ad sponsored by the California Department of Health Services shows a young man in a dark suit holding a cigar while sitting in a big leather chair. "Say, Chad," the narrator asks him, "any idea how many cigarettes you'd need to equal the nicotine in that big fat stogie?"
After Chad repeatedly guesses wrong, the narrator says, "No, Chad, you'd have to smoke more than 70." Seventy cigarettes appear in poor Chad's mouth as a slogan is displayed at the bottom of the screen: "CIGARS. The Big New Trend in Cancer."
When the Chad ad was first aired last spring, the Los Angeles Times described it as "comparing the effects of one cigar to smoking the equivalent of 70 cigarettes." According to the Sacramento Bee, "the television spot . . . points out that smoking cigars poses the same health risks as smoking cigarettes."
Those are fair interpretations of the ad's implicit message. The problem is, the message isn't true. It is well established by decades of research that cigar smokers face hazards far less serious than cigarette smokers do, primarily because they inhale less smoke. That point was confirmed last year by a National Cancer Institute report that was wrongly portrayed as equating the risks of cigars and cigarettes. (More on that later.)
Even in terms of nicotine delivery, the California ad is misleading. First, there is little evidence that nicotine contributes to smoking-related diseases (which is why pharmaceutical companies can sell nicotine gum and patches as safe alternatives to cigarettes). Second, a cigar that delivered the amount of nicotine in three and half packs of cigarettes would be very unusual. According to the NCI report, a premium cigar typically yields about as much nicotine as a dozen cigarettes, not 70.
The Chad ad is part of a nationwide strategy aimed at scaring people away from cigars. U.S. cigar consumption rose more than 50 percent from 1993 to 1997, with imports of premium cigars more than quadrupling. Just when tobacco's opponents thought that smoking was permanently déclassé, cigars have become newly fashionable among the rich and famous. In response, public-health officials and anti-smoking activists are calling for federal warning labels, restrictions on advertising and promotion, and regulation by the Food and Drug Administration. Meanwhile, they have been encouraging the press and the public to believe that cigars are just as dangerous as cigarettes, if not more so.
The implied equation between cigars and cigarettes was conspicuous in late February, when the Department of Health and Human Services released a report recommending government warnings on cigars "analogous to the labels on cigarettes." Most cigar packages already carry a warning that "this product contains/produces chemicals known . . . to cause cancer, and birth defects or other reproductive harm." Making the case for additional warnings, surgeon general David Satcher declared that "cigars contain the same kind of carcinogens that are found in cigarettes, and in some cases, maybe more of them." While this is true as far as it goes, it does not mean that the typical cigar smoker absorbs the same dose of carcinogens or faces the same cancer risk as the typical cigarette smoker. Satcher also said, "The absence of labels implies cigars are different and don't carry the same risk." (They are, and they don't.) Predictably, the Associated Press reporter got the impression that, as she put it in her lead, "scientists say [cigars] are just as deadly as cigarettes."
Satcher is not the only official whose pronouncements about cigars are easily misinterpreted. Consider how Michael Eriksen, director of the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention (CDC), described the hazards of cigars in a May 1997 New York Times story: "Tobacco is tobacco is tobacco." Asked to interpret that quote, CDC epidemiologist Ann Malarcher says, "There are a lot of meanings to that." The literal meaning, of course, is a tautology; but surely many people would understand Eriksen to be saying that all tobacco products are equally hazardous. The Times itself went further, announcing that cigars pose "higher risks than . . . cigarettes."
We could simply blame journalists for leaping to the wrong conclusions, but it's clear that public-health officials are giving them a good shove. In February 1998, for example, the NCI's Donald Shopland told USA Today, "You're smoking a whole pack of cigarettes" when you smoke a cigar. And Jack Henningfield, an addiction specialist who contributed to the NCI's cigar report, told the Wall Street Journal, "It will help explode some of the myths about cigars," including the belief "that they are relatively safe."
Yet when it came out in April, the NCI monograph demonstrated, once again, that cigars are safer than cigarettes. Overall, the NCI reported, daily cigar smokers get oral and esophageal cancers almost as often as cigarette smokers. But they face much lower risks of lung cancer, coronary heart disease, and chronic obstructive pulmonary disease -- the three main smoking-related causes of death. The upshot can be seen in mortality figures. In a 1985 American Cancer Society study cited by the NCI, men who smoked a cigar or two a day were only 2 percent more likely to die during a 12-year period than nonsmokers, a difference that was not statistically significant. By contrast, the mortality rate was 69 percent higher for men who smoked a pack of cigarettes a day.
The only really bad news for cigar smokers in the NCI report applied to a small minority. The NCI emphasized that the risk from cigars increases with the frequency of smoking and the degree of inhalation. Cigar smokers who inhale deeply face measurably higher risks of heart disease and emphysema (though still not as high as those faced by cigarette smokers), and the risk of lung cancer for a five-cigar-a-day smoker who inhales approaches the risk for a pack-a-day cigarette smoker. That sort of cigar smoker is quite unusual, however. "As many as three-quarters of cigar smokers smoke only occasionally," the NCI noted, and "the majority of cigar smokers do not inhale." Since the available data apply only to people who smoke at least one cigar a day, "the health risks of occasional cigar smokers . . . are not known."
In other words, there is no evidence that smoking cigars in moderation-with moderation defined by the way most cigar smokers actually behave -- poses a measurable health risk. But because the NCI emphasized that "cigars are not safe alternatives to cigarettes" (something no one had claimed), this point was lost on the press. The headline in the San Francisco Chronicle read, "Cancer Institute's Warning on Cigars: Just As Bad As Cigarettes." An Associated Press story said the NCI report was "intended to equate dangers posed by the two products." The article began, "Smoking cigars can be just as deadly as smoking cigarettes." This is like saying that riding a bicycle "can be just as deadly" as riding a motorcycle. It's true in the sense that both activities can result in fatal accidents. But that does not mean they are equally dangerous.
After the NCI report came out, John Banzhaf, executive director of Action on Smoking and Health, said FDA regulation of cigars was all the more vital "now that we know that cigars are as dangerous as cigarettes." Banzhaf also filed a petition with the Federal Trade Commission, asking it to require "cigarette-like warnings on cigar labels and in ads." FTC chairman Robert Pitofsky seemed sympathetic to the idea. "If the National Cancer Institute is saying that regular cigar smoking is roughly as dangerous as cigarette smoking," he told the Washington Post, "I would expect people would want health warnings."
Even if they do not value truth for its own sake, public-health officials should recognize that misleading comparisons between cigars and cigarettes have the potential to backfire. After seeing the California ad equating one cigar with 70 cigarettes, for example, a guy who smokes a couple of cigars a week might mistakenly conclude that he would be no worse off smoking a pack of cigarettes a day. And anyone who realizes how deceptive the ad is will probably be more inclined to dismiss other warnings from public-health agencies.
Despite such risks, we may soon be seeing more messages of this kind. In its February report, HHS called for a national "public awareness campaign about the health effects of cigars." With any luck, Chad will still be available.
