Studies on Pipe and Cigar smokers - Inconsistent!?

[fishmansf]

Title abreviated and capitalized. Original:
Why do health studies on pipe and cigar smokers have such wildly different results?

I am getting my graduate degree in Data Science so I tend to nerd out of research articles around topics that interest me. I have read nearly ten articles on the health effects of pipe and cigar smoking, primarily revolving around different cancers they cause. Nearly every article has the same sample size and each of the control groups are nearly identical in number. Most articles don't go in depth about the granular details of the pipe smokers, they simply label them as pipe smokers but mostly don't touch on: what kind of tobacco they are smoking (roll your own or high quality pipe tobacco), if they inhale, how hot they smoke, if they smoke inside or outside, how many bowls a day do they have or are the predisposed to other diseases like cancer (with the exception of two of the ten studies I have read). Regardless of the difference in granularity, the majority of these study have significantly different results, some of them painting the hazard ratios for different types of cancer in the range from 1.2-3.7 in comparison to the baseline HR of 1 whereas others paint them even higher in the range from 1.7-5.0. Even the relative risk (RR) are wildly inconsistent, some studies making it seem that if you are an exclusive pipe smoker, you WILL cancer and FAST whereas others summarize that it is significantly more dangerous than not smoking but not all that dangerous. From your perspective, what do you think accounts for these wide ranges of results between different studies?

 

[Briar Lee]

Two factors, I’ll speculate.

The first is, many cigarette smokers take up a pipe and keep on inhaling. Bad.

The second is more controversial.

I smoke like a chimney. I smoke a pipe.

I could smoke an entire can of Capstan a day for less than the price of one Cuban cigar.

Cigar only smokers are not only wealthier, they likely come from generational wealth. Their mothers had excellent pre natal care. They grew up in homes with excellent nutrition, they lead softer and easier lives.

Ever notice, when a tornado hits a town it spares the mansions on the hill and hits the trailer park dead center?.

 

[Chasing Embers]

From your perspective, what do you think accounts for these wide ranges of results between different studies?

How much the backers of the study hate tobacco and how much money they offer for results.

 

[fireground_piper]

Like any type of report:

Who funded it, who planned it, who performed it, what were the goals going into it, what was the quality of the test pool and how are the results presented.

 

[HawkeyeLinus]

Read only ten? That's a very tiny sample size so not much to draw on but ten more than I care anything about, and without reading them and the many studies they cite to for myself really no way to comment intelligently about their methodology or conclusions.

IMO, last thing we need to do is dive into the weeds on studies and health effects.

 

[metalheadycigarguy]

One, there are so many variables that could come into play, such as:
how old are the test individuals, what is their general health, are there any under-lying health issues, do health issues run in the family, do they see a dentists regularly, what is their daily diet look like, how long have you smoked, do you smoke daily, do you inhale or not, do you only smoke a pipe or a cigar or both, how many bowls do you smoke per day and how big are the bowls, how many cigars do you smoke a day, how big are the cigars, is the pipe tobacco or cigars mild or strong, are you or were you a cigarette smoker.

Two, is the test looking for the positive effects or the negative effects of the pipe or cigar smoking. Who funded the test and what results are they looking for.

Three, when was the study conducted, in the past as compared to present day with newer technology, etc.

 

[David D. Davidson]

As with all things related to health and nutrition, exact science is not an exact science. Too many confounds to control for completely; all you can do is try to quiet the noise as much as possible. I doubt we’ll ever know just how dangerous pipe smoking is, just that it is in fact dangerous.

I personally tend to lean towards the more dire studies - when it comes to my personal health, I’d rather base my risk assessment on a worst case scenario than best.

 

[BPatrick]

They have a predetermined, negative outcome they are funded for and are looking for a d will manipulate results to achieve that end. Or they will ignore studies that disprove their goal. Kinda like all the global warming paid for infomercials

 

[beerandbaccy]

I guess many pipe and cigar smokers are current /ex cigarette smokers. To get a genuine study of health ramifications you would have to find enough smokers who haven't smoked cigarettes and I would have thought don't inhale either. It must be difficult to get any kind of objective accuracy.

