Sunday, October 9, 2011

Pipes and Health


It would probably be disingenuous of me to write a blog dedicated to pipes and not discuss the issue of health. There are several aspects to health, however, more than the issue of cancer that everyone always focuses on.

First, allow me to say that I am not going to deny that pipes have a chance of negatively impacting my mortality. Of course, they do. With that acceptance on my part out of the way, allow me to shed some light on this issue. According to a number of studies, including, but not limited to, a report from the Surgeon General, a pipe smoker would have to smoke between four and ten bowl of tobacco a day, every day, for 30 years before it negatively impacted his lifespan in any significant manner. According to that same report from the Surgeon General, a pipe smoker smoking four bowls a day regularly increases his mortality chances by 30% or so. In medicine, however, an outside force is not considered a significant influence on one's health until it reaches a factor of 200% or more.

It also seems important to emphasize that not all tobacco products are alike. Cigarettes are, as a general rule, an addiction used in order to reduce stress or as a force of nervous habit. Cigarettes, as we well know, are inhaled to the lungs and the average cigarette smoker smokes more than a pack a day. Additionally, the processing and harvesting of the tobacco used for cigarettes is what gives them so much of their harmful qualities: saltpeter (potassium nitrate) is added in order to make the cigarettes burn better, while other chemicals are added for for addictive qualities. Every single aspect that I just mentioned is not true about pipes and cigars. Pipes are not an addiction; pipes are not used in stressful situations or as a force of habit; pipes are not inhaled into the lungs and are not smoked nearly as often as cigarettes; the tobacco for pipes is not chemically altered. Pipes are not cigarettes.

Further, pipes can actually have some very positive impacts on one's health. To smoke a pipe is relaxing in a number of ways: the comfort, the ritual or preparation, the requirement of slowing down to enjoy the pipe, and the physical act of smoking the pipe. Though there are those who smoke a pipe while working, even while doing strenuous physical work – a feat which never ceases to impress – the majority of people use the blessing of a pipe as an opportunity to relax and take a break. Many people have rituals, such as reclining in a favorite leather chair with a book, lounging on the couch to watch golf or a movie, or sitting outside in the fresh air. All of these experiences are relaxing, which lowers the blood pressure and reduces stress. For these reasons, studies have shown that those pipe smokers who enjoy fewer than four bowls a day actually tend to live longer than non-smokers. Of course, there are other possible reasons for this fact, such as the fact that pipe smoking tends to be a vice of the more well-off in society, who are thus better able to afford medical care. Either way, however, the fact remains the same: smoking a pipe three times a day, generally speaking, increases the life span. How you like them apples?

14 comments:

  1. I preface my response by saying that I am both a pipesmoker and a scientific sceptic, and I hope you won't consider a request for the sources of all your claims an attack.

    The mortality percentages (studies and confidence intervals), the assertions that 'gunpowder' is added to tobacco, that cigarettes become more harmful and addictive by processing, that pipe and cigar tobaccos contain no additives, that pipesmokers live longer than nonsmokers, &c. are all in dire need of references.

    And the last sentence, you must surely agree, is patently nosensical. If a person who smokes a pipe exercises regularly, eats healthy food, buys the finest medical care and so stays healthy, the pipe was not the thing that increased longevity.

    I do not like these apples, sir, for they are at best unsupported and at worst untrue.

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  2. I absolutely understand your call for sources, and I only did not include them because this is a blog and not a scholarly work. I will happily provide them once I am by a computer and not on my phone. I know that you want sources, but alow me to assure you that I did not make up these statements and I will happily amend them should the evidence demand that. I would, in turn, request that you be willing to do the same should the evidence be produced, and it will be shortly.

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  3. I am ever ready to have my mind changed; however, I have no statements to amend as I have so far avoided drawing any conclusions other than one of uncertainty regarding the information provided. You may accuse my penultimate passage of harbouring some conviction, but as it was a statement concerning logic rather than evidence, let's leave it out of the equation for the time being.

    Whatever the case may be, I eagerly await the references and thank you for your swift and friendly response.

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  4. In the mean time, Mr. Folmer, I would suggest you look here: http://www.seattlepipeclub.org/content.aspx?page_id=22&club_id=969877&module_id=17020

    And also at the US surgeon General report: Smoking and Health, specifically page 90.

    As for "gunpowder", it is actually potassium nitrate that is added to the paper, also known as saltpeter, which is a major componant in black powder and the production of other explosives.

