Congress and the Civil War Over Marijuana

Two lawmakers take a stab at ending federal prohibition of pot.

Two new bills designed to end federal marijuana prohibition and let states set their own policies were introduced today in the U.S. Congress by Rep. Earl Blumenauer (Dem-OR) and Rep. Jared Polis (D-CO). Legislation introduced by Rep. Polis would formally end federal prohibition of pot, while establishing a state regulatory permitting process similar to frameworks used to regulate alcohol. Rep. Blumenauer’s bill would set up mechanisms for taxing marijuana at the federal level.

While President Obama has said that his administration has “bigger fish to fry” when asked about state marijuana crackdowns, the two U.S. congressmen contend that “too many United States Attorneys and drug enforcement personnel are still ‘frying those little fish.’ Only Congress has the power to unravel this mess.”

Rep. Polis’ legislation would also remove marijuana oversight from the Drug Enforcement Administration (DEA), and hand it over to a newly repositioned Bureau of Alcohol, Tobacco, Marijuana, and Firearms. Under the Polis bill, it would remain unlawful to move marijuana from states where it is legal to states where it is not. Meanwhile, Blumenauer’s piece of legislation would give the feds a healthy chunk of income in the form of a 50% excise tax on “first sales” between a grower and a processor/retailer, in addition to possible state sales taxes on a per ounce basis.

The congressional representatives also released a report in which they note that after “decades of failed policies and tremors of varying intensity, the tectonic plates of marijuana regulation abruptly shifted November 2012 as the citizens of Washington and Colorado voted to legalize the drug for personal, recreational use…. These developments have played out against a backdrop of the least effective, and arguably, most questionable front in America’s ‘War on Drugs.’”

Despite recent efforts to reclassify marijuana, pot remains a Schedule I Controlled Substance, along with heroin and LSD, meaning it is considered a drug with high abuse potential and no accepted medical applications. The report notes that more than 660,000 Americans were arrested for marijuana possession in 2011, despite the rapid adoption of medical marijuana laws in 18 states. “This situation has created a gray area,” the report notes, “where medical marijuana enterprises are operating in a patchwork of conflicting state, local, and federal regulations. Common sense suggests that these enterprises have the potential for abuse and other criminal activity.”

Using figures from the 2010 U.S. census, the report contends that more than 100 million people now live in jurisdictions where some aspect of marijuana use is now legally permitted under state regulations. The result? “Confusion, uncertainty, and conflicting government action.”

The congressmen conclude by warning that “no one should minimize the potential harmful effects of marijuana,” and challenged legislators, in their efforts to protect the health and safety of Americans, to “acknowledge when existing mechanisms don’t work, go too far, or cause more harm than good.”

Neither of the bills is likely to pass, although Senator Patrick Leahy (D-VT), who chairs the Senate Judiciary Committee, has said that he plans to hold a hearing on conflicting state and federal pot laws. The Justice Department remains mum on its strategy for dealing with state marijuana rebellions. Former White House drug policy advisor Kevin Sabet, a member of Project SAM, for “smart approaches to marijuana,” told Associated Press that he considered the bills to be “really extreme solutions to the marijuana problem we have in this country. The marijuana problem we have is a problem of addiction among kids, and stigma of people who have a criminal record for marijuana crimes. There are a lot more people in Congress who think that marijuana should be illegal but treated as a public health problem, than think it should be legal.”

Science On the Web and In the Flesh

Thoughts on the ScienceOnline2013 conference.

As a blogger, I write about the science-based investigation of drugs and addiction—but I am not a scientist. Far from it. My educational background is in the Liberal Arts and the Humanities, with a degree in journalism and mass communications. I cover science, and I talk to scientists, but I don’t DO science. And in fact, there is often an adversarial relationship between a journalist and the people a journalist writes about.

A remarkable conference held annually in the Raleigh-Durham Research Triangle, hosted by North Carolina State, attempts to do something about this divide by throwing together 450 bloggers, journalists, editors, scientists, science teachers, public information officers, and science artists—plus a smattering of entrepreneurs, web developers, government workers, librarians, literary agents, and all-around gadflies. A few years ago, a troika of innovative thinkers in the Raleigh area—Boris Zivkovic, Anton Zuiker, and Karyn Traphagen—put together what became the annual ScienceOnline conference. They realized that science writers and scientists were on the same team, and that their mutual business was the effective communication of scientific and evidence-based knowledge. It may sound obvious, but in actual practice, it isn’t.

