Intended for healthcare professionals

Rapid response to:


Estimate of deaths attributable to passive smoking among UK adults: database analysis

BMJ 2005; 330 doi: (Published 07 April 2005) Cite this as: BMJ 2005;330:812

Rapid Response:

Secondary Smoke, Alcohol, and Deaths...

Two points raised in the Rapid Responses immediately prior to this
come together with a question I have written about for several years.
USDHHS (U.S. Dept. of Health and Human Services) has classified Ethyl
Alcohol as a carcinogen. To be true, they have only classified it as such
when it is "consumed," presumably in liquid form, but alcohol is a very
volatile liquid. (1)

A cigarette emits roughly a half milligram of active Class A
carcinogens with the most significant in terms of weight being benzene at
3/10ths of a milligram. A standard martini releases roughly one full gram
of the Class A carcinogen ethyl alcohol into the air in the space of an
hour: an amount equal to 2,000 cigarettes. You can see this for yourself
most clearly if you pour a large shot (48 grams) of grain alcohol into a
martini glass and set it someplace ventilated and safe for two days. When
you come back it will be gone. If the cat didn't drink it the alcohol
went into the air and was breathed and ingested by any who wandered
through the room during that period.

Some might claim that DHHS specified "consumption" of alcohol in
order to rule out any airborne effects, but to say that mucosal cancers
from liquid alcohol do not imply mucosal cancers from evaporated alcohol
makes an absolute mockery of the old "tar in acetone painted on mouse
skin" proofs that medical scientists were so fond of in the 1950s and 60s.

As Dr. Lee, in the Response immediately above this one, points out:
"Logic dictates that if cigarette smoke is harmful when inhaled into the
lungs of smokers then the same smoke when inhaled into the lungs of non-
smokers will also be harmful. To argue otherwise would be foolhardy."
People like myself argue that the dilution of that smoke, particularly in
modern venues with far better ventilation than generally reflected in
epidemiological studies based on exposures stretching back 30 or 40 years,
make a huge difference.

Nonsmokers in well designed and ventilated bars and restaurants would
normally inhale no more than a few micrograms of active Class A
carcinogenic material from cigarettes. In exceptionally well designed and
ventilated venues the total amount would probably be measurable only in
nano- and picograms. The alcohol case is clearly far stronger:
nondrinkers would be likely to inhale milligrams rather than mere
micrograms in drinking allowed venues... particularly if smoking is banned
and ventilation levels reduced.

Of course there's no massively funded Antialcohol lobby to run huge
epidemiological studies on passive drinking and such studies would be very
difficult to design. Non-drinking bar workers could be compared to non-
drinking pool-hall workers (both groups would be exposed to similar
amounts of smoke thereby removing that as a variable) but such population
pools aren't very large. However, as Luc Bonneux pointed out above, risk
management often involves making decisions "not supported by hard
epidemiologic data."

He also points out that risk management principles dictate that
"risks are to be reduced to levels as low as possible. The lowest level
possible is easy to identify: apply the law, ban smoking in all public
places." Following those principles, and following the thinking and
reasoning of Dr. Lee, one would have to accept the necessity of banning
alcoholic drinks in restaurants and perhaps even in bars.

Sure, it might hurt their businesses a bit. Fancy upscale
restaurants would lose their profits on $100 bottles of wine and the
clientele frequenting bars would probably suffer an initial dip until
people got used to enjoying each others' company over glasses of vegetable
juice or soda pop. However, as has been stated consistently by smoking ban
proponents, any possible risk to health is first and foremost:
nonpartakers should not be forced to partake anything over a zero-
tolerance exposure to any potentially harmful chemical, and the removal of
drug use from the visual environment of children and teenagers will make
them less likely to become addicted themselves.

We should remember that underage drinkers account for nearly 20% of
alcohol consumption (2) while underage smokers account for just 3% to 5%
of the cigarette market (3). Would removing alcohol from bars,
restaurants, TV commercials, movies, and sports events while quintupling
its taxes cut underage drinking by 400%? Antismoking advocates feel such
measures are effective for tobacco so they should be similarly effective
for alcohol, true?

Do I really think alcohol should be banned from bars and restaurants,
from movies and TV, from sports events and wedding champagne toasts? Of
course not: the risk levels of nondrinkers, if evaluated honestly in
studies not funded by pressure groups would be below consideration by any rational person. And
anyone who did not want to be exposed to such fantastical wisps of risk
could simply avoid establishments where alcohol was allowed.

Exactly the same argument can be made about smoking and smoking bans.

Michael J. McFadden

Author of "Dissecting Antismokers' Brains"


(1) National Toxicology Program. DHHS. 11th Report on Carcinogens

(2) Foster, S.E., R.D. Vaughn, W.H. Foster and J. A. Califano, Jr.
2003. Alcohol consumption and expenditures for underage drinking and adult
excessive drinking. JAMA 289 (8): 989-95

(3) Viscusi, W. Kip. "Smoke and Mirrors...." The Brookings Review,
Winter 1998 Vol. 16 No. 1, pp. 14-19

I am a member of several Free Choice organizations, and have
absolutely no financial interests with Big Tobacco, Big Hospitality, or
any other player in this arena other than as a customer and as the author
of a book in the field.

Competing interests:
I am a member of several Free Choice organizations, and have absolutely no financial interests with Big Tobacco, Big Hospitality, Big Pharma, or any other player in this arena other than as a customer and as the author of a book in the field.

Competing interests: No competing interests

28 April 2005
Michael J. McFadden