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“”Smoke, smoke, smoke that cigarette
Puff, puff, puff
|—Tex Ritter, "Smoke, Smoke, Smoke (That Cigarette)"|
Tobacco smoking, most often associated with "coffin nails," or cigarettes of the tobacco plant (Nicotiana tabacum), is a foul, expensive, unhealthy habit that stains your fingers and teeth, costs a fortune, "harms nearly every organ of the body" and causes or increases the risks of a staggering amount of diseases below:
- cancer of the lung (most cases), and some cancers of the bladder, blood (acute myeloid leukemia), cervix, colon and rectum, esophagus, kidney and ureter, larynx, liver, oropharynx, pancreas, and stomach
- cardiovascular disease, including stroke
- chronic obstructive pulmonary disease [COPD] (formerly called chronic bronchitis or emphysema)
- reproductive risks (preterm birth, stillbirth, low birth weight, sudden infant death syndrome, ectopic pregnancy, orofacial clefts, reduced sperm quality)
- lower bone density
- tooth and gum disease
- cataracts and age-related macular degeneration
- type 2 diabetes mellitus
- rheumatoid arthritis
- increased risk for short-term complications following total hip and total knee replacement
Unfortunately, the smokers that visit this page will likely not care about that stuff or will be too addicted to quit.
As drugs go, tobacco has a ridiculously low buzz/harm ratio — in other words, very little buzz, and extremely harmful. And tobacco is actually at least as addictive as heroin or cocaine. And delivered like crack.
Depending on your dose, it feels either like a very weak stimulant that lasts about 2 minutes or a very weak opiate that last about one minute. The purported "cognitive benefits," if they exist, are purported to last about 15 minutes, and after that you're left with a drug that starts exiting your system within 2 hours, fully leaving it within 3 days (This is why withdrawal symptoms peak during this time). This leads to a very insidious pattern where you end up needing a pack a day eventually as you keep smoking every hour or so despite your body still having nicotine in its blood. When you do need a cigarette a very good way to describe the feeling would be a distinct, "hot" headache. Despite this headache not being as bad as certain other ones, the irritability is debilitating, and it becomes impossible to think.
The Native Americans used tobacco as a traditional remedy for centuries; they considered it a panacea, using it for teeth whitening, pain relief, diarrhea, neck gland diseases, ulcerated abscesses, burns, wounds, fistulas, sores, polyps, colds, catarrh, headaches, and many other things. According to one account, some natives in what is now Cuba carried around a burning torch containing tobacco in order "to disinfect and help ward off disease and fatigue." The Europeans, when they arrived, immediately took a liking to the plant, calling it "God's remedy", and the "holy herb", and started using it for virtually everything. Nicolas Monardes, a physician from Seville, claimed tobacco could cure 36 diseases, including cancer, toothache, and worms. Here are some of his thoughts on tobacco:
I having ministered it to many people as well men as women, in great number, and being grieved of ten, and of twenty years they have healed old rotten sores in legs, and other parts of the body, with only this remedy to the great admiration of all men.
I saw a man that had certain old sores in his nose, whereby he did cast out from him much matter, and daily did rot and canker, and I caused him to take at his nose the juice of this Tobacco, and so he did, and at the second time, he did cast out from him, more then twenty little worms, and afterward a few more, until that he remained clean of them, and using it so certain days, he did heal of the sores, that he had in the inner part of his nose: and if he had tarried any longer, I think that there had remained nothing of his nose, but all had been eaten away, as it does happen to many, which we do see without them. And being writing of this, a daughter of a gentle man of this City, had many years a certain manner of dry scabs, or well near scurvy in her head, I had cured her, and done unto her many benefits, universal, and particular: and also Masters of Surgery had done their diligence, and all did not profit.
Aren't anecdotes fun?
The name nicotiana derives from the name of the French ambassador to Portugal, Jean Nicot, who considered tobacco to be a very good remedy and used it to treat cancer (among other things). He also used it for wounds:
When a cook in Nicot's household nearly cut off his thumb with a chopping knife, the steward ran for the tobacco plant and bound the thumb back on; after five or six dressings of the same sort, the wound healed.
One observer noted in 1582, "with the herbe, many have bene eased of the reumes".:9 Sir John Davies praised the herb in his poem "On Tobacco", which contains such lines as:
It is Tobacco, whose sweet substantial fume
The hellish torment of the teeth doth ease
By drawing down, and drying up the rheum,
The mother and the nurse of each disease;
It is Tobacco, which doth cold expel,
And clears the obstructions of the arteries,
And surfeits, threatening death, digesteth well,
Decocting all the stomach's crudities;
In the seventeenth century, "Physicians were busily engaged in analyzing the properties of the herb and discovering its use in all diseases; it was recommended as an infallible cure for nearly every ill and as a preventative of many ailments." William Barclay's "Nepenthes, or the Vertues of Tabacco" of 1614 also recommended tobacco for many illnesses, and described tobacco as "this sacred herb," describing America as "the countrie which God hath honoured and blessed with this happie and holy herb." Tobacco was also thought to prevent and cure the plague, with one document saying, "It corrects the air by Fumigation, and it avoids corrupt humours by Salivation; for when one takes it either by Chewing it in the leaf, or Smoaking it in the pipe, the humours are drawn and brought from all parts of the body, to the stomach, and from thence rising up to the mouth of the Tobacconist, as to the helme of a Sublimatory, are voided and spitted out." Yet another says, "Headless-cross the market-people, having their mouths primed with tobacco as a preservative, brought their provisions. It was observed that this cruel affliction never attempted the premises of a tobacconist, a tanner, or a shoemaker". Another observer writing in 1721 noted, "I have been told that in the last great plague at London none that kept tobaconist's shops had the plague. It is certain, that smoaking it was looked upon as a most excellent preservative, in so much, that even children were obliged to smoked," and another, in 1693: "Diemerbrockins, in his book De Peste, very much commends the use of tobacco in the time of plague; he says, it absolutely cured him when he had it; he also observes, that almost all those houses, where tobacco was sold, both in Spires ... and likewise in London, were never infected, whereas the houses round about them were.":9-45
Critics of tobacco started becoming active from the 17th century onward (though medicinal tobacco use never really ceased); a notable opponent of tobacco was King James VI of Scotland (of Bible fame), who wrote A Counterblaste to Tobacco in 1604, in which he criticized the use of tobacco to treat syphilis, calling the plant "a stinking and unsavorie Antidot, for so corrupted and execrable a Maladie, the stinking Suffumigation whereof they [Native Americans] yet use against that disease, making so one canker or venime to eate out another."
