Smoking Causes Cancer | Hacker News Reader

Smoking Causes Cancer

allendowney.com

89 pointsalexmolas124 comments

I quit for the longest of time...(started at 16), all of the sudden I found myself in Colombia, and all the restrictions I've gotten used to (no smoking in public places, etc) where non-existent. Further more, the packing of the cigarettes was still all branded, almost no warnings, and all kinds of 'clicky' flavored types. Don't want a whole pack? no problem, we got you! Buy singles on every corner...

Needless to say I started smoking again... I then quit again for a few years... went to northern Africa, and guess what? People literally smoking at the airport, £1 packs of camel, etc...

I haven't had one in a bit now... People think the restrictions don't work, but they absolutely do.

> People think the restrictions don't work, but they absolutely do

It's wild to me that people make assertions like this. We can (and should) argue about the effectiveness of smoking restrictions on decreasing cancer and heart disease, but to make the argument that they have no effect is just silliness.

You hear the same arguments from the right whenever gun control, environmental protections or really any sort of government regulation comes up, and from the left (though to a much lesser degree) on the topic of tax rates. We should all be able to agree that any sort of regulation will have a marginal effect, and be able to have a discussion about the level of that effect.

I was always under the impression from people here on HN that regulation stifles the free market, one of the pillars of the US. This in turn negatively affects innovation, impacting jobs and sectors across the country.

Is this no longer the case?

The "free market" is a corruption of the phrase "freely competitive market" coined by Adam Smith. He was quite clear about the need for legal control to keep markets competitive for them to function.

I can't speak for HN, but I'm of the view that some reasonable degree of regulation is necessary for a properly functioning market. Imagine if everyone engaged in drip pricing [1]. It'd be less of a market that competed on pricing and quality of product/service, and more of a market of who can trick the buyer most effectively.

[1] https://en.wikipedia.org/wiki/Drip_pricing

> pillars of the US

Systems without regulations ends either with monopoly or towards entropy. To keep system balanced, regulations need to adapt in time. Contrary to this, it is not uncommon in US to think that Constitution is set in stone and regulations are bad.

How about legalizing drugs? Somehow people believe that it is going to magically work.

Legalized, regulated, taxed substances with guarantees, legal vendor liability and consumer protections are safer and better for everyone than unregulated markets with no guarantees or consumer protections and with zero vendor liability. There's no magic involved.

A regulated drug market such as cigarettes can do more to reduce harmful consumption than an unregulated drug market. It also eliminates criminalisation for what is essentially a health issue.

It magically kept people from going to prison for possession of not legal drugs.

Well we could make Tobacco illegal too, at the cost of creating a black market and increasing crime. Would we start locking people up for smoking? Would workplaces include nicotine in their mandatory drug testing?

> Would workplaces include nicotine in their mandatory drug testing?

That's already happening in USA.

https://www.reliasmedia.com/articles/13807-cleveland-clinic-...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788708/

And perhaps baselessly, not just testing for tobacco, but any form of nicotine.

I just think it is better for things like fentanyl to stay illegal than freely available in streets. I would be interested to see an alternative universe where tobacco was illegal. You do not necessarily lock people up but just reduce the supply as much as you can.

The big problem with fentanyl is that it is an extremely potent drug with a low therapeutic index, which, with the poor quality control of street drugs, is a perfect recipe for overdoses.

I am not saying the fentanyl should be made legal, but its criminalization is a big part of the problem. It is also why it is used so much over other, less risky opioids. Because it is so potent, only small quantities are needed, which makes trafficking easier.

This is the part I also do not understand. Why is criminalization the issue? Do you think having such drugs makes the world better in any way? We are not talking about buying eggs. These are super addictive substances.

I would say that criminalization is "an" issue - when the drugs go through black markets quality suffers, it's harder to drive out bad suppliers, keep markets open, etc. This decreases the quality of the product overall, but also lowers the availability somewhat.

On the other hand, look at cigarettes - everyone agrees they are very bad for you, the packages say it, and you pay an extremely high premium for them over their costs. But no one dies from fentanyl (or whatever) in them because they're a regulated industry. We used to know less about it and let people smoke as much as they want. Now that we have good data on that we raise the social and financial cost of cigarettes to keep them as unpopular as possible.

