Banning cigarette filters

Have they really thought this through?

The WHO recently published a list of “forward-looking” (i.e. lunatic) anti-smoking policies in preparation for its secret, biennial tobacco control conference next month. I’ll write more about this next week, but there is one I’d like to focus on:

(iv) Ban on cigarette filters

This policy prohibits the sale, import, distribution and manufacture (where relevant) of cigarettes with filters, as well as filters that are sold separately from cigarettes.

This idea has been around for many years. In Velvet Glove, Iron Fist, I quoted the late anti-smoking campaigner John Slade who said in 1990 that he wished the American government had stopped cigarette innovation in 1950 because then “the only cigarettes on the market would be unfiltered 70 mm smokes, and far fewer people would be smoking.” I’m not quite convinced about this. If there is one thing that would get me smoking again, it is the availability of unfiltered cigarettes. Most smokers today don’t know what a real cigarette is.

But I may be alone in this, as in so many other things.

The idea of banning filters has never got anywhere because it is so obviously a harm maximisation strategy, but as the ‘public health’ lobby scrapes the barrel for policies to enact, silly old ideas have been dusted down (see also: banning people born after a certain year from ever buying cigarettes). To soften the public up for the idea, some of the WHO’s outriders have placed an article in Addiction to make the case. The Guardian gave it some coverage yesterday.

When I wrote about the same issue for The Critic a few months ago, I looked at the evidence and found that there are a lot of studies showing that filters make a difference.

Hardly anyone smokes unfiltered cigarettes anymore so the evidence necessarily comes from the past, but there is a lot of it. One of the most recent studies was published in the British Medical Journal in 2004. It found that smokers of unfiltered cigarettes were 44 per cent more likely to develop lung cancer than smokers of filtered cigarettes. The authors noted that their findings were consistent with 22 previous studies going back to 1968.

These studies include a piece of research by Ernst Wynder, the American who pipped Richard Doll and Austin Bradford Hill to the post in 1950 when he identified the link between smoking and lung cancer. In a study published in 1979, he found that the “relative risks of developing lung or larynx cancer were consistently lower among long-term smokers of filter cigarettes than among smokers of nonfilter cigarettes, irrespective of quantity smoked.” In 1976, another pioneer of tobacco research, E. Cuyler Hammond, found that rates of lung cancer and heart disease were significantly higher among smokers of high tar (mostly unfiltered) cigarettes and suggested taking them off the market. A study from Britain published two years later, based on evidence from more than 10,000 people, found that smokers of filtered cigarettes had an 18 per cent lower overall mortality rate than those who smoked unfiltered cigarettes.

An interesting study published in the British Medical Journal in 1984 found that smokers who consumed unfiltered cigarettes had a 60 per cent higher risk of developing lung cancer than smokers who switched to filtered brands. Still more interesting is the evidence that smokers of menthol cigarettes have historically had a lower rate of lung cancer than other smokers. The most plausible explanation for this finding, which have been documented in several studies, is that menthol cigarettes are invariably filtered and smokers of menthol cigarettes (which have been around since the 1920s) were the first to switch to filters.

Research in this field has all but dried up, but one more study appeared in JAMA Internal Medicine in 2019. Based on evidence from 14,123 smokers in America, it found that consumers of unfiltered cigarettes were nearly twice as likely to die from lung cancer as those who consumed filtered cigarettes.

The argument against cigarette filters is that they give smokers a misplaced sense of safety and that, as Slade said, more people would be scared off smoking if they didn’t exist. From a public health perspective, this means that a ban would be justified if the health harms from there being more smokers outweighed the health benefits of cigarettes having filters. It would also have to be shown that smokers believe that filters offer significantly more protection than they do.

This requires a complex calculation and we would need a lot of data to make the right trade-off. The authors of the Addiction article get around this by simply denying that filters offer any benefits at all.

Since the inception of filter-tipped cigarettes, followed by ventilated filters (i.e. ‘light’ cigarettes), tobacco companies have promoted cigarettes with filters as ‘safer’ than unfiltered cigarettes [1, 2]. However, an established, industry-independent, body of evidence has shown that filters and filter ventilation do not reduce toxicant exposure from smoking [1, 2].

