Sunday, July 25, 2010

Lung cancer, smoking & statistical chicanery

The Lung Cancer Alliance (LCA), as noted in my last post, claims the majority (60%) of new lung cancer cases in the US occur among former smokers, with roughly 21% occurring in current smokers and 18% among those who have never smoked. The information is provided in a neat little chart on their website.

I noted in a previous post that the same site claimed that former smokers (45 million) in the US now outnumbered current smokers (40 million), suggesting this was a recent phenomenon in the US. I really didn't give the numbers much thought. If 35% of lung cancer cases occurred in an estimated 21% of the population (smokers), and only 15% among never smokers (55% to 60% of the population), then it still indicated a strong correlation between smoking and lung cancer.

But, these latest figures from LCA gave me pause. The gap between lung cancer cases among current smokers and never smokers appeared to be narrowing as the number among former smokers increased.

And, although the fact that former smokers outnumber current smokers may be a recent phenomenon in the US, (is that possible?) it certainly isn't in Canada. Data from Health Canada's last report on smoking attributable mortality clearly shows that former smokers far outnumber current smokers in every age bracket.

But, Health Canada data doesn't tell us how many current, former or never smokers die from lung cancer. They speak only of smoking attributable deaths and those ostensibly from other causes.

To be sure, extrapolating data from the US to Canada can be a hazardous proposition, as Health Canada found out a couple of year ago. In 2008, they were forced to revise their smoking attributable deaths downwards from roughly 47,000 to 37,000 because the US data they were using was not appropriate for the Canadian population.

Still, I thought it might be interesting to apply the numbers from the Lung Cancer Alliance to the Canadian mortality data from StatCan to see if a reasonable estimate could be made as to the number of lung cancer deaths in each of the three smoker classifications in Canada.

Not surprisingly, applying the Lung Cancer Alliance estimates to the Canadian mortality data paints an entirely different picture than the one presented by Health Canada's smoking attributable mortality figures, as noted in Chart 1.

It's not that the total smoking attributable deaths varied by a huge amount In fact, using the Lung Cancer Alliance percentages actually increases the estimates given by Health Canada by roughly 4%. Of course, the LCA calculations would be reduced somewhat since a small portion of those current and former smokers would be expected to die whether they smoked or not, reflecting the numbers expected in a never smoking population.

But, what was most perplexing was the ratio between deaths among current and former smokers when using the LCA percentages. In fact, those ratios practically eliminated the strong correlation between smoking and lung cancer. The number of lung cancer deaths among current smokers would be only slightly higher than the number among never smokers, despite similar population sizes. Which, in turn, brings into question the anti-smoker claim that “men who are current smokers are 23 times more likely to die of lung cancer than men who have never smoked.”

And, it also suggests that quitting smoking is not the deterrent to lung cancer the anti-smoker crowd claims.

I know what you're thinking. That's ridiculous. But, before dismissing this possibility as unrealistic balderdash, perhaps we should have a look at the smoking attributable mortality report from Health Canada and what it shows.

Almost 99% of all lung cancer deaths in Canada (2002 data) occur after the age of 45. But, at no time after the age of 45 is the percentage of former smokers less than double the number of current smokers. And the ratio between former smokers and current smokers increases cumulatively as the population ages. You may be a smoker for 5, 10 or 20 years, but you're a former smoker for life.

Looking at the male component in the age group between 45 and 59, we see that former smokers already outnumbered current smokers by roughly 2 to 1, as can be seen in Chart 2. In the age group between 60 and 69, where 28% of lung cancer deaths occur, the ratio between former smokers and current smokers is almost 4 to 1. In the age group between 70 and 79, where 36% of lung cancer deaths occur, the ratio is 7 to 1. And, in the age group 80 and over, where 20% of lung cancer deaths occur, the ratio is a whopping 9 former smokers for every current smoker.