I'd encourage you to think about this less like eggs and more like the weather. On some level, drugs exist "out there" and people will use them "sometimes." We can't change that. What we can change are the systems that make the already difficult problem of addiction worse by introducing lethal surprises.

Criminalization doesn’t make drugs go away. It just means you can throw addicts in jail. Is that a better world? Maybe. There are certainly downsides, which is where the discussion should be.

Yeah when people have no legal pain management you get the current opioid crisis (as opposed to the previous version where people were aggressively given highly addictive substances without sufficient support or oversight).

Legal drugs may actually be more expensive and less available than their illegal counterparts.

It's worked out that way in a lot of US states for weed -- the illegal stuff is still around and still cheaper. I read recently that in California, illegal weed is still 75% of the market.

I think you are speaking way too soon on this. We are just getting started. Plus price is not the only determinant in how widespread usage for certain drugs are.

Maybe so, but it was legalized in CA for recreational use way back in 2016, and the scheme came into force in 2018. Part of the issue is that nobody wants to permit a dispensary in their neighborhood, so coverage is poor. Another problem is that it's simply much more expensive.

If you're already happy with your friendly neighborhood plug, why change?

I found the the article I mentioned:

https://www.latimes.com/opinion/story/2022-05-22/legal-weed-...

> Under Proposition 64, legal-weed businesses must first obtain approval from local authorities, which is impossible in many parts of California.

Not exactly encouraging new businesses, but to still go from 0 to 25% that’s not too bad

How many times have people smoking cigarettes been killed because somebody dosed their smokes with fentanyl?

I stopped smoking when I moved to the uk. A pack of 20 is 4 times as much as it is back in Spain or Italy. That alone made the trick

Absolutely, and I love it. No branded packs, no flavored cigarettes, no menthol, huge horrendous depictions of what you're exposing yourself to, £12 a pack, cannot smoke near public buildings, cannot smoke in public places, etc... This is beautiful. I will never stop saying, please, tax me on this crap, tax me more.

Counter-dote: I started smoking when deployed. It took me a few years to quit and that was a smoking -> chew -> patch/gum -> nothing.

No restrictions on sale other than 18+ (I was 24 when I started), and inside public places were only restricted a few years after I came back so I smoked a fair bit in local bars.

Smoking and similar habits are such a wild spectrum you can't prescribe any one thing and restrictions might help some who are prone but aren't really a cure.

Now that we are no longer used to smell the smoke, even getting close to someone smoking a cigarette makes me nauseous. Does not work with rolling tobacco, though.

> If you think that’s the stupidest thing you’ve ever heard, you can take it up with Sir Ronald Fisher, who actually made this argument with apparent sincerity in a 1957 letter to the British Medical Journal. I mention this in case you didn’t already know what an ass he was.

Not only did Fisher state this, and not only was he an ass, but it is almost embarrassing —it turns out he was partly right. You can read all about it in Pearl’s gem The Book of Why.

In essence Fisher argued that there could be a confound between the neurochemical and behavioral propensity to smoke, and the risk of developing lung cancer.

And strange as it seems to me, the DNA variant in CHRNA5 that is most highly associated with higher risk of nicotine addiction also modulates (independently) lung cancer risk. His principle was kinda-sorta defensible for an avid smoker.

Mendelian randomization of people by their CHRNA5 gene status can indeed demonstrate that Fisher was wrong. The majority causal risk is in fact smoking.

Interesting! Within almost every truth there lurks a valid but ultimately very minor counter-point.

Sorta a tangent here, but it's annoying that this is the very thing that causes people biased to not believe to latch onto as evidence they're right. Once introduced, further reasoning or curiosity about the subject tends to stop before weighing matters of degree, which leads to missing the big picture.

To generalize a lot, this is kinda where we are in the current meta of truth fracturing. Our biases drive us to discover nuances we grasp onto to avoid believing what we don't want to.