 

[Lumbridge]

I don't have much to contribute, but I've noticed a fair amount of confirmation bias - on the part of both smokers and anti-smokers - regarding information on the heath effects of tobacco consumption. Anti-smokers tend to point to any article or study implying that any tobacco use is an imminent death sentence, whereas smokers often gravitate towards sources which seemingly downplay any potential negative health consequences of smoking (pipes, cigars, or otherwise).
The truth, as with most things, is likely somewhere in the middle. Pipe smoking is certainly not without its risks, but I believe that it is less risky than inhaling tobacco smoke.

 

[anotherbob]

big factor is if exclusively pipe smokers or not. In more in depth studies that makes a big difference in results. The other big question is how many pipes smoked daily.

 

[sardonicus87]

Most studies are crap anyway regardless of subject matter. But even then, if there's any statistics involved and no actual statistician involved, likely to have many mistakes there (statistics is very difficult even for professional statisticians, and most people that haven't actually studied the subject are terrible at statistics with many people's intuitions about stats being way wrong) even if the methodology in the testing is sound. There's also manipulation of P-values, misunderstandings of what P-values actually mean (likelyhood that the null hypothesis is or isn't a factor in one specific data point, which doesn't prove reliability in and of itself), studies that only rely on P-values and no other statistics validation methods, etc.

Studies should have peer review and followup studies, but often don't because there's no money in peer review or followup. Publish or perish bs.

I'm not saying all studies are bad and you shouldn't trust any, just that you should have a healthy skepticism.

 

[kcghost]

How much the backers of the study hate tobacco and how much money they offer for results.

This is the whole crux of the issue. They hate us for living as long as non-smokers and it is driving them crazy.

 

[Briar Lee]

For over sixty years the do gooders tried for all they were worth to indict and convict coffee,,,,for something.

Early studies linked coffee with cancer, until they eliminated the cigarrete smokers.

All they ever accomplished was to deprive the unborn babies of real coffee.

Beginning in the late 19th century the medical sciences tried to link bad health outcomes to tobacco, and failed.

Only after millions smoked and inhaled cigarettes for about forty years, did medical studies find Inhaling smoke was a really bad idea.

 

[fishmansf]

One, there are so many variables that could come into play, such as:
how old are the test individuals, what is their general health, are there any under-lying health issues, do health issues run in the family, do they see a dentists regularly, what is their daily diet look like, how long have you smoked, do you smoke daily, do you inhale or not, do you only smoke a pipe or a cigar or both, how many bowls do you smoke per day and how big are the bowls, how many cigars do you smoke a day, how big are the cigars, is the pipe tobacco or cigars mild or strong, are you or were you a cigarette smoker.

Two, is the test looking for the positive effects or the negative effects of the pipe or cigar smoking. Who funded the test and what results are they looking for.

Three, when was the study conducted, in the past as compared to present day with newer technology, etc.

That is what I am leaning towards, there is still so many variables that are not accounted for. The largest portion of mortalities on the report were "all tobacco related deaths". Like, what does that even mean? Sort of akin to people who died of a heart attack but had COVID being counted as a "covid death" (probably will have this comment removed lol).

 

[sardonicus87]

That is what I am leaning towards, there is still so many variables that are not accounted for. The largest portion of mortalities on the report were "all tobacco related deaths". Like, what does that even mean? Sort of akin to people who died of a heart attack but had COVID being counted as a "covid death" (probably will have this comment removed lol).

That is a big part of the issue.

Someone was a smoker and died of a heart attack. The heart attack was caused by cardiovascular disease. Did the tobacco alone cause the cardiovascular disease? Or was it a lack of exercise? Or was it poor dietary choices? Genetics? Or was it a combination of some or all of these things? Some sort of other environmental exposure (like working with asbestos or glass or something, or living in a particular area)? If a combination, what percentage did each contribute?

That's all before you have to try to figure out how to even calculate that. Can't really do that, so you need large numbers of people in each of the varying backgrounds, finding people that are extremely similar in lifestyle and controlling a multitude of variables. And then you need also large numbers of people that are the same as each of these groups with the exception of smoking.

That's just one factor of why any kind of study is really difficult to do.

