The 1964 Surgeon General Report, which declared that the inhalation of cigarettes would likely cause lung cancer and heart disease, had a profound impact in the United States. This report started America thinking that the practice of inhaling cigarette smoke was unhealthy and began a long series of studies, lawsuits, and laws, that changed the face of America from a primary smoking society—where over 60 percent of adults in the U.S. smoked—to a number that is now about 30 percent.
On June 27, 2006, long after the first Report and yet likely based on its long-lasting impact, Surgeon General Richard Carmona issued the following statements regarding second hand smoke:
(a) The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults.
(b) Secondhand smoke contains more than 50 cancer-causing chemicals, and is itself a known human carcinogen
(c) There is no risk-free level of exposure to secondhand smoke. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 40 percent and lung cancer by 20 to 30 percent.
The Surgeon General also stated that 49,000 deaths per year were caused by second hand smoke. As a surgeon, I was stunned, because I had never seen an autopsy report listing second hand smoke as the cause of death. Nor had I seen this as a secondary cause of death. So I asked six pathologists if they had ever listed second hand smoke as a cause of death – not one had. In my years of clinical practice, I have seen patients die from many devastating diseases, and yet I have never seen anyone who has been disabled by, or has died as a result of, second hand smoke. This was my first clue that perhaps there was more hyperbole than science involved in the reports issuing from the Surgeon General’s Office. To give a contrast: 33,000 people die per year of pancreatic cancer – all of the pathologists have listed pancreatic cancer as a cause of death.
Composition of Smoke
Second hand smoke, also called Environmental Tobacco Smoke, is a combination of Mainstream Smoke, which is exhaled by smokers and Sidestream Smoke, which is released directly from the burning tip of cigarettes or cigars. Sidestream smoke is the primary constituent of environmental tobacco smoke, providing most of the vapor phase and over half the particles. Hence, at events such as “The Big Smoke”, the majority of particulate matter comes from sidestream smoke. Exhaled mainstream smoke contributes between 15 and 43 percent of the particulate matter in environmental tobacco smoke. Sidestream smoke is generated at lower temperatures and a higher alkalinity than mainstream smoke, and as a result has a different chemical composition.
During environmental tobacco smoke formation, both sidestream smoke and exhaled mainstream smoke are diluted by many orders of magnitude and subsequently undergo physical transformation and alterations in chemical composition. For example, nicotine and many other semi-volatile compounds of tobacco smoke tend to be present in the particle phase of inhaled mainstream smoke, but evaporate into the vapor phase as exhaled mainstream smoke is rapidly diluted during the formation of environmental tobacco smoke.
Second Hand Smoke and Lung Cancer
If second hand smoke exposure is a significant risk factor for developing lung cancer, then we should expect to see increased numbers of cancer cases in non-smokers who are exposed to regular doses of second hand smoke. Has there been an increase in the incidence of lung cancer among nonsmokers over the last 40 years? The answer is quite simply… No.
Data from national mortality studies show that rates of lung cancer among non-smoking women remained stable between the 1950’s to the 1980’s (very few women smoked during those years) and didn’t rise until substantial numbers of women started smoking in more recent years. These non-smoking women were included in numerous studies as control groups for examining lung cancer rates in their smoking spouses. As anti-smoking logic would dictate, the longer one is exposed to second hand smoke the more we should see a rise in lung cancer. However, when we examine the data from the studies noted above, we do not see such a rise in cancer rates for these non-smoking women.
In 1992, second hand smoke was labeled a Class A carcinogen: one that causes lung cancer and is responsible for the deaths of 3,000 Americans annually (U.S. EPA, 1993). However, there were no autopsies, no bodies, nor one person that could be claimed as a victim. The EPA did not base their classification on their own independent study but examined over thirty epidemiological studies (i.e., studies that attempt to correlate various risk factors with early death in different populations). Eleven of those studies were done in the United States, and of those eight found a positive risk, three found a negative risk but none of them were statistically significant (that is, none of the U.S. studies could make the statement that there was a causal relationship between second hand smoke and cancer).
In medical research, a statistical confidence level of 95% means that there is only a five percent chance that a significant finding could be due to chance (i.e., a random result). In their interpretation of the epidemiological studies, the EPA made a critical procedural statistical alteration. They changed the confidence level to 90%. This statistical manipulation made it more likely that their findings would show significant negative health effects of second hand smoke, but also made more likely the potential for erroneous conclusions. Furthermore, the EPA did not take into consideration the factors independently associated with both the development of lung cancer and exposure to second hand smoke, factors that certainly could account for the purported relationship between second hand smoke and early death. Finally, they did not attempt to assure that the subjects were properly identified into the correct experimental group. The EPA left several important questions unanswered such as: Were the exposed cases truly ill with primary lung cancer? Had the subjects been smokers previously? Were they truly exposed to second hand smoke? And, did the subjects accurately report their exposure levels?
