Tobacco and Alcohol


Here’s a quick survey of the last forty years of research on smoking, drinking, and human health.

In 1833 when the Prophet Joseph Smith received the Word of Wisdom, medical science was still in embryo, and members of the Church followed the Word of Wisdom, like other instructions from the Lord, as a matter of faith. In the last forty years, medical researchers have compiled massive amounts of data that suggest some of the reasons why it is wisdom indeed to follow this health code.

Before we review some of the results, let’s make two points clear:

1. The Word of Wisdom is a religious belief, not a scientific one. Its basis must rest on faith, scriptural study, prayer, and experience. Scientific corroboration may be interesting for investigators as well as members, but it’s no substitute for spiritual discernment. (See 1 Cor. 2:11–14.)

2. Not all scientific studies are reliable, and we need to be careful about accepting evidence uncritically. If we support our religious beliefs with shoddy studies, our nonmember friends who can tell the difference may feel justified in rejecting all of what we say.

But how can we know if a particular report is valid? The best way is to have an experienced scientist in that field evaluate it. If you don’t happen to have access to qualified experts, it’s best to be skeptical of any scientific report. Those reports which are supported by a government agency, a scientific journal, or scientists known to be reputable are generally reliable. Reports in newspapers and popular magazines seldom discriminate between good and bad results; laymen easily exaggerate the reliability and significance of what they read.

Now, with those two observations, let’s look at some data. They come from two sources: human population studies and laboratory experiments. Human population studies survey various groups; from these studies, the association of a disease with a certain factor can be established. However, in some cases it may be impossible to prove that the factor causes the disease. For instance, physicians have long noticed that nearly all of their lung cancer patients are smokers; human population studies have associated smoking with lung cancer. But does smoking cause lung cancer? People who carry matches in their pockets more frequently have lung cancer too. To establish cause, we need to go to laboratory experiments. Not all laboratory experiments are conclusive either, but they can provide better evidence of causation than either general observations or human population studies.

Tobacco. It may surprise some people to know that the first reports linking tobacco and cancer were published in the 1920s. In the last forty years, literally thousands of medical investigators have studied millions of people and put together a picture of tobacco’s association with cancer, heart attacks, strokes, and chronic lung disease. These conditions account for over half of the deaths in the United States annually. The first famous “Surgeon General’s Report” was published in 1964. By 1975, eight additional reports on smoking and disease had been prepared by government scientists; just these summaries fill more than 2,000 pages. 1

Massive studies have been done: over 1,600,000 people in the United States, Canada, Great Britain, and Sweden, both smokers and nonsmokers, were studied for an average of eight years each to see how many deaths occurred among these people, all of whom were healthy at the beginning of the studies. Some conclusions from these and other studies are summarized in the table shown, listing the major tobacco-related causes of death among men in the United States, and estimating the range of lives that could be saved by nonsmoking. The results are given for men only. They would be less dramatic for women: the Hammond study of a million Americans shows that only half as many women smoke as men, they smoke fewer cigarettes for fewer years, and inhale less deeply. 2

Preventable Male Deaths from Smoking-related Diseases*

Diseases Aggravated or Caused by Smoking Cigarettes

Total Male Deaths per Year in U.S. from That Disease

Percent of Deaths in Male Smokers Preventable by Quitting**

Number of Deaths Preventable Each Year in U.S. if All Male Smokers Quit**

Heart Attacks

345,154

19–54%

40,800–204,100

Cancers

Lung Larynx Esophagus Oral Bladder

45,383 2,468 4,306 5,262 6,019

89–93% 83–90% 44–84% 64–75% 28–59%

38,400–40,800 1,900–2,100 1,500–3,300 2,800–3,600 1,300–3,000

Stroke

93,071

0–33%

0–23,400

Chronic Lung Disease

21,507

64–85%

11,800–16,900

Peptic Ulcers

9,823

38–86%

2,800–17,200

All Causes of Death

925,600

17–33%

101,300–314,400

* Calculations in this table were based on 1967 U.S. mortality rates for males, mortality ratios from major prospective studies of smoking given in summary tables of the 1971 “Surgeon General’s Report,” 1 and using 67 percent as the average number of U.S. males having smoked sometime in their life, as found among Hammond’s 440,000 subjects. 2

Most medical investigators agree that cigarette smoking plays a causal role for the diseases listed in this table.

