Jan 09 2014

Smoking – Some Good and Bad News

I am extremely anti-smoking for numerous reasons, but primarily because it is one of the most preventable causes of death and disease. Over my lifetime the cultural attitude toward smoking has changed significantly, mostly for the better.

I was born in 1964, the same year that the US Surgeon General came out with his report about the health risks of smoking, leading in part to the famous Surgeon General’s warning on every pack of cigarettes. I was a child in the time of Mad Men, when every adult seemed to smoke. I hated it.

Now I rarely see anyone smoking. It is not allowed at all where I work (a hospital), in restaurants, on airplanes, or in most public places. This is definitely a change for the better.

A recent report looks at the decline of smoking in the US, and estimates that 8 million lives were saved from decreasing smoking rates since the Surgeon General’s report in 1964. This new reports comes out at the same time as the American Cancer Society annual report on cancer deaths and survival. There is more good news here – cancer deaths are down overall by 20% over the last 20 years.

There has been a slow, steady decline in cancer deaths in recent decades. This is partly due to better diagnosis and also to better treatment options with higher remission rates. Some cancers, like pancreatic cancer and the worst forms of brain cancer, have not made much gains. Cancer is still a serious and often deadly disease, but we are steadily moving in the right direction.

To put this into perspective:

Moreover, during the last 20 years, the death rate from cancer has continued to drop from a high of about 215 per 100,000 people to about 172 per 100,000 people in 2010. This means that 1,340,400 fewer cancer deaths (952,700 among men and 387,700 among women) were avoided during that time period, the researchers explained.

Some of the gains have also been made due to lifestyle changes, and chief among them is the decrease in smoking. According to the American Lung Association:

Lung cancer is the leading cancer killer in both men and women in the United States. In 1987, it surpassed breast cancer to become the leading cause of cancer deaths in women.
Lung cancer causes more deaths than the next three most common cancers combined (colon, breast and prostate). An estimated 160,340 Americans were expected to die from lung cancer in 2012, accounting for approximately 28 percent of all cancer deaths.


Smoking, a main cause of small cell and non-small cell lung cancer, contributes to 80 percent and 90 percent of lung cancer deaths in women and men, respectively. Men who smoke are 23 times more likely to develop lung cancer. Women are 13 times more likely, compared to never smokers.

In other words, we can still take a huge chunk out of cancer deaths just by reducing smoking further.

While we are moving in the right direction regarding smoking in the US, worldwide trends are going in the wrong direction. We are close to 1 billion daily smokers worldwide.

Around three in 10 men (31%) and one in 20 women (6%) now smoke daily compared with four in 10 men (41%) and one in 10 women (10%) in 1980.

This is largely due to population increases, but also to increasing rates of smoking in the developing world. China, for example, has seen a dramatic increase in smoking rates. East Timor has the highest rate in the world at 61%.

As health care costs rise, reducing smoking is a clear way to reduce health care costs. 

Smoking cost the United States over $193 billion in 2004, including $97 billion in lost productivity and $96 billion in direct health care expenditures, or an average of $4,260 per adult smoker.

This should be a huge incentive, especially for poorer countries, to put policies into place designed to limit smoking.  Many countries have experimented with numerous policies, so they won’t have to reinvent the wheel. We have some data on what works – such as prohibiting smoking in restaurants and other public venues, graphic warnings on tobacco products, banning advertising, plain packaging, and age limits on purchasing tobacco products.

17 responses so far

17 thoughts on “Smoking – Some Good and Bad News”

  1. oldmanjenkins says:

    It was sad to watch an episode on Vice on HBO related to this worldwide increase. It was on Episode 7 “Addiction.” The synopsis “Tobaccoland: Tobacco obsession in Indonesia;….” In it they actually have “clinics” which treat cancer with…..you guessed it…..smoking cigarettes. Children as young as 6 or 7 would go by stores before going to school to buy their packs of cigarettes. Apparently according to the report, tobacco manufacturers have lined the pockets of politicians in Indonesia to the point pretty there are very few if any restrictions on smoking. As we smoke less in the United States, the industry has focused on third world countries as well as countries who have a higher propensity for corruption (as though we don’t but we have more regulations on the tobacco industry than in most any other country). The industry apparently see’s the US as a “lost market.”

  2. I see a parallel between the cigarette companies and religions. As education increases and the population understands more, both of these organizations move on to other places where the people understand less, are more impoverished, and the governments are more susceptible to corruption.

    Weird how education solves so many societal ills.

