October 7, 2025 • 36 mins
It’s the leading cause of preventable death across much of Europe and North America, responsible for the loss of 41 million lives in the US, UK and Canada between 1960 and 2020. These staggering statistics beg the question: Why is anyone still smoking? Dr. Lynn Kozlowski, renowned expert in tobacco use and nicotine policy, is Professor Emeritus and Dean Emeritus of Community Health and Health Behavior at the University of Buffalo. A founding member of the Society for Nicotine and Tobacco Research, he has contributed to four U.S. Surgeon General reports on smoking. Host Alec Baldwin speaks with Dr. Kozlowski about how perceptions of smoking have evolved over the years, the dangers of smoking traditional cigarettes versus vaping, and his advice on what he believes is the best way to quit.
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Episode Transcript
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Speaker 1 (00:02):
This is Alec Baldwin, and you were listening to Here's
the Thing from iHeartRadio. These days, a pack of Marlboroughs
could set you back thirteen dollars. If you actually want
to smoke them, You've got to stand in a designated
area twenty five feet from the building's entrance, and the
package will contain the most dire warnings of illness and death.
(00:26):
Overcoming these hurdles requires a true commitment to the habit.
It's enough to ask who is still smoking? My guest today,
Doctor Lin Koslowski is here to shed some light on
this question. Doctor Kozlowski is an expert on tobacco use
and nicotine policy and his professor Emeritus and Dean Emeritus
(00:48):
of Community Health and Health Behavior at the University at Buffalo.
He is also a founding member of the Society for
Nicotine and Tobacco Research and has contributed to four US
Surgeon General's Reports of smoking. I wanted to know if
doctor Kozlowski was ever tempted to pick up a pack himself.
Speaker 2 (01:10):
I certainly tried to be a smoker, so in high
school I experimented. In college, I had roommates who were
devoted heavy smokers. I tried to smoke. There was no
moral sense had got in the way. I just kept
getting sick from smoking, so it wasn't worth it to me.
But so it's fair to say I was tempted. I tried.
(01:31):
I experimented with packs of cigarettes and pipes and cigars
and so on. But I never became a regular smoker.
Speaker 1 (01:39):
I smoked, never heavily, never habitually. I'd smoke usually when
I was shooting a film, because filmmaking is such a
boring process. You work for ten or fifteen minutes, then
you go away for an hour while they get ready
for the next angle, and so forth. And I smoked
out of boredom on the sets of films and so forth,
And whenever the project was over and I went home,
quote unquote, I stopped because the people in my life
(02:01):
wouldn't tolerate that.
Speaker 2 (02:03):
So when you were smoking, how early in the morning
did you have your first cigarette?
Speaker 1 (02:07):
Probably in the afternoon, Like when I was doing films
and shooting, I didn't have the taste for it. And
one thing I did for a period of time, I
smoked cigars. To give up cigarette smoking. I would be
on the road shooting films, traveling and I'd be making
films and I could smoke cigars there unrepentantly because my
wife was miles away, and I'd fire up and there
was a period where I was smoking three of these
(02:29):
big fat boomers every day. Well, I want to ask
you in terms of I can probably guess what the
order is in terms of the number of people who
were consuming the following. But I was wondering, from your
research and from your work, are they all equivalently bad
in their own way? And I'm talking about cigarettes, pipes, cigars,
(02:49):
chewing tobacco.
Speaker 2 (02:50):
It's very different in terms of harm, right, And cigarettes
are at the pinnacle of risk, and cigars if you
inhale them, or pipes you inhale them, are also pretty risky.
So inhalation is a key issue with tobacco products. The
key factors I think about and talking about different types
of tobacco use. For it to be popular, it's got
(03:13):
to get nicotine to the brain. Secondly, it's got to
taste good. It's got to be pleasant for the user
to be using. Often non users don't like it, but
users like the taste of it and smell of it.
And third's got to be a convenient product. So if
you go back to the eighteen hundreds, when the US
was a largely rural society, the most popular form of
(03:35):
tobacco with smokeless tobacco, chewing tobacco, wet snuff, moist snuff.
It got nicotine to the brain, it tasted good to
the user, and it also didn't burn the barn down
in an agrarian society, so that was a real advantage.
But at the end of the eighteen hundreds, something called
the germ theory of disease became common and public spitting
(03:56):
got outlawed in major cities all over the country. So
spitting became very inconvenient. And it's hard to use chewing
tobacco if you don't have an opportunity to spit. And
the late eighteen hundred cigars started to become popular.
Speaker 1 (04:11):
But also interjected that back in those days there were
spittoons everywhere, replaces to spit.
Speaker 2 (04:16):
There's a wonderful account by Charles Dickens who visited the
United States when chewing tobacco was king, and he was
grossed out by all the spitting that he saw. But
General Ulysses S. Grant, former President Ulysses S. Grant, died
a very public death in eighteen eighty five of jaw cancer.
It was the New York Times of supporting daily on
(04:38):
the state of his health, and people got afraid of
cigars because here you have this major figure dying of
a very painful jaw cancer. That set the stage for cigarettes.
Cigarettes started, if you will, as a safer kind of smoke.
It was think of it. It was so safe you
could inhale it easily. So in the early twentieth century
(05:01):
that was the first time that there was a national
marketing of cigarettes. Previously there had been local brands of cigarettes,
but then they became national brands like Camel and Lucky
Strike in Chesterfield, and Cigarette You started to take off dramatically.
So physicians in the nineteen twenties almost never sought a
(05:22):
case of lung cancer in their patients. In the nineteen
thirties and forties, they started to see lung cancer, and
this is coincident with the rise in cigarettes. Now marketing
modern marketing, emotionally based marketing, imagery based marketing became important
in the twentieth century and cigarettes was the biggest funder
(05:42):
of advertising agencies, and there was no better marketer of
cigarettes than movies. Companies were paying to get their products
placed in movies. Now I know, Alec, you were interviewed
in the twenty sixteen Toronto International Film festal Well, you
talked about major actors who influenced you, and you spoke
(06:04):
about their colorful, stylized performances. I'd like to mention four
people that you mentioned in order. Jimmy Cagney. James Cagney,
you mentioned his performance in White Heat. In that performance,
Cody Jarrett doesn't touch a cigarette. Turns out that Cagney
disliked cigarettes. He had been forced to market them in
early films. Cagney was a pipe smoker. Cagney died at
(06:28):
eighty six, eighty six years old. Keep that in mind.
Let's go to the next actor you mentioned, Humphrey Bogart.
I would say that for Humphrey Bogart, a cigarette was
a kind of supporting actor in his performances. I mean,
you can't imagine many of his performances without a cigarette
being a player in it. Humphrey Bogart died of aesophageal
(06:50):
cancer at age fifty seven fifty seven. Next, you mentioned
Gary Cooper, who died at sixty. Gary Cooper advertised Lucky
Strikes in the nightenineteen thirties, and one of his print
ads he says, ever since switching to Lucky's, my throat
has been in fine shape. Now, if you think of it,
that's a bit of a health claim that an irritating
(07:12):
product is a more dangerous product. Clark Gable use praised
Clark Gable's performance in The Misfits. Two days after The
Misfits wrapped, Gable had a heart attack and he was
dead ten days later at age fifty nine. Now that
comparison is just meant to get one's attention. That's not
scientific data. But you've got Magna dyeing dying at a
(07:35):
ripe old age of eighty six, and these major figures
dying much too young. Let me talk a bit about
the percentage of smokers in the United States and how
that rose in nineteen forty young men at about twenty
years old. Eighty percent of young men were smoking in
nineteen forty eighty percent. If you jump to the most
(07:57):
recent data provided by the CDC in twenty two twenty one,
looking at a similar age group, people eighteen to twenty four,
only five percent are smoking. So think of it when
eighty percent of people are doing it. That's a very
trendy activity. But the social pressures have changed. Smoking has
become much more stigmatized and the bands that have become
(08:20):
commonplace on indoor smoking and government buildings in many states.
That adds to the inconvenience of smoking.
