Australia - The Nanny State

One of the most common complaints you’ll hear from cigar smokers in Australia is the increasing heavy-handedness of State legislation. It’s one things to ban smoking of any kind from places likely to be frequented by non-smokers, such as restaurants, sporting facilities, and offices. It’s entirely another thing to ban smoking cigars in a dedicated cigar club. If I may be permitted a loose analogy, it is like banning street prostitution and then also lumping into the legislation banning sex between consulting adults in a brothel. Brothels are legal in most Australian states but smoking cigars in a cigar club is not? That doesn’t make much sense to me.

Like many cigar smokers I know, I have never been a cigarette smoker. Therefore, I am quite conscious that many people (myself included) do not like secondhand smoke. I don’t like to smoke cigars in public places where it might offend. Only an asshole would want to stick their cigar smoke in other people’s faces. As much as I don’t understand why people don’t appreciate the aroma of a premium cigar, I would never wish to force it upon them, any more than I would try to force a tee-totaller to drink a finger of Talisker.

Which is all the more reason to have dedicated venues for cigar smokers.

As I understand it, the main reasons for the introduction of heavier smoking restrictions are as follows:

1. Protecting non-smokers from secondhand smoke.
2. Protecting smokers from themselves.

The first point is obvious and I doubt many of us would disagree.

The second point is more troubling.

In a free society, it seems that people should have the right to eat, drink and smoke whatever they choose, as long as they aren’t hurting others in the process. The excuse used by governments to curb smoking is the burden on the public health system, which is reasonable, but does this apply to cigars?

The science conclusively says NO. The most comprehensive report on the subject (which I’ve blogged about before), a 1998 report called “Cigar Smoking: Overview and Current State of the Science” by David M. Burns that is published on the U.S. National Cancer Institute’s site, is very clear on the subject:

The pattern of excess disease risk among cigar smokers is not identical to that observed in cigarette smokers. Mortality ratios among cigarette smokers are much higher than those among cigar smokers for coronary heart disease, COPD (Chronic obstructive pulmonary disease) and lung cancer.

An explanation for the difference in mortality pattern between cigarette smokers and cigar smokers lies in differences in the depth and likelihood of inhalation of tobacco smoke between these two groups of smokers. Most cigarette smokers report inhaling the smoke into their lungs, while over three-quarters of the males who have only smoked cigars report that they never inhale.

The fraction of adult cigar smokers who smoke cigars every day is much smaller than the fraction of cigarette or smokeless tobacco users who use every day. This suggests that cigar smoking among adults, while probably able to cause addiction to nicotine, is less likely to do so than cigarette smoking or smokeless tobacco use. Data from California, which show that the recent change in cigar use among adults is largely an increase in occasional use, also suggests that the addictive potential of cigars is lower than that for cigarettes.

When cigar smokers don’t inhale or smoke few cigars per day, the risks are only slightly above those of never smokers.

So it seems clear that suggesting the risks associated with smoking cigars is the same as smoking cigarettes is not based on science. It’s like saying that the risk of riding a motor bike is the same as flying in a commercial plane. It just doesn’t work that way.

Unfortunately, cigars are regularly being subjected to bad science and bad journalism.

A few months ago, Parade magazine ran an article called “The Dangers of Pipes and Cigars”. In the article, they reference a report done recently by Columbia University which, the article claims, showed that “smoking pipes or cigars doubled the odds of having an airflow obstruction.”

If this were indeed true, many of us would have to seriously reconsider our cigar habits.

The problem many cigar smokers have with this report, however, is that it is based on fluffy science.

As Smoke Magazine pointed out recently:

The Columbia study contained no new research, but an examination of a previous study that included just 56 individuals who smoked either cigars or pipes and did not smoke cigarettes.

Moreover, the study itself says “few participants smoked pipes or cigars…Effect estimates in this group were therefore relatively imprecise…” No kidding; what the survey actually showed was that among cigar-only smokers, the odds for decreased airflow to the lungs increased a trivial 1 percent when adjusted for age, race, sex, and height, and were 37 percent less than non-smokers when more carefully adjusted for 13 factors also including body mass, education, family history, and so on.

Additionally, the study report states “no U.S. studies have reported on the possible effects of cumulative pipe and cigar smoking on lung function.” This is wrong. In fact, the impact of cigar smoking was exhaustively reviewed by the National Cancer Institute in its monograph on cigars published in 1998.

Incidence of Chronic Obstructive Pulmonary Disease (COPD) was examined using the American Cancer Society’s massive CPS-I study, which included 15,072 cigar smokers. The result? For those who smoked an average of 1–2 cigars per day, there was no impact at all vs. non-smokers up through age 64, and for those who do not inhale, no impact through age 79!

Now consider that in the U.S. in 2009, smokers of all types of cigars averaged just 2.93 per week and smokers of handmade, premium cigars averaged a grand total of 1.59 per week!

But the CPS-I results are nowhere mentioned in the Columbia “study.”

As I’ve said on the blog before when I covered the CPS-I study, I take my health very seriously and so I’m always keeping an eye out on the latest science on cigars and health. It is unfortunate that a lot of the media coverage on the subject is pretty fluffy and either out-right biased or based on bad science.

