I have been reading some quasi-medical literature on lung cancer and emphysema. The Wikipedia entry here, despite some wiki-criticism, seems to me an excellent start to the subject of lung cancer. The graph above I pinched from this survey. It shows nicely the 20 year lag between smoking and the contracting of lung cancer in the US and complements an earlier picture I provided due to Weiss. The survey also contains reference to a fascinating paper by Witschi (2001) ‘A Short History of Lung Cancer’.
I have for the past few months been scouring the pre-1950s literature for early medical insights into the connection between cancer and smoking – I knew, for example, that Adolf Hitler was very anti-smoking and, yes, it is true – many of the earliest recognitions of the connection (e.g. Mϋller (1940)) were medicos from Germany who published in German. Robert Proctor has written a book eulogising the role of the Nazis in recognising the threat from cigarettes!
Some American environmentalists of the 1960s, like Rachel Carson – who emphasised the role of environmental chemicals in causing cancer - never mentioned tobacco smoke. This is a major oversight. Tobacco smoke is the most important carcinogen in the environment and the one that can be completely controlled. Recognising its existence has simple implications - don’t smoke and do not allow yourself to be exposed to secondary tobacco smoke.
Lung cancer describes a condition where tissue cells in the lung grow out of control. It is the major cause of cancer-related death among men and the second-greatest among women. It is more than 90% caused by inhaling tobacco smoke. There are various ways lung cancer can be treated (surgery, chemotherapy, radiotherapy) but it is one of the nasty cancers – it kills 86% within 5 years. The death that results from lung cancer is, in the words of one leading surgeon, ‘horrible’. Not in any sense a painless exit.
The changes made in cigarettes over recent decades have altered the types of lung cancers generated in humans. In early studies tar from cigarettes was painted onto the shaved backs of animals, like mice, and shown to produce cancers. With the advent of low-tar, low-nicotine cigarettes people smoke harder. They consequently do not reduce their cancer risks at all – the tobacco industry and medical authorities refer to this as compensation. Compensated cigarette smoking activates a new set of carcinogens in tobacco smoke – 'tobacco specific nitrosamines' and volatile carcinogens in the gas phase. These produce a distinct range of cancers - 'adenocarcinomas' rather than 'squamous cell carcinomas'. Passive smoking also produces its own range of tumors.
Cigarette products when consumed as intended have about a 0.2 chance of killing a smoker from these types of cancer outcomes alone. A smoker's overall health risks from smoking can be summarised by saying that they have a 1 in 2.5 chance of prematurely dying from a smoking-related disease. That this is not new news does not make it less than true.
That cigarette companies have continued to provide addictive products that they have known for 50 years have these devastating consequences makes me somewhat despondent about the human condition.
To say that issues of smoking are primarily questions of individual choice seems to me close to an outright lie. It is universally known that it is mainly young, immature kids who initiate this disastrous habit.
On the other hand creates puzzles for people such as myself. The smoking debate brings into question many of the basic issues I have accepted in my 35 years of work as an economist.
The case for letting people choose and the consequent 'gains-from-trade’, the notion that a profit-seeking firm would not find it in their self-interest to produce a product that they knew produced harm are both brought into question. Moreover there are a myriad of widely-discussed externalities (e.g. passive smoking) and much-less-discussed (though more important) issues of internalities (information failures and irrational choices that mean people make stupid decisions).
Related to the positive issues of trying to limit the harm from smoking are profound ethical issues about why societies have allowed things to continue to this point.
The tobacco smoking debate provokes uncomfortable and pessimistic thoughts.