As late as 1931, the herbalist book A Modern Herbal promoted the use of tobacco (emphasis added):
The alkaloid nicotine is a virulent poison producing great disturbance in the digestive and circulatory organs. It innervates the heart, causing palpitation and cardiac irregularities and vascular contraction, and is considered one of the causes of arterial degeneration.
Tobacco was once used as a relaxant, but is no longer employed except occasionally in chronic asthma. Its active principle is readily absorbed by the skin, and serious, even fatal, poisoning, from a too free application of it to the surface of the skin has resulted.
The smoke acts on the brain, causing nausea, vomiting and drowsiness.
Medicinally it is used as a sedative, diuretic, expectorant, discutient, and sialagogue, and internally only as an emetic, when all other emetics fail. The smoke injected into the rectum or the leaf rolled into a suppository has been beneficial in strangulated hernia, also for obstinate constipation, due to spasm of the bowels, also for retention of urine, spasmodic urethral stricture, hysterical convulsions, worms, and in spasms caused by lead, for croup, and inflammation of the peritoneum, to produce evacuation of the bowels, moderating reaction and dispelling tympanitis, and also in tetanus. To inject the smoke it should be blown into milk and injected, for croup and spasms of the rima glottides it is made into a plaster with Scotch snuff and lard and applied to throat and breast, and has proved very effectual. A cataplasm of the leaves may be used as an ointment for cutaneous diseases. The leaves in combination with the leaves of belladonna or stramonium make an excellent application for obstinate ulcers, painful tremors and spasmodic affections. A wet Tobacco leaf applied to piles is a certain cure. The inspissated juice cures facial neuralgia if rubbed along the tracks of the affected nerve. The quantity of the injection must never exceed a scruple to begin with; half a drachm has been known to produce amaurosis and other eye affections, deafness, etc.
Externally nicotine is an antiseptic. It is eliminated partly by the lungs, but chiefly in the urine, the secretion of which it increases. Formerly Tobacco in the form of an enema of the leaves was used to relax muscular spasms, to facilitate the reduction of dislocations.
The admission that "nicotine is a virulent poison" is not based on traditional knowledge; nicotine was only discovered to be a component of tobacco as a result of chemical research conducted in 1828, meaning that if science had left tobacco alone, the book would have probably been much more positive. Note also that no mention is made of the carcinogenity of the plant.[note 1]
The reason that naturopaths and herbalists today don't recommend tobacco probably has more to do with social taboos and current public opinion rather than any real thought on their part. From a traditional and anecdotal point of view (Native Americans used tobacco for hundreds, if not thousands, of years as a panacea and didn't notice any harmful effects), there is no reason not to prescribe tobacco. It is true that, from a scientific point of view, medicinal tobacco use is indefensible, but then so are homeopathy and Reiki, key parts of naturopathic healthcare. Naturopaths have absolutely no problem denying the evidence when it suits them, and this anti-science attitude is completely compatible with the prescribing of medicinal tobacco.
Because of anti-smoking campaigns, mandated warnings and graphic images of tobacco-induced diseases on cigarette packs, and bans on pro-tobacco ads, the harms of tobacco are common knowledge – there is virtually no one who does not know tobacco is harmful. In other words, the scientific establishment and governments of the world forcibly imposed the scientific consensus that a traditional herbal remedy is ineffective and harmful on the general public, and curtailed its sale by means of stringent regulation. (This is very similar to the sort of scenario that health freedom advocates try to prevent, and it also reminds one of conspiracy theories claiming that pharmaceutical companies attempt to ban alternative remedies (which ignore the fact that many of these pharmaceutical companies themselves sell alternative supplements.)) Naturopathy is based pretty much on believing whatever "feels" good, regardless of the evidence, so the position of most naturopaths that tobacco is harmful is probably due to social attitudes caused by education regarding the risks of tobacco (people who seriously claim that tobacco is harmless or even beneficial are met with suspicion or hostility). Naturopaths' rejection of tobacco is a sheer accident that has nothing to do with their cherry-picking approach being correct. The 19th-century physician Dan King, in the introduction to his 1861 book Tobacco: What it is, and What it does, said:
In intellectual philosophy, nothing is more difficult, than to convince men of truths against the testimony of their own senses. By observations and reasoning, the ancient philosophers became convinced of the earth's rotundity, and its diurnal and annual revolutions, but the publication of these discoveries, met with instantaneous and universal opposition; besides, their supposed contradiction of scripture, the new doctrine was summarily refuted by the evidence of every man's senses — the earth was obviously a broad, horizontal expanse — day after day, and year year after year, all their lives long, all had seen the sun rise in the east, move slowly across the heavens, and go down in the west; and against such palpable testimony, no arguments founded upon abstract principles, had any force; the world looked upon the science of astronomy as the vagaries of mad men, and treated its authors as felons. At length the dawning of science slowly dissipated the darkness of ignorance and superstition, and by degrees men began to question the testimony of their senses, and reluctantly to acknowledge the wonderful truths announced by Gallileo and his followers. Yet, although the main principles of Grecian astronomy were susceptable of easy demonstration, men were slow to set aside the prima facie evidence of their own senses, and embrace the sublime truths which it brought to light. And at the present time, the chemists, physicians, and scientific men who by their labors and observations have ascertained the poisonous nature of tobacco, and its deleterious effects upon mankind, are regarded much as the ancients regarded the first promulgators of astronomy. Every one has seen tobacco in constant use, all around him, his life long; and he is not aware that any one has been poisoned, or in any manner injured by it, and therefore he believes it to be harmless. Acting upon his own brief and imperfect experience, and yielding to motives of interest or inclination, he looks with perfect contempt upon all the evidences and arguments that scientific investigations can present. The march of intelligence may correct the mistakes of the senses, but the universal cupidity of mankind, which ever seeks for gain, regardless of means, and the unlimited love of animal pleasure, can only be corrected by moral considerations, the power of example, and the force of public opinion. The more the subject is examined, the greater its importance appears, and the constantly increasing consumption of tobacco, certainly deserves attention; we live in the midst of tobacco fields and tobacco manufactories, and, judging from appearances, one might be led to conclude, that the chief errand of life was to smoke. Apparently regardless of all consequences, the habit is spread over the whole country, and communicated from parents to children, generation after generation. A most virulent poison has come to be considered, not only innocent, but absolutely necessary to the common enjoyments of life, and whoever attempts to hold a parley with its devotees, if he does not find himself required to answer for his temerity before a legal tribunal, will be pretty sure to incur the most severe public censure.