The EPA also classified second hand smoke as a carcinogen based on chemical “similarities” between inhaled mainstream smoke and environmental tobacco smoke. Their logic was that since inhaled tobacco smoke is a carcinogen, environmental tobacco smoke must also be. Inhaled mainstream smoke, however, contains chemicals at concentrations of up to one million times those found in environmental tobacco smoke (which is a combination of exhaled mainstream smoke and sidestream smoke). Further, deep inhalation affects the degree of exposure to those chemicals, as well as the deposition of those chemicals into the respiratory passages of the smoker. One of the frustrating issues is we do not know the chemical, or chemical compounds responsible for the link to lung cancer and/or heart disease. This leads to another difficult issue – the length of exposure to the chemical might not yield a linear relationship to the formation of cancer (also known as the exposure-risk relationship). Single dose exposure likely does not yield 100 percent incidence of carcinoma. For example, low exposures of materials in drinking water does not yield disease, but higher and longer exposures of materials – such as arsenic, certainly produce disease. Much as a single aspirin may produce the effect of headache relief, a large dose of aspirin will be toxic. What was not evident in many of these studies was a dose-response curve to second hand (passive) smoking and disease.
At the behest of Congressman Henry Waxman (D-Ca), the Congressional Research Service (CRS) spent two years examining reports and came up with the following conclusions regarding second hand smoke and lung cancer (Redhead and Rowberg, 1995):
(a) The statistical evidence does not appear to support a conclusion that there are substantial health effects of passive smoking.
(b) It is possible that very few or even no deaths can be attributed to second hand smoke.
(c) If there are any lung cancer deaths from second hand smoke, they are likely to be concentrated among those subjected to the highest exposure levels (e.g., spouses).
(d) The absolute risk, even to those with the greatest exposure levels, is uncertain.
The CRS found that, what was considered an “obvious” conclusion by the EPA was, in fact, flawed. The EPA reasoned that if the smoke inhaled by a smoker was close enough in composition to that which is exhaled, then if one was carcinogenic the other must also be carcinogenic. This assumption is chemically incorrect and was rejected.
The CRS examination of the various studies concluded that someone exposed to significant second hand smoke—a spouse for example—might increase their risk of dying from lung cancer to 2/10 of one percent, while those who are exposed on the job would have less risk: 7/100 of one percent.
The most devastating opinion about the EPA’s decision to classify second hand smoke as a class A carcinogen, came from Federal Judge William Osteen who interviewed scientists for four years and in 1998 opined,
The Agency disregarded information and made findings based on selective information… [The EPA] deviated from its risk assessment guidelines; failed to disclose important (opposing) findings and reasons; and left significant questions without answers… Gathering all relevant information, researching and disseminating findings, were subordinate to EPA’s [goal of] demonstrating [that] ETS was a Group A carcinogen… In this case, the EPA publicly committed to a conclusion before research had begun; adjusted established procedure and scientific norms to validate the Agency’s public conclusion, and aggressively utilized the Act’s authority to disseminate findings to establish a de facto regulatory scheme…and to influence public opinion… While doing so, [the EPA] produced limited evidence, then claimed the weight of the Agency’s researched evidence demonstrated ETS causes cancer. (Osteen, 1998)
Because the EPA report was “advisory” and not “regulatory,” Judge Osteen’s indictment was reversed. However, it is important to note that the decision was reversed on a technical distinction, not the merits of the EPA’s report.
In another large-scale study, and in contradistinction to the EPA conclusions, the World Health Organization International Agency on Cancer published a report concluding that there was no statistically significant risk of lung cancer in non-smokers who lived or worked with smokers (Boffetta, et al, 1998). This study was the product of ten years of data gathered from seven European countries.
Health Risks of Second Hand Smoke
In a study spanning 16 U.S. cities, the U.S. Department of Energy researchers placed monitors on nonsmoking bartenders and waiters who worked in smoke-filled bars and restaurants to measure the amount of environmental tobacco. The conclusion was that the monitors detected minuscule amounts of tobacco products. (Jenkins, et al, 1999) The harm that might come from such minuscule amounts of exposure was calculated as “none” to “improbable harm”. The anti-tobacco forces have condemned this study because it was partly funded by the R.J. Reynolds Company. Later, a group of individuals visited the establishments and concluded that since they saw few individuals smoking, the study was flawed. In spite of this study being done by Oak Ridge National Laboratories, it was painted with a broad brush because of the funding from the tobacco industry.
