How many years is pleasure worth?

FuturePundit reports on research which suggests that smoking removes 10 years from your life expectancy. It's nice to see a number on this; it isn't like this is a counterintuitive finding. But this sort of quantification is important. I don't smoke, and I never have, but my experience in college was that people who smoked found it pleasurable and a social lubricant. There's some value in that. On the other hand, unlike alcohol consumption, smoking seems to have uniformly deleterious health effects, so the utilitarian calculus is more straightforward. Greasy food, alcohol, sweets, smoking, etc. So many things which humans crave, enjoy, and take pleasure in are "bad" for you. Why?

Do the extra years between 70 to 80 in expected life span matter that much? They do to me. I don't smoke, avoid greasy foods, don't consume much that is heavy on sugar (though I don't have a sweet-tooth, so it isn't hard) and drink alcohol in moderation. On the other hand, what if I was missing out on a lot of pleasure? Perhaps we should consider it a quality vs. quantity choice; I'm not a particularly "sensory" person for whom tastes and physical experiences rank highly. The "rational" trade off is then rather easy for me compare to someone else. For a specific example men who develop Type II Diabetes can lose 5-10 years in life expectancy. To reduce my likelihood of developing this chronic disease I've basically cut all refined sugar out of my diet, and am very moderate in the amount of fruit I consume. I'm doing other things obviously, but for me losing sugar is not a major headache, I was never a connoisseur of sugar. Perhaps there are individuals in the world who would trade 5-10 years for dessert every day?

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I am an avid smoker. My life expectancy at birth was 76 years. The other day I read that smokers on average live to be 77. I love statistics.

When I was in school, we were shown an anti-smoking poster: a burning cigarette with a time scale printed on its side. The full length was eight minutes. If you smoke a pack a day, that adds up to 40 days per year. In fifty years, 5.5 years lost. It's in the same ballpark.

So nothing new here. This has been known since the seventies at the latest.

By Lassi Hippeläinen (not verified) on 15 Oct 2008 #permalink

This sort of question gives me a headache every time I think about it. It's analogous to asking the Greg Clark-y question of whether plagues are a good thing in the Malthusian world since the people left alive after the plague ends have a better standard of living.

One thing I can say though -- grease per se isn't a problem. There's really no compelling evidence that most lipids are bad for you, the one possible exception being trans fats:

http://jn.nutrition.org/cgi/content/full/135/3/562

CRP is actually the best predictor of CVD -- better than HDL fraction. But then the trans fat case is pretty much built on that one study, and I'm not even sure I believe in that since this experimental study found no effect of trans fats on CRP:

http://dx.doi.org/10.1016/j.atherosclerosis.2003.07.005

The problem is that deep frying at high temperatures using cis unsaturated fats converts them to the (more favorable) trans configuration. So yeah, deep fried foods *might* be bad for you, maybe, but a plate of bacon is perfectly safe.

By Matt McIntosh (not verified) on 16 Oct 2008 #permalink

My father, a heavy smoker, lived to 75. On the other hand, his mother, a non-smoker, lived to 91. Furthermore, because of heart disease (two non-fatal heart attacks + bypass) my father was physically very weak during the last 13 years of his life.

My mother, a lighter smoker, died of lung cancer too, but at 87. Not exactly cut off in her prime, but around here lots of women live past 90 and a few past 100. (She was only the third oldest of five on the obituary page). She was very active and her quality of life was excellent until she was about 85; up until she was 80 she traveled internationally to Mexico, Canada, and London. (Her non-smoker parents lived to 91 and 92).

The ill effects of non-smoking are most evident in old age, so it's easy to put off thinking about it, or just say that old people never have any fun anyway, but that's not true. It's really worth it.

On Diabetes II, how much research have you done? From my time in a medical clinic, I came to believe that it was obesity, not sugar consumption that was the deciding factor.

By John Emerson (not verified) on 16 Oct 2008 #permalink

Re: smoking, if you do a literature search on smoking+infection and smoking+inflammation you get a bunch of stuff. It's annoying that cancer gets all the attention in relation to smoking when the way it fucks with your immune system has a far bigger statistical effect. Especially since a lot of cancers are probably viral anyway.