Speaker 1 (08:33):
Doctor Lynn Kaslowski. If you enjoy conversations with experts in
public health, check out my episode with doctor Anthony Fauci,
former director of the National Institute of Allergy and Infectious Diseases.
Speaker 3 (08:47):
Is know what a disease that can actually kill you
by a rispiratory root? That is that people half of
them don't have any symptoms. When we realize that, it
became clear that we really needed to do mass But
yet people who want to be ultraly critical will say, oh,
he flip flops. If you don't change your mind with
(09:10):
the evolution of the new information, then you are really
guilty of something that's not good.
Speaker 1 (09:19):
To hear more of my conversation with doctor Fauci, go
to Here's the Thing dot org. After the break, doctor
Lynn Kozlowski gives a risk assessment for smoking traditional cigarettes
versus vaping. I'm Alec Baldwin and you're listening to. Here's
(09:44):
the thing. There are currently an estimated twenty eight point
three million people in the United States who smoke, which
incredibly is nearly twelve percent of adults. The figures can
seem inexplicable when put up against the the fact that
smoking manufactured cigarettes is the leading cause of premature death
(10:05):
in much of Europe and North America, and smoking related
diseases killed forty one million people in the US, UK,
and Canada between nineteen sixty and twenty twenty. Doctor Lynn
Keslowski has spent his career studying the deleterious effects of smoking.
Working with these statistics must be no easy task, so
(10:28):
I was curious to learn how he found his way
to this line of study.
Speaker 2 (10:34):
My doctoral dissertation, which was conducted in nineteen seventy four,
looked at the relationship between coffee drinking and nicotine use,
coffee drinking and cigarette smoking. So I had an early
contact with cigarette research and my mentor at Columbia University,
Stanley Schachter, a very noted psychologist. He well, I would
(10:55):
say he was my beloved mentor, and he was a
very heavy smoker, and he got into smoking research initially
because he was interested in the issue of why does
smoking seem to calm people down when they're in stressful circumstances.
Speaker 1 (11:10):
What was his answer, Well, that's.
Speaker 2 (11:12):
Actually kind of interesting because what we looked at. I
was involved with those studies that it turns out that
under stress, your urine becomes more acidic and you excrete
more nicotine from your blood, and so that under stressful circumstances,
more nicotines leaving your bloodstream, and so you need to
(11:32):
smoke more to maintain your doses of nicotine. And I
would say the chacter, a very heavy smoker, smoked as
soon as his eyes opened in the morning. He knew
he was addicted to cigarettes, and so I learned a
lot from him.
Speaker 1 (11:49):
So throughout your career, smoking has been the bulwark of
what you've done.
Speaker 2 (11:52):
Correct, Yeah, largely. My first job was at Western University,
and it was harder to do the kind of smoking
research that I wanted to do there. And then I
got a job in Toronto at the Addiction Research Foundation
to become head of their behavioral research on tobacco use,
and that was a perfect environment where I had physician colleagues,
(12:14):
pharmacologist colleagues to collaborate with so in Toronto. That was
the focus of my research.
Speaker 1 (12:22):
So when you start the Department of Health Behavior at
the University of Buffalo, I mean one would assume even
somebody that doesn't know much about the infrastructure of academia
and the protocols of academia, you don't just walk up
and go, hey, I got this idea. What were you
working on that they thought was important?
Speaker 2 (12:41):
Well, I think the reason I got that job is
that I had long experience as a department head at
Penn State. I'd been department head for a department of
buyby Here Full of Health at Penn State for over
a decade, and so that experience as an academic and administrator,
(13:01):
as well as having significant research credentials, was what wanted
them to recruit me. They were trying to get the
new School of Public Health and Health Professions accredit it
as a school of public health, and they needed to
create that new department. And in terms of public health,
tobacco use has been one of the major public health
issues of twentieth century.
Speaker 1 (13:22):
For me, the arc of smoking. I mean, I remember
when I first came into this business, people lit cigarettes
on the set of the TV show at thirty Rockefeller Plose.
We'd be on the set of a soap opera that
I was doing. The first job I had was one
of the old school soap operas, and I could name
a handful of people who were smokers, and those people
who were non smokers didn't really say anything. They didn't
(13:44):
really complain me. Now, you wouldn't hesitate to scold someone
who's smoking publicly. I'll never forget. There was this line
that someone said, they said, the moomme outlaws smoking. Only
outlaws will smoke. You're really going to alienate them in
a very strong and very kind.
Speaker 2 (13:58):
Of aggressive wayeen eighties, at the Addiction Research Foundation in Toronto,
clinicians who were working with people with cocaine dependencies and
opioid dependencies in their clinical sessions, they would often share cigarettes.
The clinician and the patient would share a cigarette. Now,
after a decade's work, that stopped that notion of it
(14:21):
was appropriate for a clinician to be sharing a cigarette
with somebody with alcohol or opioid problems. That was recognized
as an ato, But in nineteen eighty it was commonplace.
Speaker 1 (14:34):
So for me, the next turn of the wheel, if
you will, is these labels on cigarettes, which have become
increasingly dire over the years have gone by. I mean
they might as well say, you know, if you smoke,
one of your eyeballs is going to fall out. I mean,
they make it as stark and as dramatic as they can.
When those first came on, I recall that the tobacco
industry fought it tooth and nail. They didn't want those
(14:56):
warnings on those cigarette pecks. Did that have a big
effect on people warning labels in general?
Speaker 2 (15:01):
Yes, I would say the United States is behind many
other places in the world in terms of warning labels.
Speaker 1 (15:09):
Where are the warning labels more effective as far as
you're concerned.
Speaker 2 (15:12):
Canada, the United Kingdom, they have graphic images of diseases
and set of loss to people and so on, and
so much so that there was sure it still happens
in Canada that when they first came on the pack,
some smokers were buying little pouches or slipcases as they
(15:32):
could put their packs in so they didn't have to
look at the image of it. But no, there's no
doubt that the strong warning labels do help remind smokers
that it's a problem to be smoking.
Speaker 1 (15:44):
Yeah, I mean, I was always wondering because I thought,
here's a set of words on the side of a box,
and you got a cigarette in your hand, and you're
just somebody who smoking is as natural as breathing or
drinking water. If you're a real smoker, it just doesn't
even occur to you. And here's a bunch of words
on a box. How much of an efact is they're
really going to have? But it had some effect?
Speaker 2 (16:02):
Yeah, Actually there have been in the US, there been
some i would call negative effects to some of the warnings.
You asked about the risks of different products. It turns
out that smokeless tobacco products like moist snuff, the thing
you put between your cheek and gums, that's much much
less dangerous than cigarettes. Really, think about it, if you're
not getting stuff in your lungs, that alone is going
(16:25):
to knock off the majority of things that kill you
from smoking. Lung cancer and respiratory diseases are the majority
of things that kill you from smoking cigarettes. And with
the first warning labels on smokeless tobacco products included a
warning label that the industry supported, and it was this
(16:45):
product is not a safe alternative to cigarettes. Now it
turns out that the way consumers interpreted that warning this
product is not a safe alternative cigarettes, they interpreted as
saying they're just as dangerous as cigarettes, when in fact
they're much dangerous and cigarettes. Let me give you a
good example of that. I would bet you would think
(17:05):
that oral tobacco like that is a major cause of
oral cancer.
Speaker 1 (17:10):
I would assume. Yeah.
Speaker 2 (17:11):
It turns out cigarettes are a bigger cause of oral
cancer than those products. Why, just because of the nature
of the toxins exposed in the mouth and some of them,
so the people don't know that.
Speaker 1 (17:22):
I would have assumed otherwise. Yeah.
Speaker 2 (17:24):
Yeah. And it turns out there are gross misunderstandings about
the risks of different dement For example, if you talk
about vaping products e cigarettes, that public understanding of the
harms of vaping products has gotten more mistaken and more
mistaken that a few years ago, about half of people
(17:46):
were saying that vaping is equal in harm or more
harmful in cigarettes. It turns out the eighty three percent
of smokers think that vaping is as dangerous or more
dangerous in cigarettes. And why did they think that, I'm
not entirely clear why they do, But they're wrong. It
turns out that again, when you get all of the
(18:07):
carcinogens out of smoke, and that's what you're taking to
your lungs, you do your lungs a big favor. Still
an addictive product, but it's much less dangerous than cigarette.