Environmental tobacco smoke (ETS) is considered by many authorities to be an important component of indoor air pollution in part because it is often viewed as being equivalent to mainstream cigarette smoke (MS). It has been clearly demonstrated that ETS is not the same as MS. Side stream cigarette smoke (SS) is a major contributor to ETS. Side-stream smoke is generated under different conditions than MS, and as a result, has a different relative chemical composition. Exhaled MS, the second primary contributor to ETS, is a different material from that which leaves the cigarette butt and enters the lungs. Exhaled MS has been substantially depleted in vapor-phase constituents, and the particulate matter is likely to have increased its water content in the high-humidity environment of the respiratory tract. As the cigarette smoke, both SS and exhaled MS, enters the atmosphere, it is diluted by many orders of magnitude and subsequently undergoes both physical transformation and alterations in its chemical composition. Upon standing, or during air exchange from other sources, ETS continues to change… (Guerin, et al, 2000)
The science and chemistry of this field of research are complex, and if the conclusions reached do not meet with current public policy, the research scientist is often stereotyped as being “pro-tobacco”. Because these studies are expensive, and because tobacco companies often supply the grant funds to purchase the supplies, anti-tobacco advocates will often say this is equivalent to bribing the researchers. They sometimes fail to mention, however, the anti-tobacco-funded individuals who personally receive thousands of dollars to vent anti-tobacco research and lend their name to the anti-tobacco movement. One of those individuals, Stanton Glantz, a Ph.D. whose field of expertise is aerospace engineering, attempted to convince the EPA to accept that there were over 50,000 deaths a year, from cardiac events, attributed to second hand smoke. The Congressional Research office examined the statistics related to second hand smoke and cardiac events and determined that those numbers were implausible (Gravelle and Redhead, 1994)
And yet, the anti-smoking advocates continue to march their cause…
The Occupational Safety and Health Administration (OSHA) withdrew a 12-year-old petition that smoking be banned from all indoor workplaces. The withdrawal was based on a lack of evidence. The decision was taken to court in an attempt to force OSHA to reverse its decision. OSHA stated that it would regulate based on permissible levels of the various ingredients in environmental tobacco smoke, and the lawsuit was withdrawn on the grounds that OSHA would do nothing. (Henshaw, 2001)
It’s no wonder OSHA decided to withdraw its complaint, since even its own people couldn’t agree on a position. In 1997, Acting Assistant Secretary of OSHA, Greg Watchman aired his own view:
Field studies of environmental tobacco smoke indicate that under normal conditions, the components in tobacco smoke are diluted below existing Permissible Exposure Levels (PELS) as referenced in the Air Contaminant Standard (29 CFR 1910.1000). It would be very rare to find a workplace with so much smoking that any individual PEL would be exceeded. (Letter from Greg Watchman, 1997)
As with arsenic content in drinking water, for example, setting scientific numbers to permissible levels would compel the scientific community to make real statements as to levels that are acceptable. Given that science had already answered the question with a number of chemicals in tobacco, such a regulation would be a blow to all anti-smoking advocates and their contention that there is no “safe” level of second hand smoke.
With no scientific evidence to back his statement, Mayor Bloomberg of New York City proclaimed that bartenders inhale the equivalent of half a pack of cigarettes a day. In fact, a study from the U.K. showed that the average London bartender inhaled the equivalent of six cigarettes annually (about one quarter of a pack). (Matthews and MacDonald, 1998)
Perhaps one of the better studies was published in the British Medical Journal by epidemiologist James Enstrom and Geoffrey Kabat (2003). Their study of 35,000 Californians showed that lifelong exposure to a husband or wife’s smoke produced no increased risk of coronary heart disease or lung cancer among the non-smoking spouses. As with most who oppose the anti-tobacco lobby, Enstrom was forced to defend his study on the basis that it had received funding from a tobacco company. The study was condemned as biased, even though it was published in a peer-reviewed journal, the statistics were not flawed, and the conclusions were sound.
When the cigar lounge at Seattle’s El Gaucho restaurant was closed because smoking in public places in the state of Washington became illegal, one of the reasons cited was to “protect the workers”. The premise of this law has no evidence. Suffice it to say, there is far more evidence to ban the sale of alcohol in bars and restaurants than cigar smoking. Every day in every major city there are deaths from people who have consumed alcohol and driven. Alcohol is directly responsible for about 100,000 deaths a year and an estimated 2.3 million years of lost life. Alcohol prohibition didn’t work. So why attempt to prohibit tobacco?
The press frequently overlooks inconsistent data when reporting about environmental tobacco smoke. The most recent example was when a group of radiologists noted that one-third of patients who had never smoked, but were exposed to “high levels” of second hand smoke, showed MRI changes in their lungs similar to the changes seen in smokers. What failed to make the mainstream news was that two-thirds of the patients who were listed as non-smokers, but exposed to “high levels” of second hand smoke, paradoxically, had lower diffusion through the lungs than the “low exposure” group. That is, they showed the opposite of changes seen with heavy smokers. Again, what made the news in most circles was that this was more proof about the negative effects of environmental tobacco smoke. What did not make the news was that the paradoxical report might prove the opposite of their conclusion. (Science Daily, 2007)
The Surgeon General was incorrect. Second hand smoke may be an irritant and an annoyance, but it’s not a cause of death. There are no body bags filled with those who have developed tumors or heart disease as a result of second-hand smoke. The body bags are filled, however, with scientists and physicians who dare go against the anti-smoking lobby and state the obvious—the science isn’t there. As much as they want to ban all smoking in all places, the health risk is grossly overstated. Whenever someone dies of lung cancer, such as Diane Reeves, the late wife of Christopher Reeves, the anti-smoking lobby uses the news as a media circus. They want to relate the unfortunate death to something… even if such a relationship has no basis in solid scientific research.