However, the rise of online science communication means that everybody is talking to everybody else all the time, and that the divide separating the writer from the scientist is permeable under the right conditions. The “Unconference,” as ScienceOnline quickly became known, features a collaborative style of creating and moderating panel sessions—sessions in which, wonder of wonders, the audience is expected to participate as much as the panel moderators. Some panels become more like casual group bullshit sessions than formal laser-pointer presentations by a moderator doing a monologue. (Not that some moderators don’t lapse into monologues, but usually those offenders are professors, so we must forgive them.)

I hate conferences, and generally avoid them. But ScienceOnline caught my interest due to the way it invokes a variety of subtle structures and cues to bring a relaxed, improvisatory, conversational tone to the 4-day event. To begin with, attendance is held to 450 people, who apply on a first-come, first-served basis. Despite pressure to expand as the popularity of the conference has grown, the organizers have chosen instead to encourage Watch Parties in cities around the world. In addition, a constant stream of conference information courses through online social media for months before and after the actual event. Rather than leading to a feeling of exclusivity, this approach puts everyone on an equal footing, scrambling like rock fans trying to score a ticket to a good show before they sell out.

Upon arrival, you find that your standard conference badge has your name on it—but no job title, institutional affiliation, or any other outright clue to whatever the hell it is that you do for a living. In place of that is your Twitter handle, since this conference pulls heavily from a group that is already well entrenched online. Some people know each other; some people are there for the first time, like any conference. Without the obvious indications of rank and hierarchy of employment, people will be much more willing to approach people they don’t know for conversation, is the idea. It is one of the ways that the producers of the conference attempt to move the emphasis from speakers on the stage to conversations between people in the conference café, the lobby, the lounge, the bars... Like atoms banging against each other as the heat rises, attendees trade thoughts, hatch projects, land freelance assignments, and hear from other people about the one thing everyone has in common: the business of communicating the work of science to the world at large—a task that can only become more crucial with time.

The same ethos applies to the sundry sessions and panels that make up the conference. Moderators, who have cooked up the topics and ideas for the panels in group wiki sessions during the previous year, are expected to make some prefatory remarks and then starting fielding questions in order to get a sense of where the audience wants to take the subject. Of particular interest to me this year were sessions about how to be appropriately skeptical when covering scientific and medical studies, how to blog for the long haul, how to navigate the perils and pleasures of explanatory journalism, and how to use history to relate current events in science.

In the end, the conference does what it is intended to do: Provide a comfortable, optimistic environment in which a pack of nerd scientists, rogue journalists, extreme introverts, and knowledge-hungry students can shoot the shit with each other without the distractions of poster sessions and prepared presentations. That may sound like it’s a lot easier to do than it really is. Such conferences are rare indeed, and ScienceOnline2013 is a rare example of the successful blending of conference, convention, and think tank retreat. Plus it’s the only conference I’ve ever gone to where the free goodies turn out to be books. A literal stack of them. Like cocaine to a herd of hyper-literate scientists and professional writers. The registrations costs are absurdly low, the shuttle buses incredibly efficient, the wifi access unbeatable. Early figures indicate a level of coffee consumption somewhere in the neighborhood of 15 gallons per hour. And did I mention the food?

For more on the conference, go to ScienceOnline Information Central HERE.

Novartis Gives Up On Nicotine Vaccine

Another one bites the dust.

Novartis, a leading health care products company, called it quits on its NIC002 nicotine vaccine project, which failed badly three years ago in Phase II studies undertaken with an eye toward government approval. Novartis said it would terminate the license it has for the NIC002 vaccine with Cytos Biotechnology, for which it paid $38 million in 2007. The Phase II study “showed formation of nicotine-specific antibodies in patients but did not meet its primary endpoint of increased smoking cessation,” according to Genetic Engineering and Biotechnology News

Much the same arc was followed by Nabi Biopharmaceuticals, which announced in 2011 that its vaccine, NicVax, had failed to outdo placebos in Phase III clinical trials—the only addiction vaccine to advance that far in the approval process. The company’s own studies had shown happier results in 2007. In regulatory filings, the company claimed that the NicVax vaccine triggered a reliable antibody response, thus preventing nicotine molecules from reaching the brain. The antibodies bind with the nicotine molecules, making nicotine too large to cross the exceedingly fine blood-brain barrier of the brain. Roughly 15 per cent of smokers who received injections of NicVax were nicotine-free after one year in company-funded studies. For comparison, early studies of Chantix as an anti-smoking medication show a quit response rate in the range of 20 per cent for heavy smokers.

