ONE FEELS BETTER TEMPERED:

An Investigation Into
The Beneficial Effects Of Smoking


“As the blue smoke curls upward the eye involuntarily follows it;” said Bismark, “the effect is soothing, one feels better tempered.” [1]

The use of the “peace pipe” amongst the American Indians perhaps can be seen as evidence of the psychological truth of this. Consider too the wartime conferences, with cigar-smoking Churchill, Roosevelt with his long, elegant cigarette holder, and Stalin with his pipe, massed against the fanatically anti-smoking Hitler, perhaps the first of the “smoke-finders general” of this century.

Other evidence may perhaps be found in the often extraordinarily bad-tempered remarks of the smoke-finders of the anti-smoking industry. For instance, at the World Health Organization conference in Winnipeg in July 1983, a Minnesota legislator, complaining that her state’s smoking restriction law was too weak, said that smoking should only be permitted among consenting adults in private, thus making it comparable with sodomy. [2]

At another WHO conference, in which a Mr Mahler used such terms as “socially embarrassing” and “socially abnormal” about smoking, there was also what was described as a “Brunhilde act” by a Dr As: The war against smoking is a territorial war. More and more places had been conquered from the smokers and had been given back to people who cared for their own and [somewhat as an afterthought, it seems] others’ well-being.

There was also an unclear and indefinably sinister remark about the “outer-space” of social life being regulated [my emphasis] by other people than the single smoker... [3]

At another WHO conference, in Australia in 1990, smoke-finder Stanton Glantz, who runs cigarette-quitting seminars and develops anti-smoking regulations for profit, had this to say: “The main thing the science has done on the issue of ETS, in addition to help people like me to pay mortgages, is it has legitimized the concerns that people have that they don’t like cigarette smoke [his grammar, not mine]. And that is a strong emotional force that needs to be harnessed and used. We’re on a roll, and the bastards are on the run.” [4]

And so on. We can all think of examples. The blue smoke is plainly not curling upwards. But does this matter? A great many people are earning their living in the anti-smoking industry, and smokers are finding that being “socially abnormal” in the “outer-space” can be quite enjoyable, and a good excuse for getting away from bores.

With the frightful example of the prohibition of alcohol in the USA, surely the anti-smoking industry would not contemplate a total ban on smoking, although hints of this have been uttered on some of the wilder shores.

Apart from the certainty that a ban would bring an enormous smuggling trade into the hands of an unpleasant criminal underground, and an increase in the habit, as the ban on alcohol did in the USA, it would put the anti-smoking industry out of work.

Raising The Devil

So I think we can dismiss the possibility. Why don’t we then, merely, shrug our shoulders, light up, and watch the blue smoke?

Is there, in fact, anything to be said in favour of smoking, apart from the fact that it is enjoyable, and if it does any harm that’s our own business? (The much debated question of passive smoking is best left until someone comes up with some definite proof that it has ever harmed anyone).

This is a very difficult subject. Anyone who tries to point out that the evidence is not wholly on one side will be castigated, socially stigmatized (this is one of the boasts of the anti-smokers), and accused of a number of surprising sins. As the witch-finders of medieval times blamed every conceivable crime and vileness on their victims, so the smoke-finders of today pour abuse on anyone who produces any evidence that does not back their claims.

An example of this is the obloquy heaped upon Sir Ronald Fisher, the great geneticist, for pointing out certain inconsistencies in the smoking-lung-cancer debate. [5]

He was called racist, and (probably worse in some people’s eyes), a “political conservative”. Every scrap of gossip about rows with his colleagues was brought up against him. Finally he was accused of taking a fee from the tobacco industry: the modern equivalent of the medieval witch-finders’ accusation of consorting with the devil.

The Biphasic Effect

So, with great care, let us look at the evidence.

A review prepared by the Smoking and Health Subcommittee of the Tobacco Industries Council, which was formed by the Japanese Minister of Finance, states unequivocally what we all knew: that a smoke both bucks you up and calms you down. (“Nicotine has a biphasic effect of stimulating or sedating”). [6]

(Incidentally, the Japanese are among the heaviest smokers in the world, and have the world’s highest expectation of life, and one of the world’s lowest lung cancer rates). [7]

Nicotine is said to be the only substance in the world that has this biphasic effect. [8] Smoking is an aid to concentration. [9] Again this is something that all smokers know, and is a not unimportant reason for continuing.