The first reference is to a study about how some cigarette filters release cellulose acetate fibres and carbon particles and should therefore be classified as “defective”. It does not draw any conclusions about the health implications of this, if any, and it does not look at the question of whether filters are effective at filtering out “toxicants”. The second reference is to a book that calls for the prohibition of cigarettes.

This seems a rather flimsy basis on which to assert that filters don’t work at all. But they cite more evidence later in the article…

Many people mistakenly believe that cigarette filters protect their health [3, 11-13], despite evidence to the contrary [1-3, 5, 6].

Reference 3 is to a general discussion paper which mostly focuses on consumer attitudes and behaviour, but it does acknowledge that filters can lead to “reduced emissions of select but not all smoke components.”

Reference 5 argues that the use of cigarette filters has led to a rise in (lung) adenocarcinoma, a specific type of cancer. The evidence for this is quite strong. Smokers of filtered cigarettes inhale more deeply, leading to cancer developing lower down in the lung (which is where you get adenocarcinoma). Squamous cell lung cancer used to be the most common type of lung cancer among smokers whereas adenocarcinoma was (and still is) the most common type of lung cancer among non-smokers. Rates of squamous cell lung cancer (and other types of lung cancer) started falling circa 1980 but rates of adenocarcinoma did not. The authors argue plausibly that this is at least partly due to the rise of filtered cigarettes from the 1950s (although rates of adenocarcinoma have been rising among non-smokers too). This is well worth knowing, but it does not tell us whether filters have had a positive or negative effect on cancer and other smoking-related diseases overall. The authors of the study - who want a ban on filters - claim that “there is no existing evidence that filter ventilation reduces lung cancer risk or has any other beneficial health effect”, but that is clearly not true. There is a wealth of epidemiological evidence (which usually trumps everything in ‘public health’).

Reference 6 is an article by a couple of Californian activist-academics in Tobacco Control who also want to ban filters and, like the authors of the Addiction article, simply assert that they serve no useful function.

The epidemiological evidence showing a protective effect of filters for lung cancer - if nothing else - is actually very strong (see p. 82-91). It is just one of those epidemiological findings, like moderate drinking reducing heart disease risk and being overweight reducing mortality risk, that doesn’t sit well with ‘public health’ ideology and is therefore always surrounded by whataboutery. My reading of the evidence is that filters probably do have some benefit but that smoking cigarettes for decades is a very risky thing to do either way.

Smokers would have to greatly overestimate the benefits of filters for a ban to provide a net benefit in public health terms, and I doubt they do. I expect most of them think they provide no protection at all. Most smokers have only ever known filtered cigarettes and they know that they are highly dangerous. In any case, making a product more dangerous in order to scare people off using it has got to be ethically questionable.

The anti-smoking lobby’s approach to this issue is all over the place. They were all in favour of the development of low tar cigarettes in the 1970s. They now say that was a mistake. Fair enough, but if it was a mistake why did they lobby for the EU to set limits on tar yields in the 1990s and then fight to lower those limits in the 2000s? They then successfully lobbied the EU to ban tobacco companies from putting the tar and nicotine content on packs because this information was (supposedly) misleading. Which is it? Either all cigarettes are as bad as each other, in which case get rid of the limits on tar and nicotine, or low tar cigarettes are safer than high tar cigarettes, in which case consumers should be informed.

Their current position seems to be that all cigarettes are as bad as each other and that filters should be banned because they give the opposite impression. If so, the EU’s limits on tar and nicotine serve no purpose and should be abolished. Indeed, they will have to be abolished if filters are banned because there is no such thing as a low-tar unfiltered cigarette. This is an issue that the authors of the Addiction article, who include ASH’s Hazel Cheeseman, never address. They can’t be dumb enough to think that the EU will accidentally ban cigarettes by banning filters and leaving the tar limits in place so they must think - if they have thought about it at all - that the EU will allow high tar cigarettes to be sold again. That would be fine with me. It’s just be a bit surprising that it’s also fine with an anti-smoking group.

UPDATE

In case you’re in any doubt about the benefits of cigarette filters, ASH have just got the permanently wrong Chris van Tulleken to make a video where he asserts that filtered cigarettes are not better for you and may well be worse for you. He says that banning them would be “one of the most important public health interventions we could make in this country”. Along with putting cancer warnings on sliced bread, presumably.