Friday 25 October 2019

Are cigarette filters useless?

Richard Kluger memorably equated twentieth century efforts to make a safer cigarette to breeding a one-fanged rattle-snake. It has become dogma in tobacco control that neither filters nor low-tar cigarettes make any difference to the risks of smoking. Low tar (or 'light') cigarettes, in particular, have been portrayed as a tobacco industry scam, with the role of government and public health scientists written out of the story.

Regulators send out mixed messages. The EU's Tobacco Products Directive bans companies from putting nicotine and tar yields on cigarette packs to prevent consumers getting the idea that lower yields are less dangerous. At the same, it banned companies from selling cigarettes with more than 15 mg of tar in them in 1993 and has since lowered the limit to 12 mg and then 10 mg, presumably because it thinks higher yields are more dangerous.

Now Martin McKee and his chums have called for filters to be banned entirely, the effect of which would be to greatly increase yields of both nicotine and tar. This is not a new idea. In Velvet Glove, Iron Fist, I wrote about anti-smoking fanatic John Slade who wished the government had banned cigarette innovation in 1950 so that 'the only cigarettes on the market would be unfiltered 70 mm smokes, and far fewer people would be smoking.'

McKee et al. make their argument on the basis of litter, but perhaps they share Slade's hope. If so, I'm not sure it will work. Smoking was never more popular than it was in 1950 and I would far rather smoke an unfiltered Lucky Strike than a modern 'light' cigarette. Most people today don't know what a decent cigarette tastes like.

McKee et al. assert that the benefits of filters are a 'myth', but the only sources they cite as evidence are an article from the New York Times Magazine and an article in the pseudo-journal Tobacco Control.

Studies looking at the issue are few and far between, so it is a weird coincidence that one was published on Monday in JAMA Internal Medicine. Awkwardly for McKee, it found that...

After adjustment, unfiltered cigarette smokers were nearly 40% (hazard ratio, 1.37; 95% CI, 1.10-1.17) more likely to develop lung cancer and nearly twice (hazard ratio, 1.96; 95%CI, 1.46-2.64) as likely to die of lung cancer compared with those who smoked filtered cigarettes. Additionally, all-cause mortality was nearly 30% (hazard ratio, 1.28; 95% CI, 1.09-1.50) higher.

.. This study confirms that smoking any type of cigarette conveys serious health risks. Within the context of this study, unfiltered cigarettes are the most dangerous, and individuals who smoke them should be targeted for aggressive tobacco treatment interventions. 

This is in line with previous epidemiological studies such as this and this. The idea that filters confer no benefit whatsoever is unproven, to put it mildly. But we already knew that McKee doesn't approve of harm reduction.

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