The idea that there's some confounding factor isn't in itself implausible, but a factor of 16 increase in risk is huge. Of course, to really be sure you should also look at how lung cancer risk and smoking correlates between countries, and within a country over time. And you can segment the population by sex and ethnicity. Oh and also look for a dose-dependent effect, very important. Heavier smokers should be at a higher risk.

Of course, the link between cancer is smoking is even stronger if some of the "non-smokers" were exposed to an increased level of cigarette smoke.

With Mendelian randomization a genotype can be used as an instrumental variable if it is causally linked to the trait (usually as part of a genome-wide “association” study)—lung cancer in this case. this can provide reasonable assurance of causality. See Book of Why.

Both my parents are lifelong smokers from their early teens and were a year or two apart in age.

My mom died of lung cancer at 54.

My dad is still going strong at 77 and smokes Camel unfiltered.

Humans are weird.

Regardless, you don't want to die from lung cancer. It is pretty horrible. Your body attacks itself, fluid collects in the lungs, it is painful, and you basically drown from within. Your only option is high doses of morphine and one day you just don't wake up. I wouldn't wish that on anyone.

People always talked about how long George Burns survived as a cigar smoker, but luck, genetics and how much you inhale all alter your risk profile. Cigar smokers tend not to inhale, but they still expose their throats and stomachs to all that smoke. Throat cancer sounds terrible.

Camel unfiltered is some sort of statistical anomaly. Hope for those genes.

> Camel unfiltered is some sort of statistical anomaly. Hope for those genes.

Never mind the addition of both of my parents alcohol abuse. My dad's mom lived to nearly 100. Lost one lung to cancer. It must be genes.

I've never smoked a day in my life (except all the 2nd hand growing up) and I'm on the generally more healthy side of life, I bet I die from some sort of cancer. ¯\_(ツ)_/¯

It's definitely in large part genetic. Similar to how some people get sick frequently and others don't - the immune system plays a large part in someone's risk for developing cancer but we've only started really internalizing that in medical research over the last decade or two.

Good friend of mine never smoked in his life, aside from cigars. Didn't inhale. One day he developed a cough, went to the doctor, diagnosed with throat cancer. Died about 9 months later, at 55 years old.

Some people are like George Burns. Some are definitely not.

A former colleague died of throat cancer. He was an avid tobacco chewer.

This is what I do not get. Is it the smoke that is bad or the tobacco? If it is the tobacco it must frigging be the most dangerous material on earth. What other plant kills you just from chewing it?

> What other plant kills you just from chewing it?

There's plenty. They're just not common in western cultures. Khat causes oral cancer, for example, but outside of Africa and parts of west Asia it's basically non-existent as a drug.

Chewing areca nuts wrapped in betel leaves can also cause cancer in the oral region, but is only commonly consumed in south-east Asia and largely unknown in the rest of the world.

And these are just examples of plants that are used recreationally/in cultural ritual - certain herbs and plenty of plants in general will kill you outright if you consume too much of them or eat/drink the wrong thing while doing so.

Both are bad. Tobacco is a poisonous plant which we consume because some of the effects of the poison are considered good. Inhaling smoke is also bad for you. There's a lot of plants which will have undesirable effects if you chew on their leaves, but in most cases they don't also have desirable effects so no one does it.

Heck, tea greatly increases your risk of oral, throat, and esophegal cancer just from the heat. Countries where tea is traditionally drank after being freshly brewed have a much higher incidence of these

Many toxic chemicals can increase your risk of cancer, and many plants contain toxic chemicals, often to stop animals chewing on them. Nicotine is a toxic chemical, but it could be others.

My understanding is that George Burns only brought the cigar in as a prop towards the tail end of his career.

My old man is over 70 now, lifelong smoker. One of his first jobs in his mid-teens was breaking up asbestos lining in steel moulds/pipes, and he sometimes tells me of the slew of now-banned chemicals his old man would use around the home, e.g. IIRC, some kind of pest detterent powder he would sprinkle handfuls of in the pantry, which was some variety of DDT. It's crazy to me that he's still going; I still expect a call some day, "well, turns out it's got me".

