preview/mmwrhtml/ss5106a1.htm)
COPD is believed to be the cumulative result of long-term smoking although some improvement is alleged to occur after smoking cessation. Mild to moderate COPD is declining which is what would be expected based on smoking reductions among those aged 45-64 years and the dying off of most of Harris’ heaviest smoking males by 1980. What of the deaths and hospitalizations? From SAUS1992, T113, the age adjusted death rate for COPD was 11.6/100,000 in 1970, and 15.9 in 1980. From SAUS2001, T 106 the death rate was 19.7/100,000 in 1990 and 21.3 in 1998. The only long-term conclusion is that serious COPD, resulting in death, doubled over the last thirty years, during a time when lifetime smoking exposure of those over age 60 is now in rapid decline due to increasing number of those over age 60 now belonging to the lesser-smoking 1935 birth group in 1998. Society did not save the costs of treating fatal cases of COPD in 1998 despite lower smoking at age 50 and age 60 among those over age 60 in 1990.
DAYS OF DISABILITY:
Antismoking activists and other health groups claim one major cost of smoking is days lost from work Yet from the disability-days data, Table IV, it is clear no employer cost savings were realized as a result of the overall smoking decline among those over age 26 from 40% to 30% during the 1970-1989 time period.
According to Healthy People, 2000 Review,1992, Table 3, during 1987, 29% of all persons over age 20 smoked; 36% of all blue collar workers smoked; and 42 % of all military personnel smoked. Smoking was more prevalent in high risk occupations. These people tend to work outside in inclement weather, work with dangerous substances and mechanical equipment, and work odd hours. It is probably because they have higher risk occupations, they are more likely to take a sick day, or become disabled; not because they smoke.
DISCUSSION:
I used incidence or prevalence data wherever possible because their time trends are more directly influenced by cause, and less influenced by improvements in medical technology over the reported periods. Death rates from most of these conditions are declining because of improved treatment, not because these conditions are occurring with decreased frequency. The purpose of the War on Tobacco was to prevent these diseases from occurring in the first place, and in this regard, it has already proved itself a failure; despite overwhelming cooperation from the public, as evidenced in the first table.
Using the same analysis for the prevalence of selected chronic conditions data and SEER cancer incidence data presented above, it is clear we should have expected national declines among these diseases after 1985, but only if smoking rates bear a strong relationship to public health. . If smoking rates actually have little influence on these disease trends, even when the people suffering from them are smokers, then we would expect time trends similar to what we are actually recording. Even while smoking declines, the true causes remain and many appear to be increasing.
While it is too early to be certain, it appears today’s younger Americans will suffer ever increasing rates of smoking related cancers in the future, despite never smoking as much as the generations of the past. From the J. Amer. Med. Assoc. article, (Davis) previously cited, the following table is constructed: M= male, F= female
THIS IS WHERE I STARTED TODAY
| Age | Period | smoking rate at specified age | smoking rel. cancer | ||
20-24 | 1973-1977 | 43.1%M | 34.1%F | 45M | 35F |
20-24 | 1978-1982 | 37.5M | 33.8F | 26M | 24F |
20-24 | 1983-1987 | 32.6M | 30.4F | 43M | 31F |
25-34 | 1973-1977 | 50.5M | 38.8F | 202M | 141F |
25-34 | 1978-1982 | 43.9M | 33.7F | 195M | 166F |
25-34 | 1983-1987 | 38.2M | 32.0F | 288M | 176F |
35-44 | 1973-1977 | 51.0M | 39.8F | 1057M | 636F |
35-44 | 1978-1982 | 41.8M | 37.0F | 1127M | 735F |
35-44 | 1983-1987 | 37.9M | 31.5F | 1297M | 774F |
Between 1973-1977 and 1983-1987, smoking declined about 20% among all these younger age groups , but smoking related cancer increased about 20%. Even without smoking as much during the beginning of their lives, the incidence of smoking related cancer is increasing with each new age group. The War on Tobacco has also been a complete failure for the health of our younger citizens. Society is not saving costs of treating smoking related cancer incidences among our youth many more of whom never took up smoking in the first place.
Brown and Kessler, J. Nat Cancer Inst., vol 80, #1, Mar. 1988 performed a computer analysis of smoking and lung cancer trends and project if smoking behavior remains steady after 1990, lung cancer rates during 2030 will be 43 male and 39 female/100,000. If the NCI objectives of 15% smoking prevalence by year 2000 had been achieved, 29 male and 23 female/100,000 would have been expected by 2030. This is rather surprising. By 2030, the average birth year of lung cancer victims will be 1955. These future victims are now age 45. They currently smoke at the rate of 29% males and 25% females, only half the rate of their grandparents when they were age 45. Yet the computer projections are that these 1955 birth group males will suffer as much lung cancer as the male birth group 1895 who, according to Harris, smoked cigarettes 48% at age 35 and also smoked cigars. Female 1955 birth group will suffer the same lung cancer rate as the 1925 female birth group. Yet the 1925 birth group smoked at 42% age 45 and the 1955 birth group now smokes 25% at age 45. Both these1955 birth groups contain twice the never smokers as the 1905 male and 1925 female birth groups. Brown and Kessler’s lung cancer projections for year 2000 are close to what has actually occurred during 2000 which helps validate their computer model. Even for the future, there will be too much lung cancer to be explained by our diminished smoking rate.
These trends have not gone unnoticed by health scientists and public health officials, and they have published reasons why we should not expect public health improvements until even more smokers quit.
One such reason was addressed in “ Twenty Five Years of Progress”, Surgeon General’s Report, 1989. On page 140, he stated that those smokers most at risk in 1985 were also smokers in 1965. He went on to say most male smokers in 1965 had also smoked pipes and cigars, but in 1985 almost exclusively cigarettes. Females made up 40% of current smokers in 1965, but nearly half in 1985. Female smokers who had started as teenagers were now approaching the age where smoking related diseases would strike. He then pointed out that the American Cancer Society’s studies indicate remaining smokers had a higher percentage of heavy smoking. Finally, during 1965, only ¼ of males who ever smoked had quit, while in 1985, ½ had quit.
Harris, 1983 already addressed the cigar and pipe smoking issue. Many males born 1881 to 1900 were still alive during 1965, but dying off rapidly. Many were deceased before the 1973 incidence data. Almost all were deceased by 1980, and practically none influenced the incidence data after 1985. Therefore most lung cancer during 1973 should be correlated with cigarette smoking. By 1985, the 1915 birth group was most at risk. They had quit more than their predecessors. The Harris data further indicate females born 1915 smoked 25% by 1935 when they were 20 years old. Many had started as teenagers. Instead of approaching the age where smoking related diseases would strike, females starting as teenagers were already at the age (70) where smoking related diseases would strike in 1985.
To address the Surgeon General’s issue that remaining smokers have a higher smoking rate, I was able to obtain cigarette consumption rates per capita for 1970 and 1990 using US Dept. of Agriculture, Economic Research Service cigarette consumption/capita data published in SAUS, 1992, T1262, and current smoking rates, SAUS 1992, T 199 and SAUS 1996, T 222. I divided the consumption/capita data by smokers/capita and obtained consumption/smoker data. In 1970, the average smoker smoked 10638 cigarettes/year, and in 1990, 10980 cigs/year. The claim remaining smokers were heavier smokers in 1985, is obviously false.
