Very good article: http://www.slate.com/id/2150354/?GT1=8592

Sum it up: If you take our drug you'll have a 31% improved chance of not having a heart attack. Sounds great, right?

Oh yeah, how do you figure that? Well, people not taking a drug for 5 years have a 7.5% chance of having a heart attack. People taking our drug every day for 5 years have a 5.3% chance of having a heart attack. So, 5.3% is 31% less than 7.5%.

Or you could say it like this:

...
Suppose that 100 people with high cholesterol levels took statins. Of them, 93 wouldn't have had heart attacks anyway. Five people have heart attacks despite taking Pravachol. Only the remaining two out of the original 100 avoided a heart attack by taking the daily pills. In the end, 100 people needed to be treated to avoid two heart attacks during the study period—so, the number of people who must get the treatment for a single person to benefit is 50. This is known as the "number needed to treat."
So, in other words you have to treat 50 people to have one positive effect. The NNT (number needed to treat) is 50.

Drug companies know the NNT number but they don't tell us or our doctors. The number they give us is the relative risk, which is meaningless!


Which way sells the pills? :p

It's not the drug companies' fault if the consumer is too stupid to understand basic arithmetic, and the difference between relative and absolute figures. This is grade school stuff.

Well, it is their fault if they bury the information or don't make it available!

Statistics is not basic arithmetic. I learned arithmetic starting in Grade 1. I learned statistics starting in Grade 11.

The reality is that few people, whether they know statistics or not, think about the background behind an advertising claim.

If you're like me, I simply ignore the numbers, unless they're from a scientific journal. Even then I'm cautious because you're never sure what 'interested' party has funded the research.

Statistics is not basic arithmetic.This isn't statistics. It's basic math, namely the concept of ratios and percentages, which should be taught in grade school. (I once studied statistics, and even in the most elementary course they wouldn't address such basic concepts.)

If I say A is 30% bigger than B, I'm just saying A/B=1.3/1, and nothing about the absolute values of A and B. This should be obvious to anyone who has a grade school education and isn't mentally retarded.The reality is that few people, whether they know statistics or not, think about the background behind an advertising claim.True, but the lead post wasn't addressing bias, merely reading comprehension.

It is very possible to be misleading without being directly dishonest. I agree with Pan that the way these things are presented is misleading. The point of declaring these percentages at all is to inform the consumer. When you inform the consumer in such a way that they have to do some math to get the number they need, its misleading, regardless of how easy you personally find the math to be.

The percentages should be reported as :"Without taking this drug, you would have a 5.5% chance of experiancing X; with it, you will have a 7.5% chance of experiancing X -- a 37% increase". THIS would inform consumers without misleading them.

Of course, the irony fly in this particular ointment is that the vastly-exaggerated risks of Secondhand Smoke Exposure fall into the exact same category. Without exposure, you have an infitesimal risk; with exposure, you have a slightly higher infitesimal risk. Divide the difference by the former, and voila -- OMG SCARY CANCER!!

The point of declaring these percentages at all is to inform the consumer.No, the point is to market their product. If you want objective information, read a peer-reviewed scientific study.Of course, the irony fly in this particular ointment is that the vastly-exaggerated risks of Secondhand Smoke Exposure fall into the exact same category. Without exposure, you have an infitesimal risk; with exposure, you have a slightly higher infitesimal risk. Divide the difference by the former, and voila -- OMG SCARY CANCER!!Not true. The risk of second hand smoke is readily available (http://www.cancer.gov/cancertopics/factsheet/Tobacco/ETS) in absolute terms. In the United States, about 3,000 people die each year from lung cancer on account of second hand smoke. I fail to see how the second hand smoke issue connects with the lead post in any way.

No, the point is to market their product. If you want objective information, read a peer-reviewed scientific study.
*LAUGH!* Your proposal is absurd.

And who funds these studies? The drug manufacturer.

