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Familiar Patterns of Man-made Disasters, Part 2 of 4: Smoking (The death toll keeps growing!)

Posted on July 29th, 2017 by in Chemical R&D

smokers lung

This post is the second in the series of four about avoidable disasters caused by human beings.  Three of the posts describe examples of man-made disasters: 1. Asbestos published July 17; 2. Smoking (July 31); and 3. Climate change (August 7).  The fourth post (August 24) discusses the common patterns of those three disasters and proposes root causes for all of them.  A review of the July 17 post would help the reader with the understanding of these posts.

People apply the term disaster as a descriptor of anything serious or even trivial that has gone wrong in their lives.  Disaster has been defined as “a sudden calamitous event bringing great damage, loss, or destruction; natural disasters; and broadly: a sudden or great misfortune or failure.”  Earthquakes, volcanic eruptions, hurricanes, tornadoes and forest fires are thought of when people hear the word disaster.  What if you were told millions of people have died and continue to die of preventable lung cancer, stomach and other cancers, cardiovascular and other diseases?  All because of tobacco consumption!  Would it fit your definition of disaster?

History of Smoking

Tobacco has been growing as a weed in the American continent for 8000 years.  Some 2000 years ago people started chewing and smoking tobacco, often during religious and other ceremonies.  Christopher Columbus is purported to have been the first European to discover smoking.  In the early 16th century European began to grow tobacco, which within decades spread through the continent.  Its rarity promoted tobacco to the ranks of a monetary standard.  In the late 1600’s tobacco was introduced into the Ottoman Empire and later found its way into the Middle Eastern and other Asian countries.  By the 18th century tobacco became widespread leading to the formation of an industry around its consumption.1

Tobacco has been a lucrative business because those who consume it come back for more due to the addictive nature of nicotine its active ingredient.  By modern times large transnational and national companies had been formed in the United States, Europe, Asia, South America and elsewhere, engaging in the manufacturing, marketing and promotion of cigarettes and other tobacco products.  The global retail value of the tobacco business in 2014 was a whopping US $744 billion through the worldwide sale of 5.6 trillion cigarettes to over a billion souls.  Powerful lobbies have protected the highly profitable tobacco business since the discovery of linkage between smoking and cancer.  Every year scores of humanity suffer and die of incurable illnesses caused by tobacco consumption.  Cigarette makers earn about a penny in profit for every cigarette sold, which means that the value of a life to a cigarette maker is about US$10,000.2

Addiction

Research has demonstrated nicotine effect on the brain leads to the production of a number of effects. Of primary importance to its addictive nature are findings that nicotine activates reward pathways—the brain circuitry that regulates feelings of pleasure. A key brain chemical involved in mediating the desire to consume drugs is the neurotransmitter dopamine, and research has shown that nicotine increases levels of dopamine in the reward circuits.3  This reaction is no different from that seen with heroin and other illicit drugs.  Nicotine is believed to be at the center of pleasurable sensations experienced by many smokers. Nicotine addicts undergo long-term brain changes induced by continued nicotine exposure with the result being addiction.  Stopping smoking at nearly any age reduces chances of death because of cancer.

Cancer risk

 

Figure 1 Cumulative risk (%) of death from lung cancer (in the absence of other causes of death) in men at ages 45–75 years4

Danger to Health

In the year 1602 an anonymous English writer published an essay with the title of Work of Chimney Sweepers.  The article stated the illnesses often seen in workers sweeping chimneys were caused by soot and tobacco may have similar effects. This is one of the earliest public instances of smoking being linked to ill health.  In 1795 Sammuel Thomas von Soemmering of Germany reported that he was increasingly noticing cancers of the lip in pipe smokers.  In 1798 the US physician Benjamin Rush wrote about the medical dangers of tobacco.  During the 1920s, the first medical reports linking smoking to lung cancer began to appear. Yet newspaper editors refused to report those findings to avoid offending tobacco companies whose heavy advertisement in the media was an important source of income for the papers.5

Major medical reports published in the 1950’s and 1960s confirmed that tobacco caused a range of serious diseases.  Four distinct lines of evidence unveiled by research converged to establish cigarette smoking as the leading cause of lung cancer.  The four lines were: population studies, animal experimentation, cellular pathology and discovery of cancer causing chemicals in cigarette smoke.  Scholars started noting the parallel rise in cigarette consumption and lung cancer, and by the 1930s had begun to investigate this relationship.  In 1954, Hammond and Horn, working with the American Cancer Society concluded that the link had been proven ‘beyond a reasonable doubt’.6  Research conducted since the early days has uncovered additional health threats of smoking or being exposed to second hand smoke.

