Well this is interesting - cigar smoking and cancer risks

[Shelby07]

 

https://www.rstreet.org/2012/08/01/the-health-risks-of-cigar-smoking/

[Guest Nekhyludov]

Thanks for the share! It's always interesting to see quantitative research on this.

I guess I'll have to try to stay below 5 cigars per day 

[xtcat9k]

1 hour ago, SenorPerfecto said:

Is there a link to the actual Kaiser study?

https://www.ncbi.nlm.nih.gov/pubmed/10362820

[KGM]

So I guess I would consider myself a light smoker at ~1 cigar a day.

[oliverdst]

very interesting.

I suggest you to chance your topic title and include words like risk, cancer, tobacco... so more people can find it in the future.

I dont know how serious this study is but it's always good to have some ammunition against tobacco haters.

I love this paragraph:

Still, even moderate cigar smokers had a 20% increase in heart disease risk, which is consequential.  That increased risk is, however, of the same magnitude that most Americans experience when they eat meat (as compared to heart disease risk for vegetarians).  Lifestyle choices have consequences; consumers should use research results to inform their choices, including those concerning tobacco.

[Shelby07]

5 hours ago, oliverdst said:

I suggest you to chance your topic title and include words like risk, cancer, tobacco... so more people can find it in the future.

Done. Thanks. 

[MD Puffer]

Oh boy.  Where to begin?  First, it's an old study so these guys aren't currently going to any epidemiology conferences and giving presentations on this data.  I'm interested in knowing how properly scrutinized this data was when it was new and being first presented.  Academics love to find design flaws and identify biases and make the presenter acknowledge their cerebral prowess during these meetings.  It's basically mental masturbation.  So allow me to get my jollies, albeit 20 years too late.

This forum's readers most likely can tell the investigators of this study were not cigar smokers. 

 

1.  What kind of cigars are being smoked?  They don't say.  They admit they didn't ask or try to categorize it.  What was the ring gauge?  What was the length?  We all know the following formula:  (RG X L) / (1 /  SMS mL) = min.  

In other words, the product of ring gauge times the length, divided by the inverse of the number of milliliters of single malt Scotch equals the number of minutes it will take to smoke the cigar.  Pfft!  Duh...

So basically, they lump smokers of minutos and prominentes together.  And smokers of both aren't even acknowledged. 

They mention people smoke at different rates (i.e. How fast do they puff?) but they can't control for this (and couldn't realistically do so in a prospective study either).

Basically, there's a big difference in smoke exposure between someone smoking 5 double coronas per day vs someone smoking 5 HUHC's. 

 

2.  Inhalation.  They state, "The questionnaire did not inquire about the degree of inhalation, the length of time cigars had been smoked, or the type of cigar usually smoked."

However, they did reference an old study that reported 10% of its participants inhaled cigar smoke, thus intimating the same might apply to their own population.  But that's pretty speculative.  I'd love it if someone conducted a poll on this site simply asking if you inhale cigar smoke or not.  Inhaling cigar smoke seems like a slow form of suicide.

More importantly- and this is the big one- they didn't address/screen for where people smoked.  Did they smoke indoors exclusively?  Outdoors exclusively?  Some combination of both?   This should have been asked.  They state it is this very secondary exposure which could be the cause of the increased disease prevalence but they don't control for it at all, let alone acknowledge it.  There's a huge difference in the amount of exposure to second hand smoke from smoking outdoors vs indoors (and that doesn't even get into if the indoor smokers are smoking in ventilated vs unventilated/poorly ventilated rooms).  

 

3.  Cohiba or Black N Milds?  Are they smoking good Cuban cigars or cheap machine made cigars?  What difference does that make?  It indicates a difference in socioeconomic status which plays into the exact same increases in disease prevalence shown (i.e., there's been a long established correlation with lower socioeconomic status and higher rates of various diseases, -cardiovascular disease and diabetes come to mind).  This was a study of middle class smokers.  Wealthy and poor cigar smokers were admittedly underrepresented.  You might say the wealthy are smoking expensive cigars (and more likely to go hiking and eat kale salad) and the poor are smoking cheap Black N Milds (and more likely to sit glued in front of the TV and eat McDonalds).  But their target demographic is varied.  They should have asked about the amount of money the patients spent on cigars.

 

Other tidbits:

-They still cannot show causation with heavy cigar use- just the association.  It might be the more sedentary lifestyle associated with smoking 5+ cigars a day that's associated with the increased disease prevalence. They don't know- and they admit as much in the study.  

-They don't even address whether or not the cigar smokers lived with any cigarette smokers.  Again, more second hand smoke exposure (presuming the cigarette smokers were smoking indoors).