So you think Joe Middleage should subscribe to JAMA to read the drug company funded study in order to determine whether he wants to risk the potential side-effects, in order to figure out that the NNT is 50?

How about we just require doctors to present that information? Oh, and we might want to require the drug companies to make that information available to doctors, so they can inform the patient. And while we're at it, how about a NNK number? The number of people killed (or hurt) by irreversible side effects?

it seems like drug manufacturers engage in pretty much the same practice all advertisers do...

I'm not surprised, nor am i particullary outraged.

Well, it is their fault if they bury the information or don't make it available!

Have you ever seen a drug ad in a magazine?

One page of their copy, and 2 pages of all the study info, contraindication, complication, and every side effect that every person in the study had during clinical trials(regardless if the drug actually caused it).

Hardly buried.

You just need to read all that fine print.

Have you ever seen a drug ad in a magazine?

One page of their copy, and 2 pages of all the study info, contraindication, complication, and every side effect that every person in the study had during clinical trials(regardless if the drug actually caused it).And 90% of the script on every drug commercial on TV is a fast-talking announcer about all the major risks and side effects.*LAUGH!* Your proposal is absurd.

And who funds these studies? The drug manufacturer.What is your point here? Misleading advertising, or biased studies? I've addressed the "misleading advertising" portion (what I <i>thought</i> your point is).

As to the biased studies, that's why you read them and make up your mind. If there's only one study, sponsored by the manufacturer, perhaps you should think twice about taking that drug -- even though a drug company sponsored study need not necessarily be biased.

Since no one bothered to read the article I linked, I'll regurgitate it back up for you, like a Momma Bird barfing up a worm for her chicks.

But drug companies don't want people thinking that way; whenever possible, they frame discussions of drugs in terms of relative risk reduction. That's why the package insert for Pravachol highlights the 31 percent reduction and mentions the NNT not at all. In Pfizer's 2005 press release promoting the Food and Drug Administration's approval of Lipitor for patients with diabetes and other risk factors for heart disease, the company said the drug "reduced the relative risk of stroke by 26 percent compared to placebo." In its 2002 press release promoting an anti-osteoperosis drug, Actonel, Aventis exulted that treated women were "75 percent less likely to experience a first vertebral fracture." It's standard for such promotions to make no reference to NNT and to bury information about absolute risks or leave it out entirely.

It's standard for such promotions to make no reference to NNT and to bury information about absolute risks or leave it out entirely.Key word: <b>promotions</b>. I didn't say read the press releases. I said read the studies. Do a Medline search.

I have not ever heard of NNT = 50, honestly.

I don't even know what it means or why it is valid.

ost of the studies that I am exposed to N=1000, or for some drugs N=4000.

The Nurses Study is the largest sample size study I know of, and that started out with 60K some odd sample size.

If the pharmaceutical company's sample size is less than a 1000, I generally disregard it as relatively scientifically anecdotal. Unless the market for the drug is substantially and remarkably small, and then and only then, would I consider it valid.

The only other sample small size I accept(or buy) is N=1, when that 1 is me.

There's another instructive way to consider the numbers. Suppose that 100 people with high cholesterol levels took statins. Of them, 93 wouldn't have had heart attacks anyway. Five people have heart attacks despite taking Pravachol. Only the remaining two out of the original 100 avoided a heart attack by taking the daily pills. In the end, 100 people needed to be treated to avoid two heart attacks during the study period—so, the number of people who must get the treatment for a single person to benefit is 50. This is known as the "number needed to treat."

Ok, ya this is familiar.

Would be kind of sucky to be one of those two guys though, and had the heart attack because you did not take a statin. Especially if it were a fatal MI.

At all of the pharmaceutical seminars, statins in particular that I have attended, this is discussed. It is no secret. It is also no secret that genetics is 8 times more likely a cause than diet, or statin use.

I fail to see how the second hand smoke issue connects with the lead post in any way.
I am not surprised. You've always been terrible at inferring B, when given evidence of A and C. But I'll spell it out for ya.

