A whiff of consolation for smokers

Press, 13 November 1981, Page 13

A whiff of consolation for smokers

DAVID LOSHAK,

“Daily Telegraph,” Lon-

don, clears some of the smog surrounding the benefits of giving up

Smoking has been described, mischievously perhaps but aptly, as the leading cause of. . . statistics. It is a pertinent observation. There can be no human habit which has been more meticulously monitored, documented, analysed, dissected, and scrutinised. Now, out of this statistical orgy, a tantalising possibility is beginning to emerge: it looks as if the experts may have got it wrong. No one is suggesting that smoking is not. after all, harmful to health. But giving it up might be harmful too. As one of the new warnings now appearing on posters reminds us, doctors — who should know — have taken the lead in giving up cigarettes. They smoke only a third as many as the national average. This trend, indeed, forms the basis of one of the most important epidemiological studies undertaken in this country — the celebrated study over 20 years by Sir Richard Doll and Mr Richard

Peto of what happened when male doctors, as a group, kicked the habit. After 1951, when studies by Sir Richard and others began to reveal strong links between smoking and such serious diseases as lung cancer, heart disease, and chronic bronchitis, doctors reduced smoking much more than other people did. By 1971, Sir Richard Doll, Regius Professor of Medicine at Oxford, found that male doctors, who smoked an average of 9.1 cigarettes a day in 1951, were down to only 3.6 a day. In the same period, there were improvements in the incidence among them of lung cancer, heart disease, and strokes. That was the good news. But it was not, and did not purport to be, the whole story. What it did not do was to analyse the bad news — that there were worsening trends among doctors in other conditions. According to Peter Lee, a statistical consultant who has closely examined

the figures of death and disease among doctors, “the benefits of giving up smoking may not be as great as has commonly been assumed.” Indeed, abandoning smoking may actually help tp provoke other serious hazards instead. For what the figures suggest is that more deaths among doctors from stressrelated conditions might partly arise from an adverse effect of giving up smoking, if the smoker had adopted the habit to reduce his stress. “If a person stops smoking,” Peter Lee observes, in the “British Medical Journal,” "he may do something else. If this is hazardous to health, ■ the risk of other diseases, not necessarily conventionally related to smoking. may rise.” Mr Lee emphasises that this might be especially important for hign-need smokers, people who may smoke to relieve stress. If they are pressurised, by colleagues or by society, to give it up, does their health

indeed benefit? The figures suggest that it may not. In 1970-72, 665 male doctors died at ages under 65. Compared with death trends among comparable men in other walks of life, although there were 107 fewer deaths from coronary heart disease (83), strokes (16) and lung cancer (8), there were 73 more deaths associated with stress. Among these were 30 accidents and poisonings, 26 suicides, and four cases — not many, but statistically significant — of cirrhosis of the liver, a condition linked with the bottle. One striking aspect is that the extra number who die from accidents and suicides, 56, is more than double the number of deaths from strokes and lung cancer that

abandonment of cigarettes is reckoned to have saved. Secondhand, or “passive” smoking — breathing other people’s cigarette smoke — may also not be as harmful as some people are suggesting. It is only recently that there was any firm basis at all for the idea that inhaling other people’s smoke was anything more than a nuisance for normally healthy adults. However, earlier this year a Tokyo researcher, Dr Takes! Hirayama. produced figures which did seem to show that long-term exposure to secondhand smoke could produce a first-hand risk of serious disease, even lung cancer, in non-smokers. This was based on observations over 14 years of

91,540 Japanese women who did not smoke but were married to men who did. Dr Hirayama’s interpretation of the statistics was that the lung cancer rates among these wives was rising alarmingly. Indeed, he even suggested that passive smoking was having a more devastating effect on the lungs of Japanese women in general than direct smoking itself. This did seem rather farfetched, and epidemiologists were quick to spot defects in Dr Hirayama’s statistics. But the anti-smoking lobby was even quicker to latch on to the findings. They did not await publication of an American study. Its author, Dr Lawrence Garfinkel, of the American Cancer Society, while emphasising that smoking is the most important cause of lung cancer. does point out the absurdity of measuring the effects of second-hand smoking on non-smoking wives when there is no way of knowing

how much time they might have spent outside the house. Dr Garfinkel's conclusion, based on data gathered over 12 years from as many as 500,000 people, is that the case against passive smoking is, at best, not proven. Wielding a new statistical bludgeon, Dr Hirayama has now sought to drown his critics in figures, covering almost two pages of the “British Medical Journal.” But even he admits that “further study is needed.” So, the issue of to what extent smoking harms health is far from settled. But some things are clear. The sometimes hectoring and often patronising campaign to ban smoking in public places could actually do harm. If passive smoking is not dangerous, then crying “wolf' could undermine an overriding public health need — to dissuade the young from taking up the habit. Smoking, undeniably, is unhealthy. The point is, it may not be as harmful as has been made out.