In 1633, the Catholic church condemned Galileo for asserting that the Earth revolves around the sun. Galileo was forced to recant his scientific findings to avoid being burned at the stake. This was a clear conflict between faith and science.
References
Boffetta, P., Agudo, A., Ahrens, W., et al. (1998). “Multicenter Case-Control Study of Exposure to Environmental Tobacco Smoke and Lung Cancer in Europe.” Journal of the National Cancer Institute. Vol. 90, No. 19:1440–50.
Enstrom, J. E. and Kabat, G. C. (2003, May 17) “Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98.” British Medical Journal, 326(7398): 1057. Available: www.pubmedcentral.nih.gov/articlerender.fcgi?artid=155687
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Gravelle, J. G., and Redhead, C. S. (1994, March 23). Congressional Research Office Memorandum “Discussion of Source of Claims of 50,000 Deaths from Passive Smoking.” “in response to request for information on the possible source of an estimated premature 50,000 deaths from passive smoking effects.” Available: www.nycclash.com/Cabinet/CRSDiscusses_50000_Deaths.html
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Guerin, M. R., Jenkins, R. A., Tomkins, B. A. (2000). “The Chemistry of Environmental Tobacco Smoke: Composition and Measurement.” (Second Ed.) CRC Press.
Henshaw, J. L. (2001). “Withdrawal of Proposal.” U.S. Department of Labor, OSHA, Notice, Indoor Air Quality – Federal Register #66:64946. Available:
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=FEDERAL_REGISTER&p_id=16954
Jenkins, R. A., Palausky, A., Counts, R. W., Bayne, C. K., Dindal, A. B., and Guerin, M. R. (1999). “Exposure to Environmental Tobacco Smoke in Sixteen Cities in the United States as Determined by Personal Breathing Zone Air Sampling.” Journal of Exposure Analysis and Environmental Epidemiology. Oct-Dec;6(4):473-502.
Letter from Greg Watchman, Acting Ass’t Sec’y, OSHA, to Leroy J Pletten, PhD, July 8, 1997.
Matthews, R., and MacDonald, V. (1998). “Passive Smokers Inhale Six Cigarettes a Year.” UK News Electronic Telegraph, Issue 1178. Available
http://www.forces.org/evidence/files/passmok2.htm
Osteen, W. L., United States District Judge (1998). “Flue-Cured Tobacco Cooperative Stabilization Corporation, et al v. United States Environmental Protection Agency, et al.” United States District Court for the Middle District of North Carolina, Winston-Salem Division, 6:93CV00370, 89-90. Available: www.forces.org/evidence/epafraud/files/osteen.htm
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Redhead, C. S. and Rowberg, R. E. (1995, November 14) CRS Report for Congress. “Environmental Tobacco Smoke and Lung Cancer Risk.” Retrieved November 2007 from the WWW. Available: www.forces.org/evidence/files/crs11-95.htm
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Science Daily. (November 27, 2007). “Second hand smoke damages lung, MRIs show.” Available:www.sciencedaily.com/releases/2007/11/071126104424.htm
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U.S. Environmental Protection Agency. (1993) “Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. ” National Institutes of Health. Monograph 4, NIH Publication No. 93-3605, August 1993.
Wow. Very interesting article.
I live in Florida, one of the states that has banned smoking in the workplace, and while I don’t believe that logic behind the ban is entirely reasonable, I do like the results. Truth is, I think most people are like me- they just don’t like the smell of smoke.
One point I didn’t see you address was the impact of second hand smoke on children, and those who have respiratory issues. I’d be interested to read your take on that. =)
Most do not like the smell of smoke, and with everything appreciate a smoke free place to work and live. For those who wish to have a place to smoke, in their bar or restaurant, it would seem they should be able to.
Second hand smoke on children – well, any environmental irritant can be cause an issue. If you smoke around a child you are an idiot – that’s my opinion. Smoke, like high ozone levels, like pollen – is an irritant. The other data about children, when re-tested was not reproduced – there are no increased ear infections, as some earlier work claimed.
Agreed with above. Even if it were proven to be true, It is still quite an annoyance to many.
And aside from that, research the first 10 pages of google. And try the American Lung Association.
http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35422
It is proven, there’s no myth here.
Google is not the basis of science, nor is The American Lung Association a scientific organization – it is a lobbying group. It is an annoyance, and for those who are annoyed and wish to have their own business free from smoke- I agree.
I am one of 5 kids. Dad smoked, mom didn’t, so mom and us kids all breathed 2nd hand smoke. All 5 of us married and all smoked along with our respective spouses. We all had kids for a total of 9. All these kids were born into homes where both parents smoked and all grew into adulthood breathing 2nd hand smoke. So we’re talking a total of 20 people who smoked and/or breathed 2nd hand smoke. As of now, all these people are still alive and well except my mom, who died of pancreatic cancer and a sister who committed suicide. Their ages range from mid to late 40′s to mid to late 50′s. None have any form of smoking related desease or other health problems that are blamed on smoking and/or 2nd hand smoke. Those are the facts and I don’t know how anyone can dispute that. How do you convince someone like me that 2nd hand smoke is dangerous to my health?
