Friday, May 28, 2010

The smoking toddler and anti-smoker opportunism

Child welfare advocates, and the general public, are outraged at the story of a two year old Indonesian boy who allegedly has a two pack a day smoking habit. A video clip of the chubby youngster engaging his habit was posted to You Tube, but has since been removed.

Tabloids around the world are expressing shock and anger over the "disgusting" and "disgraceful" situation. And, the internet is lit up like a Christmas tree with accounts of the two year old nicotine “addict”. When I Googled “the smoking toddler”, I got 374,000 results in 26 seconds. I'm not at all sure if Barak Obama got that much press when he was elected President.

And, what has most people upset, and searching for a supply of tar and feathers, is the disclosure that his father apparently admits to giving him his first cigarette when he was only 18 months old. And, according to his mother the youngster is "totally addicted. If he doesn't get cigarettes, he gets angry and screams and batters his head against the wall."

But, while there can be no debate that the father's actions were the embodiment of stupidity, especially from a North American standpoint, I think calls for castration, or even tar and feathers, are a little extreme.

The father's actions were indefensible, and he'll likely pay for his folly through the justice system. Heru Kasidin, a spokesperson for the Women's Empowerment and Child Protection Ministry in Indonesia, says an investigation is underway.

But, as revolting as the father's actions may have been, I regard the reaction from some anti-smoker activists over this one-in-a-million situation as equally abhorrent. For there are some who apparently intend to use the abuse of this child as a propaganda tool to promote their anti-smoker agenda.

For example, Heru Kasidin, when announcing the investigation into the parents of the child offered that “weak regulations surrounding the tobacco industry had enabled [tobacco] companies to target young people.”

But, neither the tobacco companies nor their marketing strategies had anything to do with this incident. The child was not lured into experimenting with cigarettes after being exposed to a “powerwall” behind the cash register at the local “Mac's Milk”. He didn't pick up his habit watching Sigourney Weaver light up on screen. He's not smoking because he liked the pretty packaging or because he saw some adult puffing on a fag in a public park. He wasn't sold cigarettes by an undisciplined or inconsiderate store clerk.

If he's addicted to cigarettes, it's because a misguided father was derelict in his parental responsibility. And, for some anti-smoker advocates to try and re-direct public loathing of the father's actions to the tobacco companies is opportunism at it's most objectionable.

An article by Mary Elizabeth Williams in Salon says: “A child's welfare is still first and foremost his parents' responsibility. But before we get too comfortable in the knowledge that we'd never even expose our own babies to cigarettes, let alone hand them a pack, maybe we can redirect a little of that indignation toward a profitable industry that's worked so hard to pour smoke down those little lungs”.

But, the tobacco companies didn't pour smoke down those little lungs. His father did.

People are justifiably sickened by the father's irresponsible conduct. They should be. As a father of three (and grandfather to seven), I'm as angry as anyone that a parent would indulge in such abusive behaviour.

But, let's not let the emotional nature of the incident cloud our judgment. Let's not lose sight of the fact that the guilty party was the parent who taught this youngster to smoke in the first place; the party who paid to support his child's alleged two pack a day habit.

Get the youngster the help he needs and stop the opportunistic political posturing.

Wednesday, May 26, 2010

Usurious tobacco taxes a criminal enterprise

As noted in my last post, the sale of contraband tobacco products, mostly cigarettes, is a growing concern here in Canada where sales of illegal (untaxed) tobacco in Ontario are now estimated at 50% of the market. And bootleggers, once confined largely to Ontario and Quebec, appear to be expanding into other provinces across the country.

The black market is driven by extreme (and extremely punitive) levels of taxation imposed on legal tobacco products. And the growing market in contraband, in turn, has generated some serious social and economic problems.

The huge black market has a negative impact on sales of legal (over-taxed) tobacco, meaning reduced income for tobacco manufacturers, wholesalers and retailers, and less tobacco tax revenue for government. It means cheap contraband tobacco is available to young people who would not have access to the legal product. In addition, more and more police resources are required to combat the “criminal activity.”

A commenter on my previous post rightly suggested that the problem of contraband is international in scope. He points to a series of raids in Manchester, England where substantial amounts of illegal and counterfeit tobacco products were seized. Similar raids have been conducted here in Canada (and other parts of the world). They're usually announced via a press conference with maximum publicity.