The ironic upshot of this is that smoking bans actually could be justified on public health grounds if smokers are much bigger vectors for airborne diseases, but almost nobody thinks about that angle and instead the battle gets fought over what amounts to aesthetics and paternalism.

By Matt McIntosh (not verified) on 16 Oct 2008 #permalink

I smoke, though I tend to prefer pipes and cigars. Don't know how much they dock off your life. Beyond sheer pleasure, they also offer me a cognitive and creative boost as well. However there's another side to it as well.

I've seen older relatives quickly die of cancer and I've had to care for older relatives who've remained physically healthy yet developed Parkinson's and other forms of dementia. Cancer is painful and ugly, for sure, but relatively quick, if you embrace it. Lingering around for untold years being a burden to the living and not even being there mentally anymore... it seems a much worse fate when viewed first-hand.

For me, the extra 10 years between 70 and 80 don't matter that much. Even if I do live to 80 or later (as several of my grandparents and great grandparents have), the quality of life during the last years seems to decline percipitously. For me, the goal is not how long you live, but how happy you are while you live. I wish our culture was mature and sophisticated enough to allow people to choose the appropriate time to die (eg, assisted suicide). Choosing to die when your quality of life is poor is a much more rational approach than wallowing in an assisted living faclity for decades waiting for your organ systems to irrevocably shut down.

The utilitarian calculation you propose overlooks the more important element. Smoking and diabetes have greater effect on morbidity than they do on mortality. It's one thing to think that the pleasure of smoking is worth missing the last ten years of life one otherwise would have. It's something else entirely to think that the pleasure of smoking is worth spending the last three years of life struggling for breath, due to emphysema.

Razib,

Can I ask what you do eat? I don't smoke and I drink moderately, but I do have a massive sweet tooth. I find resisting sodas and donuts incredibly difficult. I'm a slim guy so it doesn't cause weight problems (yet), but I still recognize it'd be better if I cut down the sugar.

(Just writing this post made me realize a donut shop I love is en route to a meeting I have later today!)

Razib, I know you assume that we will all follow your links (right?) but the researchers are quoted as saying,

"Those who had never smoked lived an average of 10 years longer than heavy smokers (more than 20 cigarettes per day)." (My emphasis)

They also observe that,

"mortality [death] and health-related quality of life showed a dose-dependent trend according to the number of cigarettes smoked daily."

The straight line from smoking -> 10 years is thus a bit misleading, since smoking less than this high level will shorten the average life by less that this.

More significantly, the generalizations in the article (I don't have access to the actual paper) seem to ignore a variety of issues.

One is whether heavy smokers tend to be differentiated from never-smokers in other lifestyle choices as well (I'd have thought it likely, since it is not improbable that attitude to smoking is a reasonable proxy for attitude to health-related lifestyle issues generally; the more so since smoking was the focus of a lot of media and government attention in 1970s Finland, hence the Tobacco Control Act of 1976).

Another is changes in cigarettes over time: although I've not been able to find out about Finnish cigarettes in the 70s, it might be that a 20-a-day Finnish smoker in the 1970s is not comparable to an American smoker in the 2000s. (I do recall reading that Axis soldiers in WWII prized Finnish cigarettes over their German equivalents because they were much stronger.)

I'm not really challenging the basic finding, but it seems to me that without analysis of these factors and others there is little new to be learned from this particular study. We knew all this stuff - I learned it in school a couple of decades back. Numbers are nice, but only if they are representative of present reality:)

I've thought about this, too. I've personally never smoked, I try to eat reasonably healthy (my limiting factor here is cost---a varied, healthy diet is expensive), and I don't even drink.

*shrugs*

I guess the trade off is there, but you also have to consider, it's not just usually a matter of 10 years gone from your life, but some other adverse side effects, e.g. increased risk of lung cancer. Smoking/whatever doesn't just make your life end 10 years earlier magically, you know? You might go through some hell to get that early death ;-)

"Do the extra years between 70 to 80 in expected life span matter that much?"

If you are 60 then the difference between 70 and 80 is large and meaningful. If you are 20 then you should expect very significant developments in medical technology that make 50 year projections moot. For longevity it would be wiser for a young person to focus on the factors that are more likely to kill in the next couple of decades, i.e., driving while talking on a cell phone or while drunk.