** The figures given for percent and number of preventable deaths are the highest and lowest values derived from several large studies for each disease.

In addition to links between smoking as a cause of death, other human population studies associate smoking with the occurrence of disease in a staggering list: heart attacks, strokes, cancers, chronic lung disease, peptic ulcers, obstruction in leg arteries, aortic aneurysm, and complications in the health of unborn children. 3

Smoking pipes and cigars appears to have the same results as smoking cigarettes for cancers of the larynx, esophagus, and some mouth cancers; but smoking pipes and cigars seems to have very little association with heart attacks and lung cancer, possibly because pipe and cigar smoke doesn’t get inhaled as deeply as cigarette smoke. 4 Chewing tobacco has strong associations with lip and gum cancer. And studies show people who quit smoking dramatically boost their chances of escaping heart attacks and get less lung cancer, too. 5

When we turn to controlled laboratory studies to see what connections exist between tobacco and disease, we come up with the following results:

1. Atherosclerosis (a fatty-fibrous deposit in the blood vessels) is worse in smokers, according to four autopsy studies of 3,053 men who had died of other causes. 6 Nicotine and/or carbon monoxide apparently decrease the amount of oxygen the blood carries, increase fat levels in the blood, and may help cause blood clots to develop. Also, nicotine makes the body release catacholamines—neural hormones that increase heart rate, blood pressure, and oxygen requirements for the heart muscle, and also increase the risk of ventricular fibrillation (a fatal disturbance in the heart’s natural pumping rhythm). 7 Thus, there are several ways that cigarette smoking can increase a person’s chances of having a heart attack, stroke, or leg-artery obstruction.

2. Researchers trained dogs to inhale cigarette smoke; the dogs developed lung cancer. When a group of chemicals found in tobacco smoke (polycyclic hydrocarbons) were injected into animal tissues, the animals developed the same type of cancers that humans develop; the same kind of pre-cancerous changes in tissue cells also occurred. These experiments provide evidence that tobacco causes certain types of cancer in certain conditions.

3. Laboratory studies have also shown that emphysema and chronic bronchitis result from cigarette smoking. Even high school students who smoke have poorer lung function than nonsmokers; autopsies have shown lung damage in adults without breathing problems who stopped smoking a decade before death. 8 Smoke causes malfunction of special white blood cells in the windpipe that guard against invading germs; smoke also slows down the microscopic hairs along the windpipe that move trapped particles up away from the lungs. 9 Thus, it is not surprising that smokers take longer to recover from mild respiratory virus infections than nonsmokers.

4. Smoking doesn’t affect just lungs. Peptic ulcers generally develop when more stomach acid is produced than the digestive tract lining can handle. Long-term smoking increases the amount of acid produced and lowers the amount of bicarbonate the pancreas secretes to neutralize the acid that leaves the stomach for the duodenum. Nicotine injections in animals have produced the same results. 10

Alcohol. The sheer volume of study on tobacco overwhelms what’s been done on alcohol, but basically research has documented some short-term and some long-term effects. When a man is drunk, a doctor would describe his condition as “acute intoxication,” which means, to put it bluntly, short-term poisoning. The brain, sensitive to alcohol, fumbles; and the results are the well-known changes in mood, lack of judgment and restraint, staggering, slurred speech, and clumsiness. Proverbs 23:29–32 [Prov. 23:29–32] records the Old Testament view of intoxication—a realistic, even repelling, description. At a higher level, intoxication can produce drowsiness, stupor, and even death. 11 The short-term effects are usually temporary but do result in permanent damage if you count highway accidents. (Half of all drivers responsible for fatal auto accidents and one-third of all fatally injured adult pedestrians are intoxicated. 12 )

Chronic alcoholism, the long-term effect of drinking, is a disease, an addiction, and a behavior disorder that interferes with the drinker’s health, job, family life, and social responsibilities. 13 One government report estimates that 5 percent of workers in the United States are alcoholic; an additional 5 percent, though not alcoholic, are serious abusers of alcohol. 14 That’s one out of ten.