The risk of second hand smoke is readily available in absolute terms. In the United States, about 3,000 people die each year from lung cancer on account of second hand smoke.
Precisely. 3000 out of just under 300 million. Thats a 0.0010% chance of lung cancer for each individual when exposed to SHS. Now what are the number of lung cancer deaths not related to SHS? 2800. Thats a 0.0008% chance of lung cancer for each individual.

So by taking away the rights of millions of Americans, we decrease the lung cancer risk from 0.0010% to 0.0008%. As I said: a tiny chance, reduced to a slighly tinier chance.

But do they ever mention this? No, its all "24% decrease in risk of lung cancer OMGz0r!!!" It sure sounds scarier that way. It sure makes me feel more secure, knowing that I have a reduced chance of contracting a disease that I already had almost no risk of developing. Ah, sweet security.

Whats the quote again about trading liberty for security, and deserving neither?

To be fair, lung cancer is not the only pathology caused by SHS.

But, to be also fair, the numbers are generated from spousal studies. Non smoking people who live with smokers, who smoke in the home, for 10 years plus.

Additionally, the mean non smoker inhales the equivalent, in the studies I have read, 9 cigarettes per day. Half a pack of cigarettes equivalence. Denoting that the smoking person is going through between 2 and 4 packs a day in the home. Which, for the smokers I know, is extraordinary.

But do they ever mention this? No, its all "24% decrease in risk of lung cancer OMGz0r!!!" It sure sounds scarier that way.All your numbers are wrong (e.g., not everyone is exposed to second hand smoke, there are actually 160,000 lung cancer deaths per year, and so on), but that aside, I still don't see your point. All second hand smoke sites I've seen list absolute numbers, and don't use the tactic you're suggesting.It sure makes me feel more secure, knowing that I have a reduced chance of contracting a disease that I already had almost no risk of developing.The point is, you shouldn't have <i>any</i> risk of developing it. When one soldier dies in Iraq, it makes the front page, but when the tobacco companies and their drug users needlessly kill 3,000 people per year (from just one cause, lung cancer), no one bats an eyelash.

Key word: <b>promotions</b>. I didn't say read the press releases. I said read the studies. Do a Medline search.
You need new glasses. It also says package insert. Most of the time I never see the package insert. It isn't given to me.

Look, my doctor gets paid something like $150 for every visit. That's what I pay him to do. Why are we spending money hand over fist on healthcare professionals if they can't even properly inform their patients of the benefits and risks? (The real answer is, they're getting the same promotional information that I'm getting).

The solution is simple. Give patients the real information and the real risks, not relative risks.

I don't even know what it means or why it is valid.
Of course not, you didn't read the frigging article! Jebus. I even summarized for the reading impaired twice now! Holy crap...

Most of the time I never see the package insert. It isn't given to me.Ask your pharmacist. They can answer your questions, or give you a fact sheet on the drug. If neither your doctor nor your pharmacist is informing you of the risks of the drugs you take, I'd suggest finding new ones.

Alternatively, you can run a Google/Medline search on the drug and find any studies. Any scientific study will give you absolute numbers.

Why are we spending money hand over fist on healthcare professionals
Well, a lot of that has to do with lawyers.
As a nurse, half of the work we actually do is documenting what we do, in case of a lawsuit. That essentially means that half of every dollar paid in salary to every nurse in the US is because of lawyers. Or that means that you pay double for their services than you would otherwise have to.

Either way, you are paying a LOT of healthcare professions to do work that is not really directly caring for patients. Has nothing really to do with the topic, but is one answer to your question.

if they can't even properly inform their patients of the benefits and risks? (The real answer is, they're getting the same promotional information that I'm getting).
Your NNT is an arcane measurement. Is it really all that useful is my question to consumers?