As I have previously written, the idea of vaccinating for addictions is not new. If you want the body to recognize a nicotine molecule as a foe rather than a friend, one strategy is to attach nicotine molecules to a foreign body--commonly a protein that the body ordinarily rejects--in order to switch on the body’s immune responses against the invader. A strong advantage to this approach, say researchers, is that the vaccinated compound does not enter the brain and therefore is free of neurological side effects.

There remain a wealth of questions related to the effects of long-lasting antibodies. And it is sometimes possible to “swamp” the vaccine by ingesting four or five times as much cocaine or nicotine as usual.

Drugs that substantially reduce a smoker’s craving for nicotine, like Chantix, may yet prove to be a more fruitful avenue of investigation. While several anti-craving medications have been approved for use by the Food and Drug Administration (FDA), no vaccines have made it onto the approved list. However, as the Genetic Engineering article reminds us, “all is not lost for the vaccine yet: in November of 2010, Duke University, in collaboration with Wake Forest University, commenced a Phase II clinical study with NIC002 performed with 65 smokers that aims to assess how nicotine antibodies, induced by vaccination, affect the pharmacokinetics of nicotine during cigarette smoking. The study is being conducted in the United States with funding from the NIH.”

Photo: Creative Commons / juliealicea1947

Big Tobacco Makes a Move Into E-Cigarettes

“A battery-operated, addiction-based market.”

While the FDA dithered, and health advocates argued, Big Tobacco began placing its bets on the e-cigarette market last year. Tobacco firm Lorillard Inc., the third largest tobacco company in America, bought privately held Blue Ecigs of Charlotte, N.C., for $135 million, driven by what the company says is a market that’s been doubling ever year since e-cigs first arrived from China in 2008.

According to the Wall Street Journal, Blue Ecigs had $30 million in revenues last year, selling through retail outlets like Walgreens, where it competes with e-brands such as NJOY and 21s Century. The FDA has announced vague plans to regulate, and state lawmakers have threatened to ban them outright, or at least place them under the same public smoking bans as cigarettes—bans that some e-smokers love to flout. (E-cigarette manufacturers, based primarily in Asia, quickly changed the electric orange glow at the end of the e-cigarette to a cool shade of blue, to help make clear to bartenders and bouncers that the thing wasn’t a lit cigarette.)

Meanwhile, Reynolds, an industry leader in smokeless products, is developing its own line of e-cigs, and is test-marketing its Vuse and Zonnic brands. “We will be in this category in 2013,” an RJ Reynolds representative said in a CNBC article by Jane Wells. “We have very big plans.”

Altria, the industry giant, is now generating $1.6 billion from smokeless tobacco products, and is expected to make a move into what is viewed as a billion-dollar industry with unlimited growth potential. Last year, the company began testing a new “nicotine-extract product” called Verve, a lozenge that can be sucked or chewed and contains about 1.5 milligrams of nicotine. Late last year, the company reportedly engaged in acquisition talks with e-cig maker Eonsmoke.

Meanwhile, the company that invented the electronic cigarette, Dragonite/Ruyan, is suing practically everybody. And the Argentinean and Venezuelan governments have attempted to ban the use and marketing of electronic cigarettes altogether.

In December, astute American TV viewers may have noticed what looked for all the world like a television commercial for cigarettes—the first since 1971, when Congress banned cigarette ads on TV. It was a commercial for NJOY Kings electronic cigarettes, a brand that currently owns about one-third of the U.S. e-cig market. Patent lawyer Mark Weiss, who founded NJOY, told Time that the company was only competing for the 45 million Americans who are current smokers, not attempting to make new recruits. In the article, Weiss noted three advantages for e-cigarettes: They’re odor free, they don’t burn tobacco, and, at about $8 per e-cigarette, Weiss claims, they’ll last you as long as two regular packs of cigarettes.

When major tobacco companies make moves like this, people notice. “I think they see this as an opportunity to get a seat at the table with opportunities to talk to the FDA about regulation over this growing category,” according to Bonnie Herzog, senior analyst and managing director of tobacco, beverage and consumer research for Wells Fargo Securities. “Lorillard wants to help steer that conversation in the right direction.”