Feeble (and futile) attempts to scare the populace and discourage participation in contraband activity.

In reference to the Manchester raids, Graham Forbes, from HMRC (Her Majesty's Revenue and Customs) claimed: "The unregulated sale of illegal cigarettes and alcohol is not a victimless or harmless crime, and encourages otherwise honest people to trade with criminals.”

But what the bureaucrats and politicians around the world refuse to acknowledge is that what “encourages otherwise honest people to trade with criminals” is the felonious level of taxation (read extortion) demanded by governments to engage in a perfectly legal activity – the consumption of tobacco by an adult population.

In jurisdictions around the globe, extortionate levels of taxation are leading tobacco consumers to seek alternate, less costly, sources of supply. They're left with little choice; either pay the legalized extortion demanded by greedy governments and their puppet masters in the anti-smoker cult, or turn to the more reasonably priced product offered on the black market.

I've made my choice. And so have hundreds of thousands of other, adult smokers in Canada and (likely) millions globally. Smokers are beginning to realize that extortion is a criminal act, whether perpetrated by governments or mobsters. And, they're beginning to rebel against the criminal activity of their governments.

The question is; why do governments insist on ever-increasing levels of tobacco taxes when the adverse consequences are so readily apparent? Why the insistence on treating smokers like social outcasts and second class citizens for engaging in a legal activity from which governments derive a substantial amount of revenue?

The facts are that governments around the globe have bought into the bullshit and bafflegab of militant anti-smoker fanatics and their continuing experiments in behaviour control. Smokers, they were told, wanted to quit. They just needed a little “encouragement”. And, according to the anti-smoker cult, penalizing smokers financially is the most effective way to encourage them to give up the habit.

And, of course, revenue generated by increased taxes could result in additional funding for other anti-smoker initiatives to harass and de-normalize smokers.

But, smokers aren't quitting in droves in response to ever-increasing taxes. Instead, in growing numbers, they're buying their smokes from the trunk of a car rather than their friendly neighbourhood convenience store. Legitimate retailers are losing money. Some dealers in contraband are becoming wealthy. They're also being seen as champions by many ordinarily honest people who are determined to resist government attempts to force them to change their personal lifestyle behaviours.

But, despite evidence from jurisdictions around the world that usurious levels of tobacco taxation have serious, unintended social and economic consequences, the anti-smoker cult continues to push for increasing levels of tobacco taxation at every opportunity. And, greedy politicians, blinded by dollars signs, appear ready and willing to support the anti-smoker crusade.

Tax increases bring in some additional revenue in the short term, but it is seldom sustainable as smokers turn to black markets which are sure to emerge, bringing undesirable and unnecessary social and economic problems.

In Ontario, tobacco tax revenue was $493 million in 2000/2001. By 2004/2005, following a series of draconian increases, provincial tax revenue had tripled to $1.45 billion. By 2008/2009 Ontario's tax revenue had dropped to $1.04 billion. And, the decline in revenues continues as more and more smokers resort to the flourishing black market to supply the demand for a legal product at a reasonable price.

Maybe if gullible politicians were to use some common sense instead of relying on the morally bankrupt policies of the anti-smoker cult . . .

No, it'll never happen.

Friday, May 21, 2010

Smokers; the real victims of punitive tax policy

According to Canadian Senator Hugh Segal, the growing market in contraband tobacco is the crime of the century.. “This may be the crime with the largest number of victims of any crime committed in this country." Uh-huh.

Crime? Victims?

I certainly hope he's not including me in his list of “victims.” When I can visit a first nations community and pick up a months supply of the demon weed for a third to a quarter of the cost demanded by the tax man, am I being victimized? Really?

When I make my monthly purchases, I may be engaging in criminal activity, but, I don't feel like a criminal. Instead, I feel a sense of empowerment. I'm striking a blow for liberty by refusing to pay the extortionist levels of taxation demanded by opportunistic and tyrannical politicians. And, I'll be damned if I'm going to feel guilty about it.

In another place and another time, I might have been tempted to seek out a boatload of the stuff just so I could toss it into Toronto harbour. And, as I watched the stuff sink slowly into the waters of Lake Ontario, I'd be screeching like a banshee: “No taxation without representation.” Or maybe something more appropriate, like: “Fuck you, Segal, and the horse you rode in on.”