In the same book, King also noted that "Some are ready to contend that tobacco can have no tendency to shorten life because there are many old persons who use it." Public opinion regarding tobacco is now, obviously, the complete opposite of that described in King's book. In all likelihood, if it had not been for evidence-based medicine and the significant efforts of anti-tobacco campaigns, both grassroots and government-sponsored, herbalists would still be prescribing medicinal tobacco today.
In fact, tobacco is indeed used by some herbalists today, such as certain shamans in the Amazon known as tabaqueros, and some alternative medicine practitioners who, astonishingly, deny that "natural tobacco" is harmful, and recommend its use, either smoked or in teas. According to them, the harmful effects of tobacco are due to "additives" and "processing". "Organic" tobacco, on the other hand, can reduce the risk of various types of cancer; nicotine, likewise, is not harmful, but actually beneficial. Tobacco has also been portrayed by conspiracy theorist Laura Knight-Jadczyk as having been unfairly maligned by Hitler. Knight-Jadczyk claimed, "Smoking natural tobacco could have significant benefits as peoples across the world have recognized for millennia." Of course, the main reason smoking plants is harmful is because the burning of plant matter itself produces various toxic substances (such as tar and carbon monoxide), regardless of whether it contains "additives" or not. It is because of this that non-tobacco-containing herbal cigarettes have many of the same harms as ones made of tobacco.
Who wins and who loses?
The winners: the cigarette manufacturers, death industry, and government
It has been estimated that cigarette makers' profit is about US$0.01 per cigarette, and they they therefore make $10,000 per premature death caused. In China, tobacco use has risen tremendously and is now close to 40% of the global total of consumption (2.4 trillion cigarettes per year). It was estimated that a single factory in China (Hongta's Yuxi Cigarette Factory) produces 90 billion cigarettes per year, causing 25,000-30,000 premature deaths per year from lung cancer and twice that many from other diseases. Even then, they're not entirely winners, since tobacco is one of the very rare occurrences of a situation (perhaps the only thing similar is the advertising for Marmite) in which the producers of a product are paying[note 2] for advertisements attempting to get people to stop using the product.[note 3]
Smoking not only fills the coffers of the death industry but also those of the government through high tobacco taxation.[note 4] At the same time it is also profitable to the pension providers[note 5] because they don't have to pay out so much to those who die before their time, and also the health insurance companies who can charge higher premiums for smokers.
The losers: the smokers
Advantages of smoking
If you smoke, your shortened life expectancy means you may need to pay less attention to these putative health hazards:
- Air pollution (that you don't create)
- Radon leaking up into your house
- Pesticides in your food
- Volcanic dust
Think of it like consolidating a pile of small debts into one even bigger debt at a higher interest rate. But dumber.
Disadvantages of smoking
If you really need to be told that smoking is bad for you, you should probably be on a Wiki that scares the shit out of you with facts rather than entertains you with them.
What's in it for the smoker?
The nicotine provides both stimulant and relaxant effects in one go. (That other site has the full list.) The really addictive element is inhaled through the lungs and straight into the brain — even weeks or months after your body has finished withdrawal from the drug, your brain remembers and craves the hit.
In addition to nicotine, tobacco smoke also contains monoamine oxidase (MAO) inhibitors (which act as anti-depressants), which may make the nicotine even more addictive.
Unsurprisingly, users see smoking as a relaxing and deliciously addictive pastime. Most nicotine addicts claim to be aware of the health risks posed by smoking, but aren't really worried until they approach 50, or until they get cancer[note 6] — whichever comes first. Other favored arguments by proponents are personal freedom (of the tobacco industry and the ebil gubbermint to make money) or the "Ah, but X is worse" fallacy.
Logic doesn't work here. Either they're addicted and know the dangers, they're addicted and in denial, or they're in the business and want to keep the money rolling in.
While it has been alleged that cigarette smoking makes one look sexy and glamorous, in truth only people who are already sexy and glamorous look this way when smoking.[note 7] No robust findings have been published on smoking's effect on how fabulously sexy one is, though it does cause premature aging, stained teeth, teeth loss, hair loss, and eye cataracts if you find those sexy. (If you're smoking during sex, get a decent water-based lubricant.) It does affect the way one's body processes fat, so it may keep one thin, but prolonged use gives a sallow, wrinkled look to the skin, if you also find that sexy.
For those who absolutely must fill their lungs with gunk, pot smoking is much more fun, but, according to some, more dangerous. Marijuana is, however, not causative of lung cancer as tobacco smoking is known to be. (The lack of marijuana chain smokers who inhale 2 packs a day may have something to do with this.) The possession of marijuana is also illegal in many countries, with punishments ranging from a small fine to execution. So, at least you get the thrill of being a genuine rebel.
The other losers: those in the vicinity of smoke including humans, pets, and even cars
It immensely irritates lungs and nonsmokers alike who may be in the vicinity.[note 8] Second-hand smoke is harmful to anything around it: it is estimated that some 15,000 children in the UK end up with asthma each year as result of their parents' tobacco addiction. Smoke lingers too, as the smell clings to clothes and remains there.
You can tell if a previous owner of a car has smoked, and smoking inside a car does decrease the value of a car while dealers and buyers are more reluctant to take cars that had smokers inside them. Additionally, smoking can be harmful for the car as the particles can work their way into ventilation systems, so simply opening windows to let smoke out will not address this.
Tobacco smoke is harmful to all sorts of pets including cats, dogs, birds, fish, guinea pigs, and probably more but birds are especially sensitive to pollutants (think about the historical canary in the gold mine that would get distressed before miners do as a warning sign), due to having efficient respiratory systems that help enable them to fly. Smoking outside will not prevent harmful particles from spreading eventually into pet birds' lungs as the particles do spread pretty far.
Who should smoke?
