Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Passive smoking
- Matt Seftel (30 December 1999)
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Radioactivity in cigarettes
- K S Parthasarathy (1 January 2000)
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To smoke or not to smoke: this is the question.
- Roberto Manfredini (1 January 2000)
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This is epidemiologic fraud
- Carol A S Thompson (1 January 2000)
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PS
- Carol A S Thompson (1 January 2000)
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Highlight benefits from quitting
- Anupam Johri (2 January 2000)
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Goa's prohibition of smoking and spitting act
- Sharad Vaidya (3 January 2000)
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Forget cigarettes, have fun, live longer!
- Mark R Goldstein (5 January 2000)
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Re: SMOKING HYSTERIA
- Andrew Moore (5 January 2000)
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The Market's Response?
- Tim Reynolds (7 January 2000)
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Revised time for a smoke.
- R Pittrof (12 January 2000)
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Re: Revised time for a smoke.
- Rudi Pittrof (14 January 2000)
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... or around £9500 per year of life squandered
- T Reynolds, A Wierzbicki (16 January 2000)
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smoking
- J E Dussek (16 January 2000)
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Tabloid statistics in the BMJ
- Richard Cove (21 January 2000)
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Time to give up!
- R Kishore Kumar (13 May 2000)
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Matt Seftel, Haematology Registrar Homerton Hospital, London, U.K.
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Congratulations to the authors of this letter for calculating this frightening statistic, albeit as they admit,a "crude" assessment. I suggest that a similar but more compicated formula might be used to calculate minutes lost per cigarette passively inhaled. I work at a hospital that still allows smoking in the stairways (so many patients congregate there that I frequently include these areas in my morning rounds). It would be ironic if the benfits of choosing to use the stairs rather than the elevator were outweighed by the risk of a passive smoke. |
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K S Parthasarathy, Scientific Officer (H) Atomic Energy Regulatory Board,Bombay
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Drs Shaw, Mitchell and Dorling attempt to provide a simple but "frightening statistic" to convince smokers to kick the "antisocial" habit and throw the "cancer stick" to the nearest dustbin. In 1987, I wrote an article titled "Radioactivity in tobacco'. Since anything "radioactive" gets top billing in the press, the item was picked up by a national news agency. Extensive coverage in several dailies must have hopefully dissuaded a few from smoking. There were several anxious responses to the news story. Tobacco contains Polonium-210 and lead-210. These are decay products of radon formed from radium present in the soil and are deposited on tobacco leaves.Polonium and lead are volatalized due to cumbustion of tobacco. About 20% of polonium and 10% of lead enter the lung through the main smoke stream. The lungs of smokers contain three times more polonium-210 and 1.5 time more lead-210 than those of nonsmokers.The daily radiation dose to the lung of a person smoking 20 cigarettes per day is about 2400 microsievert.The dose rate depends on the radioactive content of the tobacco, puff size,puff frequency and number of cigarettes smoked per day.The annual radiation dose is 40 times the dose limit to radiation workers.According to one report the polonium content in Indian tobacco is 10-15 times lower than that in US tobacco samples.(I am against the use of all tobacco!!) A 20 cigarettes per day smoker inhales atleast one kG of smoke annually.Trace amounts of radioactivity may not be a major factor in causing lung cancer as it is only one among the 3000 chemicals which have been identified and quantified in tobacco smoke. Let us hope that Dr.Dorling may be terrified by the thought of radioactive fumes from cigarettes and may quit smoking for ever! |