OK, in all honesty, I most likely would not toss it all into the drink. I'd probably confiscate a portion for personal use. But I suspect most people will get my point.

Segal may be right in his claim that some criminal elements are profiting from the sale of contraband (read untaxed) tobacco. But the criminals did not create the problem. They were/are simply responding to an opportunity created by greedy governments who sought to impose a form of backdoor prohibition on tobacco use while filling government coffers with the money extorted from smokers.

The black market in tobacco exists because a demand exists. And, if the government refuses to allow legitimate business enterprise to supply that demand at a price the public is willing to pay, then the public will seek alternate sources of supply. And, they will feel perfectly justified in doing so. I know I do.

It's not rocket science. The fundamentals are taught to first year college students in Economics 101. And, when governments ignore rudimentary economic principles, they do so at their peril - although it's the taxpayer who usually gets screwed.

"If we do not act, we avert our eyes from an illegal activity that harms young people, reduces tax revenues, hurts First Nations, hurts the credibility of the police, harms our health care system and population health, hurts small business and hurts the very integrity of our borders." Segal's comments, made on the floor of the Canadian Senate, identifies those he considers “victims”.

Not a word about Canada's 5 million tobacco consumers who bear the financial burden of ill-conceived tax policy and who are never consulted when tobacco policy is discussed; the 5 million Canadians disenfranchised to placate the loud mouth bigots in the Holy Church of the Anti-Smoker.

But, if government is so concerned about the economic impact of the black market on tobacco retailers, convenience store owners, tobacco manufacturers, etc., then the Senate should have given some serious second thought to the implications of a tax policy designed to penalize 5 million of their constituents.

Were they so blinded by the bullshit and bafflegab of the anti-smoker crowd that they couldn't anticipate the adverse consequences? Don't they understand the basic laws of supply and demand? Didn't they realize that their actions would create a black market whose sole objective is profit? That this would compromise the best interests of our young people?

Says Segal: “If we permit all of this [to] happen, we are saying that the rule of law - fundamental to how a democracy balances freedom and order - is actually negotiable, or worse, a side-car afterthought." Political posturing.

For there's another rule, ignored by Segal and the majority of the politicians anxious to kiss the collective ass of the anti-smoker crowd. It's also fundamental to how a democracy balances freedom and order. It's the understanding that democracy is not simply bowing to the demands of the majority. A true democracy must also protect the rights and privileges of the minority, despite the protests of the "majority".

The tyranny of the majority is a very real concept. And, tyranny should be, must be, opposed whenever and wherever it raises its ugly head.

Screw'em. I'll use some of the 5 hundred dollars I save every month by buying contraband to pick up a bottle of Gordon Highlanders. I'll sip my whiskey and smoke my cigarettes and chuckle at the politicians who whine and cry over a situation for which they alone are responsible. And, I'll feel no guilt for my anti-social behaviour.

The senate, it is claimed, is the government chamber of sober second thought. There's nothing like a little comedic relief to brighten your day. Unless, of course, it's a glass of decent Scotch . . .

And a good smoke.

Monday, May 17, 2010

Smoking myths examined - with a jaundiced eye

Usually when I surf the web, I do it with a purpose; looking for something specific. But sometimes I just follow links, never knowing where I'll end up or what I'll find along the way. Often, I'll come across something that's good for a laugh, if nothing else.

For example, a few days back I came across a strange, anti-smoker comment on the web. A woman was complaining that she could smell secondhand smoke from a vehicle passing her on the highway at 65 miles an hour and wondering why smokers couldn't have the courtesy to roll up their windows when smoking in their cars. That woman must have had one hell of a schnoz. Jimmy Durante would have been envious.

At any rate, while blundering around the net last week, I came across an article by Christopher Wanjek titled “ Smoking's Many Myths Examined”, written in November, 2008.

Wanjek notes that: “Surprisingly, fewer than 10 percent of lifelong smokers will get lung cancer. Fewer yet will contract the long list of other cancers, such as throat or mouth cancers. In the game of risk, you're more likely to have a condom break than to get cancer from smoking.” Uh-huh.