If it isn't already obvious by the comically grotesque breadth and severity of negative consequences smoking offers: nobody. You might hear some people claim that smoking can help alleviate symptoms from maladie du jour, but just remember: bleach would be a perfectly good antibacterial if it didn't also kill the patient. There is nothing that smoking could treat that would offset the harm done by smoking… that said, smoking has some known effects that some people might consider for self-medication.
People with mental disorders and schizophrenics in particular have heavy rates of smoking. It has been widely thought that tobacco use is a form of self-medication, but there is some evidence that usage is actually causative of psychosis. Or because mental hospitals are incredibly boring places. However, the high rate of smoking in schizophrenics and other mentally ill patients has resulted in 30% more heart disease and 30% more respiratory disorders than the general population. A doctor would be ill-advised to recommend smoking as any advisable course of action for any patient with a mental disorder.
Nicotine has been found to provide limited help with cognition (memory, attention and thought organization) impairment in patients suffering from schizophrenia, but since nicotine is still less than ideal even without the carcinogenic burning vegetable matter (e.g. it correlates with Alzheimer's), scientists are at work on drugs similar to nicotine to provide the benefits without the dangers. Smoking is however still not in any way recommendable to schizophrenics for helping with these cognition impairments because the positive effects are short-lived as resistance sets in very quickly, while the highly-addictive nature of nicotine results in a quick dependence upon the drug even though positive benefits have already been exhausted.
In short, even if you're schizophrenic, you might only find temporary relief of cognitive impairment, but once the positive effects have fully faded away, you're now addicted to a deadly poison that is killing you. So, don't smoke.
It is well known that smoking causes an increase in blood pressure, which is just one of the many reasons why doctors recommend people quit smoking, as raising blood pressure is typically a bad idea for almost everyone. However, some conditions result in symptoms of chronic low blood pressure (hypotension), and while this is typically regarded as a fortunate situation, in some cases low blood pressure can become so drastic that it starts becoming symptomatic, i.e. dizziness and fainting. But since doctors typically only deal with acute hypotension due to shock or blood loss, most treatments for symptomatic hypotension focus on treatments that are really only available in hospitals on an emergency basis. Thus, people struggling with chronic low blood pressure and inadequate healthcare might be tempted to self-medicate their condition with smoking, and unlike the case with schizophrenics, this relatively beneficial raising of the blood pressure does not quickly disappear, and would actually work as a long-term solution… You know, if it weren't for all the damages it does.
Dirty tricks played by cigarette manufacturers
For decades, Big Tobacco (in the US: Philip Morris USA (Altria), R.J. Reynolds (Reynolds American), and Lorillard) deliberately deceived the public about every negative aspect of tobacco use. Due to large expenditures on research, Big Tobacco often had evidence of negative effects prior to its availability to the general scientific community. The long, extensive and ongoing deliberate deception has served as a model for corporate denialism in other industries, including asbestos product manufacturers (cancer), Big Oil (climate change), and lead.
The first known report that tobacco might be linked to cancer was in 1898 when Hermann Rottmann proposed that tobacco dust might be causing elevated rates of lung cancer in German tobacco workers. In 1900, it was demonstrated that tobacco juice caused cancer in animals. In 1912, Isaac Adler published the first monograph on lung cancer and noted a suspicious increase in lung cancer over time and cited "abuse of tobacco and alcohol" as a possible cause. The link between primary tobacco use was firmly established in the 1950s, but Big Tobacco has been in near-continuous denial of tobacco's carcinogenicity: no longer denying primary tobacco use but in denial of secondhand tobacco exposure at least into the 1990s.
The Australian doctor William Whitby wrote books (e.g., The Smoking Scare De-Bunked) arguing that smoking was in fact not harmful at all. He did this by, among other things, citing statements made by individuals working for the tobacco industry or for tobacco industry front groups, as well as anecdotal evidence and cherry-picked animal studies (the results of which naturally can't compete with the many human studies following smokers and observing cancer incidence skyrocketing). The tobacco industry itself considered him a "nut", whose views they nevertheless privately sought to promote.
Menthol (basically mint crystals) was originally added to cigarettes to make the smoke less harsh. However, it was soon discovered that it could also increase the sensation from smoking, to make it a more "fun" (read: addictive) experience. There's now a movement afoot to ban menthol in cigarettes. Internal Big Tobacco research in the 1950s noticed a slight preference for menthol cigarettes among African Americans in the 1950s and subsequently relentlessly targeted African Americans with menthol advertisements resulting in 80% usage among African American smokers by 2010.
In the 1960s, it was not generally known that asbestos contributed to lung cancer. It was not known to the public, it may not have been known to the tobacco industry, but from the 1930s to 1960s the asbestos industry had been covering up all evidence in their research that there was a connection between asbestos and cancer. So, Kent cigarettes came out with a new, "safer" filter that would supposedly block more of the harmful chemicals in cigarette smoke and wouldn't catch fire (1952-1954). Unbeknownst to most of the public, the secret of this new filter was that it was made of asbestos.
Asbestos filters, mercifully, have been discontinued.
Oh and, the regular, secretly-defective, non-asbestos filter that was used for 40 years was also harmful but the tobacco industry didn't think you would care.
The first cigarette filters were used in 1860. As the hazards of cigarette smoking started to become apparent, the tobacco industry, from the mid-1950s to the mid-1960s, worked on the so-called "filter problem", that is how could the cigarette filter be designed to remove some or most of the dangerous substances from mainstream tobacco smoke. Toward the end of this period the industry concluded that the same substances that were harmful in mainstream smoke were those that gave smokers "satisfaction". Rather than publicly announcing this important conclusion, the industry instead recast the "filter problem" from one of eliminating hazard to one of perpetuation of the false notion that cigarette filters are effective in reducing these hazards.
"Low tar" cigarettes
"Tar", in double-quotes, is a catch-all term for everything in cigarette smoke that isn't carbon dioxide, carbon monoxide, or nicotine.
Low "tar" cigarettes were all the rage in the 1970s. They didn't use new tobacco formulations, or filter tips that were more selective to screening out "tar" compounds, or anything of the sort. Instead, they relied on the way the Federal Trade Commission tested each brand for its "tar" content: The testers plugged the filter end of a cigarette into a suction machine, ignited the other end, collected all the gases that came out, and measured the amount of "tar" in the collected sample. By adding tiny perforations to the filter in front of the point where it plugged into the suction nozzle, a significant fraction of the gases produced would escape into the air and not be collected by the machine.