The solution is simple. Give patients the real information and the real risks, not relative risks.
Well, it kinda has to be relative. For example, if a medication were developed to treat Celiac Disease. Would it really be relevant to me as a consumer, who does not have it, as to what its effectiveness is across 300 million people.

It would be relevant, though, to the subset of people who have the condition. A group much smaller than the greater population, say 2.4 million. Is it relevant to those who do have it, if the numbers of therapy were spread across the entire populations. I doubt it.

I just don't know how you, the consumer, would use it.

It seems more designed as a mechanism for validating insurance company coverage, drug benefit analysis of effectiveness vs cost between drugs for instance, than anything else.

Now, CD is really not a great example, I know, because not everyone is at risk for it. MIs are a natural human condition, with risk factors. High LDLs is just one of those factors. Previous MIs is the highest factor, if you had one MI, your chances of another are almost assured. Genetics is a huge factor. Age is a huge factor. And cholesterol(diet and lifestyle) is a factor(much lower than the previous three).

Cholesterol just happens to be the one that most people at risk of MI(which is relative) have any real control over. You can't undo a previous MI, you can't yet change your genetics, and you can't change your age.

And alternately, people with low risk factors, and low cholesterol, in the end STILL have MIs. In the end, is is like Casino Night. Jim Fixx died of an MI, and he almost single handedly started the whole running/jogging thing back in the 70s.

Do consumers really want an arcane rubrik to calculate their chances of having an MI with all of the risk factors included? Or do they want something simple, like..."If I lower my Low Density Lipoproteins and increase my High Density Lipoproteins that I will decrease my chance of heart attack." No, even that is too complicated for most people,,,they want, "I need to decrease my cholesterol."

People do not want a pharmacology class to understand that statins reduce cholesterol, which lessens their chance of MI. They want to know if it is covered by their insurance, and what their copay is, most don't even care how much it really costs.

Of course not, you didn't read the frigging article! Jebus. I even summarized for the reading impaired twice now! Holy crap...

Let me rephrase it.

I don't even know what it means or why it is valid to a consumer.

You need new glasses. . . . Look, my doctor gets paid something like $150 for every visit. That's what I pay him to do. Why are we spending money hand over fist on healthcare professionals if they can't even properly inform their patients of the benefits and risks? (The real answer is, they're getting the same promotional information that I'm getting)

No, the real answer is that most physicans are packing in as many patients as they can, at least in my experiences as a patient, the cardiologists I saw never knew as much about my heart condition as I did, seeing how it's my body, I tend to read all I can about things I have. I had to point out to one cardiologist that I had a specific type of AF, adrenal atrial fibrillation, with asymptomatic hypertrophic cardiomyopathy.

I have been on the patient side of things long enough to know that all the doctors offices I have seen the inside of are all compromised by the drug companies. When the posters on the wall, the magazine rack, the pens, the little plastic model of the heart sitting on his desk ALL have the brand names of whatever drug the rep sold him this week, that means I can't put my blind trust in him anymore than I can trust a car salesmen that the "rust preventative undercoat" is something I really need.

*I* chose the calcium-channel specific beta blocker that I would allow to be prescribed, because I went through and read every piece of literature I could find about them.

*I* chose the dosage schedule, and the amount, as I am the one that noticed that the standard morning dosage was not preventing repeat atrial events.

When my cholestrol levels began to rise, he seemed concerned that the little number he was told shouldn't rise, was rising, so being as predictable as the next rising sun, he tried to prescribe a statin drug to lower it. Statin drugs have many side effects, and my cardiac problem has jack all to do with my cholestrol serum levels. Your body makes 75% of your cholestrol, so most of it is genetics as well. If you ate nothing but bran flakes for the rest of your life, you would still have 75% of what the level is normally.

y little rant can be summed up in two sentences.

You are your own best doctor. No one will look out for your health as well as you can yourself.