Yeah my mother has been smoking since Kennedy was president, and she's still going. I do think that even without cancer or emphysema, the quality of her life is poor. My wife plays sports with ladies older than my mom and it's a bummer to see mine unable to do much.

Agreed. While my dad is still alive, he has all the textbook ailments from being a lifelong smoker / drinker. His quality of life is shit. His legs are swollen red tree stumps, skin is splotchy and very thin/prone to bruising/bleeding, overweight, can't walk more than a few feet without getting winded, who knows what's internal, but he spent 6 months in the hospital with a mrsa infection. Brain function is also clearly diminished. I love him a lot, but there is no way that I want to end up anything like him.

Just looking at him, it was easy for me to stop drinking entirely. It is poison.

Throat cancer is no fun either. Also associated with smoking. Eventually you can't swallow and basically start starving to death.

We are, sadly,practically twins in this.

My mom died from lung cancer at 50. Horrible horrible way to go. My dad is 79 and (thankfully) going reasonably well. Bit started smoking in early early teens ;-(

My mum never really smoked. She died from cancer (a rather cruel, ladies only one to start with. A reprieve with all clear and then it re-appeared after 18 months, and went berserk) around 30 years ago.

My dad did smoke for around 30 years but just stopped in the mid eighties. He's still with us but at one point a few years back a surgeon gave him a heart massage - as in heart in hand - and he came back. Long story!

I am 53 as of Pearl Harbour day. I smoked for around 30 years (I've double checked all these 30 year timescales). I gave up April 2018. My personal message is that the effects of smoking can be rather insidious. You don't notice the shortness of breath for years until you realise it isn't normal. You might blame it on getting older or less active or whatever but it isn't.

I gave up when I had obvious trouble breathing in bed after yet another chest infection. Five and a half years later I am much better off but still have snags. I will be visiting a doc soon and expecting a diagnosis of a variety of COPD. I will also be asking for a PSA test sigh. I can run up hill a way etc but I run out of puff very quickly. Even if you avoid cancer itself, the other side effects are ... insidious.

On the bright side, I'm roughly £3-4000 per year better off, have a sense of smell and taste and still going 8)

Congrats to you for kicking a really nasty habit. Seriously. Best thing you could do to lessen the effects as you age.

Cheers mate. It was quite hard and I'm still not too sure how I managed it. My original plan was to hit the vape but my epiphany was:

If nicotine is the addictive substance then patches and vapes etc would work 100% guaranteed.

There is the "habit" thing that is also trotted out as a thing - nope, not for me. I had no problem being in a pub and having a few sherbets (alcohol/booze), nor did I find after dinner/supper an issue.

I am convinced that somewhere amongst all the other stuff in a burning fag, is what is really, really addictive. It isn't nicotine.

the vast majority (90%) of lifelong smokers never develop lung cancer.

This is an important point, and making it doesn't mean you condone smoking.

"A study in Preventive Medicine Report looked at the risk of smokers developing lung cancer. The researchers found that the average risk for nonsmokers over the study period was 1.8% for males and 1.3% for females. The risk jumped to 14.8% for males and 11.2% for females in current smokers. However, the study did not take into account the number of cigarettes each person smoked per day."

https://www.medicalnewstoday.com/articles/smoking-lung-cance...

It's higher than 10%, but still, doesn't happen to most smokers. That's why so many of the anecdotes in this thread... person X smoked and lived to 90, person Y smoked and died at 35... don't make a strong point, other than cancer is purely a game of odds, and smoking increases risk by 5-10 times. Still, it shouldn't be surprising if somebody smokes and doesn't get lung cancer. That's the most likely outcome.

Tangential, but if you haven't had your house tested for radon, I strongly recommend it. Radon is a radioactive decay product of uranium in rock and soil, naturally accumulates in houses, and is the second leading cause of lung cancer in the US after smoking.

I got a RadonEye meter to check the levels in my old place. It was around 4 pCi/l, which is apparently equivalent to smoking a pack a day in terms of relative cancer risk. After adding some ventilation, it dropped to lower than 1. Great.

