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Comment by solox3 | Hacker News Reader

I am fine with abstinence as a general recommendation, but critical thinking pointed out two issues with the WHF Policy Brief, which I suppose I have read in sufficient depth:

1. There is no citation on the sentence, "Recent evidence has found that no level of alcohol consumption is safe for health." This is really the only line we are interested in.

2. There is no comparison on the effects of alcohol on the body by dosage (and frequency), which is, again, what is required from the brief to make that claim.

Again, while I don't necessarily disagree with what's in the report, and that it is already established that drinking too much is not good for the heart, considering many otherwise toxic substances have a hormetic zone, it is critical that a study like this rules out the its existence for ethanol.

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If you want to feel some dissonance about this, you might note that this is the exact language the CDC uses for things like secondhand smoke -- "There is no risk-free level of exposure to secondhand smoke" -- which everybody nods along to and accepts without much scrutiny.

Source: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/seco...

Meanwhile, when it's something like, say, cosmic radiation exposure from commercial air travel, suddenly the CDC is very interested in levels of exposure and has language that provides context intended to downplay the risks.

Source: https://www.cdc.gov/nceh/radiation/air_travel.html

Why these statements bother us when they're about one thing and not another -- or, indeed, why our health agencies would choose language like this for some kinds of risks and not others -- is left as an exercise for the reader.

The CDC has been unfortunately hopelessly politicized. It happened long before the pandemic.

OTOH, I would make the differentiating point that air travel has positive benefits to society and costs and one has to weigh those against each other. You can’t make the blanket statement “earth would be better off if air travel went away completely.”

It’s hard to find any benefit to smoking, first hand or second, so it’s easy enough to just shit on it. The ROI on whatever ills aviation may have is a topic of discussion, there’s 0 ROI on smoking.

>> It's hard to find any benefit to smoking...

Ritualistically, as an exercise in getting out of one's 'normal' consciousness, it can present useful information for self study. In habitual form, it is of course very destructive.

So the "getting out of consciousness" that is the relaxation experience many "habitual" smokers have is worthless, while changing your state for ritualistic purposes is helpful?

Both are very tiny self-reported effects that are close to non-observable for outsiders. Why would one outweigh the other, if you allow self-reported epsilon effects at all?

>> getting out of consciousness

You mean sleep (as in, night time bed activity)? I'm not talking about sleep. I am discussing getting out of normative modes of being but not going to sleep.

>> that is the relaxation experience

This is not the only experience resulting from tobacco use. There are more subtle effects as well.

>> worthless

I haven't declared a value judgment against the habit. I am saying it is destructive to the body. Do you believe that to not be a fact?

>> helpful

Again, I'm not presenting value judgments here. I am saying it can present useful information. It sounds to me like you have taken offense somewhere for some reason. I am not putting weight on one or the other.

*edit: clarity

This isn't politics, it's safety. I accept the argument that the CDC has become overly innumerate in how to live a healthy life, but it's not a liberal or conservative idea to be cautious.

There is such a thing as being unnecessarily and overly cautious, however. This sure seems like a good example of that.

Exactly. Precaution comes at a price. The question is whether the benefits of the precaution outweigh the costs. And that is an answer science cannot, and should not, answer. These days, it seems, many scientists are desperate to cloak their policy preferences in "science." That is precisely why there is presently so much distrust of scientists.

I never understood distrust, because scientists base their work on research that is extensively cited. Making conclusions that are not supported by evidence, e.g. "desperately cloaking" policy preferences, could jeopardize one's scientific career.

Many people seem to unrealistically demand scientific recommendations to be "guarantees." However, scientific conclusions are very precisely made best guesses, built on humanity's knowledge.

> I never understood distrust, because scientists base their work on research that is extensively cited.

It's good that the supply chain of science is traceable, but it doesn't guarantee truth by any means. Their are many non-scientific human endeavors that have traceability, take software development for instance.

I think the distrust comes from many fields having fairly obvious political trends, in particular social sciences. Another source of distrust is overextrapolation of science by authorities. For instance, science might say that certain drugs are harmful if abused, and politicians may use that to claim the war on drugs is based on science, which obviously is not true. Lastly, some fields struggle producing consistent and falsifiable results, such as economics and psychology.

The replication rate of Economics as a field is higher than replication rates for psychology, cancer research, pharmaceutical research, and many other fields. When was the last time you opened an econ journal?

0.1% of studies in the econ field are replication studies.

58% (quite high, higher than a lot of biology related field) are positive replications.

But! some of those use the same datasets, with different time bases, and most are narrow replication of high impact studies.

Also, economics now is not a singular field, and I'd bet gp was talking about macroeconomics. You could be more charitable.

Choosing the level of safety we enforce in society is inherently political.

There was a comment I saw the other day along the lines of "Science will tell you what the numbers are, but doesn't make a judgement of how big that number should be."

You can get a pretty good estimate of how many lives would be saved if we smoked less, or drank less, or did any number of other things, but ultimately that's an input into a public policy decision making system that doesn't have a provably right answer unless everyone involved agrees on what the desired outcome is.

Nobody is enforcing anything, either in the parent or the OP, so don't panic. Your comment seems inflammatory and irrelevant in this context, but I'm sure that's not your intent. You'll be ok, don't worry.

Safety becomes politics once acting in "unsafe" ways becomes illegal.

As we've seen in the past 2 years, there's no real positive benefit to society to frequent business flying (at pre-pandemic levels).

Like smoking, we don't need to completely ban air travel. The equivalent would be severely limiting it (for example, prohibiting business flying).

> The equivalent would be severely limiting it (for example, prohibiting business flying).

People fly to go on holiday and experience cultures other than their own which is something we should be encouraging rather than discouraging. I strongly agree with reducing needless business travel but if doing so also limited vacation travel I think it'd be a net negative.

We should be discouraging all air travel. All of it.

No, we shouldn’t. Instead, we should work on ensuring that as many people are able to enjoy new opportunities it provides if they do desire as possible. Everyone should be able to enjoy life.

Climate impact is significant. That's going to interfere with generations enjoying their lives.

We should then work on enabling people to fly with no climate impact. For example, using zero emissions energy to synthesize jet fuel. The goal should be to enable people, not to block them.

Sure, but not high on the list of priorities. How about enabling people to get healthcare, go to college, or to survive by addressing global warming.

"Stop everything above this line on Maslow's pyramid because some people fall below the line" is not a solution to any of the problems faces by people below the line. It's like demanding that an astrophysicist cure AIDS at once before ever using another telescope.

You don't help people climb a ladder by chopping off the top and declaring the ladder climbed.

flying isn't a step on maslow's heirarchy of needs.

> You don't help people climb a ladder by chopping off the top and declaring the ladder climbed.

Sounds like public schooling in the USA for the last 25 years :(

If someone said those crazy, extreme things, that would be a relevant comment.

You don't even have to be zero emissions. You just need net zero. If you're putting carbon into the air, you need to sink an equivalent amount of it. If you use biofuels for instance, so long as you replant/regrow the same biomass as you convert to fuel, you're closing the loop.

Zero emissions technologies are great where they're practical. Aircraft are one of those places where the energy density and overall density of your fuel source is very, very important.

If you care about climate, get cryptocurrency banned. Air travel has all sorts of bad consequences, but also has economic and social benefits. Crypto on the other hand is an endless black hole of energy that even when used for its intended purpose creates economic and social harm.

Talking about taking away things that people like, like airplanes and red meat and gas stoves just get people up in arms. Start with the low-hanging fruit: crypto has no value except to speculators and criminals and tax evaders. Concrete is like 10% of our energy use, and we use way too much of it for temporary structures. No one likes leaf blowers, just ban the gas-powered ones.

> Talking about taking away things that people like, like airplanes and red meat and gas stoves just get people up in arms. Start with the low-hanging fruit: crypto has no value except to speculators and criminals and tax evaders.

What distinction are you drawing here? Both flying and crypto have a handful of rabid fans who use them a lot (and seem to enjoy it) while most regular people barely think about them at all, except to get vaguely irritated when they hear them passing by.

(I'm in favour of punitively high taxes on both, FWIW)

The main distinction is that airlines generate economic activity via tourism, shipping, and cultural exchange. Cryptocoins generate mostly black market activity; corruption is generally considered bad. If airlines disappeared today, people would still travel, with more time but only one order of magnitude more energy efficiency. If BTC disappeared tomorrow, people would would make most of the same transactions with more time efficiency, and six orders of magnitude less energy.

5-10% of people take a flight every year. For the US and Australia, it’s roughly half of all people. [1] is from a climate interest group.

Supposedly 3.9% of people worldwide own cryptocoins. Thought that stays would support my argument more but I suspect lots of hodling and not much trading.

[1]: https://static1.squarespace.com/static/5d30896202a18c0001b49...

> Talking about taking away things that people like, like airplanes and red meat and gas stoves just get people up in arms.

Certain people will get up in arms regardless, partly due to certain people making up threats like 'someone is going to take away your ...!' But nobody here said that.

My favorite thing about air travel is the opportunities it takes away. Destroying the planet is so important to the future of humanity

In no way is air travel necessary for anyone to find enjoyment in their life or to seek new opportunities, even overseas.

there's no real positive benefit to society to frequent business flying

I'm seeing a lot of communication and alignment issues because people can't get into one room and hash things out.

I've seen this firsthand many times, too. Having a meeting over beers and longstanding disagreements just melt away.

> there's no real positive benefit to society to frequent business flying (at pre-pandemic levels).

I'm sorry but I don't buy that. Business flying has obvious benefits including, perhaps obviously, enabling businesses to be run efficiently.

I started a new job after the start of COVID, and it has been really hard to build the personal relationships to become fully effective (our offices are spread out globally). My manager has said that pre-COVID days, I would have had the chance to meet many of my colleagues face-to-face and have a few beers with them, which would have greased the wheel to creating some personal connections. It's always easier to request help from someone who has a good impression of you.

Similarly with clients. It's much easier for people to go on attack-mode when they are displeased when it's only through email or a video conference where people have their cameras off. Unhappy clients can be placated and turned towards working together to a solution much more easily in person, and happy clients can be turned into long term partners more easily over dinner and friendly chats. This is especially true of customers in Asia.

Nicotine (especially when consumed via smoking) has some negative side effects, but is also a neurotrophic and can be quite beneficial.

Addiction and blood pressure are really the only downsides if you were to consume it in the form of, say, gum (and boy does the addiction suck).

The addiction is one of the most difficult to quit. With repeated use the nice feelings stop as well. There's no benefit to it, you're hijacking some neural circuitry until it hijacks your life

Regular consumption of nicotine also reduces Alzheimer's risk (and probably Parkinson's). This has been known for a long time. Few things are absolute.

1991: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC1670208/

> The risk of Alzheimer's disease decreased with increasing daily number of cigarettes smoked before onset of disease (relative risk 0.3 in those smoking greater than 21/day v 1 in non-smokers). In six families in which the disease was apparently inherited as an autosomal dominant disorder, the mean age of onset was 4.17 years later in smoking patients than in non-smoking patients from the same family (p = 0.03).

There is also ongoing research on this topic funded by the US government.

https://www.alzheimers.gov/clinical-trials/memory-improvemen...

Nit: that study is cigarettes. There is more to tobacco than nicotine, such as harmala alkaloids and miscellaneous MAOIs.

Either way, that's super interesting.

> It’s hard to find any benefit to smoking, first hand or second.

The same is true about recreational travel. People expose themselves to high levels of radiation and travel risk purely for recreational purposes. Smokers inhale carcinogenic substances for recreational purposes.

Is the risk for the two even remotely in the same ballpark?

No, but the problem is that a scientifically informed (evidence based) public health site communicating risks should be consistent and shouldn't use inconsistent absolutist language.

Well, it depends on how much you smoke and how much you travel. Thing is if I smoke even one cigarette like as a digestive after a big dinner once every four months I have to pay 600 dollars of extra health insurance per year because of how all this bullshit messaging about how nicotine works. And of course it's to protect something like only 35% of the human population that will get addicted to it.

I stopped smoking for months or years many times and I never ever had any side effect except maybe I'm a bit tired the first days. I don't even put up extra weight or anything like that. I feel like an adult baby being treated like I need financial punishment to help me be a healthy person.