While still a relatively modest market—no more than $500 million, compared to the $100 billion tobacco market in the U.S.—electronic cigarettes have the potential of becoming the most contentious entry in the market for nicotine delivery systems since the advent of the machine-rolled cigarette. “We think e-cigs are to tobacco what energy drinks are to beverages,” Herzog told the media.

Lorillard chairman and CEO Murray Kessler said in an earnings conference call late last year that with e-cigarettes, “you get all of the benefits of not having combustion, but on the other hand you are maintaining the behavior that cigarette smokers enjoyed.” That’s one way of putting it. And according to critics, that’s part of the problem. Anti-smoking activists often view e-cigarettes as gateway products for young adults.

They are cheaper, primarily because of heavy taxes on traditional cigarettes, and produce no second-hand smoke, only steam-like vapor that quickly dissipates. But they have had a rocky start in the U.S. An article in the Winston-Salem Journal in prime tobacco country stated that consumers have “shied away out of safety concerns since most e-cigs are made in China.” Even North Carolina health officials have expressed concerns about “limited regulatory oversight of their contents.” But according to Wells Fargo’s Herzog, Lorillard’s purchase of Blu Ecigs had the effect of “lending credibility and legitimacy to the entire category.”

Brad Rodu, professor of medicine at the University of Louisville, insisted that “tobacco manufacturers have an obligation to smokers to develop, manufacture and sell these vastly safer cigarette substitutes.” In this view, smokers smoke for the nicotine, but it’s the tar that kills them. 

In the same Winston-Salem Journal article, a professor of family and community medicine at Wake Forest School of Medicine said that “many of the carcinogens in tobacco are volatile and would vaporize, and thus be inhaled when heated. I would not recommend that product.”

It seems safe to predict that this “battery-operated, addiction-based market,” as Forbes dubbed it, will be one to watch.

Popular “Bath Salt” Hooks Lab Rats

Mephedrone shows addictive properties in animal models.

Cathinones, like methedrine and other stimulants, are primarily dopamine-active drugs. Though they are now illegal in the U.S., they were formerly of primary interest only to pharmaceutical researchers. The best-known cathinone sold in the form of bath salts and plant food—mephedrone—has both dopamine and serotonin effects. It broke big in the UK a few years ago as a “legal” party drug alternative to MDMA. The idea was to get high without testing dirty, as the saying goes.

Behavioral clues about mephedrone have been teased out of rat studies. The Taffe Laboratory at Scripps Research Institute has been focusing on the cognitive, thermoregulatory, and potentially addictive effects of the cathinones, and mephedrone in particular. Scripps researchers have carried the investigation forward with a recent study in the journal Drug and Alcohol Dependence.

Now comes additional evidence, also from the Taffe Lab at Scripps, that mephedrone, or 4-MMC, looks like an addictive drug. In a paper accepted for publication by Addiction Biology, which Addiction Inbox was allowed to review in advance, Dr. Michael Taffe, along with lead author S.M. Aarde and coworkers, demonstrated in an animal study that lab rats will intravenously self-administer mephedrone under normal lab conditions—roughly analogous to shooting speed.

Without suitable strains of test animals, most genetic and neurobiological research would take centuries, and would involve ethical questions about human testing far stickier than the questions raised by work with animals. Animal models are one of the primary pathways of discovery available to neurobiologists and other researchers.

But it’s tricky. Establishing traditional rodent laboratory conditions is a Goldilocks endeavor: The environment must be not too hot, but not too cold, because this can effect rodent behavior. And the drug must be given at rates that are not too frequent and not too rare.

The curious thing about mephedrone is that it appears to combine the effects of prototypical stimulants like cocaine and methamphetamine, with the trippy, “entactogen” effects of MDMA, aka Ecstasy, in the bargain. The drug rapidly crosses the blood-brain barrier, reaching peak levels two minutes after injection, and full effects last about an hour. In one study, 76% of people who had snorted both cocaine and mephedrone reported that the quality of the mephedrone high was “similar to or better than” cocaine. But the paper also states that “human recreational users report 4-MMC to be subjectively similar to MDMA.”

The investigators ran a series of tests with various groups of rats, and found that 80-100% of the rats would happily reward-press a lever for an infusion of mephedrone. “Under these conditions,” writes Taffe, “methamphetamine and 4-MMC have about equal effect on rat self-administration although the 4-MMC is considerably less potent, requiring about 10 times the per-infusion dose for effect.” Although it wasn’t demonstrated directly in this paper, Ecstasy “is at best unevenly self-administered by rats,” and “despite an MDMA-like serotonin/dopamine neuropharmacological effect, mephedrone has a liability for repetitive intake more similar to the classical amphetamine-type stimulants such as methamphetamine.”