So there's a lot of studies now showing that it's
a useful tool for adult smokers to give up smoking
to switch to nicotine vape.
Speaker 1 (18:28):
Well, well, I want to get to vape right after
this next point, which is that So in the next advancement,
if you will we have the labels, then you have
the outright banning of smoking. You start having smoking is
not in places, an increasing number of places, and people
have to go into a special room. Then they get
rid of those rooms. They disappear. If they had them
(18:48):
at airports for a while, here's the smoking room, and
you saw everybody in a cloud of smoke inside some
little chamber. I mean, I've lived in New York, you know,
nearly all of my adult life, and you see people
go from they go outside and they want to smoke
so bad, and it's pouring rain, it's freezing cold. They're
hunched over. Then they drive them away from the entrance
(19:11):
of the building. The signs appear everywhere. You cannot smoke
within one hundred feet of this entrance or fifty feet,
so people have to go down, they have to walk
down to the side of the building and blah blah blah.
I mean, we've made it as difficult as possible in
many parts of the country. Is it having an effect?
Is smoking in a downward trend now in the twenty
(19:32):
twenty three Oh definitely.
Speaker 2 (19:33):
I mean it's a whole bunch of things that have
ganged up on smoking to diminish it. I mean, the
indoor smoking rules have had a big effect. Remember when
there were television ads for cigarettes. Of course, there was
a period when there was an equal time law that
you could get anti smoking ads on TV. It turned
(19:54):
out those anti smoking ads had a big effect on
discouraging smoking, so much so the companies were kind of
happy to get off TV because that equal time anti
smoking ad would go away.
Speaker 1 (20:07):
Then that battle was over. Yeah. Now, obviously in the
business I've worked in for several years, there's been a
lot of push to cut smoking. That it was a
bad idea and a poor role model for a lot
of kids. But that idea, the social stigma. You know,
in Hollywood and TV, you know pretty much banning it.
(20:27):
I mean, if you're going to smoke a cigarette, you
better be playing Edward R. Murrow in order to be
smoking a cigarette in the scene. But in my business
that had a profound effect, I think, which they wanted
us to be role models in.
Speaker 2 (20:38):
Some way, and you were role models. But let me
say something about a watershed in the United States, and
I was the nineteen sixty four Surgeon General's report which
came out declaring smoking as a cause of cancer. Within
days of the nineteen sixty four report being released, Carlton
(20:59):
cigarette were advertised for the first time. Carlton were ultra
ultra low tar cigarettes one milligram tar zero point one
milligram nicotine. And if you will, that was the start
of an ultra light light boondoggle that came about right
(21:19):
after the nineteen sixty four report that people were thinking,
I'm better off smoking a light cigarette than a full
flavor cigarette, better off smoking an ultra light And it
turned out it took years of research to show that
that wasn't the case, and that one of the key
features in creating a one milligram tar cigarette is to
take the filter and punch a whole bunch of holes
(21:40):
in it. They make it eighty percent diluted with air.
So when the smoking machine takes a puff on the cigarette,
it's trying in eighty percent air with each puff, and
that's diluting it. Now, what does a human smoker do
with a cigarette that's eighty percent ventilated. Some push it
a little bit further in their mouth and their lips
cover the vents, and that gets more smoke to their lungs,
(22:03):
or they take bigger puffs, or they take more puffs.
So in the early days of this tar derby, in
the sixties, seventies and eighties, standard smoking machine tests were
conducted by the government, and it turned out that people
don't smoke like smoking machines. They take bigger puffs. If
they want to, they take more puffs. And I had
(22:24):
colleagues who did research on smoking machines that show you
could have one cigarette that in a standard run and
a smoking machine gave you seventeen milligrams of tar one
seven seventeen milligrams of tar. But if you adjusted the
machine to simulate a heavy smoke, big puffs, lots of puffs,
you could get seventy milligrams of tar from the same cigarette,
(22:47):
so that one of the key issues with cigarettes is
that what you get from it depends how you puff
on it. It's not like a pill. It's not like with
a bottle of beer. If you don't miss your mouth,
you know how much alcohol you get from a b beer.
With a cigarette, it's a race between what's going in
the air and what's going in your lungs. And people
(23:07):
can compensate, and they did.
Speaker 1 (23:08):
There's games you can play with smoke.
Speaker 2 (23:10):
And so that people from with ultra light cigarettes could
get as much as they were getting from bull Flavor.
And that's actually one of the reasons why light and
ultra light designations were removed. But people still know what
a light and ultra light is because they can feel
it from the taste of it. They taste different. I'm
wondering if I could say a bit about cigars, please.
(23:30):
The sixty four report came out and a few days later,
the president of the American Medical Association was on the
Today Show saying, if you can't give up cigarettes, you
might switch to cigars or pipes. You'd be better off
because in the sixty four report, cigars and pipes got
a clean bill of health. It wasn't seen as a
major cause of disease. And the reason for that was
(23:53):
that the epidemiology at the time was based on people
who were so called primary cigar smokers smoke cigarettes, they'd
only smoke cigars, and those primary cigar smokers tended to
not inhale cigars. So called secondary cigar smokers, people who
were cigarette smokers switching to cigars, they tend to maintain
(24:14):
the habit of inhalation, and that's a key issue in
terms of the health risk. The other thing about cigars,
as you know, smoking big cigars sometimes that sometimes it
could take as much as an hour to smoke a
big cigar. You could smoke sick cigarette does take an hour.
You could smoke six cigarettes in the same interval. Yes,
So when somebody says I just smoke two or three cigars,
(24:37):
you got to consider how big are those cigars, how
much puffing are they doing, are they inhaling and to
the extent they're inhaling, to extent they're getting a lot
of tobacco in their lungs. It's not a harm reducing
product to be smoking cigars. The other thing about inhalation.
I actually did research on this when I was in Canada.
(24:58):
People can reliably tell you whether they inhale cigars or not.
They know whether they.
Speaker 1 (25:03):
Inhale tobacco expert doctor Lynn Kozlowski. If you're enjoying this conversation,
tell a friend and be sure to follow Here's the
thing on the iHeartRadio apps, Spotify or wherever you get
your podcasts. When we come back, doctor Lynn Kozlowski tells
us what he believes is the best way to quit smoking.
(25:38):
I'm Alec Baldwin and you're listening to Here's the thing.
The data is sobering. Smokers who start early in life
and keep smoking can lose up to a decade of
life expectancy. I wanted to know for those who were interested,
if doctor Lynn Koslowski thought there was the best time
in their lives to quit smoking.
Speaker 2 (26:00):
As early as possible. Thirty is a benchmark if you
can do it by thirty, and I think that needs
to be promoted more widely. Probat Jaw, an epidemiologist at
the University of Toronto, recently reviewed a lot of epidemiological
studies and has come up with a very simple summary
of the health risks of smoking, and the evidence shows
that at least one in two smokers dies prematurely and
(26:24):
they lose on an average ten years of life. And
if a smoker can stop at age thirty, they go
back to the longevity expectations of a never smoker. So
if you can get people to stop at age thirty,
that's great. At age forty it's ninety percent of a
return to being a never smoker. At age fifty, you
(26:45):
gain six years of life if you start smoking, and
at age sixty's four years of life. I think there
are a number of tools that people have to help
them quit smoking, but I want to emphasize that those
are tools, and I think of changing flo tire on
a car. A lug wrench is a very useful tool
for changing a flat tire, but it's a lot of
(27:06):
work to change that tire. Any of these tools you
might use for renclean is a prescription drug you might
use to help quit smoking, nicotine replacement products, patch gum, lozenges,
nicotine pouches, vaping. They're tools, and it's an important thing
for the smoker. Not to be satisfied with just cutting
(27:28):
down a bit on smoking. Your goal should be to
try to get off smoking completely and switch to those
other products, and then once you're securely off smoking, you
can think about getting off those other products.