You are your own best doctor. No one will look out for your health as well as you can yourself.
Absolutely no argument with that. However, I think about my parents and siblings. People with little interest or capacity to read and understand complicated medical findings or making these discerning judgements. When I get to be 80 years old, will I still have the brain power to figure these things out myself? Hope so, but probably not.

You are your own best doctor. No one will look out for your health as well as you can yourself.

We employ doctors because medicine isn't a subject that people can really learn for themselves in their spare time. We should expect doctors to know the effects of the drugs they prescribe as that is part of their qualification and expertise. The onus is on doctors to precribe the right drug. The onus is not on patients to have expert medical knowledge, or even knowledge of the latest advertising campaigns.

One thing I learned in Statistics class is you can make the numbers say anything you darn well want them to say.

You know what I found really funny here? The fact that no one expects the general public to figure out something that gamers can figure out for themselves all the time. For example, if you get that item that gives you a 20% increase in dodge, most gamers could tell you that if you dodge 10% of the time without the item then you would dodge 12% of the time with it. Too bad people can't be expected to take as much interest in their health as they do in their games.

LOL! I can't live my life over 100 times and figure out how many times I had a heart attack and how many times I didn't. :p

We employ doctors because medicine isn't a subject that people can really learn for themselves in their spare time. We should expect doctors to know the effects of the drugs they prescribe as that is part of their qualification and expertise. The onus is on doctors to precribe the right drug.

Actually, learning the contraindications of what drugs you are on, and your parents/siblings/people you care about are on is fairly simple. Just go to http://www.drugs.com/ . It does require time however. If you think watching that hour or two of TV, or playing that hour or two of video games is more important than their or your health, then that's your choice.

And learning systemic diagnosis of all types of illnesses, or memorizing the PDR is not required for the consumer. You don't have to get your M.D. to research a handful of diseases that you or your loved ones might have. Once you have been told you or your loved ones have X, going home and looking up all the diseases associated with X, and the possible ways in which the doctors can screw up diagnosis with the misidentification of symptoms that diseases Y, Z, AA, and BB also display can be useful too.

As you can tell, I trust the AMA to tell me what's what about as much as I trust my cat to stay off the table once I've plopped a catfish fillet dinner down on it.

Regards to your last comment, it's not the onus of the doctor to prescribe the RIGHT drug, it's the onus of the doctor to fight off the ravening hordes of drug reps so he can feel a clear conscience when he decides NOT to prescribe any drug as a kneejerk reaction to any and all illnesses. Your statement shows you have already bought into the common reaction when Americans get sick.
"I'm sick, I need to go to the doctor to get THE MAGIC PILL to make me well again."

Sorry, there is no magic pill. But the drug companies are making a killing(literally) off the naive who think one exists.

Actually, learning the contraindications of what drugs you are on, and your parents/siblings/people you care about are on is fairly simple. Just go to http://www.drugs.com/ . It does require time however. If you think watching that hour or two of TV, or playing that hour or two of video games is more important than their or your health, then that's your choice.

In my country a leaflet explaining the drug, dosage, and side effects is provided along with the made prescription. I don't know if it is the same in the US, but the patient should not routinely have to go to the web to find out medical information. I expect neither a leaflet or web site will tell you the problems occuring from a combination of drugs or complications due to a complex medical history. This is the job of the doctor and pharmacist and they are well trained and well paid professionals who have a responsibility to get it right.

y mother has received two poor prescriptions I can mention. In one case she read the description of a prescribed drug and found that her cancer record made her an unsuitable recipient. She took it back and made sure the doctor was aware of the error. In the other case she was unneccessarily prescibed a drug for high blood pressure whilst in hospital. The prescription continued after release from hospital, it gave her stiff pains in the joints, and it took a long time for the cause to be identified and her taken off the drug. This was the fault of the doctor and I cannot blame my mother for not knowing that she should not have been on this drug.