Of course, the fact that 9 out of 10 smokers will not die from lung cancer is unlikely to instil the requisite fear in the smoking population. So, as Wanjek notes, the statistics are twisted to make them even more alarming; smoking accounts for 30 percent of all cancer deaths; 87 percent of lung cancer deaths are attributable to smoking; etc, etc.

Wanjek notes that, to the average smoker, these figures are meaningless. He points out that: “The Internet is rife with pro-smoking sites dismissing these kinds of facts.”

I suppose he means blogs like this one. But, the inference is that we are dismissing “facts”, rather than questioning the propaganda of the anti-smoker crowd who tend to spin the facts beyond recognition. Perhaps if the facts about smoking, as presented by the anti-smoker crowd, were a little more consistent, a little more honest, there would be nothing to question.

For example, the claim that smoking causes 85% to 90% of lung cancer. The last figures from Health Canada show only 78% of lung cancer deaths were attributed to smoking. Isn't 78% scary enough?

In 2006, Health Canada (and everyone else in the anti-smoker brigade) was claiming over 47,000 Canadians were dying every year from smoking. By the end of 2007, there were only 37,000 deaths attributable to smoking. And, although Health Canada acknowledged using faulty data for years, some anti-smoker groups are still using the inflated numbers.

In 2004, the US Surgeon-General declared that the evidence was sufficient to declare a causal association between cervical cancer and smoking. Apparently, the SG (and Health Canada) were both wrong.

Wanjek begins his article by pointing out that: “Scientists have succeeded in associating the habit with everything from countless cancers to bad-hair days, or so it seems with some reports.” Interesting. But, I must admit, I haven't read the study on bad hair days.

Then later, he bemoans the fact that 43 million Americans continue to smoke. “Part of the problem of the misconception of real risks is the emphasis on smoking and lung cancer. The greater danger is from vascular diseases leading to heart attacks and stroke, which kill more smokers than all cancers combined.”

And, he may be right. But, then again . . .

Alas, he shoots himself in the foot when he claims that: “Rarely are simple messages heard, such as the fact that about half of all smokers will die from smoking, and of these, about half will die before or around age 50. These numbers come from a landmark 50-year study of physicians in England, initiated in 1951.”

I suspect he's referring to Doll and Hill's famous (or infamous) “British Doctors” study. I must have missed the part about half of smokers dying “before or around age 50”. Even Health Canada doesn't have the audacity to make that claim.

He also says: “The life expectancy for a smoker in the United States is about 64, which is 14 years shorter than the national average (which includes smokers), according to the Centers for Disease Control and Prevention.”

If such is the case, the US must be using a much more deadly blend of tobacco than we do up here in the Great White North. Health Canada puts the average age for smoking attributable deaths at just under 72.

Using Health Canada's Smoking Attributable Mortality (2002) data, we can see that, of the lung cancer deaths attributed to smoking, 56% occurred after the age of 70. And, for the record, 56% of deaths from lung cancer which were not attributed to smoking also occurred after the age of 70.

But, what about the other “smoking related”diseases mentioned by Wanjek? Maybe smokers are dropping like flies from “vascular diseases leading to heart attacks and stroke” before celebrating their fiftieth birthday?

Actually, no. As near as I can tell from Health Canada figures, over 70% of smoking attributable deaths occur after age 65. In every disease classification save one, over 50% of smoking attributable deaths occur after age 70, with 93% of smoking attributable deaths from atherosclerosis and 81% of those from COPD occurring after 70 years of age.

In fact, for atherosclerosis and COPD, the percentage dying past 80 years of age is 57% and 52% respectively. For pneumonia and influenza, the percentage dying at 70 plus is 89%, with over 71% dying past the age of 80.

So, Wanjek's claim that over half of smokers who die of smoking related diseases do so “before or around age 50” is shown to be grossly exaggerated. In fact, it's complete bullshit. He misses the mark by 20 years.

Anti-smoker zealots, it seems, never tire of the bullshit and bafflegab.

Wednesday, May 12, 2010

More anti-smoker hypocrisy & conflict of interest

I visited the web site of the American Lung Association earlier this week. They've launched a new anti-smoker campaign called “The Quitter in You” with funding from Pfizer Inc, the manufacturer of various smoking cessation products. And, the ALA is promoting NRT (Nicotine Replacement Therapy) and other drug therapy as the key to quitting.