  3. jasontimothyjones says:

    Hi Steven, I am a smoker, but am also extremely anti smoking, apart from the cognitive dissonance, Im rather appalled that I struggle to quit. The policies that have been tried really have no effect on me, I really wish they did, but they just don’t. I having another go at quitting next week if you have any tips let me know.

    I live in the UK at the moment, we have all the restrictions mentioned apart from the plain packaging ( i think it may be coming). However I see more and more young kids smoking, yesterday I saw a group of 8-9 boys and girls that could not have been more than 14 smoking in a group.

    The simple solution would be to make any tobacco/nicotine product illegal, but this old news item comes to mind http://www.nytimes.com/2001/07/18/news/18iht-smoking_ed3_.html

    now Im stessed, i’m going for a smoke

  4. cbecke says:

    On a slightly related topic, I’ve been led to believe that evidence for harm due to second hand smoke is quite weak. I’d love to see a Neurologica discussion on this topic!

  5. Bruce says:

    My original home, Zimbabwe, has as it’s main export tobacco, and growing up you were strange if you did not smoke. It was justified half jokingly as supporting our local economy. Smoking is stupidly cheap there and the government would not put any anti-smoking laws in place in fear of reducing the tax income from the tobacco floor sales. It is slightly better now, but people still smoke at restaurants, in the home and in the office.

    On another note, I was very shocked to find out (yesterday as it should happen) that as many as 25% of pregnant women smoke in some of the more deprived areas of the UK. The Scottish government has a tobacco free strategy that aims to get smoking prevalence to 5% by 2034, but might have a few more challenges than anticipated as it seems a lot more younger teenagers are picking up the habit than expected and figures are not going down as expected. Despite the extrremely high cost of smoking, it appears social factors are still pushing a disproportionate number of teenagers to still take up the habit.

  6. Bruce says:


    On the contrary, there is strong evidence that second hand smoke is harmful:


  7. rezistnzisfutl says:

    Remembering that probably more is gained in preventing people from starting smoking than trying to get them to stop. That’s where education comes in. Understanding the risks and dangers of smoking, especially when it’s associated with nicotine addiction, is enough to deter many people from starting in the first place.

    As far as the legality of smoking, I’m not completely settled on the issue. I do think that smoking should be banned in nearly all public spaces, especially places where attendance is compulsory, and especially indoors where ventilation is limited. I also think that it should be illegal to smoke around children, even in private homes, as children are unable to escape smoke or have a say in the environment they are forced to live in.

    However, I think policies should also be balanced with personal freedoms, as long as they don’t affect others. I’m not sure illegalizing tobacco is the right answer, either. Not only is that against the personal freedoms most western cultures put high value one, doing so would likely only serve to create an underground market a la illicit drugs as well as regulatory and enforcement overhead.

  8. ccbowers says:

    “However I see more and more young kids smoking, yesterday I saw a group of 8-9 boys and girls that could not have been more than 14 smoking in a group.”

    jasontimothyjones – Despite your subjective experience, smoking in the UK has decreased dramatically over the past 40+ years. It was close to 40-50% in the early 1970s and is now about 20%. This decline is pretty similar to what has happened in the US. It would be interesting to compare and contrast the different situations, given the similarity in the numbers.

  9. Heptron says:

    I am also anti-smoking and have never smoked, though both of my parents did. Luckily I was able to avoid it (even though I was statistically more likely to pick up the habit).
    I had a friend in university use the argument that the medical costs associated with smoking were offset by the decreases in pensions and other government spending, which was also mentioned in the NY Times article listed in the previous comments. I must stress again that this offset is a horrible way to justify smoking.
    But while the article dismisses the idea, what do the numbers say?
    Just curious, and not in the “I’m just asking questions…” kind of way.

  10. rezistnzisfutl says:

    Heptron, is the rationale that, since people tend to die early from smoking, the money that would have normally been spent on them had they not been smoking offsets any health costs incurred by others who continue to smoke and have health issues? I’d like to see numbers, too, though it’s really up to those who make the claims to provide the evidence. That being said, I’m sure there are statistics around somewhere.

  11. ccbowers says:

    The NY Times article references a report that Philip Morris provided to the Czech Republic. The internets, of course had copies of this report entitled “Public Finance Balance of Smoking in the Czech Republic”


    There have been critiques of the science, but I have not looked into it a great deal because of the complexity of the topic.
    such as:

    The report is specific to the Czech Republic over a decade ago, and has been challenged on the science. Another critique found the opposite conclusion by just correcting one aspect of the study (link above). To me their conclusion is largely irrelevant as an argument for or against smoking, since we are talking about many lives lost. I’m sure that there are many unethical things that could save money for a given government, but that doesn’t mean that they should be implemented as policy. Also there seem to be complexities to the broader social costs (and economic implications of those), which seem to be overlooked by their report.

