Is cigarette smoking really bad for the health?

All medical symposia that I have attended whether the topic is about diabetes, hypertension or coronary heart disease never fail to state the fact that cigarette smoking is a major risk factor for heart disease among others and should be avoided. Even the media warns us that it maybe dangerous to one’s health.

A few months ago I attended another medical conference held in a plush Makati hotel that was packed to capacity by physicians. The meeting was about a new drug that will break the smokers’ addiction to nicotine. There were five speakers, four medical doctors of varied specialties and a Doctor of Philosophy (PhD). The latter was the guest speaker, a foreigner and spoke last. He is well known for his work in this field and has written numerous papers and gave lectures all over the world about it. In the three-hour meeting or more there was only one convincing message conveyed to all of us — stop smoking, it kills and leads to premature deaths. It was a very fruitful and informative meeting.

Movies are not to be left behind in condemning cigarette smoking. Recently I watched a movie where Oscar winner and celebrated American actor Morgan Freeman told a companion — “I see you are still smoking that death stick”. What an impact to the audience. And who can forget another Oscar holder Yul Brynner who was quoted to say in his final agonal moments from Chronic Obstructive Pulmonary Disease — that “had I known I wouldn’t have touch a stick of it”.

The medical meeting did not fail to mention the famous commercial about a cowboy endorsing a well known brand of cigarette. The ad was so well done — the country backdrop, music, the handsome well trimmed cowboy and his horse and the roasting of meat. Unfortunately he died of lung cancer. Was he a heavy meat eater too? I will come to this point later.

The open forum came and one of the questions from an audience reactor was why vegans and fish eaters who smoke have a significantly lower all cause mortality compared to meat eaters who also smoke. Remember our cowboy. No satisfactory answer was given.

The question was formulated from a British Medical Journal article published in 1994 by Thorogood and associates from Oxford University and New Zealand. The paper was a 12-year prospective randomized controlled trial consisting of two arms with about 5,000 enrollees each starting in 1982. The study involves meat eaters and vegans, the latter included Seventh Day Adventists. The smokers in each group were categorized into light smokers (average of 11 sticks a day) and heavy smokers. The all causes of deaths among the non-meat eaters (vegans) who were light smokers were significantly lesser by 20%.

There is no similar paper published in 2006 to this year to equal this 12-year study. Would a shorter study of 3-5 years duration suffice but with 20 to 30 thousand subjects or more enrolled. Many drug investigations with the latter methodology have fallen along the wayside because of morbid or mortal events. There is no substitute for a long follow-up in this type of study.

Another investigative work that casts a less morbid opinion of cigarette smoking and possibly a way to circumvent the current fixation on its unhealthy use is the famous and often quoted Danish Steno study published in the New England Journal of Medicine in 2003 after 7.8 years of follow-up and again this year in the same journal after 13.3 years. Truly a remarkable feat for the doctors involved. The Steno study is a randomized controlled trial of parents with Type II diabetes with mild kidney involvement in the form of slight urine protein erection. The ethical study consisted of multi-factorial intensive and standard treatments of the 2 arms of the investigative work. A non-significant difference of 40 and 47.3% of the patients smoke in both arms respectively. The smokers were not quantified into light and heavy users of tobacco. The all cause mortality in the intensively treated group was significantly lower than the group who received standard treatment (31.2 vs. 52.5%).

What could have caused the remarkable difference in deaths in the 2 groups despite the same smoking incidence. Both were on a low protein diet (17.5 grams/day), exercising and have the same body mass indices. Diabetic control was fair even in the intensively treated group. The mean HBAIC levels (average of fasting blood sugars for the past 3 to 4 months) for both groups were 7.7 and 8.0% respectively. (Normal 6.0 to 7.0%).

The remarkable difference in the non-blood sugar lowering drugs maybe the answer. Eighty five to 91% of the intensively treated group received angiotensin antagonists, statins, aspirin and micronutrients in contrast to the other group where only 22 to 70% of the patients received the same drugs minus the micronutrients. What micronutrients were given daily? Vitamin C 250 mgs., Vitamin E 150 units, Chromium picolinae 100 mcgs. And Folic acid 400 mcgs.