Cigarette century

This remarkable graph from W. Weiss, ‘Cigarette Smoking and Lung Cancer Trends: A light at the end of the tunnel?’, Chest, 111, 1997, summarizes much of what we know about the health history of the cigarette in the twentieth century.

The graph shows percentages of the US male population that smoke compared to male lung cancer rates per 100,000 per year. It’s a pity the graph isn’t extended back another 20 years to about 1900 – data is available – it then illustrates, even more dramatically, the full extent of the cigarette catastrophe. In the early part of the twentieth century smoking cigarettes was a minor part of total tobacco consumption and, correspondingly, lung cancer rates were very low. Cancer rates rose from a low base through to 1920 as the cigarette habit caught on. Rates of male smoking peaked in 1959 and rates of female smoking peaked around 1965. The incidence of lung cancer peaked for both groups about 20-30 years later.

What was interesting was that the connection between cancer and smoking was clearly evident in studies published in the early 1950s. Rates of smoking started to decline soon after that. Cigarette consumption, despite the record of horrific health implications, has shown remarkable resilience but it is gradually fading at least in developed countries.

I recalled this graph because I have been reading the monumentally scholarly account of cigarette smoking in the twentieth century by Allan Brandt, The Cigarette Century, Basic Books, New York, 2007. It’s the most enthralling book I have read this year in many dimensions. I’ll blog on it when I get the time – it’s a serious read.

I liked this book because, first, it provides a fascinating account of the development of a major industry. In 1910 the tobacco industry in the US consisted primarily of one firm, the American Tobacco Monopoly which stood, after US Steel and Standard Oil, as the third largest corporation in the US. Not a bad performance given that 30 years earlier cigarette smoking was virtually unknown in America. Second, the book provides a fascinating account of how modern epidemiological studies, using data from the field, helped to identify society’s most serious public health risk. Infectious diseases had largely been replaced by chronic diseases so methods of analyzing the causes of disease also needed to change. The book also analyses the political and legal responses to the cigarette disaster.

Cigarettes were first smoked in Spain in the early 17th century. They were of poor quality – they fell apart – and their consumption was restricted to the down-and-outs. The French however took to them and built a factory in 1840. However consumption in the US and England was negligible through to the 1880s - the British thought them effeminate compared to cigars, pipes and snuff. Another factor mitigating against their widespread use was their cost – they had to be hand rolled. In 1880 a technological discovery by a Mr. Bonsack provided the means for mass production and James ‘Buck’ Duke, a small tobacco producer, eagerly adopted this innovative machine. As the first adapter of the machine he obtained it for a reduced license fee and thereby produced cigarettes much more cheaply than his competitors. He made a fortune and reinvested a substantial fraction of profits in marketing.

By 1920 cigarettes had come to dominate patterns of tobacco consumption in most countries.

In the early 1960s the British and American governments endorsed major reports, dating back to 1950, confirming the definite link between smoking and lung cancer. The cigarette companies initially denied the link but, by the end of the century, could hardly deny what their own internal scientific data (released under duress) showed. Namely that nicotine addiction drives cigarette sales and there is incontrovertible evidence that smoking is the primary cause of lung cancer and a major risk factor for coronary disease. These documents revealed that, all along, these cigarette producers were deliberately marketing to children and that they knew passive smoking was injurious. It is a fact that one-third of all lung cancers among non-smokers are caused by passive smoking - 3000 passive smoking deaths per year in the US.

The foolish libertarian view that individuals knowingly take risks is the only leg the tobacco companies can now stand on. This is an excuse the tobacco companies themselves introduced as a defence of their industry once the health risks of smoking became incontrovertible. It is a foolish defence because most smokers begin smoking at young ages – the average starting age in Australia is 15.9 years – when young people are at their most impulsive. Impulsivity helps young people to experiment and to begin to cope with and develop adult life roles, but unfortunately it also leaves them prone to various chemical experimentations and addictions. Smoking is a paediatric disease.

Given the dramatic recent declines in youth smoking in both the US and Australia in recent years one hopes that the comparatively brief and disastrous cigarette smoking experience will eventually come to disappear in all countries. In developing countries however the problem is spiraling into a catastrophe of huge proportions - dominating AIDs and other disasters by a mile. Of the world’s 1.1 billion current smokers, 80% live in poor or middle income countries – by 2030 developing countries will claim 70% of cigarette-related deaths. Far more people will die from smoking in the 21st century than in the 20th century and, by 2020, fully one quarter of all deaths in the world will be tobacco-related.

Think of this: 100 million Chinese men currently younger than 29 will eventually die from smoking. Its an amazing statistic.