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Opinion: Cigar Smoking and Coronary Health

A doctor examines the links between coronas and coronaries.
James Weiss
From the Print Edition:
maduro issue, Winter 93/94

When it comes to smoking, I guess we cigar lovers constitute one of the last beleaguered minorities. Yet even among smokers, the habit has been a source of conflict.

I don't suppose anybody remembers who Graham Lee Hemminger was. Well, in 1915 he was the fellow who wrote, at the age of 19, these prescient words:

Tobacco is a dirty weed. I like it.
It satisfies no normal need. I like it.
It makes you thin, it makes you lean,
It takes the hair right off your bean.
It's the worst darn stuff I've ever seen.
I like it.

Today, the media, doctors, health politicians and even our wives, husbands or significant others keep telling us that tobacco is not only dirty, but just about all forms of it are dangerous. The important questions, of course, are: Compared to what? And exactly how dangerous?

There are hundreds of studies that attempt to define the specific degree of risk that smoking entails in relation to a variety of health problems. These studies date back at least 50 years, when the striking similarity between the increase of cigarette sales and the incidence of primary lung cancer were first noted.

After scanning the many subsequent investigations detailed in the scientific literature, only a simpleton or a self-deceiver could deny that cigarette smoking is implicated in the etiology of all sorts of nasty ills of the flesh: cancer of the mouth, pharynx, larynx, esophagus and lungs, other pulmonary problems Such as chronic bronchitis and emphysema, various disorders of the heart and vascular system, stomach ulcers and too many more to list. Of these, the effects of smoking on coronary heart disease and on lung cancer have been most extensively studied and appear to be the most serious from a public-health point of view.

But even here, the connection is hardly one to one. Not all who smoke develop these disorders, and not all who develop them smoke. In the United States four out of five deaths from heart disease occur among nonsmokers. The risk is more serious but still far from universal when one looks at lung cancer: 10 percent of the men and 30 percent of the women who get this disease have never smoked. The experts are reduced to saying that there are wide differences in susceptibility, but that doesn't explain the peculiar anomaly of Buerger's disease, an inflammatory disorder of the blood vessels. Although this disorder seems to occur only in smokers (primarily men), in recent years its frequency of occurrence has decreased drastically-far more than would be expected from any concurrent decrease in cigarette smoking.

Thus, many risk factors other than smoking have been implicated in almost all of these illnesses, including smog, industrial pollution, automobile emissions, wood and coal fires, carcinogens in building materials, poor diet, obesity, physical inactivity, stress, certain types of behavioral patterns and personalities, genetic history and whatever else might turn up in the New England Journal of Medicine.

Nevertheless, cigarettes pose a definite danger and, face it, they don't even afford that much pleasure. Oh, once in awhile after a hike or a good meal, or when you've been under unusual pressure, that first drag tastes like ambrosia. But mostly cigarette smoking is a bad habit, quite possibly a true addiction in many users. Even the lower-tar, low-nicotine, filtered variety just postpones eventual trouble. I gave up those coffin nails a decade ago. Yet I still enjoy the occasional pipe or cigar. Pipes are effective stress reducers, and cigars, like nothing else I know, unquestionably provide rare, sensual pleasure. After a great dinner, along with a Port, brandy, or B&B, there is nothing else that can add the right finishing touch-that fitting coda-but a fine cigar from Havana, Honduras or the Dominican Republic.

How much danger to health, then, does that after-dinner cigar entail? Well, a computerized review of all recent scientific investigations that consider cigar smoking as opposed to cigarette smoking-and there are only about two dozen good ones-clearly indicates that the risk factor is substantially lower for those who smoke pipes or cigars than for those who smoke cigarettes. The risk is not a great deal higher, in fact, than for nonsmokers-including those who never smoked.

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