Calculating the 'Big Kill': CDC Estimates of Smoking-Related Deaths Do Not Add Up

By Rodu, Brad | Regulation, Winter 2007 | Go to article overview

Calculating the 'Big Kill': CDC Estimates of Smoking-Related Deaths Do Not Add Up


Rodu, Brad, Regulation


In 1985, the British Medical Association and Health Education Council published The Big Kill, a series of booklets estimating the number of people killed by smoking in England and Wales. Assigning a "precise" number of deaths to a risky behavior provided opponents with a powerful and often persuasive weapon. For two decades, the U.S. Centers for Disease Control and Prevention (CDC) has regularly produced an American version of the booklets. The CDC tallies (estimates, actually) are available on the Internet, where visitors can also review other consequences of smoking such as years of life lost, medical expenditures, and productivity losses.

Today, there are mountains of statistics about the health effects of smoking, but the purported mortality figures form the cornerstone of the global campaign against tobacco. The figures provide the justification for tobacco policy at all levels of American government--and for the massive tobacco regulation scheme now being crafted in Congress. A May 2007 New York Times editorial typifies the spin that is put on the numbers: "[T]he death toll from cigarette smoking remains disturbingly high.... Tobacco kills 440,000 smokers every year in the United States, and secondhand smoke inhaled by bystanders claims another 50,000.... [T]here is no doubt that the panel's report strengthens the case for granting the F.D.A. power to rein in one of the most dangerous products ever marketed."

The Times was quoting Big Kill numbers published and heavily publicized by the Institute of Medicine, a part of the prestigious National Academy of Sciences. The problem is that the Institute's numbers are wrong. For one thing, the CDC had reported that smoking kills 440,000 Americans, including 50,000 from secondhand smoke. The Institute mistakenly counted the secondhand smoke deaths twice, inflating the numbers by more than 11 percent.

[ILLUSTRATION OMITTED]

I brought this error to the attention of the Institute report's authors. The essence of their response: Oops, you're right; we'll make the correction in the final, bound report. Never mind that we've generated global headlines with our false data; we're not issuing a corrective press release.

The Institute had issued its report just as Congress began considering a proposal to give the Food and Drug Administration primary regulatory authority for all tobacco products--a move that would likely cost billions and dilute the agency's primary mission of safeguarding the nation's food and drugs. Given the stakes, one would assume the Institute of Medicine would have wanted legislators to have accurate information on the health consequences of smoking.

But how accurate is the underlying CDC estimate of smoking-related deaths? The agency's yearly estimates are rarely disputed, primarily because the supporting data and computations cannot be accessed by anyone outside the CDC or its collaborator, the American Cancer Society. The specifics of the agency's work are shrouded in secrecy. In 1992, a Detroit News reporter documented her quest to understand how the CDC arrives at its estimates. Stymied, she offered this summary: "The computer is fed raw data and ... employs various complex mathematical formulas to determine how many people in various age groups, locations, and heaven knows what other categories are likely to get sick or die from what diseases and how many of these can be assumed to be smoking related." In short, the estimate is marginally informative and utterly unsatisfactory.

Americans deserve more disclosure from federal agencies. In a recent study published in Nicotine and Tobacco Research, Philip Cole and I developed estimates for America's mortality rate from smoking in 1987 and 2002. Our research shows that the CDC's Big Kill estimates are inflated and that the concept itself is outdated.

This article, which is based on our research, attempts to demystify the secretive CDC process. …

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