-Interestingly, the cigar smoking group tended to be fat bastids as well, with hypertension and elevated cholesterol levels (as compared to the nonsmoking group).  

-Interestingly, the nonsmoking group drank more alcohol than the cigar smokers...a lot more. 

-No increased risk of stroke or peripheral artery disease- not really surprising though.

-Cigars aren't a nicotine "gateway" drug.  Most continued to smoke cigars at the 4 and 8 year follow up intervals but only 6% added cigarette smoking.  

 

 

Pretty crappy study.  I doubt any audience members would have ripped it apart during any presentations they gave.  Who wants to come off as a friend to Big Tobacco.

 

[Fugu]

Excellent analysis and scrutiny, @MD Puffer, on which I can only wholeheartedly agree! Typical basic issue of epidemiology on parameters with small effects to begin with, and in addition issues of poor study design. Both met in a perfect flapdoodle effect.
 

[hedgeybaby]

Non smokers die every day. 

[bsubtown]

As long as we are adding on to the problems with the study: It looks like the used self-reports to tobacco use status of health plan subscribers. An old study but people were not that much stupider in the 90s. If you health plan provider or insurance agent asks if you smoke you tell them no. 

 

All this being said I don't really doubt that smoking cigars, even fine Cubans, will increase my risk for certain diseases. I try to offset that by exercise, healthy eating and moderation. 

[Whisky91]

@MD Puffer Very well stated. You brought up a few points that I did not even consider. That being said, I smoke a few cigars a week and that’s usually during spring/summer. 

[RDB]

So, are there any good studies of the health effects of cigar smoking? 

[LGC]

There will NEVER be a scientific study with a handle on ALL relevant controls and variables. We can’t gather enough empirical data, but only jump to conclusions based on observations... which are mostly biased. Any volunteers to sit in a controlled environment and be told when/ what/where to smoke, eat, drink, sleep, exercise, take drugs, induce stress, etc., etc.???

[RDB]

Well, there must be some useful evidence out there. It’s not a question of any single study being decisive. 

[CaptainQuintero]

5 hours ago, RDB said:

So, are there any good studies of the health effects of cigar smoking? 

It's probably relative to stress levels, I know @MD Puffer will be able to chime in, but I've always been under the impression that high levels of stress opens you up to horrific diseases and conditions, if you can do something to reduce stress then it's almost always a positive thing..

  But obviously it is relative; yoga will be far better for you than a cigar but a cigar will be far better for you than shooting up heroin. The grey area is balancing it; cycling outside is a great stress reliever, but if you cycle to work everyday stuck behind vehicles pumping out pollution right into your face, then are a few cigars a week more healthy than that?! I'd hazard a guess you'd be better off with the cigars!

[MD Puffer]

3 hours ago, CaptainQuintero said:

But obviously it is relative; yoga will be far better for you than a cigar but a cigar will be far better for you than shooting up heroin. 

Can't disagree with this, but there's no way I'm ever wearing yoga pants...

 

[PapaDisco]

9 hours ago, RDB said:

So, are there any good studies of the health effects of cigar smoking? 

I still like the original bedtime read that was the Surgeon General's report on smoking from 1968.  What I liked about it was that it was huge, and a straight up mortality test; almost no "massaging" of the numbers.  They took a lot of smokers; cigar, pipe and cigarette, on multiple continents and the analysis was "live or die" and at what age.  Cause of death was not used to mess with the numbers.  So for example, the guy who died smoking his cigar when the hot ash dropped in his lap while driving 100mph through the desert to Vegas wasn't moved from the "smoker" column to the "car accident" column.

The end result of that study was that cigar smokers (and pipe smokers) who did not inhale (yes they asked that) and who smoke 5 or fewer cigars per day (considered "moderate" back then) had the same longevity, or in some cases slightly longer,  than non smokers.  Also interesting was the cigarette smoker curve: those who started late in life (after 30) and smoked modestly (I forget the number but less than a pack a day) also showed no increase in mortality, however someone who started at 15 and smoked 2 packs a day tripled their risk of early death.

And this was all in a day and age when people smoked indoors (whether you were a smoker or not  ) , so clearly there is some benefit to the relaxing practice of cigars that outweighs the harm from second hand smoke.

Here's a clip of the Surgeon General's mortality table for cigars:

Cigar Surgeon General.pdf

[oliverdst]

@MD Puffer if you want a so meticulous study about everything in life it will be hard even to breath.

cool down, bro, not everything in life must have a PhD tesis. maybe you are in academia and you get pissed when you see an out of parameter study.

every article that from time to time crosses the forum show that low level cigar smokers dont experience so bad consequences.

