Thank you for dying: Did 250 million people worldwide die from smoking over 10 years?
A character in Christopher Buckley's 1994 novel Thank You for Smoking (now a film) quotes a then-current prediction in the medical journal the Lancet: "[In the] next ten years, 250 million people in the industrialized world are going to die from smoking--one in five." It's now 12 years later. I certainly hope the Lancet's prediction--which I am guessing was bona fide, and not an invention of the novelist--proved to be overpessimistic. In the best estimate of the experts (and by "experts" I do not mean tobacco spokespersons), how many lives were lost to smoking during that ten-year period?
You'll excuse my jumping immediately into the arithmetic, David, but let's think. If Buckley meant that 250 million deaths due to smoking would account for a fifth of all deaths in the industrialized countries in the coming ten years, we'd be talking 1.25 billion total deaths--absurd given that the population of those countries in 1994 was right around 1.25 billion. But even if he just meant that the 250 million smoking deaths would claim a fifth of all people then living in the industrialized world, that's still nuts. The U.S. Census's international database tells us there were 539 million deaths worldwide between 1995 and 2004. Tobacco's a scourge all right, but if smoking in the industrialized nations alone accounted for half of human mortality over a decade, it'd make the Black Death look like a bad cough.
This isn't to say Christopher Buckley manufactured that horrifying statistic; he probably just misread his notes. Undoubtedly he's referring to a 1992 Lancet article entitled "Mortality From Tobacco in Developed Countries: Indirect Estimation from National Vital Statistics" by Richard Peto et al. (Sounds familiar? Maybe it's because I cited this article when trying to compute smoking deaths among U.S. WWII veterans. Incidentally, Peto, an Oxford don, was knighted in 1999, making him Professor Sir Richard Peto. Sometimes I wish I lived in England.) Peto and friends projected that "[based] on current smoking patterns just over 20% of those now living in developed countries will eventually be killed by tobacco (i.e., about a quarter of a billion, out of a current total population of just under one and a quarter billion)." So we're looking at 250 million lifetime smoking deaths, not just in the next ten years. In the shorter term, Peto's group projected that tobacco would kill 2.1 million people in 1995, or 21 million for 1990-'99. In sum, Buckley was off by an order of magnitude, a sizable boo-boo even for a novelist. Then again, the AIDS pandemic, generally regarded as the great plague of our time, has killed an estimated 25 million since 1981, so 21 million tobacco deaths in ten years still qualifies as a lot.
Be that as it may, we're now fourteen years on and one naturally wonders how things look on the fatal scorecard. Last December Peto and colleagues issued a revised version of their 1994 opus Mortality From Smoking in Developed Countries 1950-2000. The 50-year total, since you're probably wondering: 63 million, or one death in eight. Mean years lost per smoking death: 15. Returning to the matter at hand, Peto et al calculate 2 million smoking-related deaths in 1995 in the 45 industrialized nations and 1.9 million in 2000.
Offhand those numbers suggest the toll is mounting more slowly than expected. Maybe, but it's not like somebody is going around counting toe tags. All statistics on tobacco deaths, whether looking forward or back, are estimates of varying reliability, and from what I can tell, virtually all the synoptic international figures are the work of Peto and associates. For example, in the World Health Organization's Tobacco Atlas (2002) I find a page of color graphics with a mortality bar chart in the form of little tombstones, in my mind a sure mark of reliability, plus, in big red numbers, an estimate "of everyone alive today [who] will eventually be killed by tobacco": 500,000,000. (Attention novelists: That's lifetime, not in the next ten years, OK? Lifetime.) Confirmation of Peto's worst fears? Hold on. The likely source of the scary statistic is longtime WHO consultant--you guessed it--Richard Peto.
I'm not saying the numbers are bunk. It's true, as tobacco apologists argued for years, that given the long latency and complex causality of lung cancer, the chief smoking-related killer, it's difficult to conclusively pin any particular death on tobacco use--mostly you're stuck comparing cancer rates among smokers and nonsmokers. What's more, anyone working up a global estimate has to generalize from narrow research (Peto's major source on differential cancer rates was an American Cancer Society study). So smoking-death projections are inherently soft and won't ever be confirmed in a rigorous way. Still, there's reasonably good evidence that the leading cause of death in this bloody era is a form of suicide committed one puff at a time.