Speaker 1 (27:41):
So to the extent you can say, what do you
think in the marketplace right now, would you say is
among not the best, but among the best ways to
quit smoking.
Speaker 2 (27:49):
I think for older adult smokers, vaping products are among
the best ways to quit smoking, that they can provide
the most satisfactory substitution for cigarettes. The other thing about
quitting smoking is that repeated attempts you get smokers get
better at it. For example, I've known people have given
up smoking. They've been off for several months. They go
(28:10):
to a gathering where others are smoking, and they think
I could just have one cigarette. They do. They end
up there wrong. So the next time they try to
give up smoking, they know better. They know better than
to be fooled by the illusion that I could just
have one. And then I think there's also a kind
of no more nice guy effect that people trying repeatedly
give up they finally dig their heels in and have
(28:34):
learned from what did and didn't work. I mean, I
had one person tell me I tried this and I
was off smoking for a year, and I said, that's
a pretty good technique to try again. If you were
off smoking for a year.
Speaker 1 (28:47):
I mean renew that subscription for another year.
Speaker 2 (28:50):
So I think it's important for smokers to keep at
it now. The other thing about the health risks of smoking,
the cardiovascular risks diminish very quickly within months once you
stop smoking. The cancer risks are a bit of a
different animal. The process of smoking is causing some cancer
related issues to develop, and it takes longer for you
(29:13):
to get the benefit of stopping smoking with respect to cancer.
But the key message is stop as soon as you can.
Speaker 1 (29:20):
We'll get to vaping now, which is I mean to me?
I find vaping just kind of just exploded. And I
live in New York, and you know, street level in
New York is nothing but food shops, coffee shops, and
places to buy smoking paraphernalia and vaping. I was in
a restaurant last night with my wife and a couple
of friends, and it's a very nice restaurant, actually, one
(29:41):
that we go to all the time in our neighborhood.
And some young guy was there, probably twenty five in
his late twenties, and his girlfriend and he whips out
of machines, you know, whips out the device, starts vaping
in the restaurant, which I don't think he was necessarily
that wasn't permissible, But he goes ahead and vapes, And
I thought, you know, what was the advent of vap
meaning who developed this kind of stuff? And to explain
(30:02):
to people who think they know what vaping is, vaping
is a delivery system for like a liquid form or
some other kind of form of nicotine, and they've extracted
all the bad stuff for most of it.
Speaker 2 (30:14):
Yeah, the key thing is that the tobacco's gone in vaping,
and you can vape all kinds of drugs like cannabis
with a vaping product if you want to as well.
But the key advantage is that there's no combustion, that
you don't get the smoke and the tar and the glop,
and you don't get the complex ingredients arising from burned tobacco.
(30:35):
First products were developed in China, but there have been
a lot of different generations of products. And it's interesting.
I mentioned some of my college roommates smoked, and the
heaviest smoker I ever knew was my college roommate who
smoked unfiltered black tobacco goal walls. You could hear him
when he walked into the room, just by the sound
(30:57):
of his inhlation. You could hear him into a room.
He took such a big drag. I learned years later
that he had switched to East cigarettes. So I called
him up and said, you know, how could this be?
You were the heaviest smoker I ever knew, And he said,
I love him. Actually, it was interesting he could indulge
in his sense of connoisseurship by picking the right kind
(31:20):
of vape product and the right kind.
Speaker 1 (31:22):
Of flavor he liked.
Speaker 2 (31:23):
But he was off cigarettes, and so that was very
impressive to me to have that. One testimonial from an
old friend who was able to switch to vape said
he was the better for it.
Speaker 1 (31:34):
So is it safe to say that, in terms of
all the components that you regard and the metrics that
you regard, that vaping is much safer than cigarette smoking.
Speaker 2 (31:43):
I have no doubt about it. Right, Cigarettes inhale cigarette
smokes are at the pinnacle of risk. Smokeless tobacco products
are much less dangerous than cigarettes. Nicotine vaping is probably
a little less dangerous than smokeless tobacco, nicotine pouches. You're
really quite low levels of harm. I don't want to
suggest that any of these products are health foods, but
(32:05):
they reduce risk dramatically.
Speaker 1 (32:08):
But vaping has its hazards as well well.
Speaker 2 (32:10):
The anti tobacco forces were very quick to jump upon
lung problems that were being caused by vaping. They even
gave it a name, e Valley of Electronic Vaping Lung Disease.
It turns out that that arose largely from people smoking
black cannabis vapes that were polluted with toxins that did
(32:36):
cause lung problems in other countries. Is of a non
issue that once they got rid of that black market
vaping product, it hasn't been an ongoing issue, but the
field has continued to latch onto this, Oh, you can
get lung problems from vaping based on this bout of
lung disease a few years ago. But inhale cigarettes are
(32:59):
at the pinnacle.
Speaker 1 (32:59):
Of ris They're the highest threat and they.
Speaker 2 (33:02):
Takes a big jump down, and things like a pouch
that have no inhalation at all are much much less risky.
Speaker 1 (33:10):
I will say that in my lifetime borders a couple
of different realities as far as smoking as concerned. My
father was a cigarette smoker, he was a pipe smoker.
He quit cigarettes the smoke pipes. He died at the
age of fifty five of lung cancer. My smoking, and
I will say that with unless I was completely inebriated,
unless I was completely shit faced on some drugs and alcohol,
(33:32):
which was certainly accompanied by a good amount of smoking
and my drug use and drinking. But when I was
in my right mind and I smoked, I knew it
was wrong every time I did it. Every single time
I put a cigarette in my mouth, I said this
is wrong. I shouldn't do this. I remember saying to myself, Okay,
this is a stupid idea. Click and I'd light up.
Speaker 2 (33:51):
Yeah, even a long time ago, people call cigarettes coffin mail.
Speaker 1 (33:54):
Right, right, But I was going to say, I'm many
years in sobriety, I'm cleaning sober threaty seven years. And
the only reason I mentioned is because this idea of addiction,
of finding a way to cure the addictive mechanism, the
addictive synaptic whatever it is that happens in human beings
as it relates to smoking, as it relates to eating.
(34:15):
Of course, smoking compounded with obesity. People who are not
even morbidly obese, but who are significantly overweight and smoke,
I mean that must be a double whammy for them, correct, Sure, I.
Speaker 2 (34:27):
Mean it turns out that heavy smokers have a worse
diet than non smokers. Heavy smokers are more like to
eat more fried foods, fewer fruits and vegetables. There are
a whole bunch of things going on with heavy smokers
that contribute to health ruts.
Speaker 1 (34:43):
You were mentioning before the name of a drug that
I don't recall what you said. Now, what is that?
Speaker 2 (34:48):
It's a drug that FDA approved smoking cessation aid.
Speaker 1 (34:52):
That addresses addiction.
Speaker 2 (34:54):
It's a treating addiction. Yeah, it's a drug that's shown
to help you stop smoking. That's a little bit, little
bit too ambitious a claim. I mean that in terms
of nicotine replacement products like nicotine vape, it's a harm
reduction technique. You're replacing a very toxic form of nicotine
use with a much less toxic form of nicotine use.
(35:15):
But the addiction doesn't go away. It might be decreased.
Speaker 1 (35:18):
That's a dream, isn't it To address that addictive component
in the human brain and human behavior.
Speaker 2 (35:24):
There are other factors too. It's not just the addiction,
it's the environment you're in that For example, if you
have a spouse who smokes and isn't giving up, good
luck trying to give up smoking yourself. I mean, so
these powerful social factors. If you have coworkers who are
your best friends going outside in the winter time to smoke,
(35:45):
you've got social pressures to continue to smoke. But go
back to that figure of five percent of eighteen to
twenty four year olds smoking in the United States, Now
that's a nice low number compared to the eighty percent
in nineteen. So there's been progress, has been a huge progress.