I was following the links provided in a post by Dr. Michael Siegel on his blog “The Rest of the Story”. Siegel was pointing out the hypocrisy (and the financial conflict of interest) of the ALA in their promotion of drugs as a means of quitting smoking and all the while taking millions of dollars in funding from the pharmaceutical industry for their efforts. At the same time, they are actively engaged in a campaign to have the FDA ban electronic cigarettes, a product which threatens drug company profits from the sale of smoking cessation drugs.

It makes you wonder if the ALA, ACS and their allies in the anti-smoker brigade are promoting smoking cessation or peddling drugs.

Nothing particularly earth-shattering in that bit of news. This blog and others have been pointing out that the anti-smoker brigade has been heavily funded by the pharmaceutical industry for years.

The anti-smoker crowd promotes smoking bans and de-normalization to force smokers to quit; the drug companies rake in the profits from smoking cessation products sold to smokers trying to quit. Then the drug companies funnel a portion of the profits back to the anti-smoker zealots to push for more smoking bans, punitive taxes and the further de-normaliztion of smokers to force even more smokers to quit and buy even more drugs.

A vicious circle.

Another claim on the ALA web site that caught my eye was the assertion that: “Smoking cost the United States over $193 billion in 2004, including $97 billion in lost productivity and $96 billion in direct health care expenditures, or an average of $4,446 per adult smoker.”

This has been a standard strategy used by the anti-smoker crowd to garner support from non-smokers for decades. Use the high cost of treating “smoking related diseases” to generate anger against smokers for the financial burden they allegedly impose on society.

The numbers for “lost productivity” are, in my humble opinion, especially suspect; based on assumptions and statistical manipulation and unverifiable in the real world. The statistics raise a lot of questions. For example, does a 55 year old worker take more or fewer smoke breaks than a 68 year old retiree? Which one costs the employer more in lost productivity? Does the 68 year old retiree call in sick as frequently as a 35 year old? Have you ever known anyone to call in sick because they had too much to smoke the night before?

How exactly do they estimate "lost productivity" for the over 65 crowd? The under 65 crowd? Do they just pluck the damn numbers from someone's posterior? Would numbers plucked from some anti-smoker's ass be any more or less reliable than the method they do use to calculate the costs due to “lost productivity”. Yeah. I know . . . silly questions.

Of course, that still leaves direct medical costs of roughly $2,200 per adult smoker; a cost which is allegedly borne by the non-smoking taxpayer. But, is it? Really?

Everyone seem to forget that smokers are taxpayers too. And, here in Canada, smokers pay much more into the system than they take out. In a May, 2008 blog entry, I noted: “In fact, not only do smokers pay for their own health care, they contribute roughly $83 annually towards the health care costs of every man, woman and child in the country.” And those calculations used data provided by the anti-smoker zealots at Physicians for a Smokefree Canada.

I suspect the numbers aren't that much different in the US, once adjusted for their unbelievably high health care costs. From Wikipedia: “the latest figures showed that the US spent $2.5 trillion, $8,047 per person, on health care in 2009”. The same source claims per capita health care costs in Canada were $4,089.

The Wikipedia article on health care costs in Canada notes that: “Of the three biggest health care expenses, the amount spent on pharmaceuticals has increased the most.” The amount spent on medications increased from $1.1 billion in 1975 to $26.5 billion in 2009. Uh-huh.

And, the anti-smoker crusaders want the government to fund smoking cessation drugs which will, in turn, increase drug costs. And, naturally, they'll blame the resulting increases in drug spending on smokers. And, they'll demand more pressure be put on smokers to force them to quit, thus generating more profit for the drug companies who will provide further funding to their partners in the anti-smoker crowd to further harass smokers.

Same vicious circle.

The Wikipedia article also notes health care costs in Canada are greater for those at “extreme” old age and the newborn ($17,469 per capita in those older than 80 and $8,239 for those less than 1 year old). I suspect a similar situation exists in the States

I wonder how they'll manage to blame that on smokers. Maybe they'll just ban growing old.

Thursday, May 6, 2010

Anti-smoker hijinks? A case of disappearing data

I spend a lot of time surfing the web, researching articles for this blog. I want to be as accurate as possible in the information I present to any readers who happen by and linger long enough to actually read what I write. I don't always get it right and I readily admit to a measure of bias in my interpretation of some of the evidence.