Industry Reaction to Heath Findings

In 1953, a great deal of attention was given to an experiment by that showed tumors could be generated by painting tars of cigarette smoke onto the shaved backs of mice.  Life magazine devoted several pages to the story, and Time cited the conclusion that the case against tobacco had now been proved beyond doubt.  Public confidence in tobacco was shaken, and stock prices of American cigarette manufacturers plummeted. Tobacco companies saw this new ‘health scare’ as a mortal threat to their livelihood, and decided to organize a response. On December 14, 1953 CEOs of the six largest tobacco manufacturers in the US (all but Liggett) met to plan a response.2

The outcome was a far-reaching plan to refute the ever-growing evidence, using advertisements, so-called white papers, press releases and corporate schmoozing with popular science writers and journalists.  Support for (industry-friendly) science was a vital part of this enterprise: cigarette manufacturers called for ‘more research’ to resolve a purported ‘controversy’, and set out to reassure the public that the companies were taking charge. That campaign was a success, based on the fact that per capita consumption rebounded. Cigarette consumption in the US would in fact continue to grow throughout the 1960s and 1970s.

Cigarette makers spent countless sums for advertising and to deny and distract from the cigarette-cancer link.  In the 1980s, UK tobacco researchers commented on how Philip Morris was piloting a ‘global strategy’ to deny the reality of secondhand smoke hazards, spending vast sums of money ‘to keep the controversy alive’. Hundreds of millions of Chinese remain poorly informed about the hazards of smoking, and as recently as 2011, scholars from the International Tobacco Control Policy Evaluation Project in The Netherlands published a survey showing that only 61 per cent of Dutch adults agreed that cigarette smoke endangered non-smokers.2

Cigarettes are possibly the most heavily advertised and promoted consumer product in the world. In 2000, the six major US tobacco companies spent US$ 9.6 billion on cigarette advertising and promotion in the US. The advertising and promotion of tobacco products has lead to increase in their use particularly by the young people. Tobacco industry has spared no effort or funds to promote and glamorize cigarettes to the youth in every possible venue where they gather.  Tobacco industry has more than made up for the decline in smoking in developed countries by promoting and popularizing smoking in the developing and poor countries.

Death Toll

The cigarette is the deadliest artifact in the history of human civilization. Consumption rates are falling in most of the richer countries, but smoking rates remain high or even increasing in many parts of the globe. In China, cigarette consumption has risen from about 500 billion 1980 to over four times that in 2010, and it is not yet clear whether consumption has peaked.  China is currently producing a staggering 2.5 trillion sticks of cigarettes or 40% of the total global production.  Productivity increases of cigarette making machines have reduced the retail cost of cigarettes thus allowing more people in the world to afford this deadly product.

In 1964 Surgeon General issued a report based on the review of 7000 documents related to smoking.  The report highlighted the deleterious health consequences of tobacco use. Smoking and Health: Report of the Advisory Committee to the Surgeon General held cigarette smoking responsible for a 70 percent increase in the mortality rate of smokers over non-smokers.  The 1964 report on smoking and health had a strong, though slowly evolving, impact on public attitudes and policy.  In 1965, Congress required all cigarette packages distributed in the United States to carry a health warning, and since 1970 this warning is made in the name of the Surgeon General (Figure 2). In 1969, cigarette advertising on television and radio was banned, effective September 1970.7

cigarette

 

Figure 2 Surgeon General’s Warning

The fact is that cigarette use persists, and on a massive scale. Global cigarette use seems to have peaked at about 6 trillion cigarettes sometime after the turn of the new millennium, but the deadly effects of this epidemic will still be felt for decades even if global use continues to decline. Just in the 20th century about 100 million people died from smoking.  Several times as many are likely to die in the 21st century, even if current rates of smoking fall dramatically.  Most of the tobacco epidemic remains in the future, with the total global toll likely to approach 2 million lung cancer deaths per year in the decades of 2020s or 2030s (Table 1).2

Table 1 Projected numbers of deaths from tobacco during the twenty-first century, if current smoking patterns persist1

Tobacco deaths

It is only apt to end this post with a video of actor Yul Brynner, a chain smoker, shortly before his death due to lung cancer in 1985.

References

1. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol 83, Tobacco Smoke and Involuntary Smoking, WHO, Lyon France, 2004.

2. R. N Proctor, The history of discovery of cigarette-cancer link, Tobacco Control, 21, p87-91, 2012.

3 www.drugabuse.gov/publications/research-reports/tobacco/nicotine-addictive.

4 Peto, R., Darby, S., Deo, H., Silcocks, P., Whitley, E. & Doll, R., Smoking, smoking cessation, and lung cancer in the US since 1950: Combination of national statistics with two case – control studies. Br. med. J., 321, p323–329, 2000.

5 www.cancercouncil.com.au/31899/uncategorized/a-brief-history-of-smoking/.

6 Hammond EC, Horn D. The relationship between human smoking habits and death rates: a follow-up study of 187,766 men, Journal of American Medical Association, 155:1316-28, 1954.

7 The Reports of the Surgeon General, The 1964 Report on Smoking and Health, https://profiles.nlm.nih.gov/ps/retrieve/Narrative/NN/p-nid/60].


 

All opinions shared in this post are the author’s own.

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