This is a great topic, Razib. I ponder this daily. I would like to see a double-blind study exploring what kind of effects "doing what makes you happy" regardless of projected health impacts has on longevity.

Beyond sheer pleasure, they also offer me a cognitive and creative boost as well.

Spike Gomes, I strongly suspect that the physiological adaptations to nicotine that our bodies go through negate any benefit a long-time stimulant user might otherwise experience. People who use caffiene regularly don't get a stimulating bonus from it, they're penalized if they don't use it. Why would we expect nicotine to be fundamentally different?

Do they really offer you an improvement over base functioning? Or did they redefine your 'base' so that you're worse off without them?

Most of the things that are "bad" are only bad when consumed to excess. You can eat eggs every day for a month for breakfast without raising your cholesterol too much. Forty years of it and you're all plugged up.

Nearly all of these bad things (refined sugar, cigarettes, trans fats) didn't exist on that idealized African savanna 50,000 years ago. If they did, they were rare treats saved for a feast. Nowadays, people can and do feast every day.

There's a huge psychological literature on "discounting the future". Basically, it boils to people NOT asking themselves this question: "How will my future self feel about this decision?"

A good new book is Kluge: The Haphazard Construction of the Human Mind (where that question comes from)

http://klugethebook.com/

Smoking can enormously decrease your quality of life during the last ten years, over and above killing you in the end.

My smoker sister is about 58 and has seriously diminished lung capacity which limits her physical activity severely. For her a mile walk is hard work.

By John Emerson (not verified) on 16 Oct 2008 #permalink

I've recently started learning about this health metrics business, and I'll share my reaction to this headline; I'm trying to develop this into my immediate response. _Correlation is not necessarily causality_.

Caledonian:

Because it's all in how you use it. Drinking coffee and energy drinks throughout the day is a good way to not feel it anymore. Having a single Earl Grey in the afternoon or Espresso after dinner won't build up a serious tolerance.

Hence why I prefer pipes and cigars to cigarettes. One large slow massive dose once or twice a day, for best effect, rather than a numbing 10-20 small doses spread out throughout the day. It also makes it easier to cease if need be. I've stopped smoked for weeks on a whim just to prove I could to others.

But like Erdos, who said that his bet to prove he wasn't addicted to amphetimines set back math by a month, I feel that complete abstention from tobacco also sets back my abilities by a non-trivial amount. Also life is just less fun without it.

It's no different to a person who needs a dose of meditation, classical music, or the late night to do their best work. Part of it is just getting to the mental state where you work best.

Fruit doesn't increase your chances of getting diabetes you fool. Sugar? Yes. HFCS? Yes. BREAD? Yes. What, you didn't know that starch is basically pure sugar? Honey? Hmmm maybe. Fruits? No. Eat as much as you like.

[hey dumbass,
http://ezinearticles.com/?id=288204
In general, eating fruits can be good for people because fruits are great sources of many essential vitamins, minerals, fiber, and other nutrients that provide a lot of benefits to one's health. However, diabetics might be concerned whether fruits can increase their blood sugar levels or not. The quick answer to that is a simple yes. Fruit, like any other food that contains sugar does increase one's blood sugar. Moreover, fruit can increase blood sugar as fast and as high as other types of food with the same amount of sugar. But does this mean that a diabetic patient has to avoid eating fruits in the same manner as avoiding candy? Not entirely.

i do eat *some* fruit, but i'm a person who used to eat 10-15 tangerines in a day. i let this rude know-it-all-comment from richard kluisz, at http://richardkulisz.blogspot.com , email richard.kulisz@mailinator.com, go through as an example of what won't go through the queue :-) ]

Do the extra years between 70 to 80 in expected life span matter that much?

Unless that's merely clumsy phrasing, you know better than that. The bonus of a healthy lifestyle vs. an unhealthy one is not an extra decade of declining health and capability, but a longer lifetime of generally improved health.

So think rather about how much it matters if you have the health of a 35-year old at 28, and of a 50 year old at 40. Poor health doesn't mean you skip the geriatric years, it means you skip your prime and hit the geriatric years earlier.

By Spaulding (not verified) on 24 Oct 2008 #permalink