Part of the problem is the inconsistency in the evidence, or, more precisely, the interpretation of the evidence.

For example, I don't have hair growing on the palms of my hands and my vision is 20-20. One could conclude from that evidence that: a) I have never engaged in self-gratification, or; b) Masturbation does not cause hairy hands or blindness.

And, despite the claims of the anti-smoker cult, the scientific evidence on smoking and secondhand smoke is also open to interpretation; like most science, it's tentative, rather than definitive.

In 2004, the Surgeon General of the US added uterine cervical cancer to the list of those for which evidence was allegedly sufficient to conclude a causal relationship between smoking and the disease. Health Canada used the claim to justify the addition of cervical cancer to their list of smoking related diseases. Their 2007 SAMMEC report (Smoking Attributable Morbidity and Mortality Economic Costs) claims that 126 of 382 deaths (34.7%) from cervical cancer were caused by smoking.

As it turns out, there is even stronger evidence to suggest that HPV, not smoking, is the cause of most, perhaps all, cases of cervical cancer.

In fact, the Health Canada website (now) states unequivocally that: “HPV causes almost all cases of cervical cancer.” They also note that: “Infection with human papillomavirus (HPV) increases your risk [of cervical cancer] 20 to 100 times.”

Even the Canadian Cancer Society (still) admits: “The most important risk factor for developing cervical cancer is infection of the cervix with human papillomavirus.”

Both of these claims appear to exonerate smoking as a cause of cervical cancer. Of course, I don't recall any news headlines proclaiming: “HPV, not smoking, is the sole cause of cervical cancer.”

But, have Health Canada and the Canadian Cancer Society tempered their argument that HPV is the single most significant cause of cervical cancer to appease the more rabid elements of the anti-smoker cult? I would argue that may be the case.

On September 2, 2009, I wrote a blog entry where I referenced material from Health Canada and the Canadian Cancer Society. Here's the information I provided in that article:

“According to Health Canada, persistent HPV infection with high risk types, is the major cause of cervical cancer. It is estimated that over 99% of cervical cancers are caused by HPV.

This contention is supported by the Canadian Cancer Society: “Nearly all cervical cancers are caused by persistent high-risk HPV infection. High-risk types of HPV are considered known cancer-causing agents. About 70% of cervical cancers are associated with high-risk HPV type 16 and 18. Other high-risk types of HPV are associated with the other 30% of cervical cancers.”

At the time of writing, both claims appeared on their respective web sites. It is my practice to cut and paste comments or quotes I plan to use directly into my rough drafts, along with the hyper-link to the article. I'm confident that both statements were accurately reported in my article.

However, two weeks ago, a belated comment to my September post claimed that the Health Canada website did not contain the information purported in my article and the Canadian Cancer Society page didn't exist.

It is not unusual for links to newspaper articles to disappear; sometimes articles are archived after only a few weeks. However, web sites, more often than not, remain static unless, and until, the content contained therein requires change based on new or updated information.

At any rate, the Health Canada site no longer makes the claim that “over 99% of cervical cancers are caused by HPV”. That's been downgraded to “HPV causes almost all cases of cervical cancer.” And, the Health Canada site now contains the cryptic comment that: “In some studies, cigarette smoking has been found to increase the risk.” Uh-huh.

Of course, if the risk from HPV is “20 to 100 times” greater, it's hard to see how the additional risk of 1.9 from smoking will increase that risk to any significant level. Did Health Canada bow to pressure from their colleagues in the anti-smoker brigade and alter the content of their web page? Or, did they simply recognize that if HPV caused 99% of cervical cancer, then their claim that 126 of 382 deaths (34.7%) from cervical cancer were caused by smoking was, in diplomatic terms, grossly overstated?

The Canadian Cancer Society simply deleted the whole damn page. Follow the link and you get a blank page with the CCS logo and a notice that says: “Content not available at this time. Sorry, content is not available in English.”

Now, this could mean one of two things; a) The page content has been removed for revision and may, or may not, be available at a future date, or; b) The information is provided only in Canada's other official language.

It's not available in French either. I checked; just to be sure.

Both Health Canada and the CCS have an obligation to provide the public with accurate, reliable information. And, they may have a perfectly logical explanation for removing the information from their respective sites.