    On the issue of addictive additives, I direct your attention to this, one of many such reports: http://news.bbc.co.uk/2/hi/393075.stm and http://www.drugs.com/news/cigarette-additives-may-make-tougher-quit-8868.html

    As for harmful additives: http://wiki.answers.com/Q/What_major_harmful_chemicals_are_found_in_cigarettes and http://quitsmoking.about.com/cs/nicotineinhaler/a/cigingredients.htm and http://www.quit-smoking-stop.com/harmful-chemicals-in-cigarettes.html .

    I believe that is all of the information that you requested.

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  5. I hope you'll forgive me for a bit of a delay in my response, as I must first conjure into existence a rather voluminous report on genetics. This will be next, pipeman's word.

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  6. Please forgive my lengthiness.

    The only usable reference here is the famous 1965 report.
    For the others, which are newspaper articles and things like replies from Wikia Answers and About.com columns, I've managed to track down some of the studies in question.

    The summary of the lecture by a California-based plastic surgeon carries no mustard, I'm afraid. Except for one reference to the aforementioned 1965 study, it cites no references. It mentions something called 'Webline' and a number of subjects studied, but without a reference, this information is useless.

    If what you say about potassium nitrate is true (something of which I am not at all certain), you still cannot claim that gunpowder is added. Potassium nitrate is commonly used as a food additive, and calling it gunpowder is rather like calling hops beer because the first is an ingredient of the latter.

    The BBC article does not concern evidence; it is merely about allegations made against and denied by tobacco companies. No doubt the allegations were based on the famous '599 ingredients' list, but even it contained no basis to say that any of those ingredients were in fact in cigarettes. I'm not saying the allegations weren't correct and the companies weren't lying, but we have no evidence to make claims either way.
    For the second link, luckily the article mentioned some source material. I found the study in question: a literature examination by ASH.

    http://www.ash.org.uk/files/documents/ASH_623.pdf

    I don't recommend anyone peruse it; all it contains are some old quotes by industry people, followed by rather useless counterremarks. It mentions no proven additives (other than the ones that have been approved over the years by the US government). It cannot be called a study. If I am wrong, and there is a better source for this, I will gladly stand corrected.


    Another study which I found by looking for the name "Michael Rabinoff", apparently the author of the rather spectacularly titled "Ending the Tobacco Holocaust", is to be found here:

    http://ajph.aphapublications.org/cgi/reprint/97/11/1981

    It comes to no conclusion. It is another literature study and whilst it rightly contends that many of the substances in the '599 ingredients' list are harmful, it provides no evidence that they are actually to be found in cigarettes.


    Your last link, with the list of harmful ingredients that may actually be found in cigarettes, cites as its source what appears to be a Northern Irish health organisation. The closest thing I can find to what the website refers to is the following:

    http://www.healthpromotionagency.org.uk/Resources/tobacco/NRT.htm

    The information is, however, no longer available online and therefore I can't comment on the list's veracity.

    -continued-

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  7. -continued-

    I have saved the best for last. The most (if not only) reliable source of information so far is the 1965 survey. It has obvious problems, such as the fact that many of its subjects were born in Edwardian days, and that tobacco products will have changed immensely sice the 1950s, but let's assume that the mortality ratios between the different tobacco products have not changed appreciably. It seems likely enough and at least provides for a foundation upon which to base an argument.

    http://profiles.nlm.nih.gov/ps/access/NNBBMQ.pdf

    The data here are very interesting. When plotted they show that it's best to smoke for no shorter than 20 years, as during those 'formative' years death tallies rise, whilst after that, ratios drop for everything except cigars. After about 30 years, the death ratios once again start to shoot up.
    This phenomenon can be seen most clearly in the data collected from US veterans, as the four age categories (rather than the three for Canadian veterans) draw a clearer picture.

    I think what matters most for this particular discussion is an average death ratio. I've taken the results from page 90 (minus those of the men in 9 states due to the incompleteness of the data) and taken their average. On page 85 you'll find a similar study that didn't take age into account, which we can include as that's what the aforementioned average is, in effect. Averages have been calculated with dx/n.

    study 1
    cigarettes: 1.50
    cigarettes+: 1.29
    cigars: 1.02
    pipes: 1.11

    study 2
    cigarettes: 1.74
    cigarettes+ 1.42
    cigars: 1.06
    pipes: 1.02

    averages
    cigarettes: 1.62
    cigarettes+: 1.36
    cigars: 1.04
    pipes: 1.06

    Now, I don't think anyone expected cigarettes to come out better than pipes or cigars. It is surprising to me that "cigarettes+" (cigarettes and other) came out a bit better than just cigarettes, but it probably has to do with less inhalation, or a lower total amount of cigarettes smoked.