> Thing is if I smoke even one cigarette like as a digestive after a big dinner once every four months I have to pay 600 dollars of extra health insurance per year because of how all this bullshit messaging about how nicotine works.

Really? Where do you live? Because I'm not aware of any country that does this (other than with sin taxes on tobacco).

Health insurance in various places goes up if you consume tobacco products, and doesn't take the amount consumed into account:

https://www.kff.org/faqs/faqs-health-insurance-marketplace-a...

That's what I figured he was referring to, but you (and he, if that's what he meant) are just wrong. Your source points out that the amount consumed is taken into account:

https://www.kff.org/faqs/faqs-health-insurance-marketplace-a...

Now, it is binary. But US federal law puts "an afterdinner cigarette once every four months" very much in the "nonsmoker" category.

Where does it say that the amount consumed is taken into account? That guideline is referring to the number of consumption occurrences per-week, not the amount used.

Which is the tobacco equivalent of classifying someone as a heavy drinker because they're using red wine as a trace ingredient in cooking several times a week, and considering that the same as consuming 4 vodka bottles over a span of 4 evenings every week.

Or, to bring this back to the example that started this thread, and which you seem to be thoroughly missing, to regulate numbers of radiation exposures per week. Without taking into account whether that's from standing outside in the sun for 10 minutes, eating a banana, or standing next to an unshielded nuclear reactor.

It's not some pedantic theoretical concern. There's an astronomical difference in the health risks between smoking a pack of cigarettes 4 times a week, using E-cigarettes 4 times a week, or applying a nicotine patch 4 times a week.

I live in the US and the 600 extra are binary, the question is "have you used any tobacco products in the past three months?" and a yes means an extra 600 per year. It's not that unusual if you get health insurance through your employer because it drives the cost down for everyone else, and of course scamming money off smokers even if they just casually do it a couple of times every three months is socially accepted.

Also except executives no one is above 60, which is where one would argue that if you are a smoker you may actually needing to tap heavy into health insurance money for smoking related conditions. There's even research that if you quit before 40 your smoking related cancer risks go down 90% https://www.healio.com/news/hematology-oncology/20211228/qui...

Of course I can drink a bottle of wine per day, not exercise, eat processed meat and not consume a gram of fiber and I don't have to pay extra health insurance. It doesn't make any sense.

I thought you were in the US.

By federal law, you cannot be charged more for smoking a cigarette every four months. You can be charged more for smoking with more regularity. There is a binary cutoff, but the level isn't zero (feds have a minimum level, but states can impose higher ones.). You may want to consult a lawyer if this is something that is really happening and concerns you. Plus, you certainly should consult a lawyer before you change your answer on a the form, in case you are in a grandfathered plan or some other special case.

> Well, it depends on how much you smoke and how much you travel.

I find it hard to believe that smoking could be less dangerous than flying even for people who work as airline pilots or flight attendants.

Smoking every day? Sure it's more dangerous. Vaping at a party once per month? I don't think so.

If you say vaping now, then maybe. But actually smoking once a month I still doubt.

benefit of smoking is the buzz and social enhancement. it is not useless.

> The CDC has been unfortunately hopelessly politicized.

These accusations are a common way to tear down democratic institutions, handing power to corporations and powerful individuals. Do you have evidence of it? I've seen none, other than some things attempted by political appointees during the Trump administration.

The CDC (formally Centers for Disease Control and Prevention) has long tried to enter the gun control debate. That has nothing to do with their mission of communicable disease prevention. Congress has repeatedly voted to block them.

The wider medical community has been vocal about gun control, because guns are a leading cause of injury and death. The fact that it's not a virus or bacteria is arguably a pointless technicality, incidental to saving people's lives. The people who catch the 'bullet' disease are treated at hospitals by doctors.

You may not think it's appropriate, but many doctors disagree. There's nothing in that indicating it's politicized; people may want to politicize gun control, Coronavirus, and lots of other health issues, but that doesn't make the health institutions political for dealing with it. (They also want to politicize the CDC and every other democratic institution (the Post Office, etc.).)

Should CDC also be involved in traffic laws too?

They are not involved in writing traffic laws, but they most certainly are involved in researching traffic caused injuries. It makes sense, because they are a leading cause of death

"Involved in laws" doesn't really describe the CDC exactly, but whatever.

One example of many:

https://www.cdc.gov/sleep/about_sleep/drowsy_driving.html

The CDC is still the Centers for Disease Control and Prevention. It's mission includes but is not limited to infectious disease. Congress has mandated they cover, in addition to infectious disease, research on food borne pathogens, environmental effects on health, occupational safety, injury prevention and how best to promote health. They do research on, for example, obesity and diabetes which are noncommunicable. They also are tasked with education to improve the health of US citizens (or residents, it's unclear). They specifically and explicitly replaced the National Communicable Disease Center, as their mission grew.

Meanwhile, all they've tried to do is research gun violence, not "enter a debate".

Yes. If you want a really good explanation of how it happened and the effects it’s practically the subject of The Premonition by Michael Lewis

While I somewhat agree with your overall point, level of control is important here. I can choose whether to get on a plane or take a drink. I can't control if someone farts standing next to me, or if they exhale smoke in my face.

Did you look at any of the references at the bottom of the page? There are many, many dozens of studies in the report by the surgeon general. On page 421 when they analyze lung cancer risk, they have studies with volume and frequency of second hand smoke based on the volume and frequency of the smoking habits of the one spouse being a smoker and the other being a non smoker.

This would be a very meaningful comparison if people were regularly forcing a diner-full of people to hop on a plane with them several times per year.

Obviously the analogy to getting on the plane is walking in the diner.

I think we can all agree there are stronger arguments for air travel than habitual smoking of cigarettes.

Do you live somewhere that forces you inside of diners several times per year? I'm interested in where that is.

Have you actually done research differentiating between the risks of tobacco exposure and radiation exposure?

There's no scientific evidence to suggest that small doses of radiation (< 0.1 mSv) is harmful to you, at all. In fact, there's even scientific evidence to suggest the opposite, it's called radiation hormesis.

I can choose to take a flight or consume alcohol, but I can’t choose to not breathe while you smoke next to me. There is no need to look for conspiracy theories as homework.

In case you missed it, the claim has nothing to do with choice -- it has to do with making a blanket, absolute statement for one thing and a more nuanced statement for another.

I guess you're exactly the person these types of statements were meant to placate.

As a public statement, mathematical existence of risk may, if small enough, can very well be said to be non-existing. For all practical purposes, is a 1e-10 risk contain any sort of information for the average people? Is it lying to call it risk-free? I really don’t think so, human language is not exact - in the real world nothing would be risk-free otherwise, essentially we would loose that word.

Good points. If I can take a crack at the exercise for the reader, I think the inconsistency has fairly straight forward reasons, even if they're frustrating: humans are terrible at reasoned risk analysis (if they even see the value); people prefer absolutes and easy heuristics to "it depends"; most people have first-hand experience with the extremes of smoking and drinking and it's thus easy to vilify; the best defense of vice is pleasure, which isn't much of a defense in the eyes of many, whereas exposure to pollution and cosmic rays is impossible to prevent without giving up near-universally valued things (transportation, energy).

We see similar patterns with nuclear power, climate change, and pandemics...

I think the difference is that there is something to be gained in exchange for the risk posed by cosmic rays during air travel, so people are more interested in taking a nuanced approach to it. Meanwhile second hand smoke is a nuisance at best and a legitimate health concern at worse. Most people (myself included) are happy to ban smoking on airplanes or in restaurants even if the health benefits are negligible at best.

I do agree though, studies like this should always include useful context rather than just making absolutist statements. Perhaps alcohol and tobacco smoke need something similar to the banana equivalent dose used when talking about radiation exposure.

> Nobody gains anything from an activity that fundamentally requires exposure to tobacco smoke.

Except smokers, of course.

Smoking isn't just addictive and deadly, like alcohol, it has its own appeal to users.

We’re not talking smoking though

We’re talking second hand smoke

Who exactly is looking to get some second hand smoke in their face while avoiding actually smoking?

I seem to be in a small minority, but I always liked the smell of second hand smoke despite never smoking. I've smelled some cigarettes up close and I think I'd really like them, but I don't want to start for health reasons.

The difference is that you consent to someone else's drugs entering your body.

Me too. I liked the smell. And the bars used to be less 'clear' due to the smoke. They had more atmosphere.

I did hate the way my clothes smelled afterwards but anyway that's what a washing machine is for.

I don't go in for cigarette smoke, but cigars, oh my.

Secondhand smoke is the cost of being in a bar outside of the US. Good luck making friends with European expats without some secondhand smoke.

I can't stand the smell of cigarettes, many of them make me feel nauseous. This may be because I'm young enough that public smoking has been banned for most of my life, so I never ever got used to the smell.

Europe is the exception here, not the US.

In general European countries have bans on smoking in public places much stricter than the US.

https://en.wikipedia.org/wiki/List_of_smoking_bans#Smoking_b...

I wasn’t aware of Europe’s laws but I meant outside of Europe too with European expats. Living in Asia currently and second hand smoke is a big part of my social life.

I don't know what the laws are, but the amount of smoking centimeters away from the entrances of buildings in Europe was staggering to me as an American. Both from patrons and employees. I was breathing in smoke plumes pretty much everywhere.

Used to be that bars were the place you went in the US to smoke and drink. Since you can't smoke in bars (Note: "pubs" for UK readers) anymore, there's less of a reason to go to them, and it incentivizes drinking at home. Which has led to a lot of bars closing and fewer of them than ever.

I don't think we're trying to solve for maximizing the number of bars

All the bars where I live seam busy as ever. I don't think smoking bans are hurting them at all.

You don't need bars or luck to make friends with European expats.

Isn't smoking a terrible deal, even for smokers? If its just about the nicotine there are lots of ways to get it without ruining your lungs or arteries (inflammation is the easiest way to get heart disease).

As a former smoker: It's not just the nicotine, it's also about the ritual, the habit and the social component. Although the latter might have changed these days as smoking has become a lot less popular since then.

If you want to feel some dissonance about this dissonance, you might note that a meta-analysis was done on the evidence that using a parachute is effective at saving your life when jumping from an aircraft. It's a real, but satirical approach to worshiping randomized controlled trials for things that should effectively be obvious. There are obvious limits to empiricism, and we shouldn't proudly flaunt lack of evidence ≠ evidence of absence in cases where it's perfectly reasonable to expect results. I mean, we could be wrong about theses things, but it would be a shift in thinking akin to newtonian -> einsteinian physics.

Paper: Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial

Conclusions: Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention. However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps. When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice.

>https://www.bmj.com/content/363/bmj.k5094

As the paper's title says, it's a randomized controlled trial, not a meta-analysis. A meta-analysis would likely exclude the RCT due to poor experimental design.

You are correct, but a meta-analysis would still suggest that there is no evidence that parachutes protect people jumping out of airplanes, because we don’t have evidence because we can’t have evidence.

Actually meta-analyses are not limited to RCTs - in my experience they can be quite subjective.

So for example, a meta-analysis might say that there's a fair amount of evidence that people not wearing parachutes die after falling from airplanes (e.g. https://www.washingtonpost.com/world/2021/08/26/story-an-afg...), and plenty of evidence that people can land successfully with a parachute (skydiving videos, too many to count). The conclusion would be a strong correlation between parachute use and not dying. The only thing there isn't is an RCT, to prove that the correlation is causal. The purpose of the parachute RCT paper seems to be to prove that the design of an RCT is just as fallible as any other reasoning that attempts to prove causality, so in fact RCTs are not the "gold standard" and other forms of reasoning may be just as valid. (e.g. basic physics in the case of the parachute)

>basic physics

I totally agree, the point that organizations like the World Heart Federation are using. We are taking basic physics as a truism, but it's the result of experimentation, which creates a framework. The same is done for the way the body functions. That framework can be used to make sweeping statements about alcohol / ionizing radiation, etc.

I've been totally blown away recently listing to This Week in Virology, as the panel of experts regularly discuss their concerns about how many people are discussing the viral/vaccine mechanics as though the framework we have of disease is perfect. It's always fascinating to hear what absurdly qualified people have concerns about when discussing their area of expertise.