Medically, alcoholics develop inflammation of the digestive tract lining and organs. With cirrhosis, or liver scarring, the body loses many important chemical functions. Blood also backs up in vessels leading to the liver, with fluid collection in the abdomen. Other symptoms are prolonged diarrhea and digestion so impaired that the body cannot absorb nutrients properly. A common cause of death for alcoholics is catastrophic hemorrhaging into the digestive tract. When an alcoholic stops drinking, his withdrawal symptoms can be so severe that he risks death. Even if he’s successful in stopping, he may have permanent brain damage, loss of sensation in his legs, poor coordination, and even heart damage. Most of these problems develop if the person has been drinking heavily and eating poorly for some time.

Drinking doesn’t seem to cause a higher rate of heart attacks; but cancers of the oral cavity, esophagus, larynx, stomach, pancreas, liver, and large bowel seem to pick up. 15 Some preliminary studies also suggest a link between alcohol and cancer in the breast, thyroid, and moles. Even moderate drinking sometimes aggravates ulcers, epilepsy, and liver ailments. 16 Much research, of course, remains to be done. 17

We should point out that there is an acceptable use of alcohol. The external use of alcohol, endorsed by the Word of Wisdom, is common for disinfecting skin before needle punctures and operations. Contrary to a one-time popular misconception, alcohol is not a heart tonic or a treatment for persons in danger of freezing to death.

Alcohol abuse comes with a terrific price tag. The latest government review estimates that it costs the United States over $25 billion annually in lost production, medical costs, and auto accidents. (Slightly over $1 billion is spent on alcohol-related research development, law enforcement, and social programs.) 18 Even though most scientists conclude at this point that moderate consumption is not harmful, 19 there’s still that one chance in ten that a drinker will become an alcoholic or problem drinker.

Are Church members who live the Word of Wisdom healthier than others who don’t? Recent medical studies say yes. Most common cancers occur less frequently among Latter-day Saints. 20 The death rates for heart attack and stroke in Utah are among the lowest in the nation. 21 Those living the Word of Wisdom have indeed been protected against “the destroying angel” as promised in the 89th section of the Doctrine and Covenants.

Why, faced with these facts, do people continue to smoke and drink? Why is the rate of smoking among women and teenagers continuing to rise? Why is teenage drinking up from recent years? We can find some answers in peer pressure, in mammoth advertising budgets, 22 and in the bonds of physical and psychological addiction to tobacco and alcohol.

These habits can be so strong that some patients hospitalized with advanced lung disease continue to smoke even though their doctors warn that it will kill them. In contrast, each year thousands of converts to the gospel accept the Word of Wisdom and discard tobacco, alcohol, tea, and coffee simultaneously. This is a testimony to the difference between faith and knowledge. Faith requires action; knowledge does not. Scientific evidence provides interesting insights into the Word of Wisdom but it will never replace the need for a motivating spiritual conviction that this health code is the Lord’s law for us.

[photo] Roger R. Williams looks over “souvenirs” of research that have linked smoking and drinking to health problems. (Photography by Eldon Linschoten.)

Roger R. Williams, assistant professor of internal medicine at the University of Utah College of Medicine, is chairman of the Aaronic Priesthood/Young Women Services Committee of the Butler Twenty-fifth Ward, Salt Lake Butler Stake.

Show References

    Notes

  1.   1.

    U.S. Department of Health, Education, and Welfare, Public Health Service, Smoking and Health, Report of the Advisory Committee to the Surgeon General of the Public Health Service (Washington, D.C.: U.S. Government Printing Office, 1964); U.S. Department of Health, Education, and Welfare, The Health Consequences of Smoking (Washington, D.C.: U.S. Government Printing Office, 1967, 1968, 1969, 1971, 1972, 1973, 1974, 1975; hereafter cited as HCS, with year and pages).

  2.   2.

