How to Spot a Psychopath

A reader writes:

How dangerous is second-hand smoke, really?

The bans on indoor smoking that've taken over the Western world suggest that it's REALLY dangerous. Here in Australia you can no longer smoke even in a pub, so apparently second-hand smoke is worse for you than alcohol.

But it stands to reason that second-hand smoke is much more dilute than the smoke sucked out of the actual cigarette. I can believe it'd be a big health hazard if you were in some 1925 basement speakeasy jazz club with no ventilation and everyone smoking like crazy until you could barely see your hand in front of your face, but the thickness of smoke in a pub before the ban wasn't anything like that. It still made your clothes and hair smell like an ashtray, but that's just disgusting, not dangerous. Was it really that bad?

Richelle

Nobody knows exactly how dangerous second-hand smoke, or "passive smoking", is.

This is partly because of the, well, smoke screens, produced by astroturf organisations with the usual hilarious Decent People Opposed to the Decapitation of Adorable Ducklings names and the similarly usual giant piles of funding from the tobacco companies.

But it's also partly because there is, as you say, such a wide range of possible exposure levels.

And, I think, it's mainly because this is principally an epidemiological question, and epidemiology is a slippery area of study.

Given all these caveats, though, it's still clear, from numerous studies, that chronic exposure to second-hand smoke, even at relatively low levels, does significantly increase the chance of a non-smoker getting lung cancer and/or heart disease, plus a laundry list of other ailments that result from the inhalation of bad stuff.

If you're just waiting for a bus next to someone smoking and you get the occasional whiff of their Marlboro, nothing quantifiable will result. But being a child in a house with indoor-smoking parents, or regularly visiting a smoky pub as an adult, raises your lung cancer risk. Working in a smoky pub raises it more.

The important detail to remember here, though, is that the incidence of lung cancer in non-smokers is low. Only about 15% of all lung cancers are found in non-smokers, and most of those seem, once again within the statistical limits of what epidemiology can tell us, to have been caused by something other than second-hand smoke.

Chronic exposure to highly polluted air, for instance, will do it. A traffic policeman in Beijing, Mexico City or Ahwaz, Iran really ought to wear a gas mask, or possibly SCUBA gear, to work.

Numerous other kinds of smoke are also carcinogenic. If you work in a commercial kitchen with woks full of smoking overheated oil all over the place, that's bad. So is wood smoke; it may smell nice, but it's definitely carcinogenic. Incense is bad for you, too.

And then there's radon, a well-known danger in the USA, but almost completely unknown here in Australia, where very few houses have basements. You'll probably only have much exposure to radon if you're a miner, of if you spend a lot of time in a basement or other poorly-ventilated underground room dug into high-radon ground.

Sundry inhaled particulate matter is also bad news. This is another problem for miners, and various other industrial workers.

And there are lung-cancer-causing viruses, too.

And then there's asbestos inhalation, of course. But that's much more likely to cause the horrible-but-not-cancerous disease asbestosis than it is to cause mesothelioma.

Or you could just be fortunate enough to be genetically predisposed to develop lung cancer.

If you're a non-smoker and you can avoid all of these risk factors, then the chance that you'll get lung cancer - or, at least, that you'll get it a long enough before some other disease kills you of "old age" for the lung cancer to become an actual problem - is very small. Second-hand smoke exposure that doubles your risk of cancer sounds scary, but if there's only a one in ten thousand chance that you'll get it in the first place, then the doubling only raises it to a chance of one in five thousand, which probably won't keep you awake at night.

And the risk from different causes isn't necessarily cumulative, either. If you're a non-smoker who works without breathing protection in the Acme Smoke, Flame and Asbestos Dust Factory in the Land Occupational Health and Safety Forgot, and as a result have a 50% chance of getting lung cancer in the next ten years, then heavy exposure to second-hand smoke while you drink your way to amnesia on the weekends may only raise your cancer probability to 51 per cent.

Or it may do more. Again, epidemiology. Pick a hundred coloured marbles from the barrel of a million, try to figure out what colour the rest of them are.

Some scientists have argued that there's a somewhat unexpected public-health benefit from indoor smoking bans. Not only do they keep second-hand smoke out of the lungs of non-smokers, but the nuisance of having to go and stand outside with the rest of the Tobacco Lepers causes smokers to smoke less, and become healthier. The evidence presented for this is generally a reduction of hospital visits for smoking-related heart and pulmonary disorders after indoor-smoking bans go into effect, but this is yet more epidemiology, so it's eminently possible that the effect is from an entirely different cause, or smaller than it seems, or even nonexistent.

(Workers who hate having to go out into miserable weather to get their fix could easily, for instance, use their ten-minute break to suck down as much smoke as they possibly can in that time, to "stock up" and make sure that they can make it to the end of the day without cravings. They could, thereby, get a lot more crap in their lungs than if they were still allowed to have a leisurely cigarette or two at their desk.)

Psycho Science is a regular feature here. Ask me your science questions, and I'll answer them. Probably.

And then commenters will, I hope, correct at least the most obvious flaws in my answer.