[LordAnubis]

He’s simply pointing out flaws in the paper. The same flaws that I too, as a man of science and engineering and understanding of statistical analysis, was sceptical/concerned about the validity of the report.

I was glad to see his input. He’s clearly a researcher or something. Great to have the input.


Sent from my iPhone using Tapatalk

[MD Puffer]

3 hours ago, oliverdst said:

@MD Puffer if you want a so meticulous study about everything in life it will be hard even to breath.

cool down, bro, not everything in life must have a PhD tesis. maybe you are in academia and you get pissed when you see an out of parameter study.

every article that from time to time crosses the forum show that low level cigar smokers dont experience so bad consequences.

I'm in private practice now, but I spent 9 years in academia and routinely was involved in study design and identifying flaws and biases in studies.  This study may have been one of the publications that were required for one of the author's doctoral degrees (you generally need 4-5 publications in addition to your dissertation).  But this was a big deal- this got published in the New England Journal.  They're a top tier medical journal.  Getting published in journals are the livelihoods of researchers.  Without publications you lose lab space, funding, the ability to hire lab assistants, grad students won't want to work with you, and worst yet- you'll be forced to teach undergraduate classes.  Getting published in NEJM is like getting called up from the minors.  There are few that are more respectable.  The path to getting published in the NEJM, JAMA, Nature, etc is grueling.  Your study gets picked apart like tooth pickin' chicken.  Medicine is also political unfortunately.  And in this case, politics likely had something to do with a poorly designed study with several obvious biases (selection, observer, and cause-effect, confirmation).  If this was any other article that wasn't about a hot topic issue, it wouldn't have been published in the NEJM and would probably have only gotten published in a 3rd tier (or maybe lower) journal- provided the authors paid the publication fees (which is standard).  This is a poor study.

 

[Shelby07]

1 hour ago, MD Puffer said:

...This study may have been one of the publications that were required for one of the author's doctoral degrees (you generally need 4-5 publications in addition to your dissertation)...

 

The article stated that the study was performed by Kaiser, which I think is one of the largest and best rated medical providers in the country.  Am I missing something?

I appreciate your comments. Thanks. 

[MD Puffer]

26 minutes ago, Shelby07 said:

The article stated that the study was performed by Kaiser, which I think is one of the largest and best rated medical providers in the country.  Am I missing something?

I appreciate your comments. Thanks. 

You're not missing anything.  There was also federal grant funding.  Someone had mentioned that this study wasn't a PhD thesis and I just added that these papers very often are a requirement of doctoral candidates.  I didn't mean to confuse thing with an unnecessary remark.   Point is that the NEJM wouldn't have published a cohort study with this data on most other health disorder unless it was a hot topic.  

I don't know how insurance companies are rated.  Kaiser isn't a carrier in my state.  The study could have come out of Harvard and it would still be garbage.  You can't design a study about the effects of tobacco use that is generally non-inhaled and not control for secondary exposure (unventilated indoors or living with other smokers) or control for socioeconomic-related factors.  What information you can get out of this data set isn't fit to publish in NEJM or other top tier journals.

 

[oliverdst]

4 hours ago, MD Puffer said:

I'm in private practice now, but I spent 9 years in academia and routinely was involved in study design and identifying flaws and biases in studies.  This study may have been one of the publications that were required for one of the author's doctoral degrees (you generally need 4-5 publications in addition to your dissertation).  But this was a big deal- this got published in the New England Journal.  They're a top tier medical journal.  Getting published in journals are the livelihoods of researchers.  Without publications you lose lab space, funding, the ability to hire lab assistants, grad students won't want to work with you, and worst yet- you'll be forced to teach undergraduate classes.  Getting published in NEJM is like getting called up from the minors.  There are few that are more respectable.  The path to getting published in the NEJM, JAMA, Nature, etc is grueling.  Your study gets picked apart like tooth pickin' chicken.  Medicine is also political unfortunately.  And in this case, politics likely had something to do with a poorly designed study with several obvious biases (selection, observer, and cause-effect, confirmation).  If this was any other article that wasn't about a hot topic issue, it wouldn't have been published in the NEJM and would probably have only gotten published in a 3rd tier (or maybe lower) journal- provided the authors paid the publication fees (which is standard).  This is a poor study.

 

relax and light a cigar, bro.

[Toast & Taste]

Life will kill ya.

Big Al 

[MD Puffer]

Science.  One of the best carrots there is!  Lower tier and regional journals were the only ones I was ever able to author.