The next place I moved into had a radon level of 14+ (!!) pCi/l. I couldn't believe the meter reading, so double-checked with another meter, which produced the same result. Got a radon mitigation system installed.

Seriously, check it out, especially if your place sits below grade or you live in a risk area. It could save your life.

Identical situation. In the hills of LA, bought a house, tested at 14+. Down below 2 most of the time after mitigation. Found out the hills of LA are one of the radon hotspots in California. I talked to many real estate agents, contractors, and neighbors and no one is aware of it, no one took me seriously, and generally no one wants to hear about it.

Definitely recommend. We were at around 14 (pCi/l) as well. Peaks up to 20. Got an active mitigation system installed last year for around $1k. Hasn’t exceeded 2 since.

Unforeseen benefit of no longer having to run my dehumidifier this summer. So it’ll end up paying for itself in electricity cost after maybe a decade hah.

Do you guys live in abandoned missile silos?!

It comes from the decay of naturally occurring uranium in the ground.

Thank you for posting this. Had never heard of such things.

This and the sibling comment boggle my mind. Around here, it seems like requesting a radon test is standard when looking at buying a house. Installing radon mitigation is likewise relatively straight forward.

Are basements less common out there? Maybe it's just because we tend to have basements that are made into livable space, where the risk of exposure is higher.

Ah, it's because I'm in Australia.

>Average radon levels in Australian homes are only a little larger than the radon levels in outside air and are of minimal concern to the health.

>The average concentration of radon in Australian homes is about 10 Bq m³. This is less than in many other countries and compares to a global average indoor value of 40 Bq m³.

I checked a Radon map and my area is only 5-10Bqm3.

Naturally, Americans do things the hard way and measure radon in pCi/L. According to Google,

> 1 pCi/L is equal to 37 Bq/m3

Our EPA recommends remediation if your home measures more than two, strongly so if it measures more than 4 pCi/L.

That 4 number is supposedly equivalent to smoking 8 cigarettes a day, in terms of cancer risk.

Here in the upper Midwest US, geology creating more radon buildup combined with cold winters mean that our basements are in a constant state of slightly negative air pressure, drawing it inside.

Not only can it enter through cracks in the concrete basement walls and floors, but many or most homes will have an opening in the floor somewhere for a sump pump to help move spring snow melt moisture away from the house.

Supposedly, between 1/3 and 2/5 homes in the US have or need radon remediation, and it supposedly is the second-leading cause of lung cancer here, after smoking tobacco.

It's very location dependent, some areas have low average levels.

https://www.epa.gov/sites/default/files/2018-12/documents/ra...

I'm vaguely aware that radon testing is one of the things you should do when buying a house, but it's never really come up as an actual problem for anyone I know. My indoor air sensor claims that my apartment averages 0.6 (pCi/l), so it's very far from being an issue.

Its extremely common, and usually part of the inspection when buying and selling a home.

The author is a PhD in CS from Berkeley and teaches data science at a (decent I think?) college. And yet, he writes completely incorrect statements about statistics. Why?

> "(1) that the supposed effect is really the cause, or in this case that incipient cancer, or a pre-cancerous condition with chronic inflammation, is a factor in inducing the smoking of cigarettes, or (2) that cigarette smoking and lung cancer, though not mutually causative, are both influenced by a common cause, in this case the individual genotype."

Of course, it's very possible that there's a common cause. For example, people who are very depressed may choose to smoke, and depression may also cause cancer. I'm not saying it does, I'm just saying it's clearly a possibility that needs experiments to disprove.

The author's claim is so wrong, and yet he seems to genuinely believe it.

It also seems unprofessional to call Sir Fisher an "ass", which is called an ad-hominem attack (attack on the person is obviously not a valid logical argument), and one of a dead person at that.

Fact is: Fisher made fundamental contributions and the poster himself uses these on a daily basis: "Student" [Gossett]'s t-distribution, Fisher's linear discriminant, a precursor of linear discriminant analysis, ANOVA, Fisher information, Fisher's scoring, Minimum Fisher information, the F-distribution, Fisher–Tippett–Gnedenko theorem, the Fisher-Yates shuffle algorithm, the von Mises–Fisher distribution, inverse probability, Fisher's permutation test Fisher's inequality, sufficiency of a statistic, and more. His contribution to biology are even more impactful.