    E. C. Hammond, Smoking in Relation to the Death Rates of One Million Men and Women, National Cancer Institute Monograph, 19 (1966): 127–204; H. A. Kahn, The Dorn Study of Smoking and Mortality among U.S. Veterans: Report on Eight and One-Half Years of Observation, National Cancer Institute Monograph, 19 (1966): 1–125; E. C. Hammond and D. Horn, “Smoking and Death Rates: Report on 44 Months of Follow-up of 187,783 Men,” Journal of the American Medical Association 166 (1958):1159–72, 1294–1308; Inter-Society Commission for Heart Disease, “Primary Prevention of the Atherosclerotic Diseases,” Circulation 42 (1970):A54–A95; British Heart Journal, 33: supplement (1971):116–21; E. W. R. Best, A Canadian Study of Smoking and Health (Ottawa: Department of National Health and Welfare, 1966), pp. 1–137; R. Doll and A. B. Hill “Mortality in Relation to Smoking: Ten Years Observations of British Doctors,” British Medical Journal 1 (1964):1399–1467; R. Cederlof, L. Friberg, H. Zdenek, and U. Lorich, The Relationship of Smoking and Some Social Covariables to Mortality and Cancer Morbidity (Stockholm: Department of Environmental Hygiene, The Karolinska Institute, 1975), pp. 1–44.

  3.   1.

    U.S. Department of Health, Education, and Welfare, Public Health Service, Smoking and Health, Report of the Advisory Committee to the Surgeon General of the Public Health Service (Washington, D.C.: U.S. Government Printing Office, 1964); U.S. Department of Health, Education, and Welfare, The Health Consequences of Smoking (Washington, D.C.: U.S. Government Printing Office, 1967, 1968, 1969, 1971, 1972, 1973, 1974, 1975; hereafter cited as HCS, with year and pages).

  4.   2.

    E. C. Hammond, Smoking in Relation to the Death Rates of One Million Men and Women, National Cancer Institute Monograph, 19 (1966): 127–204; H. A. Kahn, The Dorn Study of Smoking and Mortality among U.S. Veterans: Report on Eight and One-Half Years of Observation, National Cancer Institute Monograph, 19 (1966): 1–125; E. C. Hammond and D. Horn, “Smoking and Death Rates: Report on 44 Months of Follow-up of 187,783 Men,” Journal of the American Medical Association 166 (1958):1159–72, 1294–1308; Inter-Society Commission for Heart Disease, “Primary Prevention of the Atherosclerotic Diseases,” Circulation 42 (1970):A54–A95; British Heart Journal, 33: supplement (1971):116–21; E. W. R. Best, A Canadian Study of Smoking and Health (Ottawa: Department of National Health and Welfare, 1966), pp. 1–137; R. Doll and A. B. Hill “Mortality in Relation to Smoking: Ten Years Observations of British Doctors,” British Medical Journal 1 (1964):1399–1467; R. Cederlof, L. Friberg, H. Zdenek, and U. Lorich, The Relationship of Smoking and Some Social Covariables to Mortality and Cancer Morbidity (Stockholm: Department of Environmental Hygiene, The Karolinska Institute, 1975), pp. 1–44.

  5.   3.

    T. Gordon and W. B. Kannel, “Predisposition to Atherosclerosis in Head, Heart, and Legs,” The Framingham Study, Journal of the American Medical Association 221 (1972):661–66; R. R. Williams and J. W. Horm, “Association of Cancer Sites with Tobacco and Alcohol Consumption and Socioeconomic Status: Patient Interview Study from the Third National Cancer Survey,” Journal of the National Cancer Institute (at press, March 1977); “COPD Morbidity,” HCS, 1971, pp. 145–46; “Smoking and Chronic Obstructive Pulmonary Disease Symptoms—Percent Prevalence,” HCS, 1971, pp. 195–205; “Peptic Ulcers” HCS, 1971, pp. 423–430; “Pregnancy,” HCS, 1971, pp. 389–418.

  6.   4.

    “Cancer,” HCS, 1971, pp. 229–320.

  7.   5.

    T. Gordon, W. B. Kannel, D. McGee, “Death and Coronary Attacks in Men after Giving up Cigarette Smoking,” Lancet 2 (7 December 1974):1345–48; HCS, 1971, pp. 239–41.

  8.   6.

    “Autopsy Studies of Atherosclerosis,” HCS, 1971, pp. 53–54.

  9.   7.