In 1983 a study of the reasons why college students in the US started to smoke and continued to do so was published. [10] In this it is interesting to see that although this function of smoking, or others that were similar, was not mentioned among the reasons why the students started to smoke, yet after they had done so, and were giving their reasons for continuing smoking, these included “it facilitates thinking”, “it is stimulating”, and “relaxes me when I’m upset or nervous”, which are all related to the ability to concentrate.

There has been a study devoted to this subject: Smoking, Nicotine, and Human Performance, which concluded that smoking can indeed aid concentration. [11]

A Ritual

Smoking is a ritual, says Feinhandler: “that welcomes strangers, provides companionship in solitude, fills ‘empty time’, marks the significance of certain kinds of occasions and expresses individual identity and personal style”. [12]

It is not, I think, too far-fetched to remark that there are people who dislike other people’s individual identity and personal style. It could be because of this dislike, and his desire to weld ‘the people’ into an uniform mass, that Hitler was so fanatically opposed to smoking. [13]

Feinhandler points out that tobacco is used today “in Pacific Island courtship rituals; in African councils, clan gatherings and marriage negotiations; in North and South American Indian divination and healing ceremonies; to seal bargains in Asia; and for hospitality in the Middle East.” [14]

It is all the more extraordinary when one realizes that much of this has come about within the last five hundred years, since tobacco was introduced into other parts of the world from the Americas.

Of course, other products have spread almost as rapidly (tea, coffee and chocolate are other examples), but tobacco seems to be the only one that has been elevated, in so many different parts of the world, to a special status, almost, it might be said, one that is semi-divine.

Saint Tobacco

And of course there are a lot of people who bristle at the slightest hint of reverence for the divine, in whatever form it may express itself. We may think it is very simple to do it with tobacco smoke, but is our conscience quite clear about incense? 

James I, one of the least pleasant of British kings, described by the Farjeons as: “ugly, greedy, gross, and vain”, [15] and still more unforgettably by Rudyard Kipling as: “a shifty mother’s shiftless son”, [16] was the first notability in these islands to sound off against tobacco: “A custome lothsome to to the eye, hateful to the Nose, harmefull to the braine, dangerous to the Lungs ...” [17]

They Were All Quite Wrong, Of Course

In fact, most of the modern accusations merely recap James’ polemic. In this context, it is interesting to note that James’ violent loathing has been put down to his personal hatred for that much greater man, Sir Walter Raleigh, who was credited with having introduced tobacco into Britain. [18]

The smoker was grievously harassed in Russia at the same time, being liable to have his lips slit, to have a sometimes deadly flogging, to be castrated, or sent to Siberia. In Zurich, they could be beaten, or branded, or exiled. But the worst punishments were to be found in the Ottoman Empire, where the Sultan Murad had the distinction of having, by the time of his death at the age of 29, put to death 100,000 of his subjects, many for the crime of smoking. [19]

Yet at the same time, physicians in many parts of Europe were impressed by the value that the American Indians put on their tobacco as a cure for various diseases: they took it as a cure for toothache, frostbite, venereal ulceration, tumours, and many other troubles. We know better. Every generation in turn does. Whatever the previous generations believed is wrong. This is useful, because it bolsters up our sometimes faltering belief in Progress. But there is certain evidence coming through, slowly and with evidence of reluctance on the part of its proponents, to show that our ancestors may not have been quite as wrong as all that.

European physicians followed suit, and soon were using it widely in the treatment of many diseases. Dr Johannes Vittich claimed that: “Tobacco can cleanse all impurities and disperse every gross and viscous humour, as we find by daily experience. It cures cancer of the breast, open and eating sores....” and so on. [20] First of all, there is the undoubted positive effect on any illness of a positive state of mind. It may not be as striking as suggested by a remark made by a general practitioner to me (he was drunk at the time): “My cheerful patients don’t die!”, but anyone with experience of severe illness knows that there is something in it.

It was considered that it prevented bubonic plague. Pepys describes his use of tobacco in the Great Plague of London [21], and there is a moving account of how Dr Isbrand van Diemerbroek, during an outbreak of plague in Nimuegen, devoted himself to his patients in a way that he himself was sure was only made possible by his smoking. [22]

The Chinese, with a vast culture that was still technically in some ways in advance of the West, took to tobacco readily, and besides smoking it, used it in the treatment of colds and skin diseases, malaria, skin parasites and obesity, and as a remedy against circulatory problems. [23]

At the other end of the cultural scale, the Hottentots used it against scorpion bites. [24] The boys of Eton College had to smoke a pipe every morning for the sake of their health. [25] In 1901 tobacco was still being suggested as treatment for respiratory disorders. [26] As late as the 1940s asthmatic patients were advised to smoke, and there were special asthma cigarettes. [27]

Eysenck

And curiously it has been given powerful support by one of the greatest of modern psychologists, Professor Dr. H.J. Eysenck. In his SMOKING, PERSONALITY, AND STRESS, Professor Eysenck gives detailed accounts of the effects of psychological treatment in cancer. Patients with lung cancer, breast cancer, and other unpleasant cancers have had their remaining life-span doubled when they have received psychological therapy. [28] A positive approach to the disease is seen as important by 80% of American oncologists. [29] And so on and so forth. We all know of examples.