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Roberto Manfredini, Non-smoker professor of Emergency Medicine First Internal Medicine, University of Ferrara Medical School, Ferrara, Italy
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I read with interest and greatly appreciated the letter by Shaw et al (1). It is somewhat worrying to know that one cigarette reduces the life by 11 minutes. However, a male smoker must also consider the reverse of the medal, and choose his favourite kind of death: a) shot by his friends, driven mad by 87 phone calls a day (one every 11 minutes, considering 8 hours of sleep) b) committed suicide for having been rejected by his wife-girlfriend (irritated at his poor sexual performances) or for having seen "Titanic" once a day ("Titanic" once a day throws your happiness away!) c) destroyed by jet lag or hanged by creditors, respectively, after a flight around the world or a very serious shopping every 1.5 days. Thus, to smoke or not to smoke:how do you want to die? 1) Shaw M, Mitchell R, Dorling D. Time for a smoke? One cigarette reduces your life by 11 minutes. BMJ 2000;320:53. Roberto Manfredini, MD Non-smoker Professor of Emergency Medicine First Internal Medicine, University of Ferrara Medical School, Ferrara, Italy phone: +39-0532-236817 fax: +39-0532-236816 e-mail: mfr@unife.it |
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Carol A S Thompson, machine operator Flambeau Micro Plastics
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This claim that smokers lose 11 minutes of life for every cigarette smoked is epidemiologic fraud. It consists of deliberately exploiting the phenomenon of confounding, to falsely blame smoking for diseases that are actually caused by infections, and merely more prevalent among smokers for socioeconomic reasons. Specifically, it blames smoking for cardiovascular disease caused by Chlamydia pneumoniae and other infections, for liver cancer caused by hepatitis viruses, for stomach cancer caused by Helicobacter pylori, for lung disease caused by Chlamydia pneumoniae, C. trachomatis, and mycoplasmas, and a host of other infections for their respective diseases. No, this letter does not "show the high cost of smoking in a way that everyone can understand." It LIES about the health risks of smoking, in a way that the anti-smoking conspirators (including the media) deliberately conceal from the public. REAL smokers advocates are fighting for prosecution of anti-smoker scientific frauds such as this! |
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Carol A S Thompson, machine operator Flambeau Micro plastics
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It is revealing of the extreme degree of intellectual corruption of the health establishment that AN Phillips and George Davey Smith, who are coauthors of a similar study cited in this letter, fail to acknowledge that exactly the same mechanism of confounding is being exploited in most health claims against tobacco, as they elucidated so clearly in their paper of two years before, "Cigarette smoking as a potential cause of cervical cancer: Has confounding been controlled?" (Int J Epidemiol 1994;23(1):42-49; confirmed by FX Bosch et al, Int J Epidemiol 1994;23:1100-1101). Namely, that of true risk factors with large odds ratios, and high prevalence with a different distribution by social class, along with the accepted but fraudulent procedure of adjustment for proxy variables, which generate spurious supposed risks for smoking. And Phillips and Smith are the most honest of the whole lot, because they admit that just that one health claim is confounded. So much for the rest of them! |
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Anupam Johri, Chief Representative Raiffeisen Zentralbank Ost. A.G.