To be clear, the problem here is in equating “evidence” with randomized controlled trials. We have plenty of evidence that parachutes work, just not in the form of RCTs.

David Gorski of sciencebasedmedicine.org calls it “methodolatry”:

https://twitter.com/gorskon/status/1484220420295376900

https://twitter.com/gorskon/status/1479900075602194445

https://twitter.com/gorskon/status/1483268592674217986

I think the reason one bothers us and another doesn't (in the case off smoking) relates to the level of non-contradiction evidence. It's been decades since the pseudo-research propaganda from the tobacco industry was taken seriously, and lots of legitimate research to go along with that.

Alcohol on the other hand seems to produce a fair number of contradictory studies on a regular basis. There are pretty clear negative effects of excessive use, but at the low-to-moderate levels it's a lot murkier. It's especially hard to know from some studies whether or not the proposed negative impact was caused by alcohol or whether alcohol use was a type of proxy variable for general health and lifestyle.

It seems the reason they've gone for the "no amount of alcohol is good for" precisely because of the existence and popular influence of contradictory claims. They're taking the position that it's the negative effects that have the plausible mechanisms and the associations of low-to-moderate use with sometimes better outcomes than abstinent cohorts that are most likely proxy variables for general health and [former] lifestyle.

(c.f. absolutely no pop-science reporting on supposed therapeutic benefits of cosmic radiation from frequent flying, so the average person hearing about it is likely to overestimate its negative effects rather than wonder if they should be booking a flight with every meal!)

There is no dissonance here, this is FUD. The language is wildly different because the actual risks are wildly different. One kills a lot of people and the other doesn’t.

How many people are actually dying from air travel radiation? The numbers are low enough that they’re hard to find evidence for. Here’s a study, for example, that attempted to answer the question for pilots, who obviously fly frequently. They weren’t even able to detect higher death rates at all. https://pubmed.ncbi.nlm.nih.gov/14648170/ “Neither external and internal comparisons nor nested case-control analyses showed any substantially increased risks for cancer mortality due to ionizing radiation.” (Edit: of course there are some studies that demonstrate small amounts of increased cancer risk, and increased risk of pregnancy complications for airline crews. The numbers are small.)

On the other hand, “Tobacco is the leading preventable cause of death in the United States” https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal...

Even if you are skeptical of the CDC’s estimates for mortality rates by things like second hand smoke, there are pretty clear reasons to take smoking a lot more seriously as a risk than radiation exposure from air travel, the direct risk to smokers is orders of magnitude higher than the risk of air travel radiation.

The fact that the CDC’s language reflects the actual risks is a good reason to put more trust in what they say, not less. They’re not trying to hide something from you, they’re trying to help you understand the actual relative differences in risk, which are much, much higher for smoking.

Edit2: BTW, the WHO agrees with the CDC about there being no safe levels of smoke, and is backed by significant amounts of research and outcome statistics worldwide. https://www.who.int/news-room/fact-sheets/detail/ambient-(ou...

First of all, this is a good and fair pushback.

But I’d respond that I chose secondhand smoke for a reason. I similarly doubt there’s any measurable impact of being around a smoker every once in a while, but the language around secondhand smoke got more and more hysterical leading up to the widespread implementation of smoking bans, to the point that it’s not uncommon today to hear people complain that walking near a smoker on a sidewalk outside is a risk to their health.

That’s basically absurd.

But the “no safe level of exposure” language has been used to justify such claims.

Finally, to be clear, even if you think this language is good and useful, there’s still utility in thinking about why that’s true, especially if hearing similar language about alcohol bothers you for some reason.

> to hear people complain that walking near a smoker on a sidewalk outside is a risk to their health

Doesn't have to be the smoke itself that's harmful. Presumably, if you can smell someone's second-hand smoke, you're also inhaling the bacterial spray contained in their breath, no? Something I think about if I'm walking outside without a mask on and end up stuck walking for a while behind a smoker. I tend to put my mask back on.

The bacterial spray isn't unique to smokers.

That's what our immune system is for.

Covid is a problem at the moment but bacteria really aren't. Your chance to die from a bacterial infection randomly caught from someone in the street is minimal, and exposure boosts your immunity. And they are everywhere anyway.

You might get a cold for a few days but that's life.

With over a billion smokers on the planet, or ~20% of the population, it’s not that absurd to worry about urban smoke outdoors contributing to urban pollution. Nor wood burning house & backyard fires either, nor cars, but that’s a different debate… We aren’t around smokers once in a while, we’re around them constantly. Even urban outdoor second hand smoke really is a higher risk than air travel radiation.

Yes I want the language to be specific about the levels of risk. I would agree that “no safe levels” is vague and less helpful than one or two percentile data points. That said, I completely agree with the CDC’s stance and language on both second hand smoke and air travel radiation.

> Even urban outdoor second hand smoke really is a higher risk than air travel radiation.

Isn't this exactly what's in dispute? What's the evidence that this is true?

Not really. The actual topic of conversation underneath the smoke is the political neutrality of the CDC, and public mistrust of science and government funded sources of information.

If you are really curious about the evidence, follow the thread up and click the links. I already posted links that have some stats and links to studies on the harms of second-hand smoke, and so did @dionidium too. :)

I didn't see anything in your links that addressed second-hand smoke specifically? I think there's a broad consensus that a) tobacco is a significant cause of premature death b) low outdoor air quality (e.g. high PM25) is a significant cause of premature death. But given that tobacco smoke does not show up in your link's list of major contributors to low outdoor air quality, that does not add up to a statement that second-hand smoke is significantly dangerous.

You’re talking about the WHO link specifically? You’re right, that link doesn’t mention secondhand smoke because it doesn’t have a list of major contributors (doesn’t mention cars or factories either). I’d agree it’s probably not a great example of what you’re asking about. I really only posted the WHO link because the WHO uses similar language to the CDC saying things like ‘there are no safe levels of exposure to pollution.’ Might not answer your question, but I think the WHO pollution guidelines published a few months are good reading (https://apps.who.int/iris/handle/10665/345329).

To clarify what I was talking about above, I’m saying the close exposure to smokers is high in urban areas -- in proximity, frequency, and density. There’s also broad consensus that the risks and harms of secondhand smoke are greater in proportion to proximity of the smokers, and that downtown urban areas where people congregate have higher concentrations of cigarette smoke than other places. I’m not personally claiming that average Pm2.5 air quality over time sees a measurable impact from cigarettes. (Even if true, I would expect cigarettes are dwarfed by cars --- but 6 trillion cigarettes a year isn’t nothing, right?) I’m really primarily claiming that being in an urban area like a downtown city center is high exposure to secondhand smoke, being very close to smokers is often a many times per hour occurrence in busy urban areas, walking and entering/exiting buildings.

The CDC link does reference the Surgeon General’s report, which links to a whole pile of primary sources on secondhand smoke. You can also Google around for primary sources for links between smoking and general air pollution. I just tried and found a handful of papers studying outdoor smoke exposure levels, e.g., https://erj.ersjournals.com/content/48/3/918. The main consensus that I see is that for a range of small distances like 10-20 feet, outdoor exposure is plenty high enough to be very concerned about the risks, and that high traffic areas can collect smoke and increase exposure.

> Even if true, I would expect cigarettes are dwarfed by cars --- but 6 trillion cigarettes a year isn’t nothing, right?

I don't really understand this reasoning - the way I see it any effect that's dwarfed by cars might as well be nothing, there's no sense worrying about a splinter in a broken leg.

> The CDC link does reference the Surgeon General’s report, which links to a whole pile of primary sources on secondhand smoke. You can also Google around for primary sources for links between smoking and general air pollution. I just tried and found a handful of papers studying outdoor smoke exposure levels, e.g., https://erj.ersjournals.com/content/48/3/918. The main consensus that I see is that for a range of small distances like 10-20 feet, outdoor exposure is plenty high enough to be very concerned about the risks, and that high traffic areas can collect smoke and increase exposure.

Hmm, sounds like there's a measurable impact which is honestly more than I expected. Still, it seems like a rather cherry-picked measurement; they compare levels in the evening when the traffic street is presumably mostly empty, and note that the traffic street had worse air quality after midnight. They notably don't compare levels in the morning or afternoon when traffic would actually be present and the traffic street presumably had overwhelmingly worse levels of pollution. And they jump straight to recommending a ban on smoking. To my mind to put that on any kind of rational basis you'd have to first set a safe level of PM25 and then propose banning the biggest contributors to PM25 on streets that exceeded it - but reading between the lines of that paper, I assume that once you measure PM25 over a full 24 hours that would mean banning cars long before banning smoking.

> Any effect that’s dwarfed by cars might as well be nothing, there’s no sense worrying about a splinter in a broken leg.

Now we’re conflating several different things. The overall contribution to AQI metrics might be dwarfed by cars, but the overall mortality is not - estimated rates of mortality from smoking related causes is higher than the estimated rates of mortality from pollution.

There might be no sense in looking at cigarette smoking to reduce AQI metrics, but there’s every reason to look at smoking to reduce premature death & hundreds of billions in unnecessary health care expenditure, right?

I don’t want to play armchair researcher and defend that paper, it just happened to be a primary source that I found online. If you want to pick apart the methodology, it’d be better to find a different primary source that empirically demonstrates that proximal secondhand smoke is not harmful.

I take responsibility for sending a slightly wrong impression, I didn’t mean to suggest that smoking is a huge contributor to pollution per-se, I see my comments implied that, but I was only trying to say that outdoor smoke in urban areas is a real risk factor to non-smokers, that exposure to secondhand smoke downtown is a very common occurrence, and it seems to be supported by some research. The point I was making is that secondhand smoke can and does affect people outdoors even if it doesn’t push the AQI, and the reason is proximity - smokers are on average hanging around much closer to non-smokers than cars are. The bulk of cars are far away on the freeway, while the bulk of smokers during the day are working near me, pre-pandemic anyway.

> Now we’re conflating several different things. The overall contribution to AQI metrics might be dwarfed by cars, but the overall mortality is not - estimated rates of mortality from smoking related causes is higher than the estimated rates of mortality from pollution.

But "smoking related causes" is conflating two very different things. If you want to ban smoking because it's harmful to smokers, that's a very different argument from banning smoking because it's harmful to others. It would be very convenient for people who want (out of what is - to them - legitimate concern, but is coming from a very different cultural background to that of most smokers) to ban smoking if secondhand smoking were clearly harmful, but frankly if this kind of paper is the best they have then I strongly suspect that it actually isn't.

> If you want to pick apart the methodology, it’d be better to find a different primary source that empirically demonstrates that proximal secondhand smoke is not harmful.

It's hard to publish a negative result and hard to get funding for work that goes against the narrative. And fundamentally the onus is on the people claiming an effect to demonstrate that it's real.

> The point I was making is that secondhand smoke can and does affect people outdoors even if it doesn’t push the AQI, and the reason is proximity - smokers are on average hanging around much closer to non-smokers than cars are.

Again that's something that I think would need to be scientifically shown rather than just assumed.

To be clear, secondhand smoke has absolutely been scientifically proven to kill people. We’ve been discussing the margins of outdoor secondhand smoke, which is, I admit, harder to demonstrate conclusively with simple stats. Outdoor conditions vary wildly, and proximity certainly matters.

I agree that it’s hard to publish a negative result, but the fact is that I gave you a primary research source that was trivial to find and claims to show only a moderate effect, and you’re still rationalizing your discounting of it and rationalizing why you don’t have any primary sources to support the view that outdoor secondhand smoke isn’t harmful.

It would be silly to claim that secondhand smoke is not harmful outdoors, because we already know for a fact that exposure to secondhand smoke is harmful, and being outdoors just reduces the exposure depending on conditions - wind, dissipation, distance, partial enclosure, etc. There’s no question about whether it’s harmful, the only question is how much.