Then, how do you collect the data on say, exercise? Usually by questioning the participants which, as should be no surprise, can lie or exaggerate (consciously or unconsciously). I can't remember the study off-hand, but it was used as an example when I was studying psychology and was about naturalistic observation (watching behavior without participants knowing) vs surveys/questionnaires for data collection. I can't remember off-hand either, but the people questioned about how often they washed their hands after using a public restroom was something like 90% said they always did but naturalistic observation showed the number was more like 70-something percent.

This is also why studies done properly take a very, very long time to complete.

 

[fishmansf]

That is a big part of the issue.

Someone was a smoker and died of a heart attack. The heart attack was caused by cardiovascular disease. Did the tobacco alone cause the cardiovascular disease? Or was it a lack of exercise? Or was it poor dietary choices? Genetics? Or was it a combination of some or all of these things? Some sort of other environmental exposure (like working with asbestos or glass or something, or living in a particular area)? If a combination, what percentage did each contribute?

That's all before you have to try to figure out how to even calculate that. Can't really do that, so you need large numbers of people in each of the varying backgrounds, finding people that are extremely similar in lifestyle and controlling a multitude of variables. And then you need also large numbers of people that are the same as each of these groups with the exception of smoking.

That's just one factor of why any kind of study is really difficult to do.

Then, how do you collect the data on say, exercise? Usually by questioning the participants which, as should be no surprise, can lie or exaggerate (consciously or unconsciously). I can't remember the study off-hand, but it was used as an example when I was studying psychology and was about naturalistic observation (watching behavior without participants knowing) vs surveys/questionnaires for data collection. I can't remember off-hand either, but the people questioned about how often they washed their hands after using a public restroom was something like 90% said they always did but naturalistic observation showed the number was more like 70-something percent.

This is also why studies done properly take a very, very long time to complete.

Agreed. It is nearly impossible to follow a population that meets health criteria who are also pipe smokers for a long enough time and expect them to stay in good health to strictly study the effects of pipe smoking, though I would love to see one if that were the case. However, I think we can deduce that pipe smoking is not health nor good for you, but to what extent? That is is the real question. One of the studies used an "activity" and "BMI" variable(s) but again, that is just one study and not indicative of good genes. Each of the study had one partition that showed the overall HR and RR of "all tobacco related morbidities" and in that category, it was surprisingly low, with a base HR of 1 and pipe smokers who smoke < 14 bowls a week had only a 1.6 HR which, statistically speaking, is significant but practically, isn't that significant. It is also incredibly difficult to translate statistical HR/RR into practical application. Just because a pipe smoker who smokes two bowls a day has an HR of 1.6 doesn't really mean that he is 60X more likely to develop cancer, again, statistically he is, but practically he is not. It is just one of those things where it will really be a mystery and prompt us to take as good care of ourselves as possible since we don't really know the outcome.

 

[fishmansf]

big factor is if exclusively pipe smokers or not. In more in depth studies that makes a big difference in results. The other big question is how many pipes smoked daily.

There were two studies I found that incorporated that. What they found is that people who smoked 1-3 bowls were, statistically speaking, significantly more likely to die of all types of tobacco related morbidity but practically, it's not that high, some HR of anywhere between 1.5-1.9 (I can't remember and don't feel like digging up the page lol). However, the other groups that were 3+ bowls a day, did have a significantly higher chance of tobacco related morbidities, if memory serves right, HR 1.9-3.0, again could be wrong about that.

 

[fishmansf]

This is the whole crux of the issue. They hate us for living as long as non-smokers and it is driving them crazy.

The lack of nicotine in life would truly make a miserable existence.

 

[fishmansf]

I don't have much to contribute, but I've noticed a fair amount of confirmation bias - on the part of both smokers and anti-smokers - regarding information on the heath effects of tobacco consumption. Anti-smokers tend to point to any article or study implying that any tobacco use is an imminent death sentence, whereas smokers often gravitate towards sources which seemingly downplay any potential negative health consequences of smoking (pipes, cigars, or otherwise).
The truth, as with most things, is likely somewhere in the middle. Pipe smoking is certainly not without its risks, but I believe that it is less risky than inhaling tobacco smoke.

Agreed entirely. I think anyone who would say that pipe smoking is not bad for you and is a healthy habit, is self-deceived. However, how bad is it for you? I can't imagine it is any worse for you than the amount the average person drinks throughout the week.