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The article does not highlight benefits which accrue from quitting, by any meaningful analysis of damage ( reduction of life span by cigarettes already smoked ) which can be undone by quitting smoking. Is there any such study? An analysis could be attempted which may show that chances of dying from smoking related causes are reduced by quitting; Specifically it would be very motivating to inform smokers attempting to quit that by successfully staying off smoking for varying specified periods of time, you reverse the effects of x number of cigarettes, or in other words, you increase your current life span by (x number of cigarettes ) multiplied by ( 11 minutes ) |
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Sharad Vaidya
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At long last! the Goa Prohibition of Smoking and Spitting Act comes into effect into the new Millennium. Let us wait and watch how it works. it is result of more than two decades of struggle- education, motivation and people and finally the law makers. Goa is the second state in India to have such a legislation- labelled by the tobacco industry as 'draconian'. I feel this is good certificate. It would hurt them not so much as to affect the sale of tobacco products but as an example for other states to follow. Dr. Sharad Vaidya |
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Mark R Goldstein, Department of Medicine Crozer-Chester Medical Center, Upland, PA USA
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Dear Editor: Numerous studies indicate that regular exercise increases longevity by reducing cardiovascular disease. Then, if smoking one cigarette does shorten life by 11 minutes,imagine the benefit in life gained by substituting either a "brisk walk" or "fairly frantic sexual intercourse" instead of that cigarette. And imagine the pleasure! Sincerly, Mark R Goldstein,MD
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Andrew Moore, O.D.A. HOME
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DEAR SIR THE PUBLICATION OF THIS MISLEADING ARTICLE IS NOTHING SHORT OF IRRESPONSIBLE BY THE B.M.J. WHAT ABOUT THE EVIDENCE ???????? OR RATHER I SHOULD SAY LACK OF EVIDENCE. HAS MEDICINE CEASED TO BE A LIVING SCIENCE ???? I WOULD SAY THAT THE ONLY SUITABLE PUBLICATION FOR AN ARTICLE OF THIS INTELLECTUAL HIGHT WOULD BE THE SUN NEWSPAPER. |
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Tim Reynolds, Professor of Chemical Pathology Queen's Hospital, Burton-on-Trent
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Sir, Shaw et al (1), calculate that 1 cigarette reduces life by 11 minutes. In modern medicine, we are constantly faced with cost-economic choices such as do we use drug A which costs £1000/year or drug B at £2000/year, given that drug A may keep the patient alive for 1 years and drug B for 3. To make such choices we are often forced to resort to health economic measures such as cost / life year saved but we are frequently beset by the problem that there is no benchmark against which to identify whether the money spent is worthwhile. Perhaps Shaw et al have identified a market solution. At 11 minutes / cigarette, 1 year equates to 47,800 cigarettes, which at current prices of £4 / pack of 20 makes £9560 / year of life squandered. To save 1 year of quality adjusted life with statin therapy is estimated to cost £7400 (2). It appears that the public's conception of the value of human life is in quite close accord with the medical economist's views. REFS 1) Shaw M, Mitchell R, Dorling D. Time for a smoke? One cigarette reduces your life by 11 minutes. BMJ 2000; 320: 53 2) Jacobson TA. Improving health outcomes without increasing costs: maximising the full potential of lipid lowering therapy in the primary and secondary prevention of coronary heart disease. Curr Opin Lipidol 1997; 8: 369-74 Authors Prof. TM Reynolds: Professor of Chemical Pathology, Queen's Hospital, Burton-on-Trent. Dr. AS Wierzbicki: Senior Lecturer in Chemical Pathology, St Thomas' Hospital, London. |
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R Pittrof, SpR GUM St George's Hospital, London
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Sir Shaw and colleagues (2000) suggest in a recent letter to this journal that a person who smokes for 54 years has a reduced life expectancy of 11 minutes for every cigarette smoked. Future costs are conventionally discounted at 3%. If this discount rate is applied, a cigarette smoked 54 years before death results in 2.12. minutes “discounted loss of life expectancy”. Among the “Opportunities gained in stopping smoking” Shaw et al quote “fairly frantic sexual intercourse” as the time equivalent of 1 cigarette. As the benefits of delayed death are likely to occur at a time when most couples are not practising “fairly frantic sexual intercourse”, such an example does not appear appropriate. If “fairly frantic sexual intercourse” and similar time equivalents are to be used, then “discounted life loss of expectancy should be applied. The resulting “extremely frantic sexual intercourse” may also lead to a loss of health. Reference: Mary Shaw, Richard Mitchell, and Danny Dorling Time for a smoke? One cigarette reduces your life by 11 minutes BMJ 2000; 320: 53 |