This is a political topic, more than a scientific topic. While I am a skeptic by nature- part of that is to see what real evidence there is for the political statements made about a topic. In this case we can say — most people don’t like second-hand smoke -and irritates them. So far there is no evidence that second-hand smoke causes a lot of disease.
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I always get a good laugh when people hold up the American Lung Association as though they were a bright and shining light! They get massive funding from Robert Wood Johnson Foundation, partner to Johnson and Johnson, for the purpose of lobbying for smoking bans, which are NOT bans on smoking, they are simply a way to demonize and ostracize smokers onto the nicotine replacement products distributed by J&J. They do NOT lobby to stop the selling of nicotine products. They do NOT want tobaco to be unavailable! If tobacco WAS unavailable NO ONE would buy nicotine replacement from J&J! DUH!!!
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Excellent article, well researched, and well written!
I think you’ll enjoy reading my own take on “ETS Exposure” at http://www.Antibrains.com where you’ll find you’d have to hang out in a smoking bar/restaurant for literally 165,000 hours to get the same amount of arsenic as in a “government-approved-as-safe” 16oz glass of tap water.
Keep on fightin’ Doc!
Michael J. McFadden
Author of “Dissecting Antismokers’ Brains”
I have been researching Smoking/SHS since 1998 and I have all of the information mentioned by the Doctor. I feel he is correct in everything he stated. It’s too bad the truth can’t get out to the public. Our Media is in the pocket of the Pharmaceuticals as are many of our Universities.
I too have been researching the science of smoking for a long time and I agree with the Doc.
Michelle wants to know the effect of SHS on children. The Doc mentioned the non statistically significant risk of lung cancer in non-smokers who lived or worked with smokers (Boffetta, et al, 1998). but did not point out that there WAS actually ONE statistically significant result in that study- a beneficial effect on children! There are other studies that concur with that too, although a few children suffering from chronic asthma can be adversely affected. Interestingly, child asthma has increased ‘manifold’ over the same time period that their exposure to SHS has been substantially diminished. (studies have shown that children of smokers are LESS likely to get asthma).
Anti-smokers are often quoted as saying ‘the debate is over’ on the subject of smoking ‘harm’. I agree, as it relates to passive smoking – it is undoubtedly harmless! The debate on primary smoking however, is back on the agenda. While it continues to be claimed, it has never been proved that smoking kills. The epidemiological evidence is more persuasive than that on passive smoking but actual hard evidence is ominously absent.
Conversely, there are clear anomalies in the notion of smoking ‘harm’. All cancers continue to rise in developed countries, unaffected by the reduction in smokers, Underdeveloped countries with more smokers tend to have LESS cancers, The majority of cancer sufferers are confined to a few small geographic areas and there are more cancers in large towns and cities compared to rural areas even though smoking prevalence is similar.
There is clearly more to public ill health than smoking. There is more of a link to industrial pollution and concentrations of internal combustion engines than smoking.
http://www.freedom2choose.info/news1.php?id=957
Isn’t it time to move the debate forward rather than confining it to SHS? For too long Anti-smokers (and industry and big pharma) have diverted attention away from the toxic effects of industry on public health to individual lifestyle choices. It is becoming clearer day by day that smoking harm is grossly exaggerated. Tobacco control know this and explains why other lifestyle choices are now being targeted – to explain the shortfall in, so called, ‘smoking related deaths’!
Kin Free
The issue of shs/ets is the reason and basis the Nazis were able to get the bans in place to begin with. To get the truth out requires money,money and more money or else a shake up in the political power base in washington ie..nov 2010. I firmly believe that by april 2010 the steam roller of smoking bans will slow down to neil.As the voters go against the democrats who are the ones for the majority part of the bans. But,anyway we look at it educating the public on the LIE of second hand smoke must be at the fore front of any movement as shs/ets is the foundation of tobacco control.With that destroyed the rest collapses just like climate gate is today. CLIMTEGATE is the end of the green movement. Lets hope for SHSGATE soon.
Sorry to rain on your parade Doctor. But I say your opinion piece is ill-informed and badly researched. In fact, if you’d written this for your medical peers, I suspect they would have ripped it to shreds.
1. References in death certificates. In case it’s escaped your attention, pancreatic cancer is a disease. So it’s little wonder it appears in many death certificates. Passive smoking is not a disease; it is a risk factor for lung cancer and ischaemic heart disease. If you are trying to apply a rule that nothing should be considered dangerous unless it’s referred to in numerous death certificates, then I take it that you deny that radon gas and vehicle exhaust emissions are also causal factors for lung cancer. And you presumably should also deny that speeding and reckless driving are causal factors behind fatal road traffic accidents.
2. The EPA report. My, my, my. Why are you giving so much attention to a report which is now 17 years old? There have been numerous more recent studies, which take account of latest evidence (e.g. Taylor et al (OUP, 2007), US Surgeon General (2006), IARC (2004), UK SCOTH (1998 & 2004), Law at (BMJ, 1997), Hackshaw et al (BMJ, 1997)). Other than passing reference to the USSG, you ignore all of them. Guess what? Their conclusions match those of the EPA. So, even if your criticisms of the EPA report were valid (which is debatable), your views are totally out-of-date.