People aren’t banning smoking because it’s sometimes risky. People are banning smoking because it’s always risky, and non-smokers don’t always have control over their exposure levels. The outdoor exposure levels might be considerably lower than indoor exposure, but why should you tolerate any exposure at all? If you can smell it, you’re breathing additional pollution and toxins. You haven’t given any reasons at all that we should accept and tolerate lower-than-indoor levels of risk and damage just because they’re lower. Some people prefer none, and isn’t that a right they should have in public places? Why should people even tolerate the smell if they don’t like it? Would you tolerate a small amount of tastable but moderately low risk poop from your neighbors in your drinking water, given a choice?

> To be clear, secondhand smoke has absolutely been scientifically proven to kill people.

News to me. If that's true, why do conversations about secondhand smoke involve so much rhetoric and so little science?

> People aren’t banning smoking because it’s sometimes risky. People are banning smoking because it’s always risky, and non-smokers don’t always have control over their exposure levels. The outdoor exposure levels might be considerably lower than indoor exposure, but why should you tolerate any exposure at all? If you can smell it, you’re breathing additional pollution and toxins. You haven’t given any reasons at all that we should accept and tolerate lower-than-indoor levels of risk and damage just because they’re lower. Some people prefer none, and isn’t that a right they should have in public places?

If they should have that kind of right, they should have that right in respect to other sources of air pollution like cars or wood fires too. If it's about risk, we should set a safe level and ban the biggest contributors to it. If it's about cost/benefit, we should do an honest assessment of how much benefit is required to justify how much pollution, and set a corresponding tax level on all sources of air pollution, or a cost/benefit level for which kind of sources we'll allow and which we'll ban. Maybe the missing reason here is that we're quietly putting a higher value on the pleasures of cars (i.e. of upper/middle class people) than the pleasures of smoking (i.e. of lower-class people)?

> Would you tolerate a small amount of tastable but moderately low risk poop from your neighbors in your drinking water, given a choice?

I think the fact that you go for a disgust-based argument is pretty telling: this isn't about the health risks of secondhand smoke, it's about a cultural disgust of smoking and smokers.

I hate smoking and smokers as much as anyone, but this thread has really made me think about public officials' eagerness to ban it.

> News to me. If that’s true, why do conversations about secondhand smoke involve so much rhetoric and so little science?

If the fact that second hand smoking has been proven risky is news you to, even indoors, it means you haven’t even googled the question, and that you didn’t click any of the links at the top of this thread. The CDC page has a literal pile of primary source research and data. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/seco...

Do you really want to know the answer to the question you asked? You can find the answers without talking to me. I fully encourage not reading the rest of my reply and just answering the questions you asked yourself with an open mind. Or is this about debating me with logic alone until I stop responding? Logic doesn’t compete with history. It’s irrelevant whether rhetoric is involved, but for the record the reasons rhetoric gets used sometimes is precisely demonstrated by your response to primary research: you didn’t believe it. Okay, if you discount the science, then maybe reason or emotion can work. If you discount reason and emotion too, then maybe you’ve decided and are closed to hearing any input on this topic?

> If they should have that kind of right, they should have that right in respect to other sources of air pollution like cars or wood fires too. If it’s about risk…

I agree with you, we should all have rights about clean air. But you’re now intentionally ignoring the reasons we already discussed. It’s was never about risk alone, it’s about risk vs benefit. Do you need to jump to strawman arguments after we’ve already covered this? Cars have high value in addition to their risks. Cigarettes have no value. It’s weakening your argument and leading me to believe you’ve simply decided that safety is not a valid concern and that you’re choosing to ignore facts. I’m giving you more credit than this, I know you know that cars have real utility and that cigarettes don’t. Your class distinction is a bit cringey and broadly speaking mostly false, I think you already know that too.

> I think the fact that you go for a disgust-based argument is pretty telling

I think the fact that you’re the one using spin framing and rhetoric here while accusing others of doing what you’re doing is telling. I didn’t go for a disgust based argument, I went for a safety argument. Poop is not safe to drink in any amount, my “moderately low risk” was a cheeky parallel to the smoking safety argument. Poop is gross, so I see why you’re trying to use that against me, but secondhand smoke is also gross.

> this thread has really made me think about public officials’ eagerness to ban it.

Why? Are you confusing what I’m saying with what the CDC says? Are you using my rhetoric to justify claiming that public officials are using rhetoric? Isn’t that jumping to conclusions? You still haven’t yet given a single reason why smoking should not be banned, despite the fact that it’s harmful to human health and harmful to the economy, and has no redeeming values. You’ve only expressed fear, doubt, and uncertainty as a response to both reason and primary source research, with only rhetoric of your own in response.

> The CDC page has a literal pile of primary source research and data. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/seco...

There's certainly some interesting stuff there, but it's very clearly written with a heavy bias and very clearly not a primary source (indeed they state explicitly that their second-hand smoke estimates are based on unpublished data, which seems like a huge red flag).

> Do you really want to know the answer to the question you asked? You can find the answers without talking to me.

I am genuinely interested, just common-sense sceptical. Even heavy smoking is not that deadly (especially compared to something like cars - just looking at the impact on people I've known personally). The idea that there would be this huge mortality impact from the much smaller level of smoke exposure that second-hand smokers get just doesn't pass the sniff test. If I take the report you linked at face value, I'm supposed to believe that second-hand smoke kills fully 1/10th as many people as actual smoking - but most of the risks of smoke exposure are linear, and there's just no way that people are breathing in 1/10th as much tobacco as second-hand smoke as actual smokers do. So something stinks.

> Cars have high value in addition to their risks. Cigarettes have no value.

This is your fundamental assumption that's been going unspoken until now, and it's the part I'm taking issue with. Cars don't have a lot of value, IMO. And you're simply ignoring the fact that many people enjoy smoking, or you've decided it somehow doesn't count. It has a lot of value to them, that's why they do it.

Of course if you start by assuming that the value of smoking is zero then you'll reach the conclusion that the cost/benefit isn't worth it. But you could justify banning anything that way (I'm sure there's not a single thing in existence that has absolutely zero health risks associated with it). And I'm pretty sure the decisions about what things are zero value are being made mainly by classism (probably not intentionally, but just because the people who contribute to this kind of public health report come almost exclusively from a particular class).

To be clear, I don't think the CDC is full of political operatives intent on fighting a culture war. What I think is that almost nobody at the CDC smokes, that they don't know many smokers, that they (correctly, more or less) perceive smoking to be a lower-class-coded activity, that there is probably near-universal agreement within the CDC that smoking is an undesirable (maybe even "gross") activity (associated with low levels of educational attainment).

On the other hand, they all fly in airplanes. They attach little or no moral weight to flying. Everybody they know flies on airplanes. Etc, etc.

I think it's unlikely that this isn't influencing their language. The risk of smoking, in their view, isn't something to be managed or weighed or compared; rather, smoking is an abhorrent activity that should be stamped out of existence.

How could that possibly not influence how they write about it?

That’s extremely heavy and unfounded speculation on your part. How do you know who flies, or what their morals are, or who they know?? You’re now attempting to move the goal posts to a different playing field entirely. Your beef was over radiation, which has extremely low levels of risk compared to air pollution, not the morals of flying. The questions about the environmental impacts of flying is certainly getting enormous amounts of exposure currently, why do you think people at the CDC are any different from the rest of us in that respect?

You’re still trying to paint a picture of hypocrisy where none exists. The CDC is presenting facts on risks, not moral judgements. The fact is that the risks of smoking are large, it kills many times more people than all causes of flying related mortality combined, and that is the reason there is a lot of information decided to educating people about those risks. Smoking is also one of the easiest things to change, it’s a choice, and it’s a luxury, not necessary for anyone to do. Why not try to reduce it? They’re not judging people who smoke as low class, they’re pointing out correctly that smoking is something that statistically harms people of low SES disproportionately, not just health wise, but financially. The whole idea is to try to help those people escape. It seems strange to me to spend any energy complaining about the CDC’s language of smoking, while ignoring the vast amounts of social damage left in the wake of Big Tobacco.

I don't care about the morality of flying and I'm not suggesting they should, either. That's the whole point. Of course they use stronger language wrt activities they look down upon than for activities they don't.

And maybe that's as it should be! Again, I am asking people to notice when this happens.

The CDC hasn’t been “politicized,” in other words; their project is intrinsically political.

> their project is intrinsically political

I don’t think that case has been made here, you’re failing to demonstrate it. I disagree that intrinsic politics has anything whatsoever to do with the safety of smoking vs radiation exposure of air travel.

There are times when other people politicize what the CDC says. Your comments here explicitly and repeatedly attempted to politicize the secondhand smoke recommendations. Covid is also one of them, and it seems like you might be dancing around and hoping to implicate Covid politics while trying not to talk about it directly. The CDC has been actively trying to stay out of the politics and simply help people understand the risks and statistics, and what choices they can make to reduce their risks.

> of course they use stronger language wrt activities they look down upon

They don’t look down on any activities. They report safety stats and safety guidelines. The language is stronger when the mortality rates are higher, period.

You're not the only one here who has suggested I might be trying to make some kind of clandestine point about COVID. I've been on this difference in how the CDC treats these two topics since long before COVID existed and COVID couldn't be further from my mind.

Then I’m sorry. Truly. I was speculating wildly and incorrectly. My apologies.

It's not a proof but I really enjoyed Zizek's thoughts on how fight against smoking is an ideology :) https://www.youtube.com/watch?v=r238kp3ar_A

Hehe, I don’t know who this is, but it was fun to watch. “I’m a kind of Stalinist fascist ... if I take drugs, then I become passive, and enemies can attack!” LOL!

So, the argument he didn’t even attempt to address in his comparison of smoking to other drugs is that smoking hurts other people directly, while other drugs don’t. The primary reason we have rules against smoking in public is it’s effects on people nearby who are not choosing to smoke. This entire thread was about secondhand smoke, and Zizek didn’t address it.

Similarly, the reasons we have some regulations on smoking in private, and the entire reason we have regulations on drugs is because of the direct damage it does, statistically, to the users, and to the indirect damage it does to other people. For the minority of bad cases, hospital visits for overdoses and car accidents, social services for addicts or their children, rehab, and loss of jobs are real issues. For the larger majority there are still measurable effects on drug users’ lifespans and on the economy.

We are a collective and have no choice about that. We have some shared resources that we need to agree on. If you want to enjoy freedoms, you have to respect other people’s freedoms. Where’s my freedom to breathe clean air if you smoke near me? (I happen to have some athsma, the risks to me of secondhand smoke are greater than mild exposure to carcinogens.)

So yeah, not only is it not a proof, it’s not even a reason to buy the argument that anti-smoking sentiment is ideological. To prove that it’s ideology, you need to demonstrate that smoking is safe.

I wish it were acceptable to complain about stinky purfumes and body sprays. They fill the air with volatile organic compounds. Plenty of people are happy to chuck on something smelly while hypocritically complaining about other types of smells. Some cause allergies (hayfever) in me to the point I have to leave an enclosed space or suffer consequences. I know friends that get headaches from them.

Hear, hear! Some are worse than others, some don't bother much, but lots of perfumes give me headaches.

Right. And where is the "no safe level of exposure to perfume" PSA?

It's entirely rational to suspect the motives and veracity of statements like this.

The harder you make it to engage a behavior, the more likely it is to become extinguished or reduce. These are nusges. It's basically how you influence people incrementally toward a desired outcome.

I too, am bothered by some of the history of tobacco-related data. I am ok with the government using indirect methods to reduce tobacco deaths.

Wearing perfume doesn't makebthe too of preventable deaths. Perfume smell may be as annoying as cigarette smoke to some people. There's a clear reason why there's societal pressure to address and regulate one I dustry as opposed to another.

Whether a given government is using shit science and where it draws its concerns in regards to societal pressure valves to release, has a lot to do with who the leaders of the administration are. This is why politics needs to be a leading concern for any researcher or citizen that prefers effective methods of dispersing evidence-based knowledge.

I once encountered a smoker who smoked something seriously insane that smelled like burning shit. I could barely believe it's happening.

It's not absurd to worry about it, it is absurd to say there is no safe exposure level and leave it at that. Especially because so many people smoke it is important to be informed about the actual risks of second hand smoke.

If I'm walking down the street do I need to cross the street if I see someone approach with a cigarette? If I'm at a bar and smell smoke coming in should I leave?

No safe level means one person a mile away is a problem.

