Wikipedia:Reference desk/Archives/Science/2019 January 11

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January 11

Making smoking healthy/healthier

What efforts have their been in making the practice of smoking healthier for users? For example, research into tobacco that burns with a cooler smoke lower in carcinogens.--Leon (talk) 15:07, 11 January 2019 (UTC)

For one thing, the FDA has enforced laws that make it illegal to claim certain types of tobacco products are "healthier" or "safer" than other types.

From their Public Health Education webpage: Tobacco-Related Health Fraud: "All tobacco products are harmful to your health, despite what they taste, smell, or look like. Claiming less harm or reduced risk of disease from using tobacco products misleads consumers to think that these products are safe to use. FDA considers these kinds of claims to be health fraud."

Scientific research is pretty clear on this topic. If you want more information, here is a full scientific literature review textbook, available at zero cost and also available online in digital form, How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. This book was authored by expert researchers at CDC, and endorsed by Regina Benjamin, who was the Surgeon General, and is a qualified medical doctor). It contains an entire chapter on the history of cigarette technology, and presents scientific evidence explaining why the use of tobacco products still is not safe or healthy.

If you need help quitting smoking, here are links to many free resources to help: Quit Smoking!

"Smoking remains the leading cause of preventable death and disease in the United States, killing more than 480,000 Americans each year." "More people in the United States are addicted to nicotine than to any other drug. Research suggests that nicotine may be as addictive as heroin, cocaine, or alcohol." ...according to CDC, with over a dozen cited references, including peer-reviewed scientific research. By golly, this cigarette crisis kills more Americans than several of the manufactured crises I keep hearing about in the news! When will we do something about it?

Nimur (talk) 15:32, 11 January 2019 (UTC)

By the way, by way of analogy, the reason why the FDA refuses to allow any nicotine-delivery system to claim that it is "healthier" than another, be it dip, smoke, vape, or what have you, is that even the "least deadly" forms are deadly enough to massively increase your chances of negative health effects. It's sort of like saying that a fall from the top of the Empire State Building is healthier for you than the fall from the top of the Burj Khalifa, because the Burj Khalifa is taller. Sort of, but I still don't want to jump off of either. --Jayron32 17:05, 11 January 2019 (UTC)

I never suggested that any of the existing alternatives were healthy or even healthier, and I certainly don't dispute the degree to which smoking is said to be injurious to health. I was asking what research had been done on producing healthier alternatives other than giving up. I would have thought that the tobacco companies would have good reason to do such research; have they?!--Leon (talk) 21:33, 11 January 2019 (UTC)

Did you look at the book I linked? It summarizes hundreds of studies and cites hundreds of research papers on exactly this topic. If you want a short answer, instead of 727 pages of science, the conclusions are pretty clear: changing the tobacco product has not yielded better health effects on an individual or on a population level. Nimur (talk) 01:02, 12 January 2019 (UTC)

The title of that paper is "How tobacco smoke causes disease" (emphasis mine). Since neither tobacco vapers nor chewers consume tobacco smoke per se, perhaps you could point to the specific sections that are relevant to vaping and chewing?

(Just to lay bare my own possible biases, I do not consume tobacco or nicotine in any form. However, I perceive from these sorts of agencies a kind of innate hostility to the notion of harm reduction, and in particular to the idea that individuals might choose to derive pleasure from a substance, and look for a safer, even if not perfectly safe, way of doing so. So my guess is that they aren't really looking at the right questions. The right question is not, is vaping a good idea for my health? but rather, if I wish to consume nicotine, is vaping a safer way than smoking? If anyone can disabuse me of this suspicion, by all means, pleas do so.) --Trovatore (talk) 08:13, 12 January 2019 (UTC)

Trovatore: Smokeless tobacco products were described in five chapters, including a section on "harm reduction". Here's a review article, cited therein: New and traditional smokeless tobacco: comparison of toxicant and carcinogen levels. "Crotonaldehyde levels were about 5 times higher in (new product types) than in traditional products." It's a fun read if you like learning about HAZMAT!

Other products, including "cigarette-like products," E-Cigarettes, and vapor inhalers, are also discussed in Chapter 2.

On "harm reduction": "Another concept that has been considered is changing the cigarette itself to make it less toxic. The concept of modifying conventional cigarettes to be potentially less harmful is not new ... However, evidence now demonstrates that these modifications did not reduce the risk of cigarette smoking and in addition may have undermined efforts to prevent tobacco use and promote cessation (NCI 2001)."