Smokers, of course, could simply cover up the filter perforations with their fingers, thus getting far more "tar" in their lungs than the FTC method would suggest. They had an incentive to do so, too: Every bit of escaping "tar" smoke also took some of the precious nicotine with it.
Ever on the lookout for new ways to keep their customers hooked, cigarette companies eventually stumbled upon the notion of adding ammonia to the tobacco. This resulted in the nicotine being absorbed more quickly into the smokers' lungs, thereby increasing the "hit" that they experienced and deepening their addiction.
“”Today, I'm on a mission to rip the fattest vape.
|—Ya boi EK from h3|
Electronic cigarettes (a.k.a. e-cigarettes, or vaporisers) dispense a still-dodgy nicotine hit without the immense amounts of intensely carcinogenic burning vegetable matter. They are much more convenient, as the user does not have to worry about smoke detectors/smoking bans, a lasting smell, having an ashtray on hand indoors, etc., and is not restricted to single cigarette lengths, easily turning a light smoker into a
chain smoker heavy nicotine addict. E-cigarettes are largely unregulated. As of December 2014, children can legally buy them in 10 US states and the District of Columbia.
E-cigarettes were introduced in the US in 2007 and marketed as a way for smokers to quit. Unfortunately, they actually do not increase the rate of smoking cessation, though there are anecdotal cases of some smokers quitting due to vaping, but that doesn't mean that people are more likely to quit with vaping than without vaping.
Teen use of e-cigarettes has become especially high recently, even surpassing the use of regular cigarettes starting in 2014. Though e-cigarettes are often marketed as being harmless — or at least not harmful — nicotine in itself is particularly addictive to young people (as tobacco companies have long known) and can be harmful in itself, causing impaired attention, depression, anxiety and increased impulsive behavior. Vaporized nicotine alone, as well as nicotine-free e-liquid, can harm lung tissue in vitro. E-liquids, with or without nicotine, both caused toxicity, oxidative stress and inflammation to mouse lung tissues when tested in vivo. Chronic inflammation is a known cause of cancer. As far as acute toxicity in humans, there were 1351 poisonings from e-liquids in 2013, including one suicide by injection of nicotine.
The contents of e-liquids used in vaping are rarely fully disclosed, and the amounts of nicotine or other chemicals included is often not accurate. Claims of safety may be based on FDA approval of food additives, but the safety of food additives was never intended to imply inhalation safety. Some of the chemicals found in e-liquids even exceeded workplace safety levels. Pyrazines, long added to cigarettes, have also been added to e-cigarettes, making them less harsh (and likely more addictive). Expect a campaign of denialism by Big Tobacco and/or Little Vape, as the hazards become more evident.
JUUL Labs, one of the largest vaping companies has already been following the Big Tobacco playbook of 1) extensive funding private research and 2) designing their own school education program. The can be used in preparation for having scientists on-hand to testify in lawsuits, as well as being a type of "distraction research" because it is not hypothesis-driven. JUUL has designed a school education curriculum, is offering what amounts to a $10,000 bribe for school districts that implement it; the curriculum has strong similarities the 1980s Big Tobacco curriculum that intentionally did not discourage young people from smoking.
JUUL, unlike many other vaping companies, produces standardized pods of liquid that contain either 3% or 5% nicotine, the latter being the more popular strength. A person who inhaled a single 5%-nicotine pod would receive the equivalent amount of nicotine from between 26-40 cigarettes, which could be consumed in a day by a heavy user. Nicotine is not harmless. Besides being highly addictive, nicotine "harms brain development — ongoing until around age 25 — affecting mood and impulse control." Rather than just giving smokers a safer alternative to cigarettes, for young people vaping is primarily attracting non-smokers who had no intention of becoming smokers.
Although one former senior manager at JUUL claimed that the company hadn't specifically targeted teenagers, the company was well-aware that the product appealed to them. JUUL had initially required its advertising models to be at least 21 (an age which would indeed appeal to teenagers), by 2016 or 2017 raised the age minimum for models to 35. As of 2018 JUUL has been under investigation by the FDA for whether the company had been intentionally marketing to young people.
And if all that wasn't bad enough, there have been 195 incidents reported from burns or explosions caused by e-cigarettes in the US between 2009-2016. 2,035 such incidents were estimated to have occurred by the BMJ's Tobacco Control journal between 2015-2017, based on a keyword search of the US Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS). In 2018, a man was killed from an exploding vaping pen, in which a projectile from the pen entered his head.
Follow the money
There's a government conspiracy theory making the rounds:
- Cigarettes are taxed, but e-cigarettes, currently, are not.
- By switching from cigarettes to e-cigarettes, consumers are depriving the Federal, State, and local governments of cigarette tax revenue.
- Therefore, anything bad you read about e-cigarettes is just a vicious campaign by the government to keep you smoking regular cigarettes, so that they can keep lining their coffers[note 9] at the expense of your health.
In reality, Big Tobacco has seen the writing on the wall: there is big money to be made from addicting young people to vaping. Altria purchased a 35% stake of JUUL for $12.8 billion in December 2018.
In a nutshell
|What's the Deal with E-cigarettes and Vaping? (Healthcare Triage)|
|What We Don't Know about E-Cigs (SciShow)|
|Smoking vs Vaping (AsapSCIENCE)|
Stopping smoking is very difficult for most people. Nicotine is ridiculously addictive. The removal of nicotine's antipsychotic effects means that many quitters find themselves becoming crazy people for a time.
Nicotine patches or gum work for some people, but don't provide the hit.
Alternatively, one can read a certain book, which has the effect of brainwashing the reader into believing quitting smoking is easy and the best thing you will do in your life by repeating an analogy about smoking being like wearing tight shoes all day to experience the relief of taking them off (a lot). This (along with hypnosis and other self-help programs and support groups) might rely on the placebo effect, but unfortunately, when it comes to any addiction without a convenient agonist (and nicotine doesn't have one), the placebo effect is in medical terms the only effect you can count on.