The ratios are only slightly less for the female population, ranging from almost 2 to 1 between the ages of 45 and 59 to a high of roughly 6.5 to 1 in the population 80 and over.

Given these high ratios between former and current smokers, is it really unreasonable that former smokers might account for 50% to 60% (and, possibly more) of lung cancer deaths in Canada? Think about it.

In 2002, roughly 56% of lung cancer deaths were among the population aged 70 or older. In that same population, former smokers outnumbered current smokers by at least 7 to 1 for men, over 4 to 1 for women, and in the over 80 crowd, the ratio was 9 to 1, for men and 6.5 to 1 for women.

Common sense would suggest that the vast majority of those deaths occurred among former smokers, many of whom would have quit decades earlier.

So, just what conclusions can be drawn from this highly speculative foray into the maddening world of smoking attributable mortality.

And, the answer is: absolutely none. I'm neither an epidemiologist nor a statistician. And, this little exercise, as previously noted, is highly speculative. It is also postulated on the belief that smoking related statistics are grossly exaggerated and manipulated to the point where they're totally unreliable, which may introduce an element of bias.

But, it sure as hell raises a lot of questions which deserve answers. And, unfortunately, I don't expect that any will be forthcoming from either Health Canada or the rest of the anti-smoker crowd.

Of course, that's just the opinion of a rapidly aging old rambling man.

Friday, July 23, 2010

Anti-smoker funding, yes; lung cancer research, no

According to an article in the Hamilton Spectator, the stigma attached to lung cancer patients could “seriously impede attention and research funding on the disease”. Dr. James Gowing, a doctor and co-chair of the Cancer Advocacy Coalition of Canada (CACC), noted in the article that: "It [lung cancer] gets 3 per cent of the total research funding for all cancers, and yet it is the No. 1 killer."

The funding disparity can be attributed to a tendency to blame the victims for their disease. Anti-smokers claim that smoking causes 85 percent of lung cancer deaths, so lung cancer generates little public sympathy.

The Lung Cancer Alliance echos the concerns of Dr. Gowing, noting: “Lung cancer kills more women than any other cancer - nearly 200 women each day. Most die within a year of diagnosis. Yet lung cancer remains the “hidden” women’s cancer - little known and rarely discussed. It is the least funded cancer in terms of research dollars per death of all the major cancers, and one of the only cancer where patients are routinely blamed as responsible for their condition.”

To put what the Lung Cancer Alliance is talking about into some context, 62.5% of lung cancers among women were attributed to smoking according to Health Canada's last report on smoking attributable mortality. And, that figure is likely a gross exaggeration. That means that at least 37.5% of lung cancer deaths among Canadian women were caused by something other than smoking. And, there's not a lot of research funding dedicated to finding out what that something might be.

The facts are that massive amounts of funding that might otherwise go into legitimate research on lung cancer is going to anti-smoker campaigns, in the belief that if people will simply stop smoking, then lung cancer can be eradicated.

But, is that a reasonable assumption? Or are anti-smoker estimates of “smoking attributable” deaths obfuscating the true extent of the disease among never smokers and masking other potential causes of lung cancer? Are anti-smoker efforts to link smoking to lung cancer (and every other disease imaginable) siphoning off funds which might be better spent on legitimate research into the other causes and possible treatments of the disease?

The public has been led to believe that smoking is “the” cause of lung cancer. That, if smokers quit, they can escape the ravages of that dread disease. But, there is evidence to suggest this may not be the case.

A Nov. 21, 2008 article in Science Daily, states: “Smoking is the biggest risk factor for developing lung cancer, even after quitting for long periods of time. "More than 50 percent of newly diagnosed lung cancer patients are former smokers," said Emily A. Vucic, a graduate student at the British Columbia Cancer Research Centre, Vancouver, B.C. "Understanding why some former smokers develop lung cancer is clearly important to the development of early detection, prevention and treatment strategies."”

