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Gone in a puff of smoke

By Simon Chapman - posted Thursday, 30 December 2004


You'd have to have been asleep in a cave on Mars for 40 years not to have heard that smoking is harmful to your health.

Indeed, as the tobacco industry likes to point out, nearly all smokers have "heard" this message.

But how many agree with it, or are able to list more than one or two items on the very long list of diseases that have now been connected with smoking? Depressingly few.

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The idea that today's smokers are aware of the full magnitude of the risks they take has been repeatedly shown to be a fantasy. Most smokers have no idea what the probability of smoking killing them is, how these chances compare with other risks to their life, or how many Australians die each year from smoking-related diseases.

Also, how often have you heard smokers rationalise their smoking, with statements like, "I know it's bad but I play squash every Thursday night and get the tar out of my system."

New research just published in the international journal Preventive Medicine maps the extent to which Australian smokers cling to leaky life rafts like this.

The researchers, led by the NSW Cancer Council's Wendy Oakes, found there are three broad categories of excuses that remain disturbingly common among smokers today.

The first are "sceptic" beliefs. These are a set of beliefs that basically say, "I just don't believe it". For example, 14 per cent of smokers believe "lots of doctors smoke, so it cannot be all that harmful".

To the tobacco industry, a smoking doctor is invaluable reassurance fodder. But in fact, only 2 per cent of doctors smoke in Australia, the lowest rate in the community, with the possible exception of nuns and some religious groups that forbid smoking.

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Moreover, nearly one in four smokers today believes that "smoking cannot be that bad for you because many people who smoke live long lives".

While a smoking Fidel Castro or old Uncle Barney who still smokes at 80, fuel this image, they are the exceptions that prove the rule.

The lowest rates of smoking in the community are found in the oldest age groups (11 per cent of men aged 60 or more smoke, compared with 37 per cent of 20 to 29-year-olds). This is caused by a combination of quitting and "attrition" an oblique way of saying that many smokers have died by then.

Then there's the old favourite: that more lung cancer cases are caused by air pollution and diesel fumes than by smoking.

This belief was fuelled by a caravan of travelling scientific stooges who were brought out on speaking tours by the tobacco industry in the 1970s. They did a fine job because today one in four smokers agrees that air pollution is a bigger killer than tobacco.

The problem with this belief is that the highest rates of lung cancer are found in the remotest parts of the country with the freshest air, not in city suburbs adjacent to factories.

Why? Because smoking rates are highest in the bush.

The second category of excuses are "bullet-proof" beliefs. These rationalise that while smoking is harmful to most people, they are somehow "bullet-proof": that they have protective genes (14 per cent of smokers); that they don't smoke often enough to harm themselves (19 per cent); that scientists will have found a cure for cancer by the time they are old (16 per cent); that exercise and a good diet will help them avoid smoking-related risks (almost 33 per cent).

Sorry, guys, but scientists have been looking in vain for that magic cancer bullet for 50 years. Then there's the small problem of heart disease, which kills more smokers than cancer.

Those who bank on having "good genes" rather than those that make them susceptible to cancer face the same problem smoking causes multiple diseases, with lung and other cancers, heart disease, and chronic obstructive lung disease being the most prevalent. The combination of multiple susceptibility genes and multiple diseases means that all smokers will have at least one susceptibility gene for one or more smoking-related diseases.

So if you win on the cancer swings, you may well lose on the heart disease roundabout.

The third category of excuses are known as "life's a jungle" beliefs. This lumps smoking risks in with all the other dangers of life. An amazing 41 per cent of smokers take comfort in the idea that "everything causes cancer these days", while 56 per cent agree that "it's dangerous to walk across the street', and 46 per cent believe "smoking is no more risky than lots of other things that people do".

In this way, news of the latest reports on smoking scares can be blithely dismissed as just more confirmation that life's a jungle. And you can't go through life worrying about all these risks that doctors go on about, right?

So just how dangerous is smoking compared to walking across the road?

Most of us cross at least one road each day. In the year to July 2004, 246 pedestrians were killed in Australia. In a population of 20 million, that means each of us has a one in 81,300 chance of being killed as a pedestrian each year.

If we assume that we each cross four streets a day on average, then the probability of being killed on any one crossing is 1 in 325,200 - far worse than winning first prize in the lottery. Still, the rationalisation trips easily off the tongue.

The most famous study examining the risks of smoking is Richard Doll's study of 34,439 British male doctors, which he commenced in 1951. This year he published his 50-year follow-up in the British Medical Journal. He concluded that up to two-thirds of the continuing smokers in his study had died from diseases caused by smoking, on average about 10 years younger than lifelong non-smokers.

But his study had some important good news too: that if you stopped smoking at age 60, 50, 40, or 30, then you gained, respectively, about three, six, nine, or 10 years of life expectancy.

About 19,000 smokers in Australia die each year from smoking-related diseases, about 4200 before retirement age.

That's more than all deaths from road injury, alcohol, illicit drugs, skin cancer, suicide, and breast cancer combined.

If a person smokes 18 cigarettes a day for 40 years, they deep baste their lungs with the toxic smoke from 262,980 cigarettes. A cigarette typically takes 5.6 minutes to smoke. If you add up all the time they spend smoking it comes to 1023 solid days or 2.8 years smoking.

Doll's research shows that the average lifetime smoker loses 10 years of life. So next time you suck on a cigarette, ponder that the time it takes you to smoke it takes more than 350 per cent of that time off your life.

Quitting smoking is the single most important thing anyone can do to improve their health. There are now many more ex-smokers in the community than smokers. This holiday season is a great time to join them.

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First published in the Australian Financial Review  December 16, 2004.



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About the Author

Professor Simon Chapman is professor of public health at the University of Sydney and author of Over Our Dead Bodies: Port Arthur and Australia's Fight for Gun Control.

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