Is U.S. Surgeon General Benjamin exaggerating 1 cigarette exposure risk?

Dr. Regina Benjamin, US Surgeon General

The thirtieth tobacco-related report of the U.S. Surgeon General has just been released by Dr. Regina Benjamin, the current USSG, titled:

How Tobacco Smoke Causes Disease – The Biology and Behavioral Basis for Smoking-Attributable Disease

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.

Dr. Michael Siegel, Boston University School of Public Health

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):

Just one cigarette can harm DNA, Surgeon General says

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:

Surgeon General’s Office Again Misrepresents and Distorts the Science in Report Press Release; Why the Need to Lie to the American Public?

The USA TODAY article referenced above is pasted below:

Just one cigarette can harm DNA, Surgeon General says

Photo By Darron Cummings, AP #3

By Liz Szabo, USA TODAY

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

9 responses to “Is U.S. Surgeon General Benjamin exaggerating 1 cigarette exposure risk?

  1. Has anyone figured out the relationship between the cost of health care due to smoking, and the savings in health care due to dying?

    mogasp: Philip Morris some time ago launched a campaign in support of smoking on the grounds it saved money if people died earlier. It was quickly withdrawn after an uproar on ethical grounds. Your question is in the somewhat the same vein.

    • Well Kim, there are other sources besides Glantz’s “Library of Horrors”:
      http://www.msnbc.msn.com/id/22995659/ns/health-diet_and_nutrition/
      that gives figures that may answer your question. While I’ve not been able to access the text of the Dutch study for critique, I thought the articles statement, “Lung cancer is a cheap disease to treat because people don’t survive very long ” was insensitive. The article did point out that social and productivity cost were not included.
      Your question does bring up how Dr. Dolores Gunn came up with the figure of $400 million:
      http://www.stltoday.com/news/local/metro/article_accf5ec9-8c19-592a-acd1-ae0a853c9059.html
      I can’t dispute the amount but, like you, I’d like to learn how the total was computed.

      • Paul, On the one hand, I agree with you that saying “lung cancer is a cheap disease to treat because people don’t survive very long” is insensitive. At the same time, it appears to be factually accurate. My sister was given 6 months to 2 years to live after being diagnosed with incurable inoperable lung cancer. She actually died 6 months after her diagnosis. She took lots of pills but they were evidently palliative. A recommended diet she found and followed proved to be just a hoax.
        The reality is that lung cancer is a killer. I recommend avoiding it if possible.

  2. Mr. Pion, no doubt that Dr. Siegel, who believes tiny amounts of daily ETS exposure can cause heart disease, will also blame a few cigarettes a day for heart disease deaths too.

  3. 2 points:

    1) These “recent” changes are not very “recent.” True put holes in filters 40 years ago after SG Reports called for lower tar and nicotine and promoted “lighter” cigarettes by listing FTC numbers. I believe the UK even offered tax breaks for low tar smokes. Funny how they turned around 30 years later and accused the tobacco companies of a “plot” to market lights, eh?

    2) The ammonia thing has been going on for about 25 years also I believe.

    3) To Kim: read my “Taxes, Costs, and the MSA” at: http://pasan.thetruthisalie.com/modules.php?name=News&file=article&sid=7 More recently there was a Dutch study showing cost savings from smoking and obesity. Antismokers like to play “Let’s Pretend” and pretend that economic cost valuation only goes one way. That’s a silly game that they should have outgrown in grammar school. Economics *ALWAYS* calculates both sides of the equation: otherwise it’s simply NOT economics!

    Michael J. McFadden
    Author of “Dissecting Antismokers’ Brains”

  4. Who smokes a single cigarette, who is exposed to second hand smoke once and then never again?

    • Hans, I’ve tried smoking a single cigarette. Actually twice that I can remember. I bought a pack of Wills Woodbines as an adolescent for my “Mom” and then went into the backyard of a friend’s house to share them: they were sickening! As a young man I bought another pack of cigarettes, thinking they would be helpful for meeting girls. The smoke got up my nose and into my eyes, and no girls I met smoked, so that didn’t work out either.

  5. They also like to pretend apples are oranges, is there any integrity amongst scientist anymore or is it all science by political agenda.
    http://peoplesrepubmadison.wordpress.com/2010/12/17/universiy-of-wisconsin-guilty-of-science-by-poltical-agenda/

    Marshall Keith

  6. For me, anytime I am around cigarette smoke, it irritates my nasal passages which causes breathing problems and if I am exposed very long I get a very bad headache. Also the smell it leaves in your clothes (even from a brief exposure) is terrible. Please give me the couresty of not being exposed to this when I am around you. Thank you.

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