    Philip Morris initially defended the report, then later apologized due to the bad PR.
    None of this does supports the broader question either way. Even if we restrict the question to the net financial impact, this report (even if taked at face value) is restricted to the situation in the Czech Republic in the 1990s.

  12. tmac57 says:

    I suppose if we were to do away with the health measures that prevented the plague and other pandemic diseases,then we could drastically reduce deaths from cancer and heart disease.That’s how an economist might evaluate the cost benefit ratio.

  13. wunibald says:

    I used to smoke about third a pack daily and have recently switched to electronic cigarettes for harm reduction. I had tried quitting with nicotine gum several times previously with no long-term success. Many smokers seem to be switching to electronic cigarettes for harm reduction.

    Here is a list of evidence in favour of electronic cigarettes, as compared to conventional smoking: http://www.ecigalternative.com/ecigarette-studies-research.htm. I am aware that this list may be biased, leaving out more critical studies (e.g. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61842-5/abstract). Also, research in this area is just starting and I have read very controversial expert opinions.

    I am interested in hearing what you think of using electronic cigarettes as a device for harm reduction or quitting. Of course quitting altogether is best for health, but success rates with conventional nicotine replacement therapies (nicotine gum and patches) are quite low, often below 10% one-year abstinence.

  14. Kawarthajon says:

    Another personal anecdote:

    I lived overseas for much of my childhood, so spent a lot of time on airplanes. Smoking was allowed in the “smoking section”, which was ridiculous, because the smoke from that section not only billowed throughout the plane naturally, but was also actively circulated around the plane by the ventilation system. I, having smoking parents, was always in the smoking section. I remember hating those 10 – 15 hour plane rides with a passion, barely being able to breath, even though I have no respiratory problems (i.e. asthma). I can’t imagine what torture it must have been for those who had asthma and other respiratory problems. I am sooooo glad that smoking has been restricted in my country from planes, restaurants, malls, bars, etc. (In Canada, one of the strictest countries with regards to anti-smoking regulations, cigarettes have to be hidden behind a plan white shelf, preventing people from even seeing the labels when they go to buy them!) I still hate walking behind someone who is smoking or even driving behind someone who has the window open while smoking. Another pet peeve is the fact that smokers typically throw their butts on the ground, which causes litter and environmental problems. People who wouldn’t dream of throwing any other kind of litter on the ground seem to feel it’s ok to throw cigarettes around.

    I did smoke as a teenager and young adult, but it caused (contributed to) a never ending serious of really bad lung/throat infections. While infected, I couldn’t smoke because it was too painful (believe me, I tried). Luckily, every time I quit and then returned to smoking, I got a serious infection and had to stop smoking because of the pain. Eventually, my periods of non-smoking increased and it took longer and longer for me to return to smoking, until I finally quit altogether. I have to admit that I still love smoking cigars, although I only do so once every couple of years. Cuban cigars are my guilty pleasure!

  15. Heptron says:

    @ rezistnzisfutl

    I think that was exactly the rationale behind my friend’s point of view. A smoker dies 10 years earlier (for lack of a better word) than he would if he had not been a smoker. There’s more health care costs associated with this person, but there is 10 years less they are paid from a pension plan (in this case, since I am Canadian, I am thinking of the Canada Pension Plan, CPP, which is given out at the federal level).

    @ ccbowers

    You’re right, the study is narrow. Not only that, the study comes from one side of the argument which may have good reason to be biased. That’s why I was wondering if there were any other numbers to either support or negate this point.

    @ Kawarthajon

    It also drives me nuts to see people throwing their butts on the ground, mostly because if I did it with a bottle of water of fast food containers, I feel like I would get a dirty look from them. Additionally, I see a lot of cigarette butts on sand beaches and I’ve always wondered if that was a product of using sand in ashtrays in places like hotel lobbies.

  16. BillyJoe7 says:


    I think your reaction to cigarette smoke is probably largely psychosomatic, based on your knowledge of the harm that cigarette smoke causes in the long run.

  17. norrisL says:

    My wife used to smoke in the dark room at school. One night not long after we were married she brought a girlfriend home and she “suggested” that I go to bed. So I did. For a reason lost in time I got out of bed and found the two of them smoking in the back yard. After what I said to her that night, she has never smoked again. I like to think that I firstly saved our marriage but more importantly saved her health as well as mine and our two children’s health.

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