All that aside, the horrifying fact is that the pathways physical dependency emerges from are highly flexible, but not elastic. They adapt to a certain dosage schedule and respond (as any ex-smoker can tell you, do they ever!) when that schedule isn't met. The result for most narcotics (and certainly for nicotine) is a ratchet effect. The only way to go from the constant agony of withdrawal to the occasional agony of post-addiction is to stop introducing the addictive stimulus. Or, in even simpler terms, if you're addicted to nicotine to the point that you need a biologically significant amount in your system at all times, whenever you stop taking nicotine, you will undergo severe withdrawals. Once you're habituated, the severity and length of habit make only a minor difference in how nasty it is to break that habit.
What's worse, significantly undercutting the habitual dosage schedule is also highly unpleasant — and can only reduce the body's anticipated dosage schedule glacially. You are going to experience what many people rate as the worst experience of their lives, and levels of discomfort, unease, mental instability, and craving you literally have no way to imagine, for no less than a week. And that's being optimistic. (If you don't smoke or are only doing so "occasionally", best to avoid that, huh?) Any smoking cessation plan in which one actually quits smoking eventually ends in 1-2 weeks of withdrawal, months to years of situational cravings, and a lifetime with that much less respiratory damage, carcinogenic risk, and hand-over-fist expense to worry about.
There's medically just no way better than cold turkey. Unlike alcohol, heroin, and certain benzodiazepines, abrupt cessation is never going to kill you. (Don't go cold turkey from those after long-term addiction, please.) Nicotine delivery methods other than cigarettes as a quitting system will only kick the can down the road. They are, on the other hand, a good way for the people selling them to make money off of your anxiety, and their commercials look almost as scientific as the ones for shampoo. It's your call, isn't it?
The best advice for supporting a quitter is to take it seriously. Help them avoid nicotine, even though everything in their body is incessantly begging for it. If they've given over the pack or carton they have on hand just in case, put a few degrees of separation between it and you. At the very least, never make it easier for them to lapse.
If you're a smoker, keep it out of the environment. Don't smoke around them, try not to have cigarettes on you when dealing with them if possible, and don't talk about smoking. If their quitting bothers you for some reason, suck it up and deal with it like an adult; if you blow smoke in their face or offer them one on the side like a giant Goddamn baby, you're basically angling to sentence them to more time in withdrawal, which is a lot like Hell (only it's a real thing and there's no way to cheat your way out of it by being a nice person or saying the right magic words). Don't be Denis Leary.
If you're not a smoker or a vicious prick, by all means make yourself useful, but don't get in their way. They're likely to snap at you, like everything else in the world, because their brains have temporarily replaced the "response" part of stimulus/response with "impotent rage". Let them have it after they're out of the woods, by all means, but don't bother trying to beat it out of them — their reptile brain would swan dive into a family of bears for another smoke before being hugged to a paste and devoured, and you're no bear.
If you're a bear, why are you here? This is a wiki. There is nothing for bears here.
What about quitting smoking, without quitting nicotine?
Since nicotine is so ferociously addictive, it may not be possible for every smoker to quit. Some may see the alternative of getting their nicotine fix in a non-carcinogenic package as preferable to both the incessant cravings of quitting and the death sentence of continuing to smoke cigarettes.
If you're planning to go this route — whether through nicotine gum, inhalers, e-cigarettes,
air-cured smokeless tobacco or some other nicotine delivery system — be aware of two things:
- Other means of getting nicotine are not guaranteed to eliminate your craving for cigarettes. Cigarettes deliver the nicotine to your lungs in a very specific way, which contributes to its addictive quality and which other means might lack. Cigarette smoke also contains MAO Inhibitors, which contribute to the addictive nature of smoking and which other nicotine delivery systems lack.
- Nicotine itself has some health risks, separate and distinct from tobacco smoke. It's linked with Alzheimer's disease (though correlation does not imply causation), it causes a temporary constriction of the blood vessels and increase in blood pressure, and may very well be the component of cigarette smoke that contributes to atherosclerosis.
Quitting all nicotine products entirely carries the greatest potential health benefit. You'll just have to weigh that benefit against its cost.
Restrictions and bans
There is a long history of attempts to ban evil tobacco. These can be grouped into three stages. In the early years of tobacco's availability, in the 16th and 17th centuries, many European powers decided that because it was pleasurable it had to be banned: these include Pope Urban VII in 1590, James I of England (and James VI of Scotland) in 1604, and other leaders in China, Russia, and the Ottoman Empire.
Then in the late 19th century the religious asceticism of the temperance movement expanded from prohibition of alcohol (and coffee) to tobacco: at the same time the industrial manufacture of cigarettes made smoking cheaper and more pleasurable than ever before. This led to bans on cigarettes in 15 US states, with North Dakota the first to introduce legislation in 1895. But the popularity of smoking among soldiers in World War One made prohibition unpatriotic and by 1927 the last ban was repealed. One lasting legacy of this was widespread bans on the sale of tobacco to minors.
Finally came evidence-based bans. At first the focus was on smoking in restaurants, which suggested the comfort of other diners was part of the reason, but in the 1990s and early 21st century bans became more common and widespread, despite opposition from libertarians and Big Tobacco.
Ye Olde Cigarette Shoppe
These claims are completely different from the ones used to sell supplements. Not the same at all. Really.
Many of these ancient "medicinal" cigarettes used cubeb instead of tobacco. While cubeb (Piper cubeba) does not contain nicotine, setting it on fire and inhaling the smoke will surely impart just as nasty a cocktail of carcinogens to your lungs as smoking a tobacco cigarette will.
The following ads don't go quite so far as to claim that smoking cigarettes will cure ailments. But all the same!
Endorsed by Joe DiMaggio.
Endorsed by "the Golden Boy" of American football Paul Hornung.
Argentine soccer star Alfredo Di Stéfano says he plays better because he smokes them.
Show your loved ones how much you care for them this Christmas.
Santa Claus himself smoked cigarettes in 1919.
Although he'd changed brands, he was still smoking them in 1951.[note 10]
Santa may not have smoked this brand himself, but he obviously thought it was one heck of a good present during World War II.
More vintage cigarette ads that can't be added to RationalWiki for copyright reasons can be found here and here (medical claims abound).
|For those of you in the mood, RationalWiki has a fun article about Tobacco.|
- Legacy Tobacco Documents Library
- "12 Things The Tobacco Industry Doesn't Want You To Know", from Huffington Post
- Article on the science of e-cigarettes (or, rather, on the lack thereof) from the Respectful Insolence blog
- "Light Up a Torch of Freedom", a video on the history of cigarette smoking in America by "Knowing Better"
- ↑ Raw tobacco leaves actually contain no known carcinogens. During flue-curing (but not air-curing), carcinogenic compounds develop in tobacco leaves, which is why smokeless tobacco (including chewing tobacco) causes oral and pancreatic cancers in humans. Setting tobacco on fire, on the other hand, creates a far worse cocktail of carcinogens; this is the main reason cigarette smoking causes cancer.
