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Pleasures of pipe smoking |
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Pleasures of pipe smoking
We were rather shocked to see a pro-smoking letter in
the Lancet(1)
(http://prepub.elsevier.co.uk/newlancet/sub/issues/vol351no9106/correspondence916_2.html
), and we suspect that we are not alone. That tobacco in any form or dose harms doesn't
even need a reference. As we read the sentence "about third of the population can
probably use tobacco sensibly and enjoy it", we were happy that Dr Passmore was lucky to
be in those 1/3rd spared but we could immediately see all the smokers among the 9
million Lancet readers, and all the smokers among their patients, and all the passive
smokers around them trying to accommodate themselves in those 33%. Alas, we have yet to
find a test that can tell whether one is born with "the shield" (the existance of shield
may be a delusion) against all the myriad hazards of tobacco and since there is no
minimum dose that is harmless, there cannot be a "sensible" way to use tobacco.
And to disillusion those who think pipe smoking is harmless or switching to pipe smoking
is nearly as good as quitting, here goes: For lung cancer, in areas of Sweden where pipe
are as popular as cigarettes, both gave similar relative risks. An obvious dose-response
relation was found for both cigarette and pipe smoking. The relative risk gradually
decreased from five years after cessation of smoking. This decrease was, however, much
less pronounced in ex-pipe smokers than in ex-cigarette smokers (2).
In a prospective study of 21520 men (3) pipe and cigar smokers who had switched from
cigarettes over 20 years before entry to the study were found to have smoked less
tobacco but had higher carboxyhaemoglobin saturations (1.2% v 1.0%, P < 0.001)
indicating that they inhaled tobacco smoke to a greater extent. Although their risk of
dying from the lung cancer, ischaemic heart disease and chronic obstructive pulmonary
disease was now lower than continuing cigarette smokers, they still had a 68% higher
risk than lifelong non-smokers (1.68; 1.16 to 2.45) and a greater risk of lung cancer
than lifelong non-smokers or former smokers.
For stroke, people who switch from cigarette to pipe smoking have a RR of 3.3 and
primary pipe smoking a relative risk of 2.2 (cigarette smoking RR:3.7) (4). When
analysing risk factors for first acute myocardial infarction in the Copenhagen City
Heart Study, a large prospective population study of 20,000 men and women (5), smoking
was found to influence risk significantly in a dose-dependent manner, the risk
increasing 2% to 3% for each gram of tobacco smoked daily and no difference in risk
could be demonstrated between various types of tobacco (pipe, cigar/cheroots, or plain
and filtered cigarettes).
We are not advocating puritanism, but the industry driven choice between being a
non-smoker, pipe-smoker and cigarette-smoker is to us like the choice between walking on
a railway platform, on the railtrack of a slow train, and on the railtrack of a fast
train.
Jayant S Vaidya MS DNB
Sucheta J Vaidya MD
References
1.Passmore R. The pleasures of pipe smoking. Lancet 21 March 1998;351:916
2. Damber LA, Larsson LG Smoking and lung cancer with special regard to type of smoking
and type of cancer. A case-control study in north Sweden. Br J Cancer May
1986;53(5):673-81
3. Wald NJ, Watt HC Prospective study of effect of switching from cigarettes to pipes or
cigars on mortality from three smoking related diseases.BMJ 28 June 1997
314(7098):1860-3
4. Wannamethee SG, Shaper AG, Whincup PH, Walker M Smoking cessation and the risk of
stroke in middle-aged men. JAMA 12 Jul 1995;274(2):155-60
5. Nyboe J, Jensen G, Appleyard M, Schnohr P Smoking and the risk of first acute
myocardial infarction. Am Heart J Aug 1991;122(2):438-47
