Editor’s Corner | Alfred A. Bove, MD, PhD, MACC, Editor-in-Chief, CardioSource WorldNews

There used to be commercials and endorsements telling us precisely that: smoking was absolutely safe—one brand even advertised “not a cough in a carload.” But when we go back to 1964, the Surgeon General of the United States issued the report Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service, we find a clear statement that cigarette smoking was related to definite health disorders, including lung cancer and vascular disease.

The initial report was met with much skepticism, particularly from the tobacco industry, which claimed that there wasn’t proof and the analysis was flawed. Subsequent reports over another decade refined the analysis, developed better statistics, and confirmed the same relationships. By now, 50 years later, we have accepted the inevitable results of what we were seeing in society and in our clinical practice: smoking increased the risk of many leading diseases.

The government has implemented many policies to reduce tobacco use, cardiology organizations are on a continuous no-smoking campaign, and cardiology practitioners are committed to querying all of our patients about smoking and then providing advice and help in stopping if the answer is yes.

First-hand Experience with Second-hand Smoke

Along the way, we also learned that smoking is not only detrimental to the smoker, but also affects those nearby who inhale the second-hand smoke and, thus, are subjected to health risks similar to the smoker. In closed spaces, this problem becomes particularly concerning, leading to smoking bans on commercial aircraft and Navy submarines.

Back in 1985, I was amazed to find a lot of submariners smoking when I did my submarine training as a Navy undersea medical officer. The Navy spent money to build advanced air purifier systems on submarines mostly in an effort to remove cigarette smoke and tobacco combustion particulates from the air. (Air purification in subs was introduced towards the end of World War II but it was limited to the use of soda lime for the removal of carbon dioxide and oxygen candles for the regeneration of oxygen.) The smoke was not only a health hazard for the sailors, but could affect delicate instruments needed for proper operation of the craft.

Today we expect the places we go to be smoke-free, whether they are open or closed spaces, but it took considerable campaigning by public and private organizations to achieve this goal. Moreover, there remains some resistance based, primarily, on economic reasons. We have also seen a considerable reduction in the number of smokers in the United States, but this is not the case in other parts of the world where smoking remains a popular behavior.

Smoking 2.0

Recently we have seen clever new methods to entice the public to again take up smoking. Of particular concern is the development of an electronic cigarette that burns a purified nicotine as well as a number of other ingredients to enhance flavor. These are touted as safe, but assessing their safety will require several decades based on our risk experience with conventional cigarette smoking. However, that past experience also tells us there is no reason to expand the smoking population with a product that is likely to have similar results to the use of regular cigarettes. The fact that e-cigarettes in their multitude of flavors seem to be targeted to kids—who are quickly taking up “vaping,” as it’s called—is alarming.

In a similar way, cigarettes that provide a lower dose of nicotine also present an unknown risk that will only be defined by years of observation. In the meantime, individuals who are motivated to restart smoking with the hope of safer exposure have no basis for that assumption and we might find ourselves once again encountering a growing number of patients with lung cancer, coronary and peripheral arterial disease, strokes, and other smoking complication 20 years from now. Is this seriously a road we want to travel again?

I know I don’t—so I continue to advise my patients to avoid smoking of any type, and not to assume that newer modern methods of exposure will protect them from the well-established complications of smoking. Hopefully, we won’t need to go through the same cycle again that began in 1964 and continued into the 21st century before we see a significant reduction in e-cigarette smoking and its medical complications.

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Alfred A. Bove, MD, PhD, MACC, is professor emeritus of medicine at Temple University School of Medicine in Philadelphia, and former president of the ACC.

Keywords: CardioSource WorldNews, Electronic Nicotine Delivery Systems, Smoke, Tobacco Smoke Pollution, Smoking, United States Public Health Service

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