Why smoking kills

My inbox is full of comments on my columns supporting the anti-tobacco campaign. The other day I put out the argument of Joe Nacilla that there is not enough evidence “to damn conclusively” that smoking causes cancer.

Below I am putting out Dr. Ulysses Doroteo’s reply to Nacilla’s letter. Dr. Doroteo is the Framework, Convention on Tobacco Control ((FCTC) program manager of the Southeast Asia Tobacco Control Alliance.

“The perception that the research evidence is inconclusive is the result of the tobacco industry’s attempts to keep the debate alive and stir up controversy as to whether or not smoking is harmful,” writes Doroteo. “This was a strategy that they used very commonly in the ’70s to the ’90s, and which they still try to use today in societies that are not so well informed of the issues. This is well documented by the World Health Organization, as well as through the internal tobacco industry documents gathered in the US Master Settlement case in the ’90s.” Writes Doroteo: “The truth is that the science relating to tobacco harm IS conclusive. Scientific and medical evidence over the past several decades has proven beyond doubt the health harms of tobacco. This is also documented by the tobacco companies’ own research as seen in their internal documents from the MSA case. They knew that tobacco use was harmful and addictive many years before even the US Surgeon General reported similar conclusions. Today, even Philip Morris acknowledges the health harms and addiction on its website (philipmor risusa.com). “Unfortunately, the most alarming picture that is presented by research is the most common picture. Many of the top killers in our country (e.g. cancer, stroke, cardiovascular disease, chronic lung disease) are smoking-related. And there is no way to NOT be alarmed, especially if one was familiar with the suffering inflicted on both patients and their families, or knew that one person in the world dies every six seconds due to tobacco use.

“Pictures speak for themselves, which is why picture-based warnings on cigarette packs should be required by law. Once they’ve seen such picture warnings, smokers or would-be smokers can judge for themselves if they should or should not smoke or continue to smoke.

“If smoking pure, unadulterated tobacco were safe, yes, without a doubt, we would hear about it... from the tobacco companies,” writes Doroteo. “But we haven’t, and that’s because they cannot make such a claim, and there is no evidence to support such a claim.”

“It is tobacco itself that is harmful. Even non-smoked tobacco causes cancer and other diseases. Burning tobacco (i.e. smoking it) releases further carcinogens and toxic substances that cause further diseases. The Philippines’ own National Tobacco Administration has studies that prove that tobacco dust (a by-product) is effective as a molluskicide; it kills.

“Additives used by cigarette manufacturers serve various purposes: to mask the unpalatable taste and/or smell of tobacco and its smoke, to act as an anesthetic to make smoke less irritating to the throat of smokers, to increase absorption of nicotine by smokers, etc. There is research evidence that shows this. Unfortunately, we do not know what all these additives are, how much of them are used in manufacturing, or what they are used for. We require such ingredient disclosures for food, medications, soaps and shampoo, and many other household items, but NOT for cigarettes. In this sense, the tobacco industry is one of the LEAST regulated of all industries.”

According to Doroteo, the risk of premature death from chronic smoking is 50 percent. “One out of two regular smokers will die prematurely, an average of 10 years younger than their non-smoking counterparts. This means that if the average Ilocano lifespan was 65 years old, a regular smoker could die by age 55. This does not mean that entire populations will be wiped out. Even if all Ilocanos smoked (every man, woman, and child — which is thankfully not the case), only half of them would die prematurely.”

“Also, not everyone would die at the same time, and considering the positive birth rate, there will always be Ilocanos around (as well as other non-Ilocano Pinoys in spite of our high smoking prevalence rates).” “It has been proven that smoking causes cancer and many other diseases. There are various reasons for tobacco not having been banned, and definitely, the non-existent lack of conclusive evidence is not one of them.

“The Philippine government does NOT hold tobacco companies in ransom for huge government revenues. The fact is that tobacco companies make HUGE profits, whether or not the government imposes high tobacco taxes. This is true in all countries, including those with high taxes such as the US, UK, Australia, Singapore, and Thailand. This is even more true in the Philippines, where tobacco tax rates are not high at all (one cigarette costs only P1 - P1.50). Another fact is that whatever income is generated from tobacco companies is relatively much smaller than what it costs our economy when we consider health care costs and loss of productivity related to tobacco-related diseases; so who loses out really? A third fact is that it is actually the smokers who are held ransom by the tobacco companies, and it is the smokers who generate the taxes paid by tobacco companies. The companies are just middlemen who care only about their own profits.

“ I think the reader/writer meant to say ‘if a carcinogen is profitable enough.’ I don’t know if it is right to say that the government is willing to tolerate a large number of deaths, but the sentiment is probably right. For many government officials and legislators, this is about revenue, more than health or freedom. Just ask the congressmen from the Ilocos region. They are more than willing to protect and promote tobacco farming (not necessarily the farmers), so that they continue to get their share of the tobacco excise taxes, gifts and donations from tobacco companies, notwithstanding.”

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