Regards to your last comment, it's not the onus of the doctor to prescribe the RIGHT drug, it's the onus of the doctor to fight off the ravening hordes of drug reps so he can feel a clear conscience when he decides NOT to prescribe any drug as a kneejerk reaction to any and all illnesses. Your statement shows you have already bought into the common reaction when Americans get sick.

I am not American. My doctors get guidelines for prescriptions from the government and professional bodies, not the drug companies. I do agree that far too often, doctors prescribe drugs simply to get patients out of their office. It is still the doctor however who has the responsibility of prescribing any treatment using their best clinical judgement. Irrespective of whether or not you think the patient should check the effects of the drug, the doctor should get it right anyway.

It's the same in Canada, Anka. If I get a prescription the first time, the pharmacist hands me a detailed, multi-page description of the medication including benefits and risks. After the first time, the pharmacist will ask if I want the information.

Considering that most people read at... grade level 8 (if I recall correctly) that leaflet probably well over the comprehension of most people.

Ok, here's an example of what I typically get with a drug.
The prescribing information: http://products.sanofi-aventis.us/plavix/plavix.html

Find me where the NNT is in that document.

Heh... just looked up Plavix on drugs.com. I don't see NNT there either.

Considering that most people read at... grade level 8 (if I recall correctly) that leaflet probably well over the comprehension of most people.

Ok, here's an example of what I typically get with a drug.
The prescribing information: http://products.sanofi-aventis.us/plavix/plavix.html

Holy crap!! I don't doubt that it's complete, but there should be a more consumer-friendly version.

This is some mean medicine. The chemical structure has it mixed with sulphuric acid! The pH is 1!! I call stuff like this 'organic solvent'... put it on something organic, like your hand, and it dissolves the hand.

(Yes, yes... I know... it is heavily diluted in the final medicine :) )

Find me where the NNT is in that document.Why are you obsessed with that useless figure? Look at Tables 1 and 2, they list the results of studies with absolute numbers, giving a patient the most pertinent information.

Developed by epidemiologists in 1988, the NNT was heralded as a new and objective tool to help patients make informed decisions. It avoids the confusing distinction between "relative" and "absolute" reduction of risk. The NNT is intuitive: To a savvy, healthy person with high cholesterol that didn't decrease with diet and exercise, a doctor could say, "A statin might help you, or it might not. Out of every 50 people who take them, one avoids getting a heart attack. On the other hand, that means 49 out of 50 people don't get much benefit."
Doesn't sound useless to me. Or to them either.

Or American College of Physicians
Systematic reviews summarize large amounts of information and are more likely than individual trials to describe the true clinical effect of an intervention. Traditional statistical outputs from systematic reviews cannot immediately be applied to clinical practice. The number needed to treat (NNT) has that clinical immediacy. This number can be calculated easily from raw data or from statistical outputs, and the principle involved in its calculation can be applied to different outcomes: treatment efficacy, adverse events (harm), or other end points. The NNT defines the treatment-specific effect of an intervention, and we suggest it as a currency for making decisions about individual patients. Knowing the NNT for different interventions that have the same outcome for the same disorder can help shape individual and institutional practice. Knowing or estimating the number needed to harm is also an important part of the equation. Knowing or estimating an individual patient's risk can, with the NNT, be a guide to the overall or net value of a prophylactic intervention. We advocate an approach to systematic reviews that distills information into, in effect, one number: the NNT. This is simple to remember and directly supports efforts to work with patients to make the best possible clinical decisions for their care.
http://www.jr2.ox.ac.uk/bandolier/booth/painpag/NNTstuff/numeric.htm

Doesn't sound useless to me. Or to them either.It does to me. If you're considering this drug, you're obviously <i>not</i> a random American, so why should you compare yourself to the entire population?

Look at the clinical studies. The first involved 19,185 patients, all with a history of heart trouble, and 939 died in the Plavix group as compared to 1020 in the aspirin group. The second involved 12,562 patients with ST evelation, and lists absolute results for each group with similar ratios. You can make your own little sub-NNT calculation if you're that obsessed with it.