The Lung Cancer Alliance estimates an even higher percentage of former smokers among new cases. A chart on their website claims 60% of new lung cancer cases are former smokers, 20.9% are current smokers and 17.9% are among those who have never smoked. The remaining 1.2% presumably represents the fraction for which smoking status was unknown.

The fact that the overwhelming majority of new cases of lung cancer are among former smokers may be an indication that smoking attributable deaths are grossly exaggerated in that segment of the population.

A former smoker is defined as someone who has smoked more than 100 cigarettes in his or her lifetime and who has not smoked within the past year. This means that old John, who smoked ten a day the summer he worked on Uncle Matt's farm 30 years ago, is considered a former smoker. And, should he contract lung cancer, he will become a smoking attributed death, despite the fact that he quit 30 years ago, after only a brief fling with the demon weed.

But, is it really reasonable to assume that, because he smoked a carton or two of Player's Filter thirty years ago, that smoking “caused” his lung cancer? Is it reasonable to assume that an individual who smoked a pack a day during his freshman year at college before quitting has the same risk of developing lung cancer (or any other cancer, for that matter) than someone who has smoked a pack a day for fifty years? For, it is those assumptions on which smoking attributable mortality statistics are based.

And, if those aren't reasonable assumptions, then shouldn't some research be dedicated to finding out the real cause of those lung cancers?

Shouldn't some research funding go to finding out what caused the 22% of lung cancer deaths in Canada which are not attributed to smoking? According to Dr. Ping Yang, M.D., Ph.D., a Mayo Clinic genetic epidemiologist, 30% to 40% of lung cancers in Asian countries are among never smokers. Something other than smoking is obviously causing those deaths. Shouldn't someone be trying to find out what?

In a study titled “Lung Cancer Incidence in Never Smokers” by Heather A. Wakelee et al, it is noted that: “Clinical observations suggest that the percentage of never smokers among lung cancer patients may be increasing; however, it is unclear whether this apparent trend represents an increase in lung cancer incidence among never smokers or the increasing prevalence of never smokers in the general population. The growing number of never smokers in the United States and other countries underscores the importance of understanding the epidemiology and biology underlying lung cancer in this population.”

The anti-smoker brigade is waging a moral crusade against smokers. Any public health benefits which may accrue from their denormalization campaign is purely coincidental. They want the public to believe they've already found both the cause and the cure of lung cancer. Any evidence to the contrary is unwelcome news.

But, consider the facts. After four decades of anti-smoker activism, the number of lung cancer deaths in Canada continues to climb. Maybe it's time that someone with the expertise took a more critical look at those smoking attributable death statistics and what they may be hiding.

I'll continue this ramble in my next post. Hopefully, I'll be able to access a computer somewhere on Canada's east coast where I plan to spend the next few weeks.

Tuesday, July 13, 2010

The strange world of the anti-smoker

Surfing the web looking for new and interesting perspectives on the antics of the anti-smoker crowd can be depressing at times. The mind can handle only so much bullshit and bafflegab before shutting down in self defense. That's why it's such a break to come across more off beat news stories related to smoking.

For example, the Georgia man who broke out of jail, broke into a convenience store and stole fourteen cartons of cigarettes, then tried to break into jail again. No one should have to endure that kind of nicotine fit.

The obsessed anti-smoker
According to austriantimes dot at, an obsessed anti-smoker (is there any other kind?) dangled his neighbour from a third floor apartment balcony when the neighbour refused to put out his cigarette. Quipped a police spokesman: "The smoker dismissed the idea that smoking was bad for the health - it seems the anti-smoker had other ideas and wanted to prove a point."

Let's face it, this type of behaviour is totally unacceptable. The anti-smoker fanatics should stick to water-boarding and sensory deprivation.

Charging young people with possession
A proposal to make it illegal for youngsters to use or possess tobacco in Nebraska is being supported by both the American Cancer Society and Reynolds American. Uh-huh. Even the tobacco companies have jumped into bed with the anti-smoker zealots. Of course, that can only mean one thing; smokers are about to get screwed.

