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Rasheed, a Virginia anesthesiologist who asked that his last name not be used in this story, has smoked socially for years, sometimes going without a cigarette for weeks before smoking two or three nights in a row when friends are in town. He says he has never been addicted to nicotine, and indeed has stopped outright a handful of times -- one time to train for a marathon.

Rasheed, who does not drink, sees a bit of a contradiction in his colleagues' prejudices against smoking. "Drinking is still very much accepted by a lot of physicians. In medical school, a lot of my friends drank and not a lot of them smoked," he says

"I think there can be social smoking" just as there is social drinking, he says.

Like millions of chippers, Rasheed would appear to be one of those lucky individuals who isn't genetically inclined toward substance addiction. He smokes to relieve stress, to pass the time and sometimes just to have something to do with his mouth, but never, he says, because he feels he needs it, and never in great enough quantities to put him at any real risk for the litany of health problems that fell pack-a-day smokers by the busload.

About those health problems there is little debate -- unless you happen to be a Big Tobacco CEO testifying before Congress.

As shaky as they are on the topic of social smoking, each of the three public health experts interviewed for this story brightened noticeably when asked to enumerate the health risks facing daily smokers. A pack-a-day smoker is 10 to 15 times more likely to get lung cancer than a nonsmoker, according to the most current research, Shopland says. And while the increase in risk for lung cancer is slightly higher than for other smoking-related illnesses, epidemiologists have measured similar spikes in the risks of coronary heart failure, emphysema and stroke for daily smokers.

Researchers know too that the health risks associated with smoking are dose sensitive. While a pack-a-day smoker may be 10 to 15 times more likely to develop lung cancer than a nonsmoker, someone who smokes less than half a pack (nine cigarettes or fewer) daily is only four to eight times more likely to develop the disease.

"You see the same dose response in all of the major cigarette-related diseases," Shopland says.

Therein may lie a partial answer to the question of social smoking. While it appears no studies have examined the health risks facing social smokers, epidemiologists have assembled a sizable body of evidence about the risks facing so-called "passive" smokers -- nonsmokers who face daily exposure, typically either at work or at home, to secondhand smoke.

While a passive smoker may still breathe more tobacco smoke than the average chipper, passive smoking represents by far the lowest level of nicotine intake that has been seriously studied by tobacco researchers.

A chipper may be "analogous to somebody who is exposed to nothing more than environmental tobacco smoke," Kaufmann speculates. And passive smokers, researchers have found, are 20 to 50 percent more likely to develop lung cancer than true nonsmokers and roughly 30 percent more likely to develop coronary heart disease. While that is a measurable increase in risk, it is very small when compared to the risk levels associated with daily smoking. If a pack-a-day smoker is 10 to 15 times more likely to get lung cancer than a nonsmoker, then a passive smoker is, at most, half again more likely than a nonsmoker to develop the disease.

And that doesn't take into account the fact that many chippers probably take in far less cigarette smoke than do the passive smokers studied by epidemiologists. In the studies of secondhand smoke risks, the subjects have had very regular exposure to smoke, Shopland says. Many of those subjects either had spouses who smoked habitually or worked in bars or other businesses where smoking was pervasive.

Taken in that perspective, the assertion of many chippers that their risk of disease is at best minimal seems difficult to refute, prompting again the question of whether there is, as Rasheed and many of his ilk contend, such a thing as "responsible smoking" akin to the widely accepted concept of "responsible drinking."

Next page | Tobacco is more akin to heroin than to alcohol