I bet they would say that's absurd, with a straight face.

A wise man I knew used to say

"Dilution is the solution to pollution".

In fact, once you think about it, that's also the only solution.

I hear your point, and agreed already that more detail would be nice.

To be fair, the CDC does not ‘leave it at that’. Their page that @dionidium linked to does not either start with or stop with the statement “there is no risk-free level of exposure to secondhand smoke.” It’s one statement among many that include actual statistics, and so incredulity over a line of summary taken out of context might be slightly misplaced.

The CDC is in the business of setting guidelines, so the context of their statement that it’s not risk free is a suggestion that regardless of your situation, it would be better to not expose yourself to smoke. This happens to be in complete agreement with the message and recently updated guidelines by the World Health Organization, and with statements by the American Medical Association.

Reasonable people are free to make reasonable choices. A little smoking and drinking isn’t going to kill anyone, and we all know that. So we don’t need to get upset when someone says a little is a little bit bad. That said, for someone with athsma, they might reasonably choose to cross the street, since smoke is a trigger and meeting someone on the street who smokes is a very common occurrence if you walk around in urban areas. If they go to a bar, then they’re probably asking for it. :P

“ it’s not that absurd to worry about urban smoke outdoors contributing to urban pollution”

Where do you live that second hand smoke is a significant urban level pollutant?

Take a pack of cigarettes, 25g, divide it by 3 (your 30% of people are smokers) = 8.3 g per capita and burn it.

Now consider all the diesel per capita that is burned in this dystopian city of smokers.

No, we don't get to pretend these trucks have diesel particulate filters. Not if the city has 30% smokers. [1]

Anyway, at 8g/person, pollution controls wont save the argument - smoking is a negligible urban level pollutant.

[1] or propose a city with lots of smokers that has strict and enforced diesel rules. Tel Aviv? Israelis used to love to smoke.

Note the change from secondhand smoke to outdoor secondhand smoke, once you responded rationally. This poster may be a bot.

Reminds me of a discussion at a students' senate meeting on campus a few years back, when they were discussing banning tobacco smoke everywhere including in the parks away from buildings. People who noted that PM2.5/PM10 emissions from construction sites (ubiquitous at the time), or even BBQs, where much greater than cigarettes, even if all people on campus were chain smoking (we maybe had 5% smokers), were ostracized. The times we live in lol.

There are other large source of particulate emissions, larger than cigarettes, there is no doubt about that. Why would that mean we shouldn’t have rules about smoking in public places? Is it okay to try to address multiple issues at the same time, and do something about the ones we actually have control over, even if it only partially addresses the problem?

It’d probably be ideal to eliminate the other sources of particulates too, it’s not necessarily a competition, though we all like buildings and BBQ. But out of curiosity - were the people noting that one BBQ is a bigger source of particulates than one cigarette also being fair about the averages, like the fact that there are generally many fewer BBQs running at far lower density and far less often than cigarettes? Are you sure they weren’t argued down because the point might be both somewhat misleading and also somewhat irrelevant? (I’m not certain about that, just suggesting it’s possible. It’s also a fact that there are people who like to ride on high horses and get uppity about their beliefs. I might be one of them sometimes.)

Exactly, you mention beliefs, while the point was (is?) one of science. By the way, have you ever heard of banning coal BBQs? I'm not sure at all that the exposure is less severe. Say you are at a party, there's a BBQ 20ft away, and some annoying guy lights a cig 10ft away. I'd bet you money that the BBQ harms you more, or at least emits more than 4 times (you need to scale by the square, diffusion of a fluid) PM2.5 than the cigarette.

Yes, I mentioned beliefs and was admitting that some of the behavior you saw might be based more on human beliefs than science. It wouldn’t be the first time it ever happened, right? ;)

I have heard of banning coal BBQs. I’m sure you’re absolutely right that the instantaneous exposure per second can be worse if you’re close and downwind from one than a cigarette from the same distance. But how often do you go to a party? Is it dozens of times per day, every day? Because that’s how often I bump into smokers when walking around downtown. Part of the CDC’s point is that the damage is cumulative, and you need to integrate over time and space. Exposure to one big source for a short time can be a little bit bad, while exposure to many small sources for a long period of time can be much worse.

I was referring to a specific situation (a university campus) that already banned smoking from all indoor areas, and all outdoor areas within 100ft from buildings (could have been 200, I don't remember). The question was whether to ban it everywhere. That scene I used of the party was very accurate, you'd have about 1 in 20 people who smoked. You'd not bump into smokers in any other settings, basically. (You'd maybe see a random smoker smoking on their own far away from buildings.) This was early 2010s at a west coast university.

Also, you don't need to be downwind from the BBQ. It's a point emission of fluid (particulate). It diffuses. The intensity scales with the square of the distance. (Same exact process as the cigarette smoke.)

To bring it to the relevant topic of the day, I don't believe I will ever see the CDC issue a statement that "no level of exposure to the COVID-19 virus is safe", and recommend China level of quarantine.

Walking near a smoker on a sidewalk outside IS a risk to my health and the health of my children. I have asthma as do my children. Both my children and I have had asthma attacks due to second hand smoke, even limited quantities. As a smoker you may not notice this but the smell from even a whiff of second hand smoke persists for a long time and it's awful. Our family gives smokers on the sidewalk a very wide berth.

Nobody gets to create a hazard to others walking on a sidewalk. If a business wanted to dispose of an equivalently toxic substance out in the open, they would be heavily fined and shut down. Why should smokers have a special right to do this and, incidentally, litter cigarette butts all over the place?

I'm extremely grateful to live in NYC where there is a (frequently violated but still) ban on smoking inside all public parks. I would absolutely support a sidewalk smoking ban and better enforcement of the ban on smoking in parks and within 25 feet of building entrances in NYC and limit smoking to private property with the smoker responsible for ensuring second hand smoke does not affect adjoining private property.

The primary difference between smoking and alcohol is that with alcohol, there is no equivalent to second hand smoke. When someone who drinks alcohol creates a negative externality for those around, they are ticketed or arrested depending on what they did, everything from drunk driving laws to drunken disorderly laws. I'd love to see a laws on the books similar to drunk driving laws that addressed the issue of smoking around minors.

Now if the CDC said there was no safe level of exposure to nicotine and so we should ban all nicotine gum, that would be absurd.

Well at least now nobody can claim I made up this objection.

Along the lines of second hand smoke, are there any levels of safe exposure to air pollution (considering recent studies saying that chronic exposure is equivalent to losing one year of education)? In that case, internal combustion engine exhaust might be a larger source of health risk than outdoor second hand smoke, depending on where you live.

The research and statistics are trending toward the conclusion that there are no safe levels of exposure to pollution, car/ICE or otherwise. The 2021 WHO report is pretty good/interesting stuff https://apps.who.int/iris/bitstream/handle/10665/345329/9789...

Personally, I’m pretty certain that cars are a bigger contributor to overall air pollution than cigarettes. I would guess much bigger, however Googling this question will return studies that claim to show cigarette pollution is worse per gram of smoke or whatever.

I don’t know what it means to lose a year of education, that sounds like it could be a little hyperbolic, and hyperbolic stuff does get said unfortunately.

Anyway, we can and should work on both problems, cars and cigarettes, we don’t need to limit ourselves to which one is worse, they’re both bad. Smoking alone really does contribute significantly to early mortality globally, so it really is a problem to solve.

Cigarettes are also, unlike cars, a completely optional choice. Unlike the reasons to drive, the reasons to smoke are not backed by any economic needs or economic benefits aside from income to the tobacco companies. There is no socially redeeming value to smoking, where there is a lot for cars (jobs, food distribution, transportation & travel, etc). So, it will be far easier to stop people from smoking, and reduce overall death, than it will be to stop people from driving.

Great comment. Way too much of HN is invested in "nanny state bad and corrupt" justified with FUD-like narratives. There's always this low-simmering culture war here. And really, air travel radiation is the hill these types of people want to die on?

The problem with conservative forums like HN is eventually you get on this treadmill of "and so and so isn't so bad" be it alcohol, smoking, Hitler, etc that's a mix of ignorant and purposely dishonest to push agendas. This takes people down some strange and often ignorant and hateful roads, which then helps craft their personalities and core beliefs into something very negative.

The reality is, alcohol is pretty toxic and a health organization really shouldn't recommend a daily allowance of it. I think the cognitive dissonance with people who want to be "right with the science" but also want to drink needs to come out somehow and it often comes out, at least with health issues, with these overly-broad and just weird attacks on groups like the CDC or WHO or whatever. Instead, these people could just admit that "Yes, I do this very unhealthy thing for pleasure and its as unhealthy as the experts say it is." Instead, they'd rather nitpick at random things and reach an irrational conclusion than accept the truth of it all.

On the healthcare end it works the other way like "Here's some unwarranted nitpicking about vaccines," that terminates to a crazed anti-vaxxer position. Its the same kind of dishonesty and leads to the same types of irrational conclusions.

For a lot of people, not only is this how they often think, its the default mode of how they think. They sling mud, project, and attack at any perceived slight against their personal beliefs and the culture war they're always fighting. Its a sign of an emotionally immature mind and these people are everywhere and they build powerful echo chambers. When we see them die of covid as they post facebook memes denying its existence, we then know the fruits of this kind of mental labor. Its dishonestly all the way down.

> The problem with conservative forums like HN

Not terribly on topic, but I've been lurking here for more than a decade, and today I learned that it's a conservative forum. And on top of that, it has the same problems inherent to conservative forums (fora?). Weird.

While i wouldn't agree that HN is a conservative forum, there is certainly a lot more conservative-leaning material posted here than similar tech-focused forums.

See any thread about California, Texas, diversity & affirmative action, COVID, etc.

The pattern only overlaps with conservative on the topics of regulation, maybe taxes, definitely affirmative action.

Everything you said but it's not about conservatism in general or most of the rest of the current conservative platform.

It's just anything that annoys a tech bro who never had a problem in life except that it's a crime that his copycat app was taken down and some girl got a job he thought the world owed him, or he succeeded and believes he did it all himself and doesn't owe anyone else anything.

I mean, it is a large overlap. You could describe both this and the coservative platform as "whatever rationalization works to justify being selfish"

But for instance, I bet almost none of these "conservatives" have a moral or religious objection to sex outside of marriage, sex outside of their race/ethnicity/religion, definitely aren't down at the soup kitchen every wednesday to feed the hungry, never turned the other cheek in their lives, will happily ridicule "preppers" even while researching about data islands...

I think I'm not really articulating my point all that well but hopefully you do still get what I mean despite my weak examples.

This thread was diverted from questioning alcohol as a poison in "any amount " to culture war. This is the borderline astroturfing that destroys communities. Turn every discussion into a political one. I no longer read Slashdot knowing I'll find commenters with more insight than the OP, because they're buried in fragile outrage. Sorry I'm making it worse, just this thread, which should be a few references on each point, became panic and FUD disorientingly fast.

> Not terribly on topic, but I've been lurking here for more than a decade, and today I learned that it's a conservative forum

Me too.

I understand that the commentary on HN can sometimes be frustrating, but many topics are nuanced and worthy of discussion. If you are looking for a forum which converges on one version of the truth and does nothing but repeat that version of the truth to itself, well, maybe try another discussion forum. If you are not interested in participating in those discussions, it's fine to just keep scrolling or collapse the thread entirely.

It may not be deadly, but female flight attendants become infertile earlier than women working on the ground.

Just speculating here, but doesn't it have something to do with accumulation in the body? Your body obviously can't accumulate radiations. It also does process and eliminate the like of ethanol and many other substances. That's not the case, I believe, for heavy metals like mercury, lead or arsenic, that are eliminated much more slowly (if at all?).

That's why you can enjoy lychees by eating a few everyday if you fancy it, and will only poison yourself if you eat a lot at once. But you can poison someone by exposing them to a little bit of arsenic everyday (at least in the movies, not sure how true it is...)

I think tar from smoke accumulates, and there is a lot of it in second-hand smoke.

Obviously not a doctor, so I'm probably completely wrong...

The damage from smoking is accumulative. I have noticed it in the skin of young female smokers after a few years of heavy smoking. You can see it's affects on some other parts of the body over longer periods.