Under a bill introduced by State Senator, Arnie Stuthman, youngsters under age 18 could be charged with infractions for using or possessing cigarettes or other tobacco products. The penalty for a first violation would be a $100 fine. A second violation within two years would be $200 and a third violation in that time period would be $300. The bill doesn't stipulate what happens to the kids if mom and dad refuse to pay the fine.

Kids charged under the proposed law could get themselves out of trouble by providing evidence against the people who sold or gave them the tobacco. Uh-huh. Don't worry kid. Your mother/father/brother will be out in no time. Just tell us what we need to know and you can walk away a free boy.

Calling Sherlock Holmes
The body of a man found dead from smoke inhalation following a fire in a townhouse complex was sitting in a classic yoga position. Police were baffled by the positioning of the body, but believe the fire may have been caused by a cigarette smouldering on the bed's mattress, which was covered by an electric blanket. Uh-huh.

So the guy lights up a fag, drops it on the bed and assumes the lotus position for a little quiet contemplation. He goes into a trance so deep he doesn't realize the bed is on fire and he wakes up dead, er . . . he's dead before he wakes up. Just another smoking related death.

It will be interesting to see what the Coroner's Inquest comes up with for this one. Assuming of course they have such things down under. Maybe they'll be able to answer a few questions. Was the electric blanket plugged in? And, just what the fuck was in that cigarette?

Police said that the fire was not suspicious. Huh?

Fake tobacco smells
Anti-smokers, and even some non-smokers, find the smell of burning tobacco offensive. But some smokers in the Netherlands apparently miss the odour of the evil weed. Who wants to wake up and smell the coffee if its not mingled with the unmistakeable aroma of good tobacco. Coffee without the fag is just not natural.

Which may be why Rain Showtechniek, a Dutch company, now sells fake cigarette smells to Dutch bars and cafes. Company spokesman, Erwin van den Bergh, says: "People find that smells such as Mocha coffee, Havana cigars or cigarettes can be about good moods and different ideas of living well.”

Van den Bergh also suggests there are other good reasons to use the fake smells, like to mask the reek of sweat and stale Beer.

I wonder if the stuff is available through mail order. There's an anti-smoker fanatic at the local Legion who would make an ideal candidate for a practical joke. I could smear her favourite chair with the fake smell and watch her work herself into a frenzy trying to figure out what lout had the audacity to light up and foul her airspace.

Customers desert smoke-free restaurant
The Chinese have the world's highest rate of smoking prevalence. A state owned company has a virtual monopoly on the tobacco trade. Prior to the Olympics held in that city a year or so back,. Beijing authorities had written to 30,000 restaurants asking them to voluntarily put smoking bans in place. There were apparently no takers.

Well, OK, there was one. Meizhou Dongpo, a restaurant chain serving the spicy fare of southwest Sichuan province, apparently lost about 80 percent of its clientele after going smoke free in October, 2008.

"We figure that if we're going to die, at least we're going to die honorably," Guo Xiaodong, deputy director of the restaurant chain, was quoted as saying in a Reuters article.

I guess no one told them about the need for a “level playing field” before going smoke free.

Pig’s blood in cigarette filters?
A recent study in the Netherlands reports it has identified 185 different industrial uses of a pig, including the use of its haemoglobin in cigarette filters.

According to the Money Times: “During the course of the research, at least one cigarette brand sold in Greece was confirmed streamlined with pig’s blood to make the product fairly effective in blocking harmful chemicals before they could enter a smoker's lungs, said Simon Chapman, University of Sydney Professor in Public Health.”

Chapman fears the findings could be problematic for Muslims, Jews and vegetarians who refrain from pork consumption due to religious beliefs.

The Greek cigarette brand in question was not identified.

