Including references and index, it’s an impressive 706 pages long.
By necessity, the synthesis of the report and media reviews of it focus on its highlights. The one that seems to have caught public attention though is due to one aspect of the report which USSG Dr. Regina Benjamin has apparently emphasized: the risk to a smoker of inhaling just one cigarette or to which a nonsmoker is exposed.
The way it’s been described suggests that one inhalation or exposure may be enough to put in train events that will doom the individual. The science doesn’t support that and such a view ultimately undermines public health, according to Dr. Michael Siegel, author of the popular and insightful blog “The Rest of the Story“. He is a critic of tobacco control advocates who exaggerate the risks of smoking and secondhand smoke, arguing that this erodes public confidence and support in the scientific community and public health advocates.
The following e-mail exchange with Dr. Siegel was informative on the subject of exposure and risk that is pertinent:
MoGASP: I watched the new US Surgeon General being interviewed on the PBS Newshour last night and some of her pronouncements seemed possibly overblown. In particular, this one picked up in a USA Today story (pasted in full below):
It’s evidently being claimed in the latest USSG Report on smoking that one cigarette can harm both a smoker and an exposed nonsmoker. That may be true but how great is the harm? Can it lead irreversibly to cell damage likely to cause lung cancer, for example?
I was exposed to considerable amounts of secondhand smoke in the two workplaces where I worked after emigrating to the U.S. following a job transfer in early 1977. That only stopped after I took early retirement in 1991, but I find it hard to believe that if I’d been exposed to just ONE cigarette, which certainly occurred in my younger days in England, that would lead irrevocably to a smoking-related disease.
Dr. Michael Siegel: I agree with you completely that this is being overblown. While it is technically correct that a single whiff of secondhand smoke could affect one’s DNA, it defies the laws of dose-response relationships to argue that a single whiff of smoke could cause cancer. As you’ll see on Monday, I think this type of exaggeration could actually do damage by undermining the public’s appreciation of the dose-response relationship. If a single cigarette can kill you, then why cut down? Or why quit?
For carcinogenic effects, the dose-response relationship is a linear one. There are numerous studies which show this to be the case. The same holds true for secondhand smoke exposure.
For cardiovascular disease, the relationship is not a linear one. It increases steeply and then levels off, as you say. A good explanation for that phenomenon can be found here: http://toxsci.oxfordjournals.org/content/54/2/462.abstract.
MoGASP: My wife’s mother liked to smoke a cigarette after a meal, which she did during the time she was visiting us one year some time ago. She would sit out in the backyard, at my request, and my wife would sit with her to keep her company and avoid her feeling ostracized. My wife’s mother argued that just three cigarettes a day wasn’t very harmful. She died in her seventies of a heart attack, as I recall. Is it reasonable to assume, as I did at the time, that even that level of smoking could have been responsible?
Dr. Michael Siegel: Absolutely. Because of the dose-response relationship between tobacco smoke and cardiovascular disease, it is very possible that smoking a few cigarettes per day can lead to cardiovascular disease.
Dr. Siegel has since written an extensive article on his blog:
The USA TODAY article referenced above is pasted below:
Even brief exposure to tobacco smoke causes immediate harm to the body, damaging cells and inflaming tissue in ways that can lead to serious illness and death, according to the U.S. Surgeon General’s new report on tobacco, the first such report in four years.
While the report, out today, focuses on the medical effects of smoke on the body, it also sheds light on why cigarettes are so addictive: They are designed to deliver nicotine more quickly and more efficiently than cigarettes did decades ago.
Every exposure to tobacco, from occasional smoking or secondhand smoke, can damage DNA in ways that lead to cancer.
“Tobacco smoke damages almost every organ in your body,” says Surgeon General Regina Benjamin. In someone with underlying heart disease, she says, “One cigarette can cause a heart attack.”
About 40 million Americans smoke — 20% of adults and older teens. Tobacco kills more than 443,000 a year, says the 700-page report, written with contributions from 64 experts.
Cigarette smoking costs the country more than $193 billion a year in health care costs and lost productivity.
Recent changes in the design and ingredients in cigarettes have made them more likely to hook first-time users and keep older smokers coming back, Benjamin says. Changes include:
•Ammonia added to tobacco, which converts nicotine into a form that gets to the brain faster.
•Filter holes that allow people to inhale smoke more deeply into the lungs.
•Sugar and “moisture enhancers” to reduce the burning sensation of smoking, making it more pleasant, especially for new cigarette users.
“This is the first report that demonstrates that the industry has consciously redesigned tobacco products in ways that make them even more attractive to young people,” says Matthew Myers of the Campaign for Tobacco-Free Kids.
David Sutton, a spokesman for Altria, parent company of Philip Morris USA, declined to comment until he had time to study the report.
A Deadly Practice
1 in 5 deaths attributed to tobacco annually.
443,000 Americans killed by tobacco per year.
$193 billion annual cost in health care and lost productivity in the U.S. due to cigarette smoking.
4,100: approximate number of teens who smoke their first cigarette each day.
85% of lung cancers are caused by smoking.
Source: U.S. Department of Health and Human Services