But . . .

It will be interesting to hear what Health Canada and CCS have to say about this strange occurrence. But, I don't think I'll hold my breath waiting for the explanation.

Monday, May 3, 2010

HPV, smoking and cervical cancer

Everybody knows that smoking causes cervical cancer; that scientific studies have demonstrated a statistical association. The anti-smoker crowd has pronounced the evidence clear and unequivocal; beyond dispute. And, Health Canada concurs.

Or, at least they did as recently as 2007 when they released their latest Smoking Attributable Mortality report (based on StatCan mortality data from 2002). At that time Health Canada was claiming that 126 of 382 deaths (34.7%) from cervical cancer were caused by smoking. And, that statistic, to the best of my knowledge, has yet to be updated.

But, multiple studies, including one titled “Human papillomavirus is a necessary cause of invasive cervical cancer worldwide”, tend to disagree.

The study was published in PubMed in September, 1999 and stated: “Combining the data from this and the previous study and excluding inadequate specimens, the worldwide HPV prevalence in cervical carcinomas is 99.7 per cent. The presence of HPV in virtually all cervical cancers implies the highest worldwide attributable fraction so far reported for a specific cause of any major human cancer.”

What the study is saying is that, although both smoking and non-smoking women get cervical cancer, HPV is present in virtually all (99.7%) women who contract cervical cancer. And, the fact that at least one high risk strain of HPV (there's over 100) is present in virtually all women who contract cervical cancer clearly points to HPV, not smoking, as the sole cause of cervical cancer.

Another study, published in the Journal of Clinical Pathology in 2002, states: “The causal role of human papillomavirus infections in cervical cancer has been documented beyond reasonable doubt. The association is present in virtually all cervical cancer cases worldwide. It is the right time for medical societies and public health regulators to consider this evidence and to define its preventive and clinical implications. A comprehensive review of key studies and results is presented.”

And, unlike lung cancer, the link between cancer and HPV is not limited to a statistical association. It has been shown to cause cancer in animal experiments. A July 1999 article in Journal of Virology, titled “HPV is Both a Necessary and a Sufficient Cause of Cervical Cancer”, claims: “The human papillomavirus type 16 E6 gene alone is sufficient to induce carcinomas in transgenic animals.”

In fact, there are literally dozens of studies linking HPV and cervical cancer. You'll find links to a good number of studies, available on-line, at smokershistory. But, despite the abundance of evidence, the association between HPV and cervical cancer is not well known in the general population.

Part of the reason for that may be studies which attempt to perpetuate the myth that smoking causes cervical cancer.

At least one such study which tries to show that smoking causes cervical cancer appears to show the opposite. It states: “[C]urrent smokers with a high HPV-16 viral load had an increased risk of 27.0 (95% CI, 6.5-114.2) compared with current smokers without HPV-16 infection.” Huh?

Women who have HPV and smoke are 27 times more likely to contract cervical cancer than those who smoke and don't have the virus? Forgive my confusion, I'm not a scientist; but doesn't that point to HPV as the real risk? After all if both groups smoke and the HPV infected group has 27 times more cervical cancer . . .

The same study claims: “Within nonsmokers, however, high HPV-16 load contributed to only a 6-fold increased risk compared with HPV-16-negative nonsmokers at time of first smear.”

“Only” a six-fold increased risk? That's over 5 times the relative risk (1.9) attributed to smoking.

Again, I admit my ignorance. But, doesn't this mean that even non-smoking women with HPV are at a much higher risk of developing cervical cancer than non-smoking women without an infection? Doesn't this also point to HPV as the cause of the cancer rather than smoking?

In addition, this study considered only HPV-16 when there are numerous other types, which are known to cause cervical cancer, which were not tested for and may have been present. Remember, other studies have found 99.7 cases of cervical cancer had one strain or another of the virus present. HPV 16, a high risk strain, was merely the most prevalent.

Which brings us to today's question.

Are the anti-smoker zealots callous enough to downplay evidence which might point to the sole cause of cervical cancer (HPV), and possibly other cancers, because it would undermine their case against smoking? After all, HPV has been implicated in a number of different cancers, including lung cancer.

I'll explain in my next post why I believe some public health agencies may downplay the evidence to appease their more rabid anti-smoker colleagues.