It also happens that Fisher was a proponent of the "Frequentist" interpretation of probabilities, whereas the poster belongs to the recently more popular "Bayesian" camp of ideology (yes, ideology, if you think statistics as a part of mathematics is free from that, welcome to real life!).

He further held strong views about races, perhaps because he was a professor of eugenics (which we today know as incorrect unscientific nonsense, but obviously that was not the state at the time), and there is am ongoing controversy regarding whether he was a racist or not. What I read about him suggests to me I may not have liked him, but to just stamp him as "ass" wihtout elaborating is too cheap for a statistcs professional in my view. But then this is a personal blog, where the poster can write whatever he wants under US law.

> eugenics (which we today know as incorrect unscientific nonsense

How is it nonsense? I am not that knowledgeable on the topic but to me the biggest issue (outside of moral ones) is the decrease in genetic diversity. Is there anything else in particular you have "scientific" qualms with?

So to me it's not "nonsense" but rather "problematic, and moreso the further you take it".

Wouldn't we need, like, evidence or something to believe that possibility?

We have mountains of direct evidence with underlining theory for the straightforward explanation. Sometimes we need to believe that evidence.

No, you don't need evidence to prove that this is a possibility. You only need evidence to claim that this is impossible.

Slight change to the description:

"Sometimes interpreting data is easy. For example, one of the reasons we know that smoking causes lung cancer is that when only -6dB of the population smoked, +6dB of people with lung cancer were smokers. If you are a doctor who treats patients with lung cancer, it does not take long to notice numbers like that."

What was the change? +12dB or 10^1.2, which is 16x.

This ties into the odds form of Bayes' theorem given in the post; this representation of probability is

    dB(p) = 10*log10(p/(1-p))
    p(dB) = 10^(dB/10) / (1 + 10^(dB/10))

so roughly 0dB = 50%, 5dB = 75%, 10dB = 90%, 20dB = 99%, 30dB = 99.9%...

Didn't know that there was anyone arguing it doesn't, but... nice article.

Fisher, one of the great statisticians, argued that insufficient evidence existed to conclude with certainty that smoking causes cancer.

https://pubmed.ncbi.nlm.nih.gov/2000852/

After that, a number of well-designed experiments on rodents demonstrated that smoking causes (strong causation) cancer (in rodents) beyond a reasonable doubt (as in, if you disagree, you'd better bring some impeccable data).

Judea Pearl wrote a book, Causality, introducing Bayesian networks to address the inadequacy, even refusal, of Fisher's statistics to model causes and effects. Here's a lecture he gave almost 30 years ago [1] that's entertaining and accessible. He mentions the tobacco issue and Fisher specifically.

[1] http://bayes.cs.ucla.edu/BOOK-2K/causality2-epilogue.pdf

I think it was Pearl's Book of Why that went into far more detail about how it was decided that tobacco causes cancer from purely observational data. The technique was... relatively convoluted, and supposedly Fischer fought tooth and nail against Bayesian techniques required to adequately answer any such causal questions.

Thanks. I've never been able to understand the math behind Pearl but I appreciated the little diagram in the Fisher smoking section that clearly lays out causality of models diagrammatically.

Fisher was a smoker too right? Pretty sure his bosses played a part too

he was a consultant for the tobacco industry. I think he may have raised some legitimate questions of what constitutes "sufficient evidence" for making large-scale public health policy. But yes, I think his position mostly came from his biases.

Is this Fisher the one that proposed the "p<0.05" rule?

Yes... are you going to criticize him for that?

It's worth reading the whole backstory (start here: https://en.wikipedia.org/wiki/Ronald_Fisher)

A flawed genius

No, why should I criticize him for that? Btw, I just learned that he made the Iris dataset famous.

> No, why should I criticize him for that?

Because after that academia made it the gold standard of research in most disciplines, leading to what many describe as a "replication crisis" in social sciences.