So, it is not that these types of public health organizations have an innate "bias" against the idea of harm reduction. Rather, they have scientifically studied this option as a public health strategy, and the scientific evidence is overwhelmingly finding that modifying the products does not actually "reduce" harm to public health. If you disbelieve my abbreviated summary, have a look at the data in the citations and make up your own mind: it takes five entire pages just to list the citations to the number of public health studies that they have conducted just on this sub-topic about modifying the products to reduce harm. The depth and breadth of evidence might contribute to why the report is seven hundred pages long.

Nimur (talk) 21:21, 14 January 2019 (UTC)

@Numur: OK, let's be clear on what we're talking about. The text you pointed to about not reducing the risk of cigarette smoking is about modifications of conventional cigarettes, not about vaping. As for the other link, it seems to be comparing different forms of smokeless tobacco among themselves; it does not seem to be comparing the risk of smokeless tobacco to the risk of smoking.

Your claim that the organizations have studied the option as a public health strategy is telling. What about an individual, looking into them as a private health strategy? This fundamentally comes down to values, I think — do you value an individual's agency to weigh health risks against other private goals, based on the best information available? Personally, I do. These organizations — I have seen little evidence that they do. --Trovatore (talk) 21:46, 14 January 2019 (UTC)

Tobacco companies have good reason to market various ways of ingesting tobacco as healthier than others, but the FDA doesn't let them. Whatever the Tobacco companies do to justify their marketing strategies, it isn't anything that resembles research in the normal sense of the word. You can see the problems with that line of questioning (what do the Tobacco companies know through their own research?) at Health effects of tobacco#Forms of exposure, which notes "New research indicates that private research conducted by cigarette company Philip Morris in the 1980s showed that second-hand smoke was toxic, yet the company suppressed the finding during the next two decades." (bold mine). Any industry-sponsored "research" is tainted by such shenanigans and suspect in its conclusions to the point of being worthless; it would be irresponsible of me or anyone else to refer you to it. Of direct importance to our discussion here, the same article and section, a few paragraphs down notes, with cites to the original journal article "According to the International Agency for Research on Cancer, 'Some health scientists have suggested that smokeless tobacco should be used in smoking cessation programmes and have made implicit or explicit claims that its use would partly reduce the exposure of smokers to carcinogens and the risk for cancer. These claims, however, are not supported by the available evidence.'" (bold mine). In other words, when real scientist look, they can't find any evidence that smokeless tobacco is any less unhealthy than other forms. I hope that clarifies a bit. --Jayron32 21:47, 11 January 2019 (UTC)

It all depends what kind of cancer you'd rather have: lung vs. mouth, for example. ←Baseball Bugs ^{What's up, Doc?} carrots→ 00:39, 12 January 2019 (UTC)

I'd have thought falling from a three story building instead of a four story one might be a better analogy. But even if it is like that it is too easy for the tobacco companies if they are allowed to twist the message to imply there is something good about falling from the top floor of a three story building. Dmcq (talk) 01:21, 12 January 2019 (UTC)

A shorter fall is better, as it's over faster. It happens so fast you don't have time to think about it. Falling off the Empire State Building or whatever, you have at least 80 floors to feel regretful. ←Baseball Bugs ^{What's up, Doc?} carrots→ 01:31, 12 January 2019 (UTC)

The classic instance of trying to make a "safer cigarette" was the case of DNA Plant Technology (DNAP) and Brown and Williamson. As described at [1] (referencing [2], Brown and Williamson hit on the idea of developing a high-nicotine strain of tobacco, which could then be mixed with other substances to give what hypothetically might be a cigarette with equivalent nicotine but less carcinogen. (There must be something about it in [3] but I can't search that document) The result was that one was prosecuted (for shipping seeds to Brazil for research) and the other sued, although eventually FDA v. Brown & Williamson Tobacco Corp. did not go that way. (A simpler technology described in the B&W article was to add ammonia to cigarettes, which as far as I know works the same way as crack cocaine in that you're converting more of the alkaloid into a volatile form) Note however that nicotine - even in vaping - can be converted to nitrosonornicotine, a carcinogen in its own right, though this can be decreased by managing temperature.