3. CRS: The risk you refer to relates to lung cancer only. If you include heart disease too, then the risk of harm from passive smoking increases greatly (as much as 10-fold). Suddenly the risks of passive smoking are not as small, are they?
4. Osteen: You claim Osteen’s views were overridden on a “technical distinction”. Wrong. Osteen was not authorised to judge on the question of the case – that is fundamental, not technical. Of course, since Osteen there have been many “regulatory” decisions, as restrictions on smoking in public have been introduced. Courts are allowed to overturn these. Had the views of Osteen and the tobacco industry been as strong as you claim, we would expect these laws to be overturned following Judicial Review. So why haven’t they? Where are all these supposedly convincing judicial challenges now??
5. Boffetta study. You state the report concluded “there was no statistically significant risk of lung cancer” as if that meant that passive smoking is not harmful. That interpretation is totally wrong. In fact, the finds of this study are fully consistent with other reports which show that passive smoking IS harmful.
6. OSHA: Did you actually read the letter from Greg Watchman to which you refer? If you did, then you are deliberately trying to mislead. You quote him as saying it is unlikely that individual PELs would be exceeded. But Watchman immediately then aid “The more central concern of the Agency is that synergism of the chemicals in tobacco smoke may lead to adverse health effects even though the PELs are often not exceeded.” That’s a hugely relevant statement – so why did you ignore it??
7. Enstrom & Kabat: Actually, the conclusions were not necessarily sound and have been subject to substantial legitimate criticism (albeit E&K were also criticised personally – there was no need for that). Interestingly, Geoffrey Kabat has since stated: “As a cancer researcher who has published extensively on the harmful effects of smoking, I am in favor of vigorous smoking bans and feel there is no justification for nonsmokers to have to breathe air polluted with tobacco smoke.”
You are a trusted professional. You really should be more careful about knowing the facts before you make public claims.
Hello Rollo! Whew… you DO get around, don’t you? Heh… Glass houses speaking here admittedly…. ;>
I hope you don’t mind my popping in. The Doc is of course welcome to add his own thoughts, but some of the answers might be more familiar to me. Taking your points in turn:
1) I have to agree, in my relatively uninformed knowledge, never having actually SEEN a death certificate. However I believe in some U.S. States doctors are now allowed, even encouraged, and perhaps even REQUIRED to put ETS down as a “contributing cause of death” in a special box for anyone so exposed dies of just about anything besides meteor strikes.
2) The EPA Report is what drove and justified U.S. smoking bans from 1992 through 1998. It was more thoroughly analyzed with a critical eye than any of the others – if they were similarly analyzed I would expect the conclusions to be similar.
3) The lung cancer section was the most important when it came to promoting smoking bans. The CRS did not address heart disease because the EPA Report didn’t (despite, from what I understand, significant pressure from Glantz et al to do so – the evidence was just far too weak no matter HOW much they juggled statistics.
4) Osteen’s ruling WAS overruled on a “technical distinction.” That distinction was, as I understand it, that since the EPA’s Report was informational/advisory rather than regulatory the court had no proper jurisdiction for a ruling, no matter how valid the ruling might otherwise have been. If the EPA had believed in its report strongly enough to make it regulatory then indeed it would have been overturned. {Caveat: It is possible that the EPA was acting *totally* outside its boundaries in issuing a report on indoor non-natural conditions in the first place and that might have been the reason for the non-regulatory nature of the Report. Have they ever issued similar reports for any other indoor non-natural conditions? If so, were they also non-regulatory?}
{continued…}
{… continued … It appears my h-tee-tee-pee links may be blocking the post so I will delete that part of the referenced links.}
5) Bofetta’s study had only ONE significant finding: exposing children to smoke REDUCED their later lung cancer risk by 22%. That finding was blatantly ignored by the authors in their abstract/conclusions when they deliberately described their ONLY significant finding as showing “no association.” If you examine the RRs and CIs of childhood exposure studies listed at: http://www.nycclash.com/Philly.html#ETSTable you’ll find Bofetta’s result by no means unusual.
6) My guess is that the Doctor was not aware of the sentence you quote. It is relevant and it is indeed usually ignored. I was not aware of it myself.
7) I disagree at least partly with your characterization of E/K as having been subject to “substantial” legitimate criticism. Analyze the BMJ responses and I believe you’ll find very few that could be so characterized, and I also believe that you’ll find E & K responded to many of those criticisms … unlike the the Helena authors in response to Helena’s criticisms. As I’ve done before, I’d refer readers to both the BMJ study/responses at: http://www.bmj.com/cgi/content/short/326/7398/1057 and Dr. Enstrom’s detailed defense at: http://www.scientificintegrityinstitute.org/defense.html and http://www.epi-perspectives.com/content/pdf/1742-5573-4-11.pdf
OK…. back to the Sunday paper….