But surely anyone criticizing him for that would have to prove they've already sufficiently criticized him for the whole eugenics thing.

you seem to adhere to the intellectual norms of the great leap forward rather than those of science or philosophy

in science nobody ever has to 'prove they've already sufficiently criticized' anyone or anything

they just provide evidence

enjoy your auto-da-fe but please do it somewhere else, only involving people who are into that kind of thing

I'm sorry you feel triggered in mentioning that the guy was a leader in the eugenics movement?

Many people criticize p=0.05, https://sites.uw.edu/stlab/2016/03/09/the-arbitrary-magic-of...

"...the pre-cancerous condition with chronic inflammation, is a factor in inducing the smoking of cigarettes,"

The author mocks this possibility, but the causes of chronic inflammation are not entirely understood, and it is linked with depression, cancer, obesity, stress, and a lot of other human conditions. We can't rule out that a stressed out person might want to smoke, be more likely to get addicted, and also have chronic inflammation which opens the door to the development of uncontrolled malignancies.

Still, don't smoke.

Note that vaping also causes DNA damage and cancer (and addiction).

https://www.pnas.org/doi/10.1073/pnas.1718185115

Smoking actually kills more people by causing heart disease than by causing cancer. But the risk isn't that much increased.

https://web.archive.org/web/20231212174055/https://www.allen...

"Finally, looking at that figure you might wonder why the relative risk of smoking has increased so much. Based on my first pass through the literature, it seems like no one knows. There are at least three possibilities:

- Over this period, cigarettes have been reformulated in ways that might make them more dangerous.

- As the prevalence of smoking has decreased, it’s possible that the number of casual smokers has decreased more quickly, leaving a higher percentage of heavy smokers.

- Or maybe the denominator of the ratio — the risk for non-smokers — has decreased."

My first thought was "second hand smoke". My logic is, when smoking was more normalized, non-smokers were exposed to some of the same risk as smokers due to smoking indoors, etc, resulting in higher rates of lung cancer among non-smokers.

I think the question of our time is does vaping cause cancer?

I’d put my money on yes, but at a far lower risk than smoking.

We'll find out.

I think it has to be said, correlation is not causation. While I believe that in this case it's almost certainly true, it's still not scientific to claim that it is indeed true until you can prove causation.

When you do the math, it turns out that 100% of people who confuse correlation with causation end up dead. Dangerous stuff.

The author addresses both of the possible reasons that correlation and causation could be unlinked here (reverse causality and common cause). Did you have a comment about them?

Also, alcohol causes cancer.

https://www.cancerresearchuk.org/about-cancer/causes-of-canc...

I always found the de-alcoholization of mouth wash a bit interesting. Seemed to happen a little after big tobacco lawsuits. Almost like they know something and worry about it.

As with coca-cola decreasing bottle sizes (before that was the cool thing to do). We went from 591mL to 500mL. And new smaller cans in addition to the 355mL cans (222mL). Huge promotions on Coke Zero. Decreased the sugar content in the regular product. https://www.cbc.ca/news/health/why-coke-is-lowering-its-suga...

There are some pushes to label it as a carcinogen similar to tobacco

Yup and nobody talks about it... or not nearly enough. It kills way more than cigarettes.

Stats seem to say 140K to alcohol and 480k to smoking. Keep in mind that this is with a MASSIVE push to reduce smoking if we party like its 1990 and project current deaths vs the death rate to smoking we had in 1990 we would be seeing over 800k today.

https://ourworldindata.org/grapher/death-rate-smoking?countr...

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal...

https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-to...

all clinical data clearly shows that alcohol kills way more than cigarettes. Alcohol drives the rates of most cancers that end up killing people.

Can you back that up a link to said clinical data?

Also food causes heart disease, and cancer.

"Alcohol" and "smoking" are pretty specific terms, in a way that "food" is not. The first two refer to IARC Group 1 carcinogens, specifically.

Could you show me the cancer rates of non-eaters?

It’s probably extremely low, since they don’t tend to live long enough to develop cancer.

I think it's extremely high, since many cancer treatments suppress appetite.

Ah, good point.