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Rudi Pittrof, SpR GUM St Geoge's Hospital, Tooting
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Correction: Future costs are usually discounted at 3%/year and not just 3%. |
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T Reynolds , A Wierzbicki
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Sir, Shaw et al (1), calculate that 1 cigarette reduces life by 11 minutes. In modern medicine, we are constantly faced with cost-economic choices such as do we use drug A which costs £1000/year or drug B at £2000/year, given that drug A may keep the patient alive for 1 years and drug B for 3. To make such choices we are often forced to resort to health economic measures such as cost / life year saved but we are frequently beset by the problem that there is no benchmark against which to identify whether the money spent is worthwhile. Perhaps Shaw et al have identified a market solution. At 11 minutes / cigarette, 1 year equates to 47,800 cigarettes, which at current prices of £4 / pack of 20 makes £9560 / year of life squandered. To save 1 year of quality adjusted life with statin therapy is estimated to cost £7400 (2). It appears that the public's conception of the value of human life is in quite close accord with the medical economist's views. REFS 1) Shaw M, Mitchell R, Dorling D. Time for a smoke? One cigarette reduces your life by 11 minutes. BMJ 2000; 320: 53 2) Jacobson TA. Improving health outcomes without increasing costs: maximising the full potential of lipid lowering therapy in the primary and secondary prevention of coronary heart disease. Curr Opin Lipidol 1997; 8: 369-74 Prof. T. Reynolds
Dr. A.S. Wierzbicki
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J E Dussek
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Dear Sir, I was pleased to see the letter from Mary Shaw, "Time for a smoke ? One cigarette reduces your life by one minute" (1) because at last the actual number of cigarettes smoked is taken into account instead of the bland number of "pack years". It is very easy in Out Patients to do a quick calculation of the number of cigarettes smoked by a patient and when they hear the total number they are less surprised at the ill effect they have suffered . Twenty cigarettes a day is very roughly 7,500 per annum, 75,000 per l0 years, l50,000 for 20 years and thus 450,000 for 60 years, a fairly typical smoking history for someone who started smoking in their early teens. Double this for 40 a day and the figures become horrifying. I would suggest that all doctors think in these terms when seeing patients. The maths is simple and the message dramatic. J.E. Dussek
1.Shaw M, Mitchell R, Dorling D, Time for a smoke? One cigarette reduces your life by 11 minutes. BMJ 2000; 320: 53 |
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Richard Cove
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Dear Editor, Although the letter by Shaw, Mitchell and Dorling may have been light hearted, there is no excuse for publishing such crude figures in a serious medical journal. We all know how meaningless it is to think about the dangers of smoking in this way. This letter demeans the benefits of giving up smoking and could prove to be a costly error of judgement. How easy would it be for this play- ground statistic to be quoted in the national press, ruining so much time, effort and money spent on public education on this issue? Dr Richard Cove
Shaw, Mitchell and Dorling "Time for a smoke? One cigarette reduces your life by 11 minutes" BMJ 1,/1/00. |
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R Kishore Kumar, Consultant Paediatrician Burnie, Tasmania, Australia
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Dear Editor I read this article with interest. I have been a Paediatrician for nearly 12 years and have had the previlege of having practiced in three different continents during the last decade. The message has been loud and clear. CIGARETTE SMOKING IS INJURIOUS TO HEALTH. Now the icing on the cake has been delivered - it reduces one's life span substantially - nothing we didn't expect or know already - but needed substantial proof to say that! But being a paediatrician we see so many children being passive smokers and suffer and we can't do anything! I think it is time the governments give up the tax benefits to these tobacco industries and also include smoking during pregnancy and first five years of life as possible child abuse to prosecute some of these repeat offenders. We also have a right to protect some of the innocent lives who we know are suffering from SIGNIFICANT passive smoking. With sincere regards Yours sincerely Kishore Kumar Dr.R.Kishore Kumar MBBS,DCH(London),MD(Paed),MRCP(Paed),FRCPI,FRACP Consultant Paediatrician and Lecturer in Paediatrician & Child Health North West Regional Hospital and University of Tasmania PO Box 258 Burnie TAS 7320 Australia. Tel: + 61 3 64306666 Fax: + 61 3 64306685 E-mail: R.Kumar@utas.edu.au |
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