    W. S. Aronow and S. N. Rokaw, “Carboxyhemoglobin Caused by Smoking Non-Nicotine Cigarettes,” Circulation 44 (1971):782–88; H. Schievelbein and R. Eberhardt, “Cardiovascular Actions of Nicotine and Smoking,” Journal of the National Cancer Institute 48 (1972):1785–94; M. A. Birnstingl, K. Brinson, and B. K. Chakrabarti, “The Effect of Short-Term Exposure to Carbon Monoxide on Platelet Stickiness,” British Journal of Surgery 58 (1971):837–39; S. Bellet, N. T. DeGuzman, J. G. Kostis, L. Roman, D. Fleischmann, “The Effect of Inhalation of Cigarette Smoke on Ventricular Fibrillation Threshold in Normal Dogs and Dogs with Acute Myocardial Infarction,” American Heart Journal 83 (1972):67–76.

  10.   8.

    “Smoking and Pulmonary Function Tests,” HCS, 1975, pp. 71–82.

  11.   9.

    “Pulmonary Clearance,” HCS, 1973, pp. 51–53; “Smoking and Respiratory Morbidity,” HCS, 1975, pp. 62–63.

  12.   10.

    “Peptic Ulcer Disease, Experimental Studies,” HCS, 1973, pp. 157–64.

  13.   11.

    U.S. Department of Health, Education, and Welfare, Alcohol and Health (Washington, D.C.: U.S. Government Printing Office, 1971, 1974; hereafter cited as AAH, with year and pages); “Intoxicating Effects of Alcohol,” AAH, 1971, pp. 37–38.

  14.   12.

    “Alcohol and Highway Safety,” AAH, 1974, pp. 97–110.

  15.   13.

    M. Victor and R. Adams, “Alcohol,” Chapter 111, Harrison’s Principles of Internal Medicine, 7th ed. (New York: McGraw Hill, 1974), pp. 671–81.

  16.   14.

    “Findings,” AAH, 1971, p. viii.

  17.   15.

    “Alcohol and Cancer,” AAH, 1974, pp. 53–67; R. R. Williams and J. W. Horm, “Association of Cancer Sites with Tobacco and Alcohol Consumption and Socioeconomic Status: Patient Interview Study from the Third National Cancer Survey,” Journal of the National Cancer Institute (at press, March 1977).

  18.   16.

    J. M. Ritchie, “The Aliphatic Alcohols, Ethyl Alcohol,” in The Pharmacological Basis of Therapeutics, L. S. Goodman and A. Gilman, eds. (New York: MacMillan Co., 1968), pp. 143–53.

  19.   17.

    Laboratory evidence is needed to follow up suggestions that cancer may be caused by direct irritation of tissues, possible presence of chemical carcinogens in some beverages, nutritional defects in alcoholism, how tobacco carcinogens may become more powerful when dissolved in alcohol, and possible effects of alcohol on the pituitary gland and hormone balance. See “Alcohol and Cancer,” AAH, 1974, pp. 53–67; and R. R. Williams, “Hypothesis: Breast and Thyroid Cancer and Malignant Melanoma Promoted by Alcohol-induced Pituitary Secretion of Prolactin, TSH, and MSH,” Lancet 1 (8 May 1976):996–99.

  20.   18.

    “Economic Costs of Alcohol-Related Problems,” AAH, 1974, pp. 37–44.

  21.   19.

    “Findings,” AAH, 1974, p. x.

  22.   20.

    J. L. Lyon, M. R. Klauber, M. S. Gardner, and C. R. Smart, “Cancer Incidence in Mormons and Non-Mormons in Utah, 1966–1970,” New England Journal of Medicine 294 (1976):129–33; J. E. Enstrom, “Cancer Mortality among Mormons,” Cancer 36 (1975):825–41.

  23.   21.

    I. Moriyama and D. E. Kreuger, “Cardiovascular Disease in the United States” (Cambridge: Harvard University Press, 1971), pp. 74, 198.

  24.   22.

    Stuart Auerbach, “Nader Calls for End to Tobacco Aid,” Washington Post, 10 August 1975, p. A6, reports an annual advertising budget of $180 million for the top twenty cigarette brands, an annual $60 million appropriated by Congress to subsidize tobacco price supports and—barely a drop in the bucket—$0.9 million for education and statistics.