- ↑ Mostly involuntarily, due to legislation or court rulings.
- ↑ Yes, they are daring you not to buy cigarettes!
- ↑ Subject to change depends on the health care expenses incurred (if government pays for health care) due to the consequences of smoking.
- ↑ Unless the pension is defined-benefit and includes post-employment health care coverages for some odd reason.
- ↑ Or emphysema, heart disease, chronic hacking coughs, etc.
- ↑ Unless you have a smoking fetish. Then the smoker might as well be hideous.
- ↑ Especially those with pre-existing attitude or lung problems.
- ↑ Hah, coffers! Get it?
- ↑ Santa inhales chimney soot (another human carcinogen) anyway.
- ↑ Tex Ritter smoke smoke smoke that cigarette YouTube (written by Merle Travis & Tex Williams)
- ↑ CDC: Smoking & Tobacco Use
- ↑ Nicotine and addiction, June 2013 — http://ash.org.uk/files/documents/ASH_114.pdf
- ↑ Though in 1994 several tobacco company executives flat-out denied that it is addictive, thus winning the 1996 Ig Nobel Prize for Medicine.
- ↑ A study of pyrazines in cigarettes and how additives might be used to enhance tobacco addiction by Hillel R. Alpert et al. (2015). Tobacco Control 25(4):1–7. doi:10.1136/tobaccocontrol-2014-051943.
- ↑ https://erowid.org/chemicals/nicotine/nicotine_dose.shtml
- ↑ https://www.medicalnewstoday.com/articles/322526
- ↑ https://www.medicalnewstoday.com/articles/323012#treatment
- ↑ 9.0 9.1 9.2 9.3 9.4 Medicinal uses of tobacco in history, Anne Charlton, J R Soc Med. 2004 June; 97(6): 292–296. PMCID: PMC1079499.
- ↑ 10.0 10.1 A history of the medicinal use of tobacco 1492-1860, Grace G. Stewart, Med Hist. 1967 July; 11(3): 228–268. PMCID: PMC1033728.
- ↑ Of the Tabaco and of His Greate Vertues
- ↑ 12.0 12.1 Introduction of tobacco into Europe by Berthold Laufer (1924) Field Museum of Natural History.
- ↑ A Counterblaste to Tobacco, Wikisource.
- ↑ Tobacco, A Modern Herbal, Maud Grieve.
- ↑ Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 89. International Agency for Research on Cancer
- ↑ Tabaquero Shamanism (7/3/2012 2:20:46 PM) DMT Nexus
- ↑ 17.0 17.1 The Long Forgotten Healing Properties of Tobacco by Katarina (12 Jun 2014 16:39 UTC) SOTT (archived from 21 Nov 2015 20:41:10 UTC).
- ↑ Let's All Light Up! by Laura Knight-Jadczyk (04 Sep 2007 01:56 UTC) SOTT (archived from 9 Apr 2016 20:44:44 UTC).
- ↑ 19.0 19.1 The Hazards of Herbal Cigarettes
- ↑ 20.0 20.1 Are Herbal and 'Natural' Cigarettes Safer?
- ↑ 21.0 21.1 Herbal cigarettes, kreteks, bidis, roll-your-own and cannabis, quit.org.au.
- ↑ 22.0 22.1 22.2 22.3 22.4 22.5 22.6 22.7 The shameful past. The history of the discovery of the cigarette–lung cancer link: evidentiary traditions, corporate denial, global toll by Robert N. Proctor Tob. Control 2012;21:87-91 doi:10.1136/tobaccocontrol-2011-050338.
- ↑ Monoamine Oxidase Inhibition Dramatically Increases the Motivation to Self-Administer Nicotine in Rats, The Journal of Neuroscience, August (?) 2005
- ↑ Hays, J. (November 19, 2020). "Is it true that smoking causes wrinkles?". Mayo Clinic. Accessed May 16, 2021.
- ↑ Friedmann, M. (October 11, 2019). "Smoking and Oral Health". WebMD. Accessed May 16, 2021.
- ↑ Trüeb RM. Association between smoking and hair loss: another opportunity for health education against smoking? Dermatology. 2003;206(3):189-91. doi: 10.1159/000068894. PMID: 12673073. Accessed May 16, 2021.
- ↑ New York State Department of Health. "Smoking Can Lead to Vision Loss or Blindness"
- ↑ Lung damage from pot
- ↑ Study finds no cancer-marijuana connection
- ↑ Cannabis 'safer than alcohol and tobacco'
- ↑ Cannabis smoke less carcinogenic than tobacco smoke
- ↑ 15,000 kids with asthma
- ↑ Braithwaite-Smith, G. (September 6, 2020). "How smoking affects the value of your car." Accessed May 16, 2021.
- ↑ FDA. (April 21, 2021). "Be Smoke-free and Help Your Pets Live Longer, Healthier Lives". Accessed May 16, 2021.
- ↑ Axelson, R. "Household Hazards and Dangers to Birds". VCA. Accessed May 16, 2021.
- ↑ Most people with schizophrenia smoke tobacco, says research (myDr.com.au, 9 April 2001)
- ↑ New analysis of smoking and schizophrenia suggests causal link Fri Jul 10, 2015 4:31am IST Reuters.
- ↑ Smoking away Schizophrenia? (Lisa Conti, Scientific American, 2007-11-28)
- ↑ Nicotine tied to Alzheimer's risk (Wendy Zukerman, New Scientist, 2010-04-14). This appears to supersede earlier reports that nicotine might help break up the amyloid plaques.
- ↑ Smoking and high blood pressure
- ↑ Tobacco companies ordered to publicly admit deception on smoking dangers by Bill Mears (Updated 5:42 AM ET, Wed November 28, 2012) CNN.
- ↑ New Study Proves Tobacco Industry Deception Continues by Chris Hansen (Thursday March 14, 2013) Cancer Action Network.
- ↑ Doubt Is Their Product: How Industry's Assault on Science Threatens Your Health by David Michaels (2008) Oxford University Press. ISBN 0199719764.