I should emphasize the need for caution in this area, which historically has been a showcase of dishonesty - tobacco companies pretending their products weren't addictive, FTC operated machines certifying "low-tar cigarettes" that only the machines read as low-tar, and the outcome of the whole sorry charade of recovering money for victims of the tobacco companies was that smokers are taxed out the wazoo but you see stores all over advertising the "lowest cigarette prices allowed by law", a price floor system better known for allegedly preserving the viability of dairy farming. Wnt (talk) 01:51, 12 January 2019 (UTC)

On a side note, I remain curious whether the use of Lobelia inflata (Devil's tobacco) as an alternative historically would have offered smokers a healthier option, but should emphasize that I didn't find much useful last time I looked, and for all I know it may be more dangerous than tobacco (it definitely can be dangerous acutely, but so can tobacco). Wnt (talk) 01:55, 12 January 2019 (UTC)

Mentioned in Nimur's answer but not linked yet AFAIK, there is Electric smoking system although it could be debated if these are actually smoking especially as most of these don't produce much smoke. (Note these should not be confused with vaping which use some liquid.) Nil Einne (talk) 06:28, 12 January 2019 (UTC)

The belief that all tobacco products are 100% equal in the amount or nature of harm that they cause is an example of religion, not science, and should be treated as the WP:FRINGE view that is is. Also dubious are any claims by those who make their money selling tobacco products regarding the comparative safety of their products. We would not accept at face value claims made by Volvo that their cars are safer than Subarus, and we would be really wary of any research on the question funded by Subaru or Volvo, but that does not mean that there are no safety differences between cars and does not invalidate independent reliable sources such as NHTSA.

(Full disclosure: I smoked almost half of a cigarette when I was 13 years old. I didn't like it.) --Guy Macon (talk) 16:41, 12 January 2019 (UTC)

There's two, mostly unrelated, questions being asked here, and you need to be careful as to which one you are answering "Are all forms of nicotine ingestion equivalent in terms of health effects" and "What is the research to support that some forms of nicotine ingestion is less unhealthy than other forms." The answer to the first question is undoubtedly "Probably not" The answer to the second one is "None that we can trust to make any definitive statements about." See, that's the issue, the issue is not "could we find this out if we wanted to" this issue is "HAVE we already found this out and can you direct me to the research". The answer to the first question is yes, the answer to the second question is, sadly, no. --Jayron32 13:27, 14 January 2019 (UTC)

It's funny to hear you put it that way, because to my eye the presumption looks like it may stem from "rationalist" ways of thinking about medicine. For example, if an herbal therapy has no statistically significant effect, it is considered to have zero effect on health. By analogy, if tobacco is already proved to cause cancer, and trying a different route hasn't been shown scientifically to improve the smoker's prognosis, the "null hypothesis" is that it has zero effect to change the route, and therefore ... the two routes are 100% equal. As with Wikipedia RFCs, the most important part of the politics can be in deciding who has the status quo or null hypothesis, and who is subject to a burden of proof. :) Wnt (talk) 00:29, 13 January 2019 (UTC)

If the question is "do we have enough evidence to prove that vaping is safer than smoking?", it seems quite reasonable that the answer would be "no", because people haven't been vaping that long. It's not impossible that some currently-innocuous-seeming aspect of it could turn out to have terrible effects, in some unknown way. Proving that that doesn't happen means following a population of vapers for decades. So my guess is that this is the content of the scientific analyses that Nimur and Jaryon32 are talking about. If not; that is, if they actually have positive evidence that the health effects of vaping are as bad as those of smoking, then Nimur and Jaryon, by all means do please point me to that evidence.

In the absence of positive evidence that vaping is as bad as smoking, it seems to me that a rational person who wishes to consume nicotine might well conclude that vaping is a better choice, given the known effects of smoking versus what's known about the individual components of vaping. But the "public health" mindset generally seems to place no weight on an individual's choice to do something for pleasure. --Trovatore (talk) 01:29, 13 January 2019 (UTC)

See my answer to Guy above. The hypothesis that some forms of nicotine ingestion are better than others is reasonable. The question, however, is "can you direct me to research showing this." The answer to THAT question is "not really". Reviews of the "science" behind this (scare quotes intentional) have shown that there isn't good enough science. The research above does NOT say "Research shows that all forms of tobacco are equivalent" it says, instead (and this means a different thing) "Research does not show that different forms of tobacco use are better than others". That difference in wording is very significant. --Jayron32 13:31, 14 January 2019 (UTC)

Second and thirdhand vapor is less unhealthy and stinky than second and thirdhand cigarette smoke right? Then I don't give a damn if vaping is worse, let people do it anywhere you can smoke. Sagittarian Milky Way (talk) 02:27, 13 January 2019 (UTC)

Politics is tricky and you can argue it various ways. Note that vaping, depending somewhat on brand, includes several known harmful components such as diethylene glycol ([4]). Arguing how much risk is OK is one of the more contentious exercises in environmental politics. For that matter, if the device looks like a cigarette and contains nicotine, what is its effect on the relapse rates of ex-smokers? We certainly won't settle the political issue here. :) Wnt (talk) 02:29, 14 January 2019 (UTC)