Speaker 1 (36:07):
My thanks to doctor Lynn Keaslowski. This episode was recorded
at CDM Studios in New York City. Were produced by
Kathleen Russo, Zach MacNeice, and Maureen Hobin. Our engineer is
Frank Imperial. Our social media manager is Danielle Gingrich. I'm
Alec Baldwin. Here's the thing is brought to you by
iHeart Radio.
This is Alec Baldwin, and you were listening to Here's
the Thing from iHeartRadio. These days, a pack of Marlboroughs
could set you back thirteen dollars. If you actually want
to smoke them, You've got to stand in a designated
area twenty five feet from the building's entrance, and the
package will contain the most dire warnings of illness and death.
(00:26):
Overcoming these hurdles requires a true commitment to the habit.
It's enough to ask who is still smoking? My guest today,
Doctor Lin Koslowski is here to shed some light on
this question. Doctor Kozlowski is an expert on tobacco use
and nicotine policy and his professor Emeritus and Dean Emeritus
(00:48):
of Community Health and Health Behavior at the University at Buffalo.
He is also a founding member of the Society for
Nicotine and Tobacco Research and has contributed to four US
Surgeon General's Reports of smoking. I wanted to know if
doctor Kozlowski was ever tempted to pick up a pack himself.
Speaker 2 (01:10):
I certainly tried to be a smoker, so in high
school I experimented. In college, I had roommates who were
devoted heavy smokers. I tried to smoke. There was no
moral sense had got in the way. I just kept
getting sick from smoking, so it wasn't worth it to me.
But so it's fair to say I was tempted. I tried.
(01:31):
I experimented with packs of cigarettes and pipes and cigars
and so on. But I never became a regular smoker.
Speaker 1 (01:39):
I smoked, never heavily, never habitually. I'd smoke usually when
I was shooting a film, because filmmaking is such a
boring process. You work for ten or fifteen minutes, then
you go away for an hour while they get ready
for the next angle, and so forth. And I smoked
out of boredom on the sets of films and so forth,
And whenever the project was over and I went home,
quote unquote, I stopped because the people in my life
(02:01):
wouldn't tolerate that.
Speaker 2 (02:03):
So when you were smoking, how early in the morning
did you have your first cigarette?
Speaker 1 (02:07):
Probably in the afternoon, Like when I was doing films
and shooting, I didn't have the taste for it. And
one thing I did for a period of time, I
smoked cigars. To give up cigarette smoking. I would be
on the road shooting films, traveling and I'd be making
films and I could smoke cigars there unrepentantly because my
wife was miles away, and I'd fire up and there
was a period where I was smoking three of these
(02:29):
big fat boomers every day. Well, I want to ask
you in terms of I can probably guess what the
order is in terms of the number of people who
were consuming the following. But I was wondering, from your
research and from your work, are they all equivalently bad
in their own way? And I'm talking about cigarettes, pipes, cigars,
(02:49):
chewing tobacco.
Speaker 2 (02:50):
It's very different in terms of harm, right, And cigarettes
are at the pinnacle of risk, and cigars if you
inhale them, or pipes you inhale them, are also pretty risky.
So inhalation is a key issue with tobacco products. The
key factors I think about and talking about different types
of tobacco use. For it to be popular, it's got
(03:13):
to get nicotine to the brain. Secondly, it's got to
taste good. It's got to be pleasant for the user
to be using. Often non users don't like it, but
users like the taste of it and smell of it.
And third's got to be a convenient product. So if
you go back to the eighteen hundreds, when the US
was a largely rural society, the most popular form of
(03:35):
tobacco with smokeless tobacco, chewing tobacco, wet snuff, moist snuff.
It got nicotine to the brain, it tasted good to
the user, and it also didn't burn the barn down
in an agrarian society, so that was a real advantage.
But at the end of the eighteen hundreds, something called
the germ theory of disease became common and public spitting
(03:56):
got outlawed in major cities all over the country. So
spitting became very inconvenient. And it's hard to use chewing
tobacco if you don't have an opportunity to spit. And
the late eighteen hundred cigars started to become popular.
Speaker 1 (04:11):
But also interjected that back in those days there were
spittoons everywhere, replaces to spit.
Speaker 2 (04:16):
There's a wonderful account by Charles Dickens who visited the
United States when chewing tobacco was king, and he was
grossed out by all the spitting that he saw. But
General Ulysses S. Grant, former President Ulysses S. Grant, died
a very public death in eighteen eighty five of jaw cancer.
It was the New York Times of supporting daily on
(04:38):
the state of his health, and people got afraid of
cigars because here you have this major figure dying of
a very painful jaw cancer. That set the stage for cigarettes.
Cigarettes started, if you will, as a safer kind of smoke.
It was think of it. It was so safe you
could inhale it easily. So in the early twentieth century
(05:01):
that was the first time that there was a national
marketing of cigarettes. Previously there had been local brands of cigarettes,
but then they became national brands like Camel and Lucky
Strike in Chesterfield, and Cigarette You started to take off dramatically.
So physicians in the nineteen twenties almost never sought a
(05:22):
case of lung cancer in their patients. In the nineteen
thirties and forties, they started to see lung cancer, and
this is coincident with the rise in cigarettes. Now marketing
modern marketing, emotionally based marketing, imagery based marketing became important
in the twentieth century and cigarettes was the biggest funder
(05:42):
of advertising agencies, and there was no better marketer of
cigarettes than movies. Companies were paying to get their products
placed in movies. Now I know, Alec, you were interviewed
in the twenty sixteen Toronto International Film festal Well, you
talked about major actors who influenced you, and you spoke
(06:04):
about their colorful, stylized performances. I'd like to mention four
people that you mentioned in order. Jimmy Cagney. James Cagney,
you mentioned his performance in White Heat. In that performance,
Cody Jarrett doesn't touch a cigarette. Turns out that Cagney
disliked cigarettes. He had been forced to market them in
early films. Cagney was a pipe smoker. Cagney died at
(06:28):
eighty six, eighty six years old. Keep that in mind.
Let's go to the next actor you mentioned, Humphrey Bogart.
I would say that for Humphrey Bogart, a cigarette was
a kind of supporting actor in his performances. I mean,
you can't imagine many of his performances without a cigarette
being a player in it. Humphrey Bogart died of aesophageal
(06:50):
cancer at age fifty seven fifty seven. Next, you mentioned
Gary Cooper, who died at sixty. Gary Cooper advertised Lucky
Strikes in the nightenineteen thirties, and one of his print
ads he says, ever since switching to Lucky's, my throat
has been in fine shape. Now, if you think of it,
that's a bit of a health claim that an irritating
(07:12):
product is a more dangerous product. Clark Gable use praised
Clark Gable's performance in The Misfits. Two days after The
Misfits wrapped, Gable had a heart attack and he was
dead ten days later at age fifty nine. Now that
comparison is just meant to get one's attention. That's not
scientific data. But you've got Magna dyeing dying at a
(07:35):
ripe old age of eighty six, and these major figures
dying much too young. Let me talk a bit about
the percentage of smokers in the United States and how
that rose in nineteen forty young men at about twenty
years old. Eighty percent of young men were smoking in
nineteen forty eighty percent. If you jump to the most
(07:57):
recent data provided by the CDC in twenty two twenty one,
looking at a similar age group, people eighteen to twenty four,
only five percent are smoking. So think of it when
eighty percent of people are doing it. That's a very
trendy activity. But the social pressures have changed. Smoking has
become much more stigmatized and the bands that have become
(08:20):
commonplace on indoor smoking and government buildings in many states.
That adds to the inconvenience of smoking.
Speaker 1 (08:33):
Doctor Lynn Kaslowski. If you enjoy conversations with experts in
public health, check out my episode with doctor Anthony Fauci,
former director of the National Institute of Allergy and Infectious Diseases.
Speaker 3 (08:47):
Is know what a disease that can actually kill you
by a rispiratory root? That is that people half of
them don't have any symptoms. When we realize that, it
became clear that we really needed to do mass But
yet people who want to be ultraly critical will say, oh,
he flip flops. If you don't change your mind with
(09:10):
the evolution of the new information, then you are really
guilty of something that's not good.