- ↑ Victor Buhler SourceWatch.
- ↑ Sheldon C Sommers SourceWatch.
- ↑ Tobacco Smoke and Involuntary Smoking IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 83 (2004).
- ↑ “It is possible he is a kind of nut”*: how the tobacco industry quietly promoted Dr William Whitby
- ↑ Not Kool: It’s time to ban menthol cigarettes., New Scientist, 26-Oct-2013
- ↑ Mint That Kills: The Curious Life of Menthol Cigarettes: An FDA panel has declined to recommend a ban on menthol cigarettes—the latest coup for a well-marketed but deadly product by Tom McNichol (March 25, 2011) The Atlantic.
- ↑ 50.0 50.1 Cigarettes with defective filters marketed for 40 years: what Philip Morris never told smokers by J. L. Pauly et al. Tobacco Control 2002;11:i51-i61 doi:10.1136/tc.11.suppl_1.i51.
- ↑ Cigarettes with defective filters marketed for 40 years: what Philip Morris never told smokers
- ↑ The intractable cigarette 'filter problem'
- ↑ Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents by L. Kozlowski & R. O'Connor Tobacco Control 2002 Mar; 11(Suppl 1): i40–i50.
- ↑ Vape Nation h3h3Productions (Mar 21, 2016) YouTube.
- ↑ 55.0 55.1 55.2 55.3 55.4 55.5 55.6 E-cigarettes proving to be a danger to teens: Vaping is more popular than smoking among young people by Janet Raloff (9:00am, June 30, 2015) Science News.
- ↑ E-cigarettes don’t help smokers quit, study finds: People who tried electronic devices no more likely to give up smokes a year later by Nathan Seppa (4:00pm, March 24, 2014) Science News.
- ↑ A Longitudinal Analysis of Electronic Cigarette Use and Smoking Cessation by Rachel A. Grana et al. JAMA Intern. Med. 2014;174(5):812-813. doi:10.1001/jamainternmed.2014.187.
- ↑ Quitting Smoking | From K&C #16 Secular Talk (Sep 17, 2015) YouTube.
- ↑ Short- and Long-Term Consequences of Nicotine Exposure during Adolescence for Prefrontal Cortex Neuronal Network Function by Natalia A. Goriounova & Huibert D. Mansvelder Cold Spring Harbor Perspect Med. 2012 Dec; 2(12): a012120. doi: 10.1101/cshperspect.a012120.
- ↑ Endothelial disruptive pro-inflammatory effects of nicotine and e-cigarette vapor exposures by Kelly S. Schweitzer et al. American Journal of Physiology — Lung Cellular and Molecular Physiology (Published 15 May 2015) DOI: 10.1152/ajplung.00411.2014.
- ↑ Vapors Produced by Electronic Cigarettes and E-Juices with Flavorings Induce Toxicity, Oxidative Stress, and Inflammatory Response in Lung Epithelial Cells and in Mouse Lung by Chad A. Lerner et al. (February 6, 2015) PLOS One DOI: 10.1371/journal.pone.0116732.
- ↑ Chronic Inflammation and Cancer by Emily Shacter & Sigmund A. Weitzman (January 31, 2002) Oncology.
- ↑ Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes by Matt Richtel (March 23, 2014) New York Times.
- ↑ Flavour chemicals in electronic cigarette fluids by Peyton A. Tierney et al. (15 April 2015) Tob. Control doi:10.1136/tobaccocontrol-2014-052175.
- ↑ A study of pyrazines in cigarettes and how additives might be used to enhance tobacco addiction by Hillel R. Alpert, et al. (10 June 2015) Tob. Control doi:10.1136/tobaccocontrol-2014-051943.
- ↑ 66.0 66.1 Smoke Screen: Big Vape is copying Big Tobacco's playbook by Liza Gross (Nov 16, 2017, 9:00am EST) The Verge.
- ↑ 67.0 67.1 JUUL Takes a Page from Big Tobacco: The e-cig giant has been paying for research, contracting with labs that critics say favor the tobacco industry, and boosting its image through "school curriculum." by Molly Forster (December 04, 2018) East Bay Express.
- ↑ 68.0 68.1 68.2 68.3 E-cigarettes caught fire among teens: U.S. Food and Drug Administration set new limits on sales by Aimee Cunningham (6:00am, December 19, 2018) Science News.
- ↑ 69.0 69.1 69.2 Did Juul Lure Teenagers and Get ‘Customers for Life’? The e-cigarette company says it never sought teenage users, but the F.D.A. is investigating whether Juul intentionally marketed its devices to youth. by Matt Richtel & Sheila Kaplan (Aug. 27, 2018) The New York Times.
- ↑ 70.0 70.1 Vape pen death: Florida man killed while vaping when his e-cigarette exploded by Eli Rosenberg (May 16, 2018 at 6:00 AM) The Washington Post.
- ↑ Braden MacBeth (March 29, 2019). "Vape Nation: Vaping Is Bad, Kids". Science-Based Medicine.
- ↑ "Electronic cigarette explosion and burn injuries, US Emergency Departments 2015–2017". Tobacco Control, Volume 28, Issue 4. The BMJ. DOI: 10.1136/tobaccocontrol-2018-054518.
- ↑ E-cigarettes: the conspiracy theorists might just have it right by Fred Crawley (13 June 2013). New Statesman.
- ↑ Altria purchases 35% stake in Juul in deal worth $12.8 billion by Ben Tobin (Published 9:47 a.m. ET Dec. 20, 2018 | Updated 10:04 a.m. ET Dec. 20, 2018) USA Today.
- ↑ Smokeless tobacco is also carcinogenic, even if it's air-cured.
- ↑ From Pope Urban VII to Bloomberg, Four Centuries of Smoking Bans, History Channel website, Aug 22, 2018.
- ↑ 7 Historical bans on smoking, Mental Floss
- ↑ Social reformers and regulation: the prohibition of cigarettes in the United States and Canada, Lee J. Alston, Ruth Dupree, and Tomas Nonnenmacher, Explorations in Economic History 39 (2002) 425–445, via archive.org
- ↑ See the Wikipedia article on Anti-Cigarette League of America.
- ↑ See the Wikipedia article on Smoking ban.
- ↑ Chemical Agents and Related Occupations: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 100F (2009) International Agency for Research on Cancer.