Drinking a lot of alcohol has a similar effects as tobacco on your health, and on the skin. If you know a heavy drinker then they quit for six months and then you see their face, there is noticeable rejuvenation. There are patterns of looks to older people that drink at pubs frequently.

You might enjoy this excerpt from E. T. Jaynes’ book “Probability Theory: The Logic of Science”:

https://bayes.wustl.edu/etj/prob/book.pdf#page=16 (the section that starts with “What is ‘safe’?”)

yes but these three (radiation, smoke, alcohol) are very different hazards with quite different modes of harm

There is robust data that the risk of first-hand smoke is not a linear relationship between cancer (and other bad stuff) and dose--no amount of smoking is safe.

To be frank you are uninformed on basic statistics as well as medicine.

You are doing the standard thing that many educated people do when they think they are smarter and more informed than they are. You dress up a bad take as if you found some secret (CDC's hypocritical language) and assume that a mathematical relationship exists ("obviously exposure to bad stuff carries linear risk"), when it is actually more complex than that (if we can call a binary relationship more complex than linear lol).

> bad stuff carries linear risk

This is a straw man. I believe that a lot of stuff carries continuous risk going up from zero and increasing with dosage. If a substance does not start with zero risk at zero dose, it is most likely not a toxin but an essential (i.e. vitamin A).

Very few substances are so rare that the discreteness might matter for practical purposes.

To portray the risk as binary, centered at zero is certainly wrong. You also would have a very hard time to find study subjects who have never been exposed to a few particles of smoke.

That doesn’t mean it’s not linear to some degree; surely 24 cigarettes a day is worse than 1 a week.

Smoking by a person may or may not create benefits for the person smoking. However, secondhand smoke creates no positives and significant net negatives (the smell, the accumulation of black deposits on clothes of things around you) for anyone who encounters it even if you ignore the health effects.

It can also create pretty serious immediate issues beyond just the long term problems for people with breathing issues like asthma or certain allergies. If smoking and second hand smoke were everywhere, like it was in 80s and early 90s in the US, and you were one of the fairly large percentage of the population with these issues, you basically couldn't go anywhere without risking your health.

If the second hand inhaler were a child, it's an even more serious problem. Nicotine is highly addictive and does a real number on your brain. It makes addicted smokers justify things to themselves due to the sheer physical need and you end up with parents smoking around young kids etc.

Even if you are a libertarian, you should support restrictions on smoking consistent with the principle that each of us has freedom but your freedom to swing your fist only extends as far as my nose.

Alcohol is a bit different. Unless the drinker starts behaving badly after drinking, or there are long term issues like alcoholism that affect the whole family, they are really only hurting themselves.

To point 1. In the brief I find at the red download link [1] contains the line “ Based on recent evidence, it has been concluded that there is “no safe level of alcohol consumption”(5).”

The reference points to an article from The Lancet [2]

[1] https://world-heart-federation.org/wp-content/uploads/WHF-Po...

[2] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Another article from The Lancet from around the same time reported a whopping... 6 months of life expectancy reduction when consuming 100-200g of alcohol a week versus 0-100g of alcohol a week. [1, Figure 4] A drink is 14 grams of alcohol, so that means that your risk from consuming 150 grams, or over 10 drinks a week, is still relatively low in terms of all-cause mortality. Figure 1 also shows that consumption of 0-100g per week has virtually no consequence on all-cause mortality.

[1] https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736...

so Japanese people would live even longer than everyone else than they already do if they didn't drink so much

Japanese people don't drink a lot. They're 17th out of the 17 "high income countries" shown by default here:

https://ourworldindata.org/alcohol-consumption

They do smoke like chimneys though, which makes for some pretty surprising stats vis-a-vis lung cancer (lower rates than the US) and life expectancy (significantly higher).

For comparaison, smoking is ~10 years of life expectancy reduction https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal....

Surprisingly obesity seems to only replace some of your last years with years with diabetes, without decreasing your longevity https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4951120/. I think I didn't read that study correctly, or didn't find a good one.

Air pollution might be around 1 to 3 years: https://dynomight.net/air/

A reduction of 6 months is also more than what you can expect to gain by taking statins: https://dynomight.net/statins/.

> obesity seems to only replace some of your last years with years with diabetes, without decreasing your longevity

That's probably only because we can generally manage diabetes pretty well, though it does impose a lot of cost on society to do so.

> we can generally manage diabetes pretty well

We can but it requires the patient to manage their blood sugar very, very carefully and a lot of them can't do it 100% of the time. Whenever they don't, the damage happens and it accrues. I see a guy in the 'hood who's had much of his foot amputated as a result of diabetes.

Or so I've heard. I'm not diabetic myself.

"Nevertheless, men with obesity aged 55 y and older lived 2.8 (95% CI −6.1 to −0.1) fewer y without diabetes than normal weight individuals, whereas, for women, the difference between obese and normal weight counterparts was 4.7 (95% CI −9.0 to −0.6) y. Men and women with obesity lived 2.8 (95% CI 0.6 to 6.2) and 5.3 (95% CI 1.6 to 9.3) y longer with diabetes, respectively, compared to their normal weight counterparts."

Is this study suggesting that obese people with diabetes lived longer than obese people without diabetes? I suppose that diabetes as a condition is not harmful in and of itself and perhaps leads to a healthier lifestyle?

My (uninformed) guess would be that people with diabetes are followed more closely than people without. Your point about healthier lifestyle is a good one too.

Diabetes is extremely harmful unless perfectly controlled which it almost never is. The damage accumulates very slowly.

Severe obesity significantly decreases longevity.

https://jamanetwork.com/journals/jama/fullarticle/195748

That effect has been magnified by the current COVID-19 pandemic. Obesity directly causes more severe symptoms in infected patients.

https://www.wfae.org/health/2021-09-30/novant-says-9-of-10-c...

https://cardiologyres.org/index.php/Cardiologyres/article/vi...

https://reason.com/2022/01/03/cdc-covid-19-children-hospital...

So severe obesity would be indeed "almost as bad as smoking" according to your article, which is more in line with what I've heard before. Thanks for the sources.

> Surprisingly obesity seems to only replace some of your last years with years with diabetes

That can't possibly be right. Obesity is a negative prognostic factor in almost every disease.

I'd say quality of life is a way better measure - but its so subjective it makes it difficult.

I'm a sociable person, and in my(western) experience there are more good times when alcohol is involved, even with people who does not drink often. I get that it may have an adverse effect on health and longevity. But in the end, we are all going to die - to grow old just to be old doesn't sit right either.

There's a metric know an "Disability-adjusted life year", or DALY, that tries to quantify this: https://en.wikipedia.org/wiki/Disability-adjusted_life_year.

And your point about social alcohol is well taken. I have the luck of being a lightweight with drinking, so usually a glass of cider is enough for me, and with the right people it's always a good time. On the other hand, lots of people my age (young adults) tends to drink multiple pints of beer multiple times a week. They should at least be aware of the tradeoff they're making.

Queue the Winston Churchill quote "I've taken more out of alcohol than alcohol has taken out of me". I believe he died at age 91. Although it seems crazy that we could have ever believed alcohol is healthy in any way.

Anecdotal accounts could be one offs. We need data for a full picture and even than the data could be biased.

It may very well be Churchill could have survived longer were it not for alcohol.

This recent post seems to imply that they now have more accurate and more unbiased data leading them to this new conclusion. I think a lot of people at the WHF drink some amount of alcohol as do most people in the world. However, despite this, their conclusions and announcements must be based off data which is exactly the right thing to do and exactly what they are doing here.

There's some data on scholar, for instance a suggested health difference between wine vs beers or spirits, based on ~28k participants monitored over 2-19 years[0].

From my understanding the narrative of moderate alcohol consumption (specifically wine, via resveritrol) being beneficial comes from epidemiological studies of people living in the Mediterranean, an area with relatively long median life spans[1]

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC31093/

[1] https://www.ingentaconnect.com/content/ben/emiddt/2014/00000...

Other than this being an anecdote and doesn't mean everyone who drinks heavily will leave to their 90s, the quality of those 90 years matters too!

Though he became Prime Minister for the last time at the young age of 76 in 1951, he was plagued by health problems. He suffered many minor strokes and at least one that left him partially paralyzed for some time. He only stayed on as PM as long as he did because his successor was sick as well (Anthony Eden).

Don't know about you, but I would rather live a healthy 70 years than live 90 years but where the last 20 years are plagued with illness and thus lower quality. In that light, I try to minimize the bad habits that may result in poorer health and thus lower quality life in my later years. Not saying I'm a saint, but I don't need to drink every day or even every week. Currently I'm mostly dry. Saves a lot of money too!

It is absolutely acceptable to knowingly exchange damage to body for healing to mind, and vice versa as well. But I still appreciate that science is gradually making clear that alcohol is not perfectly harmless, and that a large-scale health foundation is finally admitting that.

The mind is part of the body

Also contrary to popular belief, alcohol does not heal or help the mind unless perhaps you have methanol poisoning or are in the middle of a panic attack

> The mind is part of the body

is it...?

Yes, the mind is an emergent property of the networks of the brain.

Or maybe you have a soul.

The soul is an emergent property of the mind and body interacting with the world.

Citation needed. Please don't invoke magic

How could it possibly not be?

if the mind is a state of consciousness, and damage to the brain damages said consciousness, the mind must be part of the body.

going further, alcohol is interesting in that, in appropriate amounts, it can improve the state of consciousness through a better quality of social interactions, and at the same time, can damage the state of consciousness through poisoning

Absolutely, and not only in a strictly physical sense (i.e. it's contained within it). Mental acuity into old age is strengthened by continued exercise and fitness - damaging the body so that it is less able to physically operate damages the potential of the mind.

Even if you want to step into the realm of the philosophy of mind[1] - there still are rather clear portions of the mind that are physically linked and a pretty wide consensus on the feedback of bodily strength to a healthy mind. Modern dualism accepts that a lot of mental functions are either enabled or assisted by our physical brain goop and classical dualism still assumed the definition of some crossover point where the metaphysical abstract expression of thought was translated into physical signals that triggered actions in the body - the existence of pain reactions necessitates a fair amount of our mental processing having the direct involvement of physical systems.

1. https://en.wikipedia.org/wiki/Philosophy_of_mind

> alcohol does not heal or help the mind

Is it not possible that some people find alcohol in reasonable doses to be a net positive mentally and mood-wise?

What people experience as positive does not need to be that. Using alcohol to not/postpone/avoid solving an underlying problem for unhappiness would be an example.

It's been basically 2 years since I've had a drink.

Before then, I drank socially-- a couple times per year I'd get buzzed with friends. Not all my social outings were buzzed.

But those hazy memories of being buzzed withe friends are little treasures that bring me smiles even long removed from them. My life is richer, and my mental health better, by virtue of hanging out with people this way and I miss it (this is a casualty of COVID).

Many memories of sober moments with friends bring joy, too. But they're qualitatively different things. I want both.

Preface: I say this as someone who has been sober from alcohol for almost 5 years.

Something can be a "net positive mentally and mood-wise" without also being something that is "not/[postponing]/[avoiding] solving an underlying problem for unhappiness".

The sibling posts make the right point: lots of things are objectively bad for your body, but your emotions are part of it, too. If alcohol or whatever makes you happier, then it's "good for you." Until you have so much that it's not good for you anymore.

It's the same for sweet desserts: why TF should you deprive yourself of all of them? Just keep it in moderation.

We could imagine a very different society with much less consumption of alcohol but people still being equally happy. If someone is made to feel unhappy when they don't drink because everyone around them is doing so, the fact that then consuming alcohol makes them happier shouldn't be pointed to as evidence the person is making a good trade off between bodily harm and happiness.

This post is kind of involved.

No, you shouldn't be made to feel unhappy; or rather, you should push back harder against anyone who tries to effectuate that. Being sorta Stoic here: no one can "make" you feel anything.

It's none of their business, after all.

People are notoriously bad at observing/examining their own behavior and mental states, although it is possible. But those people would probably be better served with a pharmacological anxiety treatment or therapy

Alcohol can be part of having a fun time, and having a fun time occasionally is good for your mental health (as opposed to the physical health of your brain, which appears to be what you're talking about).