Smoking is a pleasure. It reduces stress (“the biphasic effect”). For the patient who has few or no other pleasures, it may well contribute to his or her well-being, and thus to health. No-one with the slightest experience of disease in themselves or others can doubt the truth of this. The Greek writings attributed to Hippocrates, which go back to the fourth century BC, recognize it. [30]

Good Smoking?

As the expectation of life rises steadily in the “developed” countries, senility, or Alzheimer’s Disease, becomes an ever-increasing problem. We all know families that have been devastated by this truly terrible affliction. A report in the Daily Telegraph of the 7th March 1989 observed that of the 1,000 beds at the Royal Edinburgh Hospital, 600 are occupied by sufferers from Alzheimers, which gives some idea of the ravages of this disease. And the numbers will grow as the population continues to live ever longer.

There is now evidence to show that smoking protects against this disease. [31] It can, I think, be taken more seriously than much of this kind of evidence, because it is so unfashionable to claim that smoking is anything other than the work of the devil, or whoever the modern substitute may be. The authors of the above-mentioned report are careful to say: “Although the association is compatible with a protective effect of smoking for familial Alzheimer’s disease, it has no relevance for prevention of Alzheimer’s disease because of the adverse health effects of smoking.”

That is, because the smoker has an admittedly remote chance of getting lung cancer (though it is worth while pointing out again that much of the evidence on this is dubious [32]), or bronchitis (dubious again) [33], or heart disease (though much of the evidence on this, especially that of the Framingham study [34] flatly contradicts the idea of a link), then he should not take the only precaution that has been suggested against a very common disease that in the lengthy suffering it causes to everyone concerned is more terrible than any of those mentioned above.

There has also been a favourable link found between Parkinson’s disease and smoking. [35] This is another terrible and destructive disease, which can torture patients and their families for decades.

There is evidence to show that smokers have a better chance than non-smokers when it comes to certain other diseases. There is what is known as a “risk ratio” for all the factors connected with the chances of getting a disease. A risk ratio of 1.0 means there is no correlation, more than 1.1 means there is a relationship, and the number increases as the likelihood of the relationship rises.

But it can also be reduced. A risk ratio of 0.99 means there is less chance. The risk ratios in certain diseases are as follows:

Cancer of the rectum in women: .90
Cancer of the colon in women smokers: .78
ditto in heavy smokers: .66

The risk ratio in Parkinson’s disease is a very low .26, and there is also a reduced risk with diabetes and trigeminal neuralgia, both extremely unpleasant complaints, and, in the case of diabetes, often leading to many years of suffering from a number of related conditions, such as blindness. [36]

It should be repeated that because of the current anti-smoking hysteria, it is very difficult indeed for anyone to say anything about this, and therefore such results as do get published deserve to be given careful attention.

Was This What They Meant?

But there is a truly extraordinary fact about smoking that comes out in certain of the studies that are most bitterly opposed to the custom. It is necessary to point out that two of these studies have been crushingly attacked by other researchers, for all sorts of faults, some rather extraordinary.

To quote Dr Tage Voss on the subject of Hirayama’s study [37], which is the chief evidence that is put forward by the anti-smoking industry on passive smoking, Dr Hirayama himself turning up at WHO conferences and being effusively praised by other smoke-finders [38]: When fifty scientists and physicians gathered for a meeting in Vienna in 1984 to discuss the evidence that passive smoking may cause lung cancer, everybody - with one exception - agreed that no proof existed of any connection. The exception was Dr Takesi Hirayama.

“At boring scientific conferences a favourite way of cheering up the audience was to submit a new critique of of the Hirayama study, as Ahlborn and Ueberla did in London in 1988. To everybody’s vast amusement, they showed that even if one accepted all the errors and uncertainties of Hirayama’s data, and overlooked all the biases, a correct statistical treatment of the material could lead to the opposite conclusion.” [39]

There is also the Trichopolous study, of which Voss remarks:

“...it is not taken seriously - and Trichopolous himself has reservations about it, if for no other reason than the material is too small for any conclusion to be drawn.” [40]

In the same year that Hirayama’s ridiculous study was published, Garfinkel of the American Cancer Society published the results of a study of 180,000 American women, in which he found that there was no statistically significant difference in the lung cancer rate between women married to smokers and those to non-smokers. [41]

As far as I know this report has never been criticized; it is merely never referred to. Hirayama turns up again and again, Garfinkel is apparently forgotten.