Thursday, July 8, 2010

Outlandish threats: quit smoking or be fired

It's strange. Really.

The anti-smoker crowd is hell-bent on saving smokers from their own vile, filthy habit and reducing the number of “preventable” deaths allegedly caused by smoking and secondhand smoke. They're motivated, of course, by nothing less than an unselfish and altruistic commitment to the health and well-being of smokers. Uh-huh.

You do believe that, don't you? That the anti-smoker fanatics just want to help you?

So, how come they measure the success of their war on smokers by the number of smoking bans passed by brainwashed (or perhaps brain dead) politicians, the severity of their sin taxes and the amount of grief they can cause smokers.

I visit Tobacco-dot-org on a regular basis to keep myself informed about the latest outrage committed against smokers by “clean air” fanatics. At the top of their web page, they have a list of “This Weeks Hot Spots”.

Some of the headlines they were promoting yesterday morning were: "Kansas: Smoking ban goes into effect July 1, Hawaii: $.40 Tax hike goes into effect July 1, New York: $1.60 Tax hike goes into effect July 1, Egypt: Hefty Tax hikes go into effect July 1, Wisconsin: Smoking ban goes into effect July 5, Outdoor Smoking Bans gaining steam, College Smoking Bans gaining steam." You get the picture?

Every new smoking ban or increase in sin taxes is heralded as a victory against the evil, malodorous smokers. And, it's not just bans and sin taxes. Any restriction which makes it inconvenient for smokers to light up, or which tends to demean or denigrate smokers, advances the cause; hiding tobacco displays, outlawing cigarette vending machines, prohibitions against selling smokes in drug stores, etc.

And, of course, there's the ultimate in hypocrisy, the clowns who proclaim their commitment to the health and well-being of smokers by imposing hiring restrictions, or firing them if they continue to engage their habit even on their own time.

For example, Gwinnett Medical Center in Lawrenceville, Georgia will no longer hire smokers. They also plan to crack down on employees smoking anywhere on hospital grounds. After a few warnings, an employee could lose his/her job. In addition, according to Steve Nadeau, the hospital's VP for human resources, efforts will be made to discourage existing employees from taking cigarette breaks or coming back from lunch smelling of cigarette smoke.

Yep. Gotta control exposure to that deadly third hand smoke before non-smoking staff start dropping like flies.

Gwinnett Medical employees who smoke already pay more for health insurance. But, hypocritically, there are no additional charges for any other risky behaviors or health issues, including obesity. At least, not yet.

Of course, this blatantly discriminatory tactic drew praise from the anti-smoker crowd. The Georgia Hospital Association, for instance, through spokesman Kevin Bloye, said: “hospitals are trying more and more ways to discourage smoking, and they're connecting that to the pocketbook." Uh-huh.

So anxious are the fanatics to “help” smokers that they are prepared to deprive them of the means of earning a living. What greater expression of their devotion to the cause of saving smokers from the perils of smoking than to hand them a ticket to the unemployment line? What a wonderful idea to “encourage” smokers to quit. And, let's face it, quitting smoking becomes more or less mandatory in such situations.

Of course, it's the smoking to which the anti-smoker fanatics object, not the smoker. They love smokers. They love them so much they're ready to deny them employment, access to public housing and in some cases, medical care. In fact, the jack-booted bastards love them so much they hate them. And, they'll use any tactic available, no matter how draconian, to persuade them to change their anti-social behaviour.

Just one small question.

When do we see the evidence that the scorn and disdain heaped on smokers is actually accomplishing the goal of reducing “preventable deaths”? After all, smoking prevalence has been declining since 1965. Shouldn't we be seeing a reduction in smoking attributable deaths by now? How about a reduction in the health care costs associated with smoking?

Why do the fanatics choose to measure their success in smoking bans and sin taxes implemented and the number of smokers they can put in the unemployment line?

Just wondering.