This is certainly an opinion, but I think there are plenty of alternatives out there that can do a better job at enabling fun having without causing nearly as much bodily damage or functional impairment. We have a variety of choices in both the natural and pharmaceutical realms.

Okay, fine. It’s acceptable to damage the body to heal the body.

For example, exercise, where you damaging muscle fibers to heal, maintain, and/or improve the body.

Also for example, intoxication, by virtually every vector known to exist, often damaging the body in order to maintain the body.

Being alive is about tradeoffs, not about minmaxing. You can max out any statistic, but only at the cost of the others — sanity included. Alternately, being alive is about the exquisite joy of minmaxing, being able to hyper focus on one specific body goal at the cost of everything else in your life, including sanity (if you’re not careful).

“I’m sane without intoxicants”: so no nature, no music, no games, no social joy, then.

For example, this is either a description of an acid trip or of someone listening to orchestral music on the radio:

“It was so amazing. I’ve never felt so alive. It was, like, there was a train running through the mountains, and my room was one of the train cars, and I could see it right there, and I just stared at the wall for like half an hour and enjoyed the ride.”

I find it simpler to discuss mind and body in separate terms since people have trouble seeing transcendent experiences as intoxicants, but I hope this use of your terms helps clarify my viewpoint.

This is a dangerous statement! Alcohol is not good for the mind, even in small amounts. I feel like a cloud has been lifted since I stopped drinking.

I strongly recommend everyone read Allen Carr's Stop Drinking Now (https://www.amazon.co.uk/Stop-Drinking-Now-Allen-Carrs/dp/18...) - a fantastic book in which the author logically argues why every perceived positive of drinking is actually a negative.

This is an interesting study, and I'm not 100% sure it supports their conclusion. For example on Figure 1 the hazard ratio for all cause morality isn't much higher than 1 until you get into the 200g+ groups, and the hazard ratio for cardiovascular disease is less than 1 until you get over 200g. This would seem to support studies that find a benefit for moderate drinking on heart health. Most of this benefit seems to come from lowering the incidence of MI based on Figure 2.

This also seems to support my initial hypothesis from reading your comment which is I wonder how much of the difference in all cause mortality is due to the effects of binge drinking or drunk driving. The fact that the hazard ratio on all cause mortality isn't really above one until you get over 200g would seem to support the idea that that is where most of the increased mortality comes from.

When I read stats like that I also think about quality of life. These results don't rule out people living pretty much the same length of time, but with an assortment of ailments caused by the alcohol that make life pretty miserable, as another comment in this thread says about obesity and diabetes.

I wish we'd stop using shallow metrics life longevity over quality - it causes the layperson (who hasn't developed their critical thinking enough yet, or perhaps not capable to) to skim over that "lifespan" doesn't take into account all kinds of qualitative variables - including alcohol being a depressant, literally you're depressing how sharp your nervous system can be; yes, which people often self-medicate with because they have energies they haven't yet figured out how to regulate and are too intense, so the alcohol becomes an escape. I'm not against alcohol, I'm just for informed consent - understanding the full scope of what you're doing.

Maybe you have a different point in mind, but I am skeptical that there are any consumers of alcohol that are not aware that it is partially a depressant. This is both obvious to any consumer of it, and taught in every school that does any sort of substance (ab)use education.

Do you know if they teach that it causes cancer too?

You've uncovered the fundamental issue with numerous public health studies: the effect size is irrelevant.

You don't get attention for being modest.

Yes but "The Lancet"

“Based on recent evidence, it has been concluded that there is “no safe level of alcohol consumption”(5)

Which definitely takes artistic license with what the cited article actually said, which was:

   Our results show that the safest level of drinking is none.

Which is exactly like saying "The safest level of poppy seed consumption is none". Which of course completely dodges the question you'd really want to ask which is: "How many poppy seeds can you eat per day with either no or negligible negative health effects?" And in any case nowhere near equivalent to saying:

   It has been concluded that "there is no save level of poppy seed consumption".

Moral of the story being -- the byline quote at the top of the article:

"The evidence is clear: any level of alcohol consumption can lead to loss of healthy life"

Is not only supported by the research it cites -- but irresponsibly alarmist.

I don't think that misstates the lancet article, and i also think this information in the lancet article is useful.

There is a long belief that e.g. red wine is good for the heart, or in many places there are some herb liquors that old people drink thinking it will bring them benefits. Here the lancet unequivocally states that to our best evidence no alcohol is best. You're from now on not drinking red wine for your heart but for pleasure.

Here the lancet unequivocally states that to our best evidence no alcohol is best.

The thing is this proscription is essentially useless. It's like saying "to our best evidence no sugar is best".

So should you eat that piece of chocolate cake or should you not?

You're from now on not drinking red wine for your heart but for pleasure.

We knew that already. But it still doesn't tell us whether drinking, say, 3 or fewer glasses of wine per week has a significant negative health impact or not. For any actual measure of "significant".

Maybe figure 4 from the Lancet article [1] mentioned above is helpful here. It is titled “Relative risk curves for selected conditions by number of standard drinks consumed daily.”

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Interesting graphs.

What's interesting in particular is that for several categories (such as ischemic heart disease) the relative risk does seem to go down rather decisively for up to 6(!) standard drinks per day (which they note is "offset" by the increased risk in other categories -- including cancer).

So going by their own combined/weighted risk in Figure 5 - we see a curve that is essentially flat in the region between 0 and 1 - that is, showing negligible risk (asymptotically zero) at 1 drink per day, rising to more concerning levels starting at 2 or 3 per day.

And that's the decisive issue here: "Is having an average of 1 drink per day really any more risky than 0 per day?" The only take-way I can get from the article is that there's essentially no difference in risk level in this interval.

I've noticed that most health recommendations like these do not have any evidence associated with them, or a description of the actual risks. It seems that the doctors and health officials who write them have the evidence, but don't believe that the public needs to see it and rather should just go with whatever they say.

That’s because you’re reading a mass media report on the recommendation. It takes less than a minute of earnest effort to find the actual studies or briefs and scroll down to the sources.

https://world-heart-federation.org/wp-content/uploads/WHF-Po...

Hmm... looks like fake receipts.

For the claim "Alcohol consumption increases the risk of CVD", they cite the following paper, which actually shows statistically significant reductions in CVD from 75 to 150 g/wk.

https://pubmed.ncbi.nlm.nih.gov/29676281/#&gid=article-figur...

Having recently become pregnant, a lot of the guidance for expectant mothers echos these blanket recommendations (sushi, deli meats, hot baths etc).

On the topic of alcohol, FASD is a massive concern, but it's known that it's correlated to how much you drink and how frequently you drink (enjoying a glass of wine once a month is very different than binge drinking multiple times throughout your pregnancy).

The thing is, researchers aren't getting pregnant women different levels of hammered, and then assessing how their babies turn out (unethical much), so they're left to infer based on reported behaviors. Hence the unreliability of the data, and the "no amount is proven safe" mantra. Maybe it's the same with this recommendation?

The other thing not factored into inferred results is other associated behaviors. I'd bet that statistically, women that are binge drinking through pregnancy are more likely to also be taking hard drugs than their non-binge drinking counterparts. So is alcohol fully to blame here?

I'm not here advocating for pregnant women and drinking. But it'd be nice to have the data and evidence behind these risks, so that people can be empowered to make their own decisions.

I've seen so many women on forums stressing over a glass of wine they had at christmas, or the time they ate a cold cut without realizing. Needless stress that could be minimized if pregnant people weren't advised as if they're children.

The "no amount proven safe" mantra is refuted by epidemiological studies on the subject. There's no evidence that modern drinking is something to worry about.

It's well known that pregnant women become more risk avarse, and humans being bad at risk assessment in general they tend to channel those worries in relatively unproductive ways.

E.g. worry about obscure food safety issues, as opposed to something like traffic risk, or just focusing on staying generally healthy and anxiety free.

> The "no amount proven safe" mantra is refuted by epidemiological studies on the subject.

Is there a source?

Emily Oster's book Expecting Better talks about this, I don't have a copy on hand but you could check her sources.

Probably numerous sources, but for what it's worth my own recollection on this subject is based on this article:

https://www.independent.co.uk/news/health/pregnancy-drinking...

Epidemiological studies might not be very strong evidence though, since moderate alcohol consumption is likely correlated with class. And inversely correlated with the use of more dangerous drugs.

Congratulations!

Lacking clear research (in this case, we lack intoxicated pregnant people to study, as you say), I tend to rely more on expert judgment to sort out the facts, bringing to bear their knowledge of physiology, anatomy, chemistry, and disease; their long experience with many thousands of actual people, etc. I have none of that. If I break my arm, that's my only experience with it.

Here's a paper that combined a 30 year study on intake with MRI data and came to similar conclusions (no safe level of consumption and no observed benefit from low-dosage consumption).

https://www.bmj.com/content/357/bmj.j2353

One thing to keep in mind when reading these papers is that a "unit" of alcohol in these studies is often equivalent to about half a standard drink in the US. So when they talk about 7 units a week, it's not 7 drinks, it's usually 3.5 drinks.

Would any non-trivial substance be deemed "safe" under these criteria?

There's a very small chance you'll choke to death every time you eat something.

Another score for fasting!

BRB, gonna fast the rest of my life.

That's definitely an achievable goal with sufficient dedication.

What the studies have found is that drinking in moderation (at or below the 1–2 standard drinks a day limit) does not have cause a very large impact on life expectancy. This raises sharply after exceeding the limit.

https://www.health.harvard.edu/blog/sorting-out-the-health-e...

Personally unsure whether a reduced year or two of life is really that significant.

That article seems to back up the idea that no level of alcohol is safe, given that low / moderate alcohol consumption is still associated with a small decrease in life expectancy.

(Though there are always potential confounding factors in such studies)

It does lose you time, yes, but there's lots of other factors in a person's life like level of stress, air pollution, etc. that have similar or worse impact. Alcohol intake is at least somewhat more controllable than those factors, so it can be up to you whether that lost expectency matters.

How alcoholism can be triggered in some one is also not known. That is also an additional risk factor in every single drink consumed, perhaps?

As I recall, for this particular bit of research that I read a couple of months ago, more precisely it states there is no clear discernible level of consumption that could be deemed "safe". That's not really a surprise if you look at the data because it's such a mess. You also can't pin a point at which consumption is a high risk. What does that tell us?

You can however surmise that low / moderate consumption is not associated with high risk of mortality. There is "risk" insofar as it is non-null, anything above zero is unsafe. So what? That doesn't mean it's significant.

edit: this appears to criticize the paper - https://jamanetwork.com/journals/jamainternalmedicine/articl...

Exactly. I find the claim "no level of alcohol consumption is safe" hyperbolic. You could claim with far more justification that "no amount of driving is safe" since you could be killed pulling out of your driveway but I think most people who drive on a daily basis would find this claim odd. "safety" is a relative, not an absolute condition, since in some sense being alive is unsafe.

That is a weird comparison. No one is forcing you to drink alcohol, but you might be forced to drive to the office. One is avoidable, the other one is not. Or if you want to be even more precise: One is easily avoidable and the other might cost you your job.

How is that relevant? If you want change it to "no amount of driving to the bowling alley is safe".

I have seen many people use such comparisions, which do not match up, to justify unhealthy behavior for themselves, shutting themselves out from proper reasoning. That is how it is relevant. I am saying: Do not fool yourself using such arguments.

Also the comparison you now brought up is again not a good argument: It doesn't matter, whether there are unnecessary rides. The argument is, that there are mandatory ones for people, while there is no mandatory thing that forces you to drink alcohol. Or at least there should not be and in reality there are probably very few.

Sure there are mandatory rides, but the argument doesn't hinge on those..you can consider only nonessential rides, and drinking. Both are totally optional, what is your issue with that comparison?

I have no issue with the comparison of nonessential rides. I want to note though, that the original argument was plainly about "pulling out of your driveway".

So if one does nonessential rides only, then yes, the comparison might work. I think that is quite a special case of a situation though, which I cannot simply interpret into what the original argument said. I mean, I am not here to interpret a working version into something, that in its generality does not work as a comparison. I rather read things as they are written and try not to add things.