Michael J. McFadden,
Author of “Dissecting Antismokers’ Brains”
OK… there does seem to be a problem with multiple links. Let’s see if I can fix it:
===
5) Bofetta’s study had only one significant finding: that exposing children to smoke correlated significantly with REDUCING their later lung cancer risk by 22%. That finding was not only never even hinted at as being causal, but was even ignored by the authors in the body of the study itself when they deliberately described their ONLY significant finding as showing “no association.” If you examine the RRs and CIs of childhood exposure and lung cancer studies listed at the bottom of the “philadelphia” section of the NYCClash.com site you will see that the Bofetta finding for childhood exposure was by no means unusual.
6) My guess is that the Doctor was not aware of the sentence you quote. It is relevant and it is indeed usually ignored. I was not aware of it myself.
7) I disagree at least partly with you characterization of the E/K study as having been subject to “substantial” legitimate criticism. Do an analysis of the responses in the BMJ and you’ll find that very few seem to have anything that could be characterized as such, and I also believe that you’ll find Enstrom and Kabat responded to those criticisms … unlike the disregard shown by the Helena authors in response to the Helena criticisms. As I’ve done before in this discussion with you, I’d refer readers to both the BMJ study/responses after the BMJ Helena article itself and Dr. Enstrom’s detailed defense against the accusations lodged against them at the Journal of Epidemiologic Perspectives and Innovations, Oct. 10th, 2007 and his primary Scientific Integrity website that is listed as the third reference to that article.
OK…. back to the Sunday papers….
Michael J. McFadden,
Author of “Dissecting Antismokers’ Brains”
All along the EPA is being used as a political tool in to many scams by the prohibitionist forces. It seems collusion is the end game here of so called public health officials rubber stamping each others findings without regard to scientific integrity. GRANTS to any research facility with half a name that can guarantee the outcome based studies we must have. It seems as of late its pushing for contatin levels in hair or blood….merely an association of being around smokers or ”LAUGH;; they ate some other plants in the tobacco group……
Tobacco is IN the SAME food group as potato, tomato, cauliflower, green pepper, chili’s, egg plant and other foods. They ALL contain nicotine. Are those the next bans?
Interesting: Tobacco used to fight cancer http://www.jointogether.org/news/research/sum...
I have yet to see in any of the contatin studies where these foods were considered as possible bio-markers themselves……
But lets be fair and point out nicotine is not a carcinogen
so the face value of studies on contantin really are nothing….Another thng that always seems to get lost in the maize of anti-tobacco propaganda studys is the dose makes the poison chart…….Of all the anti-tobacco sites I have searched not one lists the main part of second hand smoke as its nearly 94% water vapor and ordinary air……if that was publicized by the tobacco control folks there would be no tobacco control…….
Propaganda is what I call all of it and the historical connection to the last prohibition movement with the anti-cigarette leagues of the early 1900s where they were able to get complete tobacco prohibtions in place before they moved onto alcohol prohibiton….same scare tactics employed then as now just change the dates………Human nature never changes it just goes forward and reacts the same way it did last time…..smoke easy/ speak easys……..smoke em and have fun in the new ROARING TWENTIES.
Above link is dead……..
Tobacco Used To Make Cancer Vaccine
Featured Article
Main Category: Lymphoma / Leukemia / Myeloma
Also Included In: Immune System / Vaccines; Cancer / Oncology
Article Date: 22 Jul 2008 – 11:00 PDT
http://www.medicalnewstoday.com/articles/115826.php
Also you may want to hear of some research that was carried out in 1991. It assumes you are in a room 100m3 about 20 feet x 20 feet by 20 feet, sealed and unventilated. Here are the number of smokers that you have to be surrounded by before you reach danger levels of the chemical is the last figure:
Benzene: 13,300 A car gives off 20,000 more chemicals than a smoker per cubed inch.
Methyl chloride 0.88 10.30 1,170
Acetaldehyde 1.26 180.00 1,430
Nitrogen oxides 2.80 50.00 1,780
Phenol 0.25 19.00 7,600
Benzene 0.24 32.00 13,300
Dimethylamine 0.036 18.00 50,000
Benzo[a]pyrene 0.00009 0.20 222,000
Polonium 210 0.4pCi 3pCi/l 750,000
Toluene 0.000035 375.00 1,000,000
What do you make of this study into lung cancer and exposure to SHS in Iowan women. This study is the latest from 2006. Yes, SHS is actually protective, and by a statistically significant amount too.
“There was no significant increase or decrease in risk for those in high-risk occupations, those with any chemical exposure, those with asbestos exposure, or those with exposure to environmental tobacco smoke as a child. A significant inverse association was found for those with some college education (OR=0.63, 95% CI=0.48-0.81) and for those with adult passive smoke exposure at home (OR=0.37, 95% CI=0.26-0.54).”
Dr. Elizabeth M. Whelan, President of the American Council on Science and Health has authored twenty-three books on nutrition, smoking, and environmental issues and over 300
articles for popular and professional publications. She states “Political correctness and fear of retribution silenced doctors who knew better. Every lung specialist
and cardiologist I questioned across the years scoffed at the story that secondhand smoke caused death. “But don’t quote me, or I’ll be dead.” Dr. Whelan also stated that she represents 350 doctors through the ACSH who also agree with that statement. I believe that represents a little peer review.