Additional Reading on this topic: The Rest of the Story

Monday, July 5, 2010

Not everyone supports smoking bans

I paid a visit to Frank Davis' blog yesterday. He's a Brit and comments regularly on the British smoking ban(s). He's an excellent writer who manages to remain consistently entertaining and informative. His latest blog entry led me to a site called “Your Freedom”.

Your Freedom is a new web site run by the British government. Its stated purpose is to give the public an opportunity to suggest ways the government can “create a more open and less intrusive society”, by ridding the country of “unnecessary laws and regulations”. The public is invited to submit various laws or regulations they'd like the government to repeal or otherwise modify.

Naturally enough, several of the suggestions dealt with the smoking ban and the need to repeal or amend it, especially as it relates to British pubs. Of course, it's unlikely the government will pay any attention to such suggestions; the anti-smoker crowd has far too much influence in Britain, as they do in most countries.

Smoking bans, in Britain and elsewhere, are a draconian solution to a problem which, more likely than not, doesn't exist. But, by constant repetition, the public has been persuaded that secondhand smoke is a major health hazard and that comprehensive smoking bans are the only viable solution to the alleged problem.

That perception has been created by the manipulation of emotions, rather than the use of valid reasoning or legitimate science. Many years ago, the anti-smoker crowd decided that the most effective method of forcing smokers to quit was an appeal to the fear of the non-smoker.

By generating fear of secondhand smoke, and prejudice towards smokers, non-smokers could be convinced to abandon common sense and support any initiative designed to force smokers to give up their “filthy habit”, for their own good and, of course, for the good of public health.

There was no evidence to support the contention that secondhand smoke could cause lung cancer or heart disease, so the anti-smoker zealots simply invented it. The 1993
study from the US EPA (Environment Protection Agency; the 1998 report from WHO (World Health Organization) being the most prominent propaganda pieces. Studies by Enstrom and Kabat, Brownson et al and a myriad of others which did not support the proposition were simply ignored.

And, with funding from major pharmaceutical companies, and a little help from their allies in the self-censored media, the fanatics managed to persuade a majority of the public that secondhand smoke was a major menace.

Once the public had been conditioned to accept secondhand smoke as hazardous to their health, it was an easy task to convince the politicians. “Look here,” they said, “80% of the population believes that secondhand smoke is a serious health hazard. Something must be done. ”

Politicians, it seems, are often devoid of common sense and logical thought processes. In the case of smoking bans, their reasoning skills were apparently restrained by the belief that, because many people believe something to be true, it is therefore true. It's absurd logic, really. But, then, we're dealing with polticians.

And, when the anti-smoker crowd proposed draconian smoking bans as the solution to the manufactured hazards of secondhand smoke, the politicians were only too willing to accept their faulty logic; thinking for themselves apparently too great a chore.

Smoking bans were the only solution to be considered. All other potential solutions were to be rejected because some small part of the problem might still exist due to the mysterious, magical powers of secondhand smoke.

Separate smoking areas could not be permitted because a technology which has put men into space is apparently incapable of devising a ventilation/exhaust system to contain secondhand smoke. Signs advising the public that they are entering a smoking establishment aren't adequate to protect bar staff, some of whom might be non-smokers.

Only the perfect solution, a complete ban on smoking, was/is acceptable. No compromise was/is to be considered. And, if the perfect solution includes the de-normalization of, and discrimination against, smokers, so what? Non-smokers must be protected from the foul-smelling, filthy brutes who cling to their addiction, spreading disease and death among the population.

At the end of the day, the politicians are not likely to repeal or amend the smoking ban in Britain, no matter how well reasoned the arguments to do so might be. The anti-smoker crowd will not allow it. And, the politicians . . .

But, there's some evidence that the truth is getting out there. More and more people are beginning to question the need for smoking bans and other forms of discrimination against smokers.

Unfortunately, for now, the bullshit and bafflegab of the anti-smoker fanatics will prevail.