Almost zero, naturally Big Food suppresses these kinds of results though. /s

Ultra processed foods, which are a large part of many people’s diets, definitely cause cancer[0].

[0]https://pubmed.ncbi.nlm.nih.gov/37087831/

While not directly what we were talking about, this is also true. :/

Yeah my bad, it originally had a comment on the multiple jokes seeming to mock a valid claim, though I now get that those were mostly in response to the broadness of “food”.

Nah you still make a good point IMO, it’s very easy to fall into the trap of a false dichotomy between “eat as much as you want of whatever you want forever” vs. “never eating again because food is cancer”. The post I responded to did this and I unthinkingly followed their lead for more laughs. It was still funny but thinking more about it as well is always good.

I agree that alcohol increases cancer but can you find any statistics of the increase of each cancer vs. non-drinkers? Like “cancer X is 1% for non-drinkers and 3% for drinkers” but I can never find this.

It’s not all cancers it’s specific cancers. Cancers aren’t monolithic: each type has different characteristics and risk factors, aka “Cancer is cancers not just a cancer.”

> Drinking about 3.5 drinks a day doubles or even triples your risk of developing cancer of the mouth, pharynx, larynx and esophagus. Drinking about 3.5 drinks a day increases your risk of developing colorectal cancer and breast cancer by 1.5 times. The less alcohol you drink, the lower your cancer risk.

https://cancer.ca/en/cancer-information/reduce-your-risk/lim....

> Nearly 4% of cancers diagnosed worldwide in 2020 can be attributed to alcohol consumption, according to the World Health Organization. In the United States alone, about 75,000 cancer cases and 19,000 cancer deaths are estimated to be linked to alcohol each year.

https://www.cancer.gov/news-events/cancer-currents-blog/2023....

Most of the research is linked to specific types of cancers and alchohol: oropharynx, larynx, esophagus, liver, colon, rectum and breast cancer. Others, like skin cancers, pancreatic and prostate are in the “probably” category.

One of the reasons for cancers in the oral & oropharynx region could be local acetaldehyde production after drinking: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383267/

Potentially that could be mitigated by acetaldehyde decomposing supplements, like Kislip or Acetium lozenges - supposedly they reduce ACH by up to 90%.

That’s extremely interesting I had no idea! Thank you.

ZBiotics produces a probiotic that is a genetically modified bacteria that breaks down acetaldehyde. My wife is a biochemist and she says the science isn't totally bullshit. The reviews of it are mixed, but personally I have found it to be quite effective at reducing hangovers.

https://zbiotics.com/

19000 cancer death linked to alkohol means your chances to be killed in road accident in US is x2 higher than to die from that type of cancer.

Yes, road safety is a serious health problem.

But if it's twice as hard to mitigate, that implies we should spend some effort on reducing alcohol deaths too.

Actually it is easy to mitigate if you have political will.

Vision zero is a common approach which is working in EU.

Or laws could be appended with requirements to install extra technical measures to the cars to prevent driving under influence and speeding.

It is unclear for me why there is no hard speed limit installed into the cars, like 140km/h.

Is that more a commentary on what a meat grinder driving actually is rather than an argument against working to mitigate cancer risk?

The point is that it is unlikely someone will get alcohol related cancer.

My anecdata is that people who has alcohol addiction are dying earlier, but not from cancer. Main causes of deaths are liver failures and drunk accidents(like freezing to death in winter or DUI).

Well that’s certainly true. I’ve seen quite a few people mess their lives up or take an early check out because of the sauce in my time.

But my understanding was that it has been difficult to directly link cancer and alcohol consumption causatively and it’s only been recent genetic research that’s opening up just how many cases are actually related.

This study made the number go from 750k to more than 3 million globally, and as research improves I imagine that number will continue to grow.

So, perhaps we shouldn’t so readily discount the link on the basis of its number of cases since we are only starting to have the science we need and the studies based on that science to create effective studies that aren’t based on correlative evidence.

https://www.ndph.ox.ac.uk/news/new-genetic-study-confirms-th...

19,000 is nothing! I thought the risk would be significantly higher.

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