Hi Michael. Good to see you. Actually, I’ve not been spending much time at all in debates on smoking, so I’m quite pleased if my limited postings are being noticed! And of course I don’t mind your popping in.
1. Death certificates: I don’t think your comments deal with my main point. The doctor was arguing that he has not seen SHS referred to on a death certificate; ergo passive smoking is not be a causal factor for death. I was making the point that there are many factors which we rightly accept can lead to death but are never or rarely referred to on death certificates. If anything, your comment undermines the doctor’s point, by indicating that there may be death certificates which refer to SHS.
2. EPA report: The doctor was trying to argue that, based on what we know now, passive smoking is harmless. He was not selling his blog as a history lesson about what the tobacco lobby was arguing in the mid-1990s. But that is all that his “evidence” amounts to. It doesn’t matter if the EPA report was a significant issue between 1992 and 1998. The fact of the matter is that a lot of evidence has emerged since 1992 and more recent assessments reflect this, including the US Surgeon General’s 2006 report, the IARC monograph of 2004 and the UK SCOTH report also of 2004. None are tarnished with the same claims as the tobacco lobby made about the EPA report in the mid-1990s. Yet they all reach similar conclusions to the EPA report – and conclude that passive smoking IS harmful to health.
3. CRS: This is another area where the doctor simply offers a history lesson about what the tobacco lobby was saying in the mid-1990s (when they referred to the CRS report), but he tries to wrap it up as a factual statement based on what we understand now. It doesn’t matter that the CRS report just focused on lung cancer. All that shows is that the CRS report did not tell the whole story about death rates. Based on what we know now, there is clear evidence that passive smoking is associated with ischemic heart disease.
4. Osteen: My understanding of what the court did is similar to yours. But to me, the fact that “the [Osteen] court had no proper jurisdiction for a ruling” is a fundamental reason for striking its ruling down, not simply a “technical distinction”.
Be that as it may, yet again all the doctor does is offer a history lesson of what the tobacco industry was telling us 10-12 years ago. The doctor implies that another court might have reached the same conclusions as Osteen. You now say there are suggestions that the EPA might have acted outwith its powers. Why are you both speaking hypothetically? There have been 12 years for another court to vindicate Osteen. Many regulations limiting smoking in public have been introduced during this time. If the EPA report really provided the basis for these laws, then each of these regulations gave someone an opportunity to seek Judicial Review on the grounds that the EPA acted outwith its powers or its report was flawed. Yet (as far as I know) none has successfully done so. The Osteen judgment is therefore a red herring and should be consigned to history.
[Comments on points 5-7 to follow]
5. Boffetta: Like many critics of the smoking laws, the doctor tries to base his claims on an interpretation of one or two cherry-picked studies, instead of what the overall body of evidence is saying. His interpretation requires him to attach a wrong definition to the concept of statistical significance. “Statistically significant” does not mean “point proven”. And, as I said before, “statistically insignificant” does not equal “no risk”. As the table from NYCClash shows, Boffetta’s results about risks to adults are consistent with those a large body of studies, the great majority of which also show an association between passive smoking and lung cancer. The table also shows how available evidence about the risk of harm from childhood exposure is less clear cut. If anything, the Boffetta findings there went against the grain of the balance of evidence.
6. Watchman: I think you’re acknowledging that the doctor’s quote was not fairly representative or accurate of the message Mr Watchman wanted to convey on behalf of OSHA in his letter.
7. Enstrom: From my reading, Enstrom’s article does not acknowledge all the criticisms levelled against their study. In particular, it doesn’t appear to acknowledge a valid and relevant line of argument that no follow-up research was carried out between 1972 and 1998. So there was no meaningful assessment of whether people’s exposure to SHS had changed in the intervening years, especially where participants had died in the meantime.
Instead of considering all the published research available, why does the doctor only cherry-pick a couple of studies, including E&K? It is not representative of the evidence as a whole. It is not exceptionally large (in particular, several other studies analyse a larger number of lung cancer cases). Its methodology is not any more highly regarded than other studies. The doctor is simply cherry-picking this study because it gives a result which is more comfortable to him.
Yet there’s an irony to this. Not even E&K share the doctor’s conclusion that passive smoking is not harmful!
Rollo I have seen your supposed new evidence, perhaps you can share your concrete evidence that shs causes ischemic heart disease..Hopefully your not referring to the death chamber where they introduced tobacco smoke 100s and thousands of times higher than would ever occur in a natural setting. Then the serum cotinine levels in blood or hair the silly local smoke free groups are touting to add some sort of medical supremacy in language for the local papers headline.
Yes they saw the same findings in a bowl of corn flakes.
If others confirm the Surgeon generals finding,they should be investigated by competent authority,if any can be found today not forced to cringe in fear that their professional name be lambasted by tobacco controls death grip of the medical community as a whole.
Ive read many parts of SG2006 report and from what I ve read its a rehash of the 1992 and revised epa shs report.
You like most of the tobacco control groups know the science for shs/ets