Speaker 1 (09:19):
To hear more of my conversation with doctor Fauci, go
to Here's the Thing dot org. After the break, doctor
Lynn Kozlowski gives a risk assessment for smoking traditional cigarettes
versus vaping. I'm Alec Baldwin and you're listening to. Here's
(09:44):
the thing. There are currently an estimated twenty eight point
three million people in the United States who smoke, which
incredibly is nearly twelve percent of adults. The figures can
seem inexplicable when put up against the the fact that
smoking manufactured cigarettes is the leading cause of premature death
(10:05):
in much of Europe and North America, and smoking related
diseases killed forty one million people in the US, UK,
and Canada between nineteen sixty and twenty twenty. Doctor Lynn
Keslowski has spent his career studying the deleterious effects of smoking.
Working with these statistics must be no easy task, so
(10:28):
I was curious to learn how he found his way
to this line of study.
Speaker 2 (10:34):
My doctoral dissertation, which was conducted in nineteen seventy four,
looked at the relationship between coffee drinking and nicotine use,
coffee drinking and cigarette smoking. So I had an early
contact with cigarette research and my mentor at Columbia University,
Stanley Schachter, a very noted psychologist. He well, I would
(10:55):
say he was my beloved mentor, and he was a
very heavy smoker, and he got into smoking research initially
because he was interested in the issue of why does
smoking seem to calm people down when they're in stressful circumstances.
Speaker 1 (11:10):
What was his answer, Well, that's.
Speaker 2 (11:12):
Actually kind of interesting because what we looked at. I
was involved with those studies that it turns out that
under stress, your urine becomes more acidic and you excrete
more nicotine from your blood, and so that under stressful circumstances,
more nicotines leaving your bloodstream, and so you need to
(11:32):
smoke more to maintain your doses of nicotine. And I
would say the chacter, a very heavy smoker, smoked as
soon as his eyes opened in the morning. He knew
he was addicted to cigarettes, and so I learned a
lot from him.
Speaker 1 (11:49):
So throughout your career, smoking has been the bulwark of
what you've done.
Speaker 2 (11:52):
Correct, Yeah, largely. My first job was at Western University,
and it was harder to do the kind of smoking
research that I wanted to do there. And then I
got a job in Toronto at the Addiction Research Foundation
to become head of their behavioral research on tobacco use,
and that was a perfect environment where I had physician colleagues,
(12:14):
pharmacologist colleagues to collaborate with so in Toronto. That was
the focus of my research.
Speaker 1 (12:22):
So when you start the Department of Health Behavior at
the University of Buffalo, I mean one would assume even
somebody that doesn't know much about the infrastructure of academia
and the protocols of academia, you don't just walk up
and go, hey, I got this idea. What were you
working on that they thought was important?
Speaker 2 (12:41):
Well, I think the reason I got that job is
that I had long experience as a department head at
Penn State. I'd been department head for a department of
buyby Here Full of Health at Penn State for over
a decade, and so that experience as an academic and administrator,
(13:01):
as well as having significant research credentials, was what wanted
them to recruit me. They were trying to get the
new School of Public Health and Health Professions accredit it
as a school of public health, and they needed to
create that new department. And in terms of public health,
tobacco use has been one of the major public health
issues of twentieth century.
Speaker 1 (13:22):
For me, the arc of smoking. I mean, I remember
when I first came into this business, people lit cigarettes
on the set of the TV show at thirty Rockefeller Plose.
We'd be on the set of a soap opera that
I was doing. The first job I had was one
of the old school soap operas, and I could name
a handful of people who were smokers, and those people
who were non smokers didn't really say anything. They didn't
(13:44):
really complain me. Now, you wouldn't hesitate to scold someone
who's smoking publicly. I'll never forget. There was this line
that someone said, they said, the moomme outlaws smoking. Only
outlaws will smoke. You're really going to alienate them in
a very strong and very kind.
Speaker 2 (13:58):
Of aggressive wayeen eighties, at the Addiction Research Foundation in Toronto,
clinicians who were working with people with cocaine dependencies and
opioid dependencies in their clinical sessions, they would often share cigarettes.
The clinician and the patient would share a cigarette. Now,
after a decade's work, that stopped that notion of it
(14:21):
was appropriate for a clinician to be sharing a cigarette
with somebody with alcohol or opioid problems. That was recognized
as an ato, But in nineteen eighty it was commonplace.
Speaker 1 (14:34):
So for me, the next turn of the wheel, if
you will, is these labels on cigarettes, which have become
increasingly dire over the years have gone by. I mean
they might as well say, you know, if you smoke,
one of your eyeballs is going to fall out. I mean,
they make it as stark and as dramatic as they can.
When those first came on, I recall that the tobacco
industry fought it tooth and nail. They didn't want those
(14:56):
warnings on those cigarette pecks. Did that have a big
effect on people warning labels in general?
Speaker 2 (15:01):
Yes, I would say the United States is behind many
other places in the world in terms of warning labels.
Speaker 1 (15:09):
Where are the warning labels more effective as far as
you're concerned.
Speaker 2 (15:12):
Canada, the United Kingdom, they have graphic images of diseases
and set of loss to people and so on, and
so much so that there was sure it still happens
in Canada that when they first came on the pack,
some smokers were buying little pouches or slipcases as they
(15:32):
could put their packs in so they didn't have to
look at the image of it. But no, there's no
doubt that the strong warning labels do help remind smokers
that it's a problem to be smoking.
Speaker 1 (15:44):
Yeah, I mean, I was always wondering because I thought,
here's a set of words on the side of a box,
and you got a cigarette in your hand, and you're
just somebody who smoking is as natural as breathing or
drinking water. If you're a real smoker, it just doesn't
even occur to you. And here's a bunch of words
on a box. How much of an efact is they're
really going to have? But it had some effect?
Speaker 2 (16:02):
Yeah, Actually there have been in the US, there been
some i would call negative effects to some of the warnings.
You asked about the risks of different products. It turns
out that smokeless tobacco products like moist snuff, the thing
you put between your cheek and gums, that's much much
less dangerous than cigarettes. Really, think about it, if you're
not getting stuff in your lungs, that alone is going
(16:25):
to knock off the majority of things that kill you
from smoking. Lung cancer and respiratory diseases are the majority
of things that kill you from smoking cigarettes. And with
the first warning labels on smokeless tobacco products included a
warning label that the industry supported, and it was this
(16:45):
product is not a safe alternative to cigarettes. Now it
turns out that the way consumers interpreted that warning this
product is not a safe alternative cigarettes, they interpreted as
saying they're just as dangerous as cigarettes, when in fact
they're much dangerous and cigarettes. Let me give you a
good example of that. I would bet you would think
(17:05):
that oral tobacco like that is a major cause of
oral cancer.
Speaker 1 (17:10):
I would assume. Yeah.
Speaker 2 (17:11):
It turns out cigarettes are a bigger cause of oral
cancer than those products. Why, just because of the nature
of the toxins exposed in the mouth and some of them,
so the people don't know that.
Speaker 1 (17:22):
I would have assumed otherwise. Yeah.
Speaker 2 (17:24):
Yeah. And it turns out there are gross misunderstandings about
the risks of different dement For example, if you talk
about vaping products e cigarettes, that public understanding of the
harms of vaping products has gotten more mistaken and more
mistaken that a few years ago, about half of people
(17:46):
were saying that vaping is equal in harm or more
harmful in cigarettes. It turns out the eighty three percent
of smokers think that vaping is as dangerous or more
dangerous in cigarettes. And why did they think that, I'm
not entirely clear why they do, But they're wrong. It
turns out that again, when you get all of the
(18:07):
carcinogens out of smoke, and that's what you're taking to
your lungs, you do your lungs a big favor. Still
an addictive product, but it's much less dangerous than cigarette.
So there's a lot of studies now showing that it's
a useful tool for adult smokers to give up smoking
to switch to nicotine vape.