It’s a weaker type of stimulant, mephedrone, but it does the trick. It is highly reinforcing. Mephedrone chemically resembles speed, but also has Ecstasy-like effects. "Furthermore, neurochemical data suggest MDMA-like patterns of relatively greater serotonin versus dopamine accumulation in nucleus accumbens.” Even with its added Ecstasy-like effects, the scientists conclude that “the potential for compulsive use of mephedrone in humans is likely quite high, particularly in comparison with MDMA.”

Photo Credit: Creative Commons

Binge Drinking in America

And the numbers are… fuzzy.

Public health officials in the UK have been wringing their hands for some time now over perceived rates of binge drinking among the populace. In a 2010 survey of 27,000 Europeans by the official polling agency of the EU, binge drinking in the UK—defined as five or more drinks in one, er, binge—clocked in at a rate of 34%, compared to an EU average of 29%. Predictably, the highest rate of UK binge drinking was found in people between the ages of 15 and 24. This still lagged well behind the Irish (44%) and the Romanians (39%). Scant comfort, perhaps, given the historical role drinking has played in those two cultures, but still, clearly, the British and the rest of the UK are above-average drinkers.

Or are they? And what about the U.S. How do we rank? For comparative purposes, we can use the “Vital Signs” survey in the United States from 2010, performed by the Centers for Disease Control and Prevention, and published in CDC’s Morbidity and Mortality Weekly Report, results of which are pictured above. Using almost the same criteria for binge drinking—five drinks at a sitting for men, four drinks for women—the study concludes that the “overall prevalence of binge drinking was 17.1%. Among binge drinkers, the frequency of binge drinking was 4.4 episodes per month, and the intensity was 7.9 drinks on occasion.”

By the CDC’s definition, the heaviest binge drinking in America takes place in the Midwest, parts of New England, D.C., and Alaska. Survey respondents with an income in excess of $75,000 were the most serious bingers (20.2%), but those making under $25,000 binged more often and had more drinks per binge than other groups, the report says. And binge drinking is about twice as prevalent among men. Binge drinking, the survey concludes, is reported by one of every six U.S. adults.

Even so, it appears that the U.S. does not have the same level of binge drinking as the UK. However, astute readers have no doubt noticed that actual binge drinkers in the U.S. were consuming almost 8 drinks per bout, well above the official mark of four or five drinks at one time. The problem is that there is no internationally agreed upon definition of binge drinking. A 2010 fact sheet from the UK’s Institute of Alcohol Studies (IAS) maintains that “drinking surveys normally define binge drinkers as men consuming at least eight, and women at least six standard units of alcohol in a single day, that is, double the maximum recommended ‘safe limit’ for men and women respectively.”

But referring to binge drinking as “high intake of alcohol in a single drinking occasion” is misleading, says IAS. The problem is biological: “Because of individual variations in, for example, body weight and alcohol tolerance, as well as factors such as speed of consumption, there is not a simple, consistent correlation between the number of units consumed, their resulting blood alcohol level and the subjective effects on the drinker.”

Furthermore, the report charges that “researchers have criticized the term ‘binge drinking’ as unclear, politically charged and therefore, unhelpful in that many (young) people do not identify themselves as binge drinkers because, despite exceeding the number of drinks officially used to define bingeing, they drink at a slow enough pace to avoid getting seriously drunk.”

There you have it. As currently defined and measured, binge drinking is a relatively useless metric for assessing a population’s alcohol habits. “The different definitions employed need to be taken into account in understanding surveys of drinking behavior and calculations of how many binge drinkers there are in the population,” as the UK report wisely puts it. Take the above chart with a few grains of salt.

Photo Credit: CDC

Have We Killed Half of our Soldiers with Cigarettes?

Two long-term studies yield grim stats, and women are no exception.

We know that smoking kills. But until the results of 50 years’ worth of observations on British male smokers was published by Richard Doll and coworkers in the British Journal of Medicine in 2004, we didn’t know how many.  Cigarettes will kill at least half of those who smoke them past the age of 30—possibly more. In older, specific populations, possibly as many as 2/3.