According to the BBC:

Mr Robaina, the only person to have a brand of Cuban cigars named after him, had been a roving ambassador for the country’s state-run cigar industry.
But more typically, he could be found on his small farm in the Vuelta Abajo region of western Cuba, tending his beloved tobacco plants.

As Jason tweeted:
They were right!! Cigars must be bad for your health. Don Alejandro Robaina dies at the young age of 91. May he RIP.

Of course the answer is ‘yes’. Cigars are made of tobacco. Smoking tobacco in any form is going to have health consequences.

However lots of things are bad for your health if you indulge in them too often – alcohol, Big Macs, chocolate, ice cream, coffee, cheese – however, in moderation, the risks are minimized.

Is that same true for cigars?

According to the most comprehensive report completed on the subject, the same report referenced by the U.S. National Cancer Institute:

“When cigar smokers don’t inhale or smoke few cigars per day, the risks are only slightly above those of never smokers.”

(page 8, paragraph 2).

But how can that be? Aren’t all tobacco products equally as dangerous?

It seems to depend a lot on how many cigars you smoke each day and whether or not you inhale.

According to the research, most cigar smokers only indulge occasionally.

From the report:

The fraction of adult cigar smokers who smoke cigars every day is much smaller than the fraction of cigarette or smokeless tobacco users who use every day.

Most cigar smokers also don’t inhale.

Most cigarette smokers report inhaling the smoke into their lungs, while over three- quarters of the males in CPS-I who have only smoked cigars report that they never inhale.

So, in terms of health risks, the majority of cigar smokers fall into the summary quoted up top:

“When cigar smokers don’t inhale or smoke few cigars per day, the risks are only slightly above those of never smokers.”

Okay, let’s look at what the scientists have to say.

The report I referred to at the beginning is called “Cigar Smoking: Overview and Current State of the Science” by David M. Burns that you can find on the U.S. National Cancer Institute’s site. This report is the most comprehensive scientific study of cigar smoking and is referenced by most cancer councils (including in the US and Australia).

The report says that cigar smoking can be very dangerous to your health under certain circumstances. So, if you *are* going to smoke cigars, then please make sure you are aware of the risks.

1. Don’t Inhale.

“Cigar smokers who inhale deeply, particularly those who smoke several cigars per day, have higher rates of coronary heart disease and chronic obstructive pulmonary disease (COPD).”

2. Avoid Breathing In Cigar Smoke

“Tobacco smoke produced by cigars contains most of the same toxic and carcinogenic constituents found in cigarette smoke.”

So if you are going to smoke, do it either outside in a well ventilated area, or do it in private rooms with extraction fans.

3. Risks of Oral Cancers Go Up

Other Studies – Centenarians In Cuba

When we were in Nicaragua recently, we met a couple of old Cuban men in their late 70s who had been smoking cigars every day all their lives and they are as fit as a bull. These gentlemen spent most of their lives in the cigar business and certainly don’t think cigars are bad for your health. A 2006 report on centenarians by Dr Nancy Nepomuceno in Cuba claimed that

“Cuba’s high number of centenarians say their longevity is down to laying off alcohol, but indulging in coffee, cigars and sex.”

Think about some of the most famous cigar smokers of all time:

Winston Churchill – Died Age 91. The man for whom the imposing Churchill cigar size is named smoked eight to 10 cigars a day.

Fidel Castro – currently 84. Until he gave up the habit in 1985 (to try to reduce cigarette smoking in Cuba), the man who has ruled Cuba with an iron fist for 50 years was synonymous with cigars.

George Burns – Died Age 100. Credited his 10- to 15-cigar-a-day habit over a 70-year span with not only keeping him spry on stage but also with helping him outlive his physician.

Groucho Marx – Died Age 87. Rarely seen without a cigar.

Sigmund Freud – Died Age 83. He began smoking at 24, enjoyed an average of 20 cigars a day, and was rarely photographed without his tobacco companion.

Mark Twain – Died Age 85. The author of The Adventures of Tom Sawyer and The Adventures of Huckleberry Finn smoked at least 22 cigars a day, maybe as many as 40. Twain, née Samuel Clemens, supposedly once declared, “If smoking is not allowed in heaven, I shall not go.”

Orson Welles – Died Age 70. Welles was a lover of the good life, especially fine cigars; he intentionally wrote cigar-smoking characters, such as Touch of Evil’s police captain Hank Quinlan, into his films.

Charlie Chaplin – Died Age 88.

Conclusion

Let me end this post by repeating what I think are the main points we all need to know regarding cigars and health.

1. Cigars are made of tobacco. Tobacco isn’t good for you. So if you are going to smoke cigars, do it in moderation, the same way you might eat pizza, cheese and chocolate. Or the same way a sensible person drinks alcohol or coffee. Be sensible.

2. According to Burns’ report, “When cigar smokers don’t inhale or smoke few cigars per day, the risks are only slightly above those of never smokers.”

3. Avoid environmental smoke by smoking cigars outdoors or by making sure you smoke in a very well ventilated room.

I’ll report back when more evidence comes out about moderate cigar smoking. Until then, enjoy your cigars in moderation, folks!