The information above is the most useful to making your decision, not information about statistical averages over a huge population of people.

Considering that most people read at... grade level 8 (if I recall correctly) that leaflet probably well over the comprehension of most people.


Apparently EEC directive 92/97 mandates the information that comes with medicinal drugs, to be provided in terms easily comprehensible to the patient. I wonder same regulation applies to vetinary products?

http://www.ikev.org/docs/eu/392L0027.pdf#search=%22EEC%20directive%2092%2F27%2 0%22 - article 7.

The point is, you shouldn't have any risk of developing it.
No, thats exactly NOT the point -- because everyone, everywhere, ALREADY has the risk of developing it, whether tobacco is eradicated from planet earth or everyone is exposed to SHS.

But that risk goes from unbelievably small to stil unbelieveably small when exposed to SHS. Look, I recognize that this is not the exact same thing as Panamah is describing. But the point is pretty clear, and its a very direct analogy: the inflation of drug effectiveness is being compared to the inflation of SHS danger.

In both cases, the actual effect is miniscule, but by using percent changes, it is falsely made to appear larger. This is not a difficult point; I expect you to be able to grasp it.

No, thats exactly NOT the point -- because everyone, everywhere, ALREADY has the risk of developing it, whether tobacco is eradicated from planet earth or everyone is exposed to SHS.By "it" I mean lung cancer caused by second hand smoke, not lung cancer generally. Obviously, if we eradicated second hand smoke, it would not cause any more lung cancer.But that risk goes from unbelievably small to stil unbelieveably small when exposed to SHS.How do you think the U.S. population would respond to your argument if 3,000 people died each year in the U.S. from terrorist attacks? Would you tell them, "Hey, I know 3,000 of you are dying yearly, but statistically, each person's risk of dying is still infinitesimally small, so we need not take action!"

I think our response would be clear: <i>no one</i> should be dying from terrorist attacks, it's unacceptable. Just as no one should be dying from breathing in your recreational toxic garbage.

Hey, I quit smoking a while back, its not my 'toxic garbage'. I'm just uncomfortable with the government taking away the freedoms of millions based on highly questionable statistics.

And the terrorist comparison is absurd. The people in the WTC on 9/11 were killed by terrorists. Every individual who dies of lung cancer is kiled by cancer. Lung Cancer is correlated with smoke exposure, but its far from a direct cause and effect relationship. Millions of smokers never get lung cancer. Hundreds of thousands have died of lung cancer without ever even smelling tobacco smoke.

Comparing terrorism and smoking is absurd. The former is a causal, deterministic event. The latter is a weak correlation.

I'm just uncomfortable with the government taking away the freedoms of millions based on highly questionable statistics.My right to life is more important than your right to spew out toxic garbage in your spare time. (I'm using "you" in the general sense, not referring specifically to <i>you</i>.)The people in the WTC on 9/11 were killed by terrorists. Every individual who dies of lung cancer is kiled by cancer. Lung Cancer is correlated with smoke exposure, but its far from a direct cause and effect relationship. Millions of smokers never get lung cancer. Hundreds of thousands have died of lung cancer without ever even smelling tobacco smoke.The people in 9/11 were killed by incineration. Terrorists just caused the fire. Many people survive terrorist attacks (and fires). Many people also die of incineration without it being caused by terrorists. So, incineration is <i>correlated</i> with terrorism, but it's far from a direct cause and effect relationship.Comparing terrorism and smoking is absurd.Hardly. It just paints the same scenario with a dramatic flair. It's a lot easier for people to accept 3,000 slow, silent deaths from lung cancer than it is to accept 3,000 dramatic deaths from an explosion. Logically, though, the danger from the former is just as serious as it is from the latter.

If you are living with a smoker and don't like it.

ove out. Convince them to quit. Or get over it.


But you are more than welcome to leave me, and what freedoms I have left, alone.