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The 'one cigarette' mantra

‘Just one cigarette a day carries greater risk of heart disease and stroke than expected, warn experts.’

This is one of many similar headlines in print and online today.

According to the British Medical Journal:

Smoking just one cigarette a day has a much higher risk of developing coronary heart disease and stroke than expected - about half the risk of smoking 20 per day - concludes a review of the evidence published by the BMJ today.

The researchers say their findings have important consequences for many smokers and health professionals who believe that smoking only a few cigarettes carries little or no harm. They argue that smokers should stop completely instead of cutting down to significantly reduce their risk of heart disease and stroke.

The findings are based on an analysis of 141 studies by researchers at the UCL Cancer Institute at University College London and they follow an unrelated analysis of 215,000 people by researchers at Queen Mary, University of London, that found that 60.3 per cent had tried a cigarette and 68.9 per cent became addicted.

Or, to put that in tabloid terms: 'One puff of a cigarette is enough to get you hooked: Two-thirds of people who try tobacco for the first time become daily smokers'.

The 'one cigarette' mantra isn't new but it's increasingly commonplace. The idea however that a single cigarette is enough to turn you into a nicotine junkie is, in my view, nonsense.

The simple reason many people go from that first experimental cigarette and become daily smokers is because they enjoy it.

The same is true of many other things – including tea, coffee or, dare I say it, jam doughnuts. You try something, you like it, and it becomes a regular part of your life.

Many smokers may in time become addicted to nicotine (or smoking) but to blame it on that first cigarette is ridiculous.

As for the alarmist claim that 'People who smoked even one cigarette a day were still about 50 per cent more likely to develop heart disease and 30 per cent more likely to have a stroke than people who had never smoked', did the researchers take into account other factors such as diet, individual fitness and socio-economic conditions?

After all, neither heart disease nor stroke are exclusive to smokers but that rarely seems to be taken into account by researchers who are more than happy to point the finger of blame at smoking.

I haven't read the full analysis yet so I'd better not comment too much until I have. What I strongly question though is the relatively new idea that cutting down is no longer a serious option.

I realise tobacco control has targets to meet but to reject such a well-established path to abstinence (reducing consumption before eventually giving up) seems rather presumptuous.

Not only does it highlight their increasing impatience to reduce smoking rates, it demonstrates a desire to control people's behaviour to the nth degree. Even if your ultimate goal is to quit, cutting down isn't good enough. You have to stop smoking NOW!

Anyway, here is Forest's response to the new orthodoxy:

“Quitting smoking can be hard and for many people cutting down is often the first step. 

"Discouraging it as an option could be counter-productive because smokers who want to stop may be dissuaded from even trying."

To this we added:

“What researchers consistently fail to understand is why many people smoke.

"Millions smoke not because they are addicted but because they enjoy it. For some it's one of their few remaining pleasures, for others it's a comfort.

"Health considerations are obviously a factor in whether or not people smoke but there are other factors, including pleasure, that determine people's choices and no amount of scaremongering about the risks of even a single cigarette a day will change that."

The Scotsman has our full response here and you'll find the odd sentence elsewhere (on the BBC News website, for example).

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Reader Comments (5)

I posted a comment over at that BBC story asking how many one cigarette per day smokers were studied, as it seems like that'd be a very small group of people. Who smokes one cigarette per day?

My comment was promptly moderated. Saw a couple of 'how does Simon Clark sleep at night', and quite a few 'ISIS has the right idea about smoking', too.

Charming people.

Thursday, January 25, 2018 at 15:22 | Unregistered CommenterChanah See

More paid for junk science to conclude what the smokerphobics in the antismoker industry want it to say.

They fear the factual dose makes poison argument is realistic and believed so they needed to make up a study to discredit it.

As for one cigarette can make someone addicted, that is utter rubbish. I know people who tried smoking once and hated it. A family member back in the 1970s wanted to smoke to be part of the cool gang, but she just could not get on with it and gave up trying.

Smoking, like drinking stout or eating olives, or drinking whisky, is an acquired taste and something that people continue to do because it is delicious once they have learned how to smoke.

I wish the media that happily repeat the rubbish that promotes the public health hate campaign would at least do some fact checking rather than take as gospel junk studies put out by vested interests.

The truth is, anyone who smokes knows very well from biological experience over several decades that the dose makes poison claim is the true one. The liars in public health need to be exposed but who will do that?

Thursday, January 25, 2018 at 15:23 | Unregistered Commenterpat nurse

"....did the researchers take into account other factors such as diet, individual fitness and socio-economic conditions?"

There was an interesting interview on radio yesterday with the Professor of Public Health at Strathclyde University. He was asked to account for the "Glasgow Effect" - the signficant disparity in longevity between Glasgow and the rest of western europe. He said that the answer was "complex" but,he thought, it lay in a number of factors interacting with each other eg loss of employment in the '50s and '60s and catastrophic housing policy which saw the destruction of communities [eg the gorbals] with people being shunted to the periphery of the city into huge estates [eg the infamous Easterhouse]. He'd worked in medicine and gave the example of patients with pancreatic cancer who he'd advised to quit drinking or they'd die and the response of many being that they didn't care, life wasn't that good. When asked what the solution was the professor said that policies had to be 'joined up' to address the underlying inequalities.

Several things struck me as I was listening. Enstrom & Kabat came to mind with their conclusion that you can't simply isolate a behaviour and blame it for health inequalities; that this professor was the first 'public health' professional that I'd heard talking sense and that he was concerned about the proper remit of public health which is not to do with individual choices but issues affecting a population which have to be dealt with at a collective level through government policy.

Thursday, January 25, 2018 at 18:35 | Unregistered CommenterJay

Chanah makes a good point. It is impossible to collect a large sample of one a day smokers. What I suspect happened was either:

the sample was of people smoking, say 1 to 5 cigs a day, which meant the press release could say, "as little as one," without actually lying;


The authors calculated the damage done by, say 20 cigs a day, and divided the result by 20, which would be nonsensical.

If I go and read the paper, I'll lose the will to live, so I won't be checking.

Friday, January 26, 2018 at 13:40 | Unregistered CommenterJonathan Bagley

Statistic inference from a meta-analysis including world wide 141 studies which are (extremely likely) unrelated, really smacks to junk science. These meta-analysis combine the smaller samples of the individual studies to conform a huge sample, but if the design of the studies differs, then the statistical uncertainties add up to make the inference totally unreliable. This is clearly stated in any epidemiology text book, but this junk gets published and widely trumpeted by the media because it meets the advocacy needs that we all know.

Also, there is a dose-response relation for every substance. Assuming that 1 daily cigarette is as harmful as 20 is assuming that tobacco smoke has a level of toxicity comparable with really nasty poisons. If this was true, smokers would be falling dead like flies in the short term.

Finally, tobacco and marijuana smoke are chemically similar (save for the nicotine and cannabis active stimulants). There has not been much protest on marijuana smoke because typically only one marijuana cigarette (joint) is smoked daily. If we assume as valid the equivalence 1 cigarette = 20, then most marijuana smokers would be facing huge health risks. Of course, nobody in nanny state California will make much noise about it because marijuana is culturally "acceptable" to liberal baby boomers while smoking is not. Liberal baby boomers say that their anti-tobacco attitudes are based on science, but this level of fanaticism is really ignorant prejudice (though these liberals will never admit they are prejudiced, only Trump's "deplorables" are).

Sunday, January 28, 2018 at 5:42 | Unregistered CommenterRoberto

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