    Pipes, whilst not quite on top, do well. You'll notice that the average ratios are still all above the average for nonsmokers (1.00); pipesmokers, on the whole, according to this study, do not live longer than nonsmokers. They live slightly shorter.

    I'll add once more that the above conclusion is based on sixty year old data and therefore almost exclusively of historical value. But it is what was provided, and these are my conclusions.

    I can't find the statistics to support your claims that "a pipe smoker would have to smoke between four and ten bowl of tobacco a day, every day, for 30 years before it negatively impacted his lifespan" and that "a pipe smoker smoking four bowls a day regularly increases his mortality chances by 30% or so" (your remark saying that an increase of 200% would be needed to be significant is untrue, certainly in a study of this scale). Are they to be found elsewhere?

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  8. Good response. I love learning new things. I apologize for the quickness of my writing, but I am about to head into class.

    As for this additives, cigarette companies have now given the list of additives to the DHHS. Here is a good, government article for you to check out: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2040350/

    That one is quite a good, if not boring, read.

    On the issue of the "gunpowder" claim, I have already stated that it was not actually gunpowder, after my research, but potassium nitrate, which, though a food additive, is added to the paper of cigarettes for the sole purpose of enhancing the burning.

    Sources for this:

    http://tobaccodocuments.org/product_design/00382055-2062.html

    http://www.google.com/patents?hl=en&lr=&vid=USPAT4231377&id=f8kvAAAAEBAJ&oi=fnd&dq=potassium+nitrate+cigarettes&printsec=abstract#v=onepage&q=potassium%20nitrate%20cigarettes&f=false

    That second one actually suggests using magnesium oxide as an alternative to potassium nitrate.

    About claims about the amount of bowls smoked to be significant. In that same 1965 study you cited (albeit that it is quite old), it says that one study "gives a mortality ratio of 0.91 for cigar and pipe smokers...who consume more than 14 gms. of tobacco daily." Fourteen grams is about a half ounce, and the average pipe smoker makes an ounce last about 10-15 bowls (according to several non-scientific sources, but they are the best that one can find). Thus, a half ounce would last 5-7.5 bowls. This mean, the pipe smoker who smokers 4 bowls (fewer bowls than that determined by the study) have a better mortality rating. Naturally, this is likely a result of being from an affluent part of society, something which I admitted in my initial post.

    The overall ratio of that study, from the U.S. and Canada, was found to be 1.01 for pipe smokers smoking 1-9 bowls a day. That is an increase that is so minimal that no scientist would consider it significant. Those who smoked 10 bowls or more a day were found to have a mortality ratio of 1.05, which is, again, minimal, though clearly greater than those who smoked fewer bowls.

    I also fear you misinterpreted my statement that "a pipe smoker smoking four bowls a day regularly increases his mortality chances by 30% or so". I meant that he increasing his chance of fatality (a negative thing). According to the report that we have been citing, that is actually a gross exaggeration, as all of the studies make it appear to be a much smaller chance than that.

    Finally, the statement about a %200 percent increase being required before being considered significant is generally true through science and medicine. Whether or not we agree that that degree is the requirement in this case, I think we can both agree that an increase of 1% (a 1.01 ratio) is barely worth consideration and certainly cannot be considered significant.

    I will happily reply more once out of class. Thank you for the discussion!

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  9. The article you quote is the one I referenced in my previous comment; it's the one by Rabinoff (who seems to have rather a conflict of interest here) that really proves nothing, as all it does is cite literature. Its conclusion is that of the ingredients approved by the US government to be in cigarettes, about 100 have nefarious purposes.

    The 14-gram-number you quote is the one for British doctors, and it is for pipes and cigars put together (although the study says it's probably mostly pipes). It is the only mortality ratio in the study in question that's below 1, and once again, the average comes out to 1.06.

    Seeing as the study presents this data, without disclaimers concerning accuracy and significance, I assume that these differences were found to be significant. A 1% difference can certainly be significant if the population is large enough; perhaps not for testing the efficacy of medicine as a 1% effective medicine is nearly useless in practice, but an effect is an effect. I think that we must assume that the statistics were considered and taken care of in this study.

    But if you maintain that a 200% difference is required, no position can be supported with the results of this report as none approach that threshold.

    As a footnote to that, I didn't misinterpret your "30%" statement; it was simply a claim and I asked for its source. I try to be impartial when science is concerned, and a claim is a claim. But it is off the table now.

    What study now remains? The 1965 report was the only real source of data in this discussion, and studies contending that some chemicals that might be in cigarettes are harmful are useless until they prove that those chemicals are in fact in cigarettes.

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  10. All right, I am going to focus my response on the issue of chemical additives, since that is one where we seem to constantly be returning.