It is worthwhile noting, by the way, that in November 1988 a major WHO review of reports published up to then on passive smoking (there were more than 1,000 of them), concluded that there were not enough to prove any connection between passive smoking and lung cancer. [42]

But there was one extraordinary result of the Hirayama and Trichopolous studies, and also a study by Humble et al. in New Mexico. [43] These showed that wives of smokers who did not or never had smoked themselves had a higher rate of lung cancer than wives of smokers who were smokers or ex-smokers themselves.  

Smoking Protects Against Lung Cancer

Burch analysed a similar situation on all cancers and showed that there are three possible explanations for such a result:

1. Active and passive smoking are both carcinogenic;
2. Active smoking causes cancer and passive smoking prevents cancer;
3. Active smoking prevents cancer and passive smoking causes cancer. [44]

The logic is impeccable. Take your choice.

And Other Cancers?

On this there is some remarkable evidence:

There has only been one study that tested smoking specifically: the Whitehall study in 1968. It is very odd, if you come to think of it, that when there have been 1,000 studies on passive smoking, there has only been one on direct smoking. Perhaps the result may give the answer...

Briefly, 1,445 British civil servants took part. Half were encouraged to give up smoking, the other half not.

At the end of a year smoking in the intervention group (those encouraged to give up smoking) was down by 75%: a percentage, it might be thought, that should result in some significant difference or other in the two groups.

Yet after ten years 17.2% of the intervention group was dead, against 17.5% of the smoking group. The difference is statistically insignificant. The death rate was virtually the same. There was no difference in the rate of deaths from lung cancer or heart disease: the only other unexpected result was that the low smokers had 28 deaths from cancer other than lung cancer, which should be compared with the 12 deaths in the smoking group from such cancers. [45]

28 against 12 is not statistically insignificant.

This result has been compared with that from the MRFIT trial (Multiple Risk Factor Intervention Trial) in the US. In this trial half of the 12,866 men tested were encouraged to give up smoking, cut down on cholesterol and saturated fats, and take drugs for their blood pressure. After seven years deaths were 41.2 per thousand in the intervention group and 40.4 per thousand in the other. [46] As Burch put it in a letter to the British Medical Journal: “because of the similarity in the designs of the two trials their results can be combined to maximize numbers.” In the low smoking intervention groups 56 cases of lung cancer were recorded in a total starting population of 7,142 men (0.78%); the corresponding numbers for the more heavily smoking normal care groups being 53 in 7,169 (0.74%).

[In fact, there was no evidence at all that smoking had any influence on lung cancer: if anything, there seemed a very slight percentage (0.04%) in favour of the smoker].

BUT, findings for cancer other than in the lungs were as follows:

“some 88 cases (1.23%) were recorded in the low smoking intervention groups, but only 60 cases (0.84%) in the normal groups. Thus in the category ‘all cancers’ there were 144 cases (2.02%) in the intervention groups but 113 cases (1.58%) in the more heavily smoking normal care groups. Reduced levels of smoking were associated with increases in cancer incidence”.

“It is fair to ask” he concludes “...experts...to explain why these remarkable findings from methodologically reputable trials [methodologically reputable as opposed to Hirayama and such disreputables] conflict so drastically with their claims.” [46]

“Strenuous efforts have been made to rescue something from the wreckage, though Stallones risked the creation of many personal enemies when he wrote: ‘No amount of squirming on the hook alters the fact that for every 1,000 test subjects 41.2 died and for every 1,000 control subjects 40.4 died.’” [47]

Or that there were 144 deaths from all types of cancer in the test groups and only 113 in the control groups. Perhaps it is not so surprising that these tests have not been repeated recently; indeed, there has never been another test concerned specifically with smoking. Of course no-one would make wild claims about smoking being a prophylactic against cancer, though the anti-smoking industry has made much wilder claims on much less clear-cut evidence: the answer is obviously in the findings of Eysenck and others: tense, wrought-up people are more liable to go under to any disease around, and smokers are less tense and wrought-up. The effect, in fact is soothing (and bad temper can kill), and smoking does have a ‘biphasic effect’ of stimulating and sedating, as “the blue smoke curls upwards...”


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