We could speculate about how many people use a car mostly to be able to get to the location of work or how many people use a car for essential reasons. We are getting further away from the actual matter of discussion though, which is drinking alcohol and that not being requried at all.

> So if one does nonessential rides only, then yes, the comparison might work.

I disagree. Just like alcohol can be eliminated from your diet, nonessential rides can be eliminated without eliminated essential ones. It doesn't matter what you mostly use a car for, it's totally irrelevant.

No one is forcing you to drive to work either. Many people in don't even have a license, yet make it to work each day. You even said it, "might be forced" meaning there are possibilities in which you aren't.

If you live outside the city, you basically are. In my home town, transportation is limited, eg a bus in the morning and one in the afternoon, both which can be late, and the stops are kilometers apart and the sidewalks are shitty. So when I'm there, I take my car everywhere, as does everyone else.

But when I lived in a big city, the opposite happened: parking was expensive and the traffic sucked, so I always took the bus and subway.

Let's not make blank statements about transportation, as it differs so much from one place from another.

Still aren't forced to drive. Walk, bike, catch an earlier bus etc.

No one is forcing you to work either

Cue we get into the weeds bickering over the analogy for the rest of the thread.

Driving is absolutely avoidable. Being willing to drive might help you get a better job - but so might being willing to drink.

(Far more importantly, drinking is actually enjoyable, whereas commute-style driving is a chore. Considering a job to be somehow more important than a social occasion is putting the cart before the horse)

This is a pretty odd comparison.

Some amount of food/caloric intake is healthy or required. Too much is bad. Some amount of water intake is healthy or required. Too much is bad.

No amount of arsenic intake is healthy or required. Any is bad. No amount of alcohol intake is healthy or required. Any is bad.

Too much of many things is bad. Any amount of some things is bad.

Safe may be an odd term for it but alcohols impact on ones health is always a negative. If we define bad as a negative effect on ones health it may be a better term than safe here.

Arsenic is in all kinds of foods, if you made the claim "no amount of arsenic consumption is safe", you would be arguing that basically everyone's diet is unsafe. What does that even mean?

To take the claim "no amount of alcohol consumption is safe" seriously would mean you shouldn't eat bread, which contains a small amount of alcohol.

What about: 'No amount of smoke inhalation is safe for the lungs'?

Obviously, if you live in a city, you're going to find yourself inhaling smoke from time to time, but it's still the case that it should be avoided. It's not extreme to think of alcohol as 'always negative' but also to accept it's a common and basically unavoidable toxin.

That's a hard argument to make. "2nd hand smoke" is (for now) unavoidable (though has decreased dramatically over the last decade or two). "2nd hand alcohol" is not really a thing at all. We choose to drink it, or we choose not to (ignoring heinous acts of coerced drinking).

Having a fireplace, barbecue, outdoor fire pit, or going camping with a campfire, are all situations where people intentionally choose to engage in activities that cause them to inhale smoke. Those activities might contribute to a healthy lifestyle in the whole. Similarly, social activities that include alcohol consumption can be analyzed as a whole, without the pretense that they can always be made 'dry'. There is no 'dry' wine tasting.

Tobacco smoke and fire smoke are generally entirely unrelated from a health perspective.

Going to a wine tasting is a decision to drink wine (though if it occured at someone's house rather than a public or commercial facility, I could imagine that the hosts might accomodate a non-drinking partner or something like that).

>Tobacco smoke and fire smoke are generally entirely unrelated from a health perspective.

But not from a scientific perspective.

Indeed, and cyanide as well for instance. Neither are "necessary" either. I don't think necessity has any bearing on the discussion. Ultimately the question is whether moderate alcohol consumption poses a significant health risk, and "no safe amount" avoids answering this.

> To take the claim "no amount of alcohol consumption is safe" seriously would mean you shouldn't eat bread, which contains a small amount of alcohol.

No, it doesn't mean this. What they mean is that any amount of alcohol consumption causes some amount of harm. From the research I have seen it seems to be more or less linear. Minuscule consumption means minimal harm.

The implication isn't that you or anyone else should necessarily reduce your consumption to zero. It's that it should not be assumed that there some level of consumption that causes no harm or is beneficial (as previously believed). That is what the phrase "no amount is safe" commonly means in medicine. It is a purely medical recommendation.

This is totally separate from a dietary guideline, which would weigh the risks of alcohol against the social reality of it's consumption. That is the way that you seem to be interpreting it.

Also I'm not the person you responded to originally, but interestingly it seems like arsenic, in tiny quantities, is actually essential to our biology.

> any amount of alcohol consumption causes some amount of harm

There is no guarantee that you will suffer harm from a single drink. What it really means is that any amount of alcohol consumption carries some (possibly minute) risk of harm. This is not, IMO, equivalent to "unsafe", which generally means something well outside the bounds of normal risks that most people already take on in their everyday lives.

If we accepted that "some risk of harm" = unsafe, we would have to describe using the stairs as unsafe, taking a shower as unsafe, putting up Christmas lights as unsafe, etc.

And medically those are unsafe. The crucial part, though, is that that's not at all to say you shouldn't do them. You are simply using a different understanding of the word safe than they are. This is a medical brief aimed at experts who should have no trouble understanding what claims are and are not being made.

This is not a lifestyle or dietary recommendation. This is not a cost benefit analysis. This is a medical brief that states that no amount of consumption is safe. The takeaway categorically should not be that we should all reduce our intake to zero, which seems to be how folks are interpreting this.

For what it's worth, I say all this as a regular drinker who has no intention of ceasing drinking.

I would argue that if those things are unsafe, the term unsafe has no useful meaning, i.e. life is unsafe.

It's a policy brief, not a medical brief, it is pro-abstinence and recommends a variety of alcohol control policies, short of actual prohibition:

"- Call for strict regulation of alcohol products

- Advocate for minimum pricing of alcohol products

- Build capacity internally and among peers to promote cessation of alcohol use and abstinence from alcohol

...

- Prioritise alcohol control in national agendas for health and support policy coherence between health and other sectors"

etc.

At least death is safe. As in, dying will not increase your risk of death.

If time word “unsafe” means “carries more than zero risk” then it isn’t very useful to me to know whether a doctor considers something unsafe.

Yes, but it's useful to them. That's the point.

I’m guessing I’m not alone in saying that some of the most enjoyable, memorable, and positively impactful nights of my life were because of alcohol.

To call ingesting it in any amount “bad” is way too reductive.

Which is why I defined bad. Meth addicts experience utter bliss and euphoria while high. I've had lots of great experiences drunk or while drinking. I've also thoroughly enjoyed utterly gorging myself on unhealthy or excessive amounts of food. I've driven too fast, stayed up too late, and generally done lots of things that are bad for me because they felt good or lead to some type of, at least in that moment, good experience.

It doenst mean those things were not bad for me. It's about being able to admit that those things were bad for my health regardless of if I decided the benefit outweighed the cost. Many people thing the cost of consuming alcohol is lower than it is and that the benefits are far greater than they are. I've had plenty of incredible experiences without booze too. In hindsight there were plenty of things I would have enjoyed just as much, if not more, if I didnt think I needed alcohol to make the experiences better in some way.

It's because for years there was a claim that low levels of consumption was beneficial, not just safe. They're working to undo that conventional wisdom.

I don't recall there ever being a time when people espoused short drives as being beneficial for one's health.

To quibble, something can be "unsafe" i.e. harm you in certain ways, and also carry health benefits, since "health benefits" does not merely translate to "life expectancy". In fact for the study in question, compare impact on different organs; for some there is a harm, for others a marginal benefit (if I remember correctly).

This is the problem with pop sci headlines, they don't give you context. If one study finds that some compound has potential benefits in one specific physiological region, the news will read "x is good for your health", and vise versa.

Looking at just mortality, we can more accurately say, for those touting this study, "there is no evidence alcohol consumption improves mortality", and also "low alcohol consumption may weakly worsen mortality rates".

A lot of studies on alcohol and mortality show a J curve where mortality actually drops, and then starts rising until it's back at baseline at 4 drinks / day. Now, I am not saying that it's safe to drink 4 drinks per day. That's a lot. What I am saying is that is the point where cardiovascular benefits seem to be outweighed by the increased cancer risks. Many studies have called the J curve into question due to the 'sick quitter' effect, but you have to realize that by trying to correct for that effect they are often just adding a fudge factor to the numbers. Alcohol is a very hard subject to study because it's always self reported, and thus almost always under reported.

Correlation doesn't equate to causation. Perhaps the people that sit down with a glass of wine at night are the ones simply taking a slower pace in life and have less stress as a result.

However be that as it may I'm not giving up alcohol lol. I only drink occasionally and I enjoy it and I simply don't care if it's bad for me. Lots of things are bad for us.

Plus driving to buy food definitely makes you live longer.

It's not exaggerated. Your claim of "no amount of driving is safe" is also not hyperbolic, it's real. You drive, you're at risk.

What's going on here is that the previous conclusion was not "no level of alcohol consumption is safe." The previous conclusion was "some alcohol is good for your heart." All this new conclusion says is that this is no longer the case.

Nobody lives their life off the mantra "no amount of driving is safe"... That would be crazy but it would be entirely wrong to say that, "some amount of driving improves your life expectancy" when this is clearly not the case.

Hence the need for the WHF to take an official stance on this. It's a data driven conclusion, but you of course need to be the judge about what you need to do with that conclusion.

> What's going on here is that the previous conclusion was not "no level of alcohol consumption is safe." The previous conclusion was "some alcohol is good for your heart."

Something can be deemed "unsafe" and good for your heart. There's more than one internal organ. The word "unsafe" doesn't provide context.

Here's a better way to put it. Alcohol never was good for your heart. IN fact it's bad for your heart and does nothing good for your body. That is what the WHF means when you ignore all the semantic pedantry.

That’s a rubbish comparison.

Of course no amount of driving is safe—that’s commonsensical. You always have a chance of getting harmed when you decide to drive a car. But driving a car has a clear utility which is non-optional in a lot of cases. The utility of recreational alcohol use is, on the other hand, more akin to joyriding—so similar to a completely optional subset of car driving.

It's impossible to eat many foods without ingesting ethanol, including bread. The advice that "no amount" of ethanol is safe is ludicrous, including from a biological perspective, as the human body is well equipped to safely handle ingestion of ethanol in moderate amounts.

That’s an illuminating argument and not at all just a technicality that disproves nothing. Consider me enlightened.

> […] So what? That doesn't mean it's significant.

It is the question, how significant it is. Then there is the question, what level of significance will make a person reconsider their consumption.

However, the statement that no amount is truly safe, if it is correct, means, that in general alcohol is an unnecessary risk. There is no need to drink it and no good for ones heart comes of it in terms of biology. What society does with this info is up to all of us.

This is only true if you assume or demonstrate that alcohol has no benefits to individuals that outweigh the downside risk to health. As the downside appears to be relatively small, this seems like a fairly difficult bar to clear.

No, their statement is correct regardless of the benefits. This brief isn't a cost benefit analysis. It's not a dietary guideline. It's a statement of medical fact (based on current research, anyway): that no amount of alcohol is safe for cardiovascular health.

There may well be benefits to alcohol consumption, but those are entirely irrelevant here.

Chris Masterjohn theorizes that alcohol can have a beneficial hormetic effect by antagonizing vitamin A and the body adapting to supply more vitamin A. However, he theorizes the maximum beneficial dosage is about 2/3 of a single drink.

https://chrismasterjohnphd.com/lite-videos/2018/12/13/is-alc...

This is a great comment. I am just usually employing a rule of:

"If there is a conflict between healthy / unhealthy, then can just minimise or avoid it."

Nobody really argues about vegetables... Meat and dairy products however, thats an interesting discussion.

A lot is riding on the unspecific usage of "safe" here.

What's disappointing is how quickly your observation was diverted to panic and inciting outrage. I'm interested to know why the CDC now says "no amount" when the evidence for decades has been that small amounts are cardioprotective. Is there truly none?

The "small amounts is cardioprotective" is most likely false, the new recommendation simply reflects this. I recall reading about this in research more than 10 years ago. (Sorry for not citing, I'm on mobile rn)

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