    Yes, the famous 599 additives is a list that has been approved and does not necessitate that every single one is used at a given time, and yes a number of those additives have been approved for use in food. The issue, however, is that those chemicals that were deemed safe for food use were tested in their unburned state. While burning, chemicals have different effects (a simple example is that sniffing plastic is not harmful, but inhaling burning plastic is). This is the reason that, after the cigarette is ignited, approximately 4,000 chemical compounds are created. (One source: http://www.tricountycessation.org/tobaccofacts/Cigarette-Ingredients.html)

    Additional evidence that chemicals and additives are added to cigarettes cane be found in a more round about way. Back in June of 2010, a study came out discussing how American brands of cigarettes are more harmful than brands produced in other countries (Sources: http://www.usatoday.com/news/health/2010-06-04-cigarettes-cancer_N.htm and http://cebp.aacrjournals.org/content/19/6/1389.abstract). The fact that one is more harmful than the other means that something else is going on besides tobacco being put inside of paper. It is suggested within the full study that there are two reasons for this: the type of tobacco used in different countries and the way that the cigarettes are made. Both of these theories go to support my statement of pipes being not nearly as bad as a result of the processing used. The cigarettes that were found to be less harmful often used flue-cured tobacco, a type which is very common in pipe tobacco, while the more harmful American brands use a blend of tobacco unique to their cigarettes. 'David Sutton, a spokesman for tobacco giant Philip Morris USA , said the finding was not surprising.

    "Previous studies have shown global differences in TSNA levels due to variations in tobacco blending and curing practices around the world," Sutton said in a statement.'
    Simply looking at it logically, cigarette companies requested permission to put approximately 600 additives in their cigarettes. This was not done for the fun of it, but because there was an intention to put these chemicals into their product. While it is true that not all 500 may be present at a given time, surely you cannot deny that healthy number of them probably are.

    Sorry to run, but I have class and must finish my response later. Once again, thank you for the stimulating discussion!

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  11. I'll first respond to your final assertion: I do not think anyone out of the know can say which of these ingredients are in tobacco. I'll bet you a bottle of whisky that some are in there, such as water and tobacco extracts, but whilst we can be quite sure things like anise and coffee were one-offs for novelty cigarettes there is no way to group the more obscure substances in that list under either category. I see no reason to assume that cigarette tobacco contains any substances that pipe tobacco doesn't. It might be the case, but I haven't seen evidence for it.

    That US cigarettes are more harmful than Canadian cigarettes could indicate a number of things. In the case of this study you can read in the abstract that the substances being studied are nitrosamines specific to tobacco. This would indicate differences in the ways the tobacco is blended, not in what foreign substances are added. Of course, you could say the difference is unimportant; if this study is correct, the conclusion that US cigarette tobacco is being blended in such a way as to make it more dangerous is alarming. But this conclusion has no proven causal link with the ingredients list. It pops up all over the place, but quite frankly, I haven't been able to even find a credible source confirming its veracity. Now, the fact that it hasn't been refuted anywhere is proof enough for me, but I certainly dare not draw any conclusions based upon it.

    I'll clarify what I've said before: I quite agree that smoking a pipe without inhaling and doing so, as I do, about once or twice a week, won't kill you as fast as smoking a pack of cigarettes per day. This is not because there's poison in cigarettes that isn't present in pipe tobacco; I'd wager that if we smoked pipes as cigarette smokers do cigarettes, we'd not make it to next week. I think, and I'll add that this is mere conjecture, that unrefined, unhomogenised pipe tobacco contains far more unhealthy stuff than does filtered, cleaned, normalised cigarette tobacco.

    I would like to be able to say something more conclusive than that, but I cannot. Sources for medical claims must be medical studies. A newspaper or anti-smoking organisation may write whatever it wants; how do we know the substances in question are the unburnt ones? How do we know pipe tobacco doesn't contain the same things as cigarette tobacco? How do we know pipe smokers live longer than cigarette smokers?

    For now, we need a study to provide evidence that there are additives in cigarettes, and that these additives are harmful. I have not yet seen such a study.

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  12. Mr. Folmer, I promise I will get back to you shortly. There are a number of pies in front me demanding my immediate attention! :-) Happy Thanksgiving!

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  13. I've spent countless hours scouring the net and other available sources for information related to the health effects of pipe smoking versus other forms of tobacco consumption. The plain and simple fact is that nobody can agree. I could probably write just such a report with no references at all, and by happenstance they will align with a claim made by one company or another. It's my opinion that, unless you conduct the studies yourself, you will never have a definitive answer. I like a bowl a day myself, and if it kills me, so be it, i'll die a happier man for it.

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