It took a prospective study of more than 34,000 British doctors, starting in 1951 and ending in 2001, to establish the grim parameters with some degree of precision. As the study authors of the 2004 summary paper put it: “A substantial progressive decrease in the mortality rates among non-smokers over the past half century… has been wholly outweighed, among cigarette smokers, by a progressive increase in the smoker v non-smoker death rate ratio due to earlier and more intensive use of cigarettes.” In other words, the great reduction in disease mortality rates achieved in the 20th Century, courtesy of better prevention and treatment, effectively never happened for long-term male smokers. Smoking in Britain and America took off in a major way between the two world wars, and sufficient time has now passed to conclude that “men born in 1900-1930 who smoked only cigarettes and continued smoking died on average about 10 years younger than lifelong non-smokers.”

As for women, it took a few decades longer to nail down the truth, because women did not begin smoking in peak numbers until the 1960s. While men born between 1900 and 1930 took to cigarettes in a big way, women born around 1940 were the first cohort of female smokers to consume a substantial number of cigarettes throughout their adult lives. This 20-year lag is crucial, because it means that solid numbers for female mortality rates require solid figures on mortality rates in the 21st Century. And now we have them, courtesy of the Million Women Study in the UK. The results were recently published in The Lancet by Kirstin Pirie and others. They are just as bad as you might have guessed, putting women on a firm equal footing with their male counterparts when it comes to smoking deaths.

The Million Women Study, a database originally used for the UK’s National Health Service Breast Screening Program, recruited female volunteers between the ages of 50 and 69. The figures were eerily similar to those from the earlier study of male British doctors: “If combined with 2010 UK national death rates, tripled mortality rates among [female] smokers indicate 53% of smokers and 22% of never-smokers dying before age 80 years, and an 11-year lifespan difference…. Although the hazards of smoking until age 40 years and then stopping are substantial, the hazards of continuing are ten times greater.” In this study, the researchers found little difference between female smokers and nonsmokers when it came to confounding variables like weight, blood pressure, or lipid profile. A four-year head start—beginning to smoke at the age of 15 rather than 19, say—can put women at a measurably greater risk for lung cancer deaths.  And a little goes a long way: “Even those smoking fewer than ten cigarettes per day at baseline had double the overall mortality rate of never-smokers.” Low-tar won’t save them, either. “Low-tar cigarettes are not low-risk cigarettes,” the investigators write, “and the Million Women Study shows that more than half of those who smoke them will eventually be killed by them, unless they stop smoking in time to avoid this.”

There it is again: Half of all smokers are going to die from smoking.  As the authors of the Lancet study wrote: “If women smoke like men, they die like men.”

In summary, those who stop smoking at age 50 gain about six years of life expectancy. Quit at 40, and you get an extra nine years. A non-smoker’s chances of living from 70 to 90 are three times higher than a smoker’s. The researchers found that the doctors who stopped smoking by age 30 managed to avoid almost all of the lifespan penalties associated with smoking—primarily lung cancer, COPD, and heart disease. (Only about 3% of smoking deaths are due to fires, accidents, poisonings, etc.). And even lifelong smokers who do not quit until the age of 60 are still rewarded with an extra three years of life span, on average.

Perhaps the saddest thing about the findings is the ways in which they suggest that British and American military commanders may have been sentencing countless numbers of soldiers to death for decades, through the simple act of giving away cigarettes in K-rations, and selling them cheaply in other circumstances. As the report in the British Medical Journal states, “widespread military conscription of 18 year old men, which began again in 1939 and continued for decades, routinely involved provision of low cost cigarettes to the conscripts. This established in many 18 year olds a persistent habit of smoking substantial numbers of manufactured cigarettes, which could well cause the death of more than half of those who continued.” In a perverse reminder of the Agent Orange scandal in Vietnam, American and British military command may have exposed their soldiers to a much greater threat, for a much longer period, with worse odds for survival.

One obvious confounding variable in such studies is alcohol. It requires a sensitive statistical analysis to work through correlations between drinking, smoking, and, say, liver disease.  But “the large majority of the excess overall mortality among smokers is actually caused by smoking,” the Lancet researchers maintain with confidence.  The overall point seems clear: These long-term results show that the risks from continual cigarette smoking are even greater than we thought.

The dismal bottom line of the two smoking studies is that we appear to be right on schedule for meeting the UN’s prediction of one billion tobacco deaths in this brave new century.

Pirie, K., Peto, R., Reeves, G., Green, J., & Beral, V. (2012). The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK The Lancet DOI: 10.1016/S0140-6736(12)61720-6

Photo Credit: Ianier67 via Creative Commons.