Speaker 1 (18:28):
Well, well, I want to get to vape right after
this next point, which is that So in the next advancement,
if you will we have the labels, then you have
the outright banning of smoking. You start having smoking is
not in places, an increasing number of places, and people
have to go into a special room. Then they get
rid of those rooms. They disappear. If they had them
(18:48):
at airports for a while, here's the smoking room, and
you saw everybody in a cloud of smoke inside some
little chamber. I mean, I've lived in New York, you know,
nearly all of my adult life, and you see people
go from they go outside and they want to smoke
so bad, and it's pouring rain, it's freezing cold. They're
hunched over. Then they drive them away from the entrance
(19:11):
of the building. The signs appear everywhere. You cannot smoke
within one hundred feet of this entrance or fifty feet,
so people have to go down, they have to walk
down to the side of the building and blah blah blah.
I mean, we've made it as difficult as possible in
many parts of the country. Is it having an effect?
Is smoking in a downward trend now in the twenty
(19:32):
twenty three Oh definitely.
Speaker 2 (19:33):
I mean it's a whole bunch of things that have
ganged up on smoking to diminish it. I mean, the
indoor smoking rules have had a big effect. Remember when
there were television ads for cigarettes. Of course, there was
a period when there was an equal time law that
you could get anti smoking ads on TV. It turned
(19:54):
out those anti smoking ads had a big effect on
discouraging smoking, so much so the companies were kind of
happy to get off TV because that equal time anti
smoking ad would go away.
Speaker 1 (20:07):
Then that battle was over. Yeah. Now, obviously in the
business I've worked in for several years, there's been a
lot of push to cut smoking. That it was a
bad idea and a poor role model for a lot
of kids. But that idea, the social stigma. You know,
in Hollywood and TV, you know pretty much banning it.
(20:27):
I mean, if you're going to smoke a cigarette, you
better be playing Edward R. Murrow in order to be
smoking a cigarette in the scene. But in my business
that had a profound effect, I think, which they wanted
us to be role models in.
Speaker 2 (20:38):
Some way, and you were role models. But let me
say something about a watershed in the United States, and
I was the nineteen sixty four Surgeon General's report which
came out declaring smoking as a cause of cancer. Within
days of the nineteen sixty four report being released, Carlton
(20:59):
cigarette were advertised for the first time. Carlton were ultra
ultra low tar cigarettes one milligram tar zero point one
milligram nicotine. And if you will, that was the start
of an ultra light light boondoggle that came about right
(21:19):
after the nineteen sixty four report that people were thinking,
I'm better off smoking a light cigarette than a full
flavor cigarette, better off smoking an ultra light And it
turned out it took years of research to show that
that wasn't the case, and that one of the key
features in creating a one milligram tar cigarette is to
take the filter and punch a whole bunch of holes
(21:40):
in it. They make it eighty percent diluted with air.
So when the smoking machine takes a puff on the cigarette,
it's trying in eighty percent air with each puff, and
that's diluting it. Now, what does a human smoker do
with a cigarette that's eighty percent ventilated. Some push it
a little bit further in their mouth and their lips
cover the vents, and that gets more smoke to their lungs,
(22:03):
or they take bigger puffs, or they take more puffs.
So in the early days of this tar derby, in
the sixties, seventies and eighties, standard smoking machine tests were
conducted by the government, and it turned out that people
don't smoke like smoking machines. They take bigger puffs. If
they want to, they take more puffs. And I had
(22:24):
colleagues who did research on smoking machines that show you
could have one cigarette that in a standard run and
a smoking machine gave you seventeen milligrams of tar one
seven seventeen milligrams of tar. But if you adjusted the
machine to simulate a heavy smoke, big puffs, lots of puffs,
you could get seventy milligrams of tar from the same cigarette,
(22:47):
so that one of the key issues with cigarettes is
that what you get from it depends how you puff
on it. It's not like a pill. It's not like with
a bottle of beer. If you don't miss your mouth,
you know how much alcohol you get from a b beer.
With a cigarette, it's a race between what's going in
the air and what's going in your lungs. And people
(23:07):
can compensate, and they did.
Speaker 1 (23:08):
There's games you can play with smoke.
Speaker 2 (23:10):
And so that people from with ultra light cigarettes could
get as much as they were getting from bull Flavor.
And that's actually one of the reasons why light and
ultra light designations were removed. But people still know what
a light and ultra light is because they can feel
it from the taste of it. They taste different. I'm
wondering if I could say a bit about cigars, please.
(23:30):
The sixty four report came out and a few days later,
the president of the American Medical Association was on the
Today Show saying, if you can't give up cigarettes, you
might switch to cigars or pipes. You'd be better off
because in the sixty four report, cigars and pipes got
a clean bill of health. It wasn't seen as a
major cause of disease. And the reason for that was
(23:53):
that the epidemiology at the time was based on people
who were so called primary cigar smokers smoke cigarettes, they'd
only smoke cigars, and those primary cigar smokers tended to
not inhale cigars. So called secondary cigar smokers, people who
were cigarette smokers switching to cigars, they tend to maintain
(24:14):
the habit of inhalation, and that's a key issue in
terms of the health risk. The other thing about cigars,
as you know, smoking big cigars sometimes that sometimes it
could take as much as an hour to smoke a
big cigar. You could smoke sick cigarette does take an hour.
You could smoke six cigarettes in the same interval. Yes,
So when somebody says I just smoke two or three cigars,
(24:37):
you got to consider how big are those cigars, how
much puffing are they doing, are they inhaling and to
the extent they're inhaling, to extent they're getting a lot
of tobacco in their lungs. It's not a harm reducing
product to be smoking cigars. The other thing about inhalation.
I actually did research on this when I was in Canada.
(24:58):
People can reliably tell you whether they inhale cigars or not.
They know whether they.
Speaker 1 (25:03):
Inhale tobacco expert doctor Lynn Kozlowski. If you're enjoying this conversation,
tell a friend and be sure to follow Here's the
thing on the iHeartRadio apps, Spotify or wherever you get
your podcasts. When we come back, doctor Lynn Kozlowski tells
us what he believes is the best way to quit smoking.
(25:38):
I'm Alec Baldwin and you're listening to Here's the thing.
The data is sobering. Smokers who start early in life
and keep smoking can lose up to a decade of
life expectancy. I wanted to know for those who were interested,
if doctor Lynn Koslowski thought there was the best time
in their lives to quit smoking.
Speaker 2 (26:00):
As early as possible. Thirty is a benchmark if you
can do it by thirty, and I think that needs
to be promoted more widely. Probat Jaw, an epidemiologist at
the University of Toronto, recently reviewed a lot of epidemiological
studies and has come up with a very simple summary
of the health risks of smoking, and the evidence shows
that at least one in two smokers dies prematurely and
(26:24):
they lose on an average ten years of life. And
if a smoker can stop at age thirty, they go
back to the longevity expectations of a never smoker. So
if you can get people to stop at age thirty,
that's great. At age forty it's ninety percent of a
return to being a never smoker. At age fifty, you
(26:45):
gain six years of life if you start smoking, and
at age sixty's four years of life. I think there
are a number of tools that people have to help
them quit smoking, but I want to emphasize that those
are tools, and I think of changing flo tire on
a car. A lug wrench is a very useful tool
for changing a flat tire, but it's a lot of
(27:06):
work to change that tire. Any of these tools you
might use for renclean is a prescription drug you might
use to help quit smoking, nicotine replacement products, patch gum, lozenges,
nicotine pouches, vaping. They're tools, and it's an important thing
for the smoker. Not to be satisfied with just cutting
(27:28):
down a bit on smoking. Your goal should be to
try to get off smoking completely and switch to those
other products, and then once you're securely off smoking, you
can think about getting off those other products.
Speaker 1 (27:41):
So to the extent you can say, what do you
think in the marketplace right now, would you say is
among not the best, but among the best ways to
quit smoking.
Speaker 2 (27:49):
I think for older adult smokers, vaping products are among
the best ways to quit smoking, that they can provide
the most satisfactory substitution for cigarettes. The other thing about
quitting smoking is that repeated attempts you get smokers get
better at it. For example, I've known people have given
up smoking. They've been off for several months. They go
(28:10):
to a gathering where others are smoking, and they think
I could just have one cigarette. They do. They end
up there wrong. So the next time they try to
give up smoking, they know better. They know better than
to be fooled by the illusion that I could just
have one. And then I think there's also a kind
of no more nice guy effect that people trying repeatedly
give up they finally dig their heels in and have
(28:34):
learned from what did and didn't work. I mean, I
had one person tell me I tried this and I
was off smoking for a year, and I said, that's
a pretty good technique to try again. If you were
off smoking for a year.
Speaker 1 (28:47):
I mean renew that subscription for another year.
Speaker 2 (28:50):
So I think it's important for smokers to keep at
it now. The other thing about the health risks of smoking,
the cardiovascular risks diminish very quickly within months once you
stop smoking. The cancer risks are a bit of a
different animal. The process of smoking is causing some cancer
related issues to develop, and it takes longer for you
(29:13):
to get the benefit of stopping smoking with respect to cancer.
But the key message is stop as soon as you can.
Speaker 1 (29:20):
We'll get to vaping now, which is I mean to me?
I find vaping just kind of just exploded. And I
live in New York, and you know, street level in
New York is nothing but food shops, coffee shops, and
places to buy smoking paraphernalia and vaping. I was in
a restaurant last night with my wife and a couple
of friends, and it's a very nice restaurant, actually, one
(29:41):
that we go to all the time in our neighborhood.
And some young guy was there, probably twenty five in
his late twenties, and his girlfriend and he whips out
of machines, you know, whips out the device, starts vaping
in the restaurant, which I don't think he was necessarily
that wasn't permissible, But he goes ahead and vapes, And
I thought, you know, what was the advent of vap
meaning who developed this kind of stuff? And to explain
(30:02):
to people who think they know what vaping is, vaping
is a delivery system for like a liquid form or
some other kind of form of nicotine, and they've extracted
all the bad stuff for most of it.
Speaker 2 (30:14):
Yeah, the key thing is that the tobacco's gone in vaping,
and you can vape all kinds of drugs like cannabis
with a vaping product if you want to as well.
But the key advantage is that there's no combustion, that
you don't get the smoke and the tar and the glop,
and you don't get the complex ingredients arising from burned tobacco.
(30:35):
First products were developed in China, but there have been
a lot of different generations of products. And it's interesting.
I mentioned some of my college roommates smoked, and the
heaviest smoker I ever knew was my college roommate who
smoked unfiltered black tobacco goal walls. You could hear him
when he walked into the room, just by the sound
(30:57):
of his inhlation. You could hear him into a room.
He took such a big drag. I learned years later
that he had switched to East cigarettes. So I called
him up and said, you know, how could this be?
You were the heaviest smoker I ever knew, And he said,
I love him. Actually, it was interesting he could indulge
in his sense of connoisseurship by picking the right kind
(31:20):
of vape product and the right kind.
Speaker 1 (31:22):
Of flavor he liked.
Speaker 2 (31:23):
But he was off cigarettes, and so that was very
impressive to me to have that. One testimonial from an
old friend who was able to switch to vape said
he was the better for it.
Speaker 1 (31:34):
So is it safe to say that, in terms of
all the components that you regard and the metrics that
you regard, that vaping is much safer than cigarette smoking.
Speaker 2 (31:43):
I have no doubt about it. Right, Cigarettes inhale cigarette
smokes are at the pinnacle of risk. Smokeless tobacco products
are much less dangerous than cigarettes. Nicotine vaping is probably
a little less dangerous than smokeless tobacco, nicotine pouches. You're
really quite low levels of harm. I don't want to
suggest that any of these products are health foods, but
(32:05):
they reduce risk dramatically.
Speaker 1 (32:08):
But vaping has its hazards as well well.
Speaker 2 (32:10):
The anti tobacco forces were very quick to jump upon
lung problems that were being caused by vaping. They even
gave it a name, e Valley of Electronic Vaping Lung Disease.
It turns out that that arose largely from people smoking
black cannabis vapes that were polluted with toxins that did
(32:36):
cause lung problems in other countries. Is of a non
issue that once they got rid of that black market
vaping product, it hasn't been an ongoing issue, but the
field has continued to latch onto this, Oh, you can
get lung problems from vaping based on this bout of
lung disease a few years ago. But inhale cigarettes are
(32:59):
at the pinnacle.
Speaker 1 (32:59):
Of ris They're the highest threat and they.
Speaker 2 (33:02):
Takes a big jump down, and things like a pouch
that have no inhalation at all are much much less risky.
Speaker 1 (33:10):
I will say that in my lifetime borders a couple
of different realities as far as smoking as concerned. My
father was a cigarette smoker, he was a pipe smoker.
He quit cigarettes the smoke pipes. He died at the
age of fifty five of lung cancer. My smoking, and
I will say that with unless I was completely inebriated,
unless I was completely shit faced on some drugs and alcohol,
(33:32):
which was certainly accompanied by a good amount of smoking
and my drug use and drinking. But when I was
in my right mind and I smoked, I knew it
was wrong every time I did it. Every single time
I put a cigarette in my mouth, I said this
is wrong. I shouldn't do this. I remember saying to myself, Okay,
this is a stupid idea. Click and I'd light up.
Speaker 2 (33:51):
Yeah, even a long time ago, people call cigarettes coffin mail.
Speaker 1 (33:54):
Right, right, But I was going to say, I'm many
years in sobriety, I'm cleaning sober threaty seven years. And
the only reason I mentioned is because this idea of addiction,
of finding a way to cure the addictive mechanism, the
addictive synaptic whatever it is that happens in human beings
as it relates to smoking, as it relates to eating.
(34:15):
Of course, smoking compounded with obesity. People who are not
even morbidly obese, but who are significantly overweight and smoke,
I mean that must be a double whammy for them, correct, Sure, I.
Speaker 2 (34:27):
Mean it turns out that heavy smokers have a worse
diet than non smokers. Heavy smokers are more like to
eat more fried foods, fewer fruits and vegetables. There are
a whole bunch of things going on with heavy smokers
that contribute to health ruts.
Speaker 1 (34:43):
You were mentioning before the name of a drug that
I don't recall what you said. Now, what is that?
Speaker 2 (34:48):
It's a drug that FDA approved smoking cessation aid.
Speaker 1 (34:52):
That addresses addiction.
Speaker 2 (34:54):
It's a treating addiction. Yeah, it's a drug that's shown
to help you stop smoking. That's a little bit, little
bit too ambitious a claim. I mean that in terms
of nicotine replacement products like nicotine vape, it's a harm
reduction technique. You're replacing a very toxic form of nicotine
use with a much less toxic form of nicotine use.
(35:15):
But the addiction doesn't go away. It might be decreased.
Speaker 1 (35:18):
That's a dream, isn't it To address that addictive component
in the human brain and human behavior.
Speaker 2 (35:24):
There are other factors too. It's not just the addiction,
it's the environment you're in that For example, if you
have a spouse who smokes and isn't giving up, good
luck trying to give up smoking yourself. I mean, so
these powerful social factors. If you have coworkers who are
your best friends going outside in the winter time to smoke,
(35:45):
you've got social pressures to continue to smoke. But go
back to that figure of five percent of eighteen to
twenty four year olds smoking in the United States, Now
that's a nice low number compared to the eighty percent
in nineteen. So there's been progress, has been a huge progress.
Speaker 1 (36:07):
My thanks to doctor Lynn Keaslowski. This episode was recorded
at CDM Studios in New York City. Were produced by
Kathleen Russo, Zach MacNeice, and Maureen Hobin. Our engineer is
Frank Imperial. Our social media manager is Danielle Gingrich. I'm
Alec Baldwin. Here's the thing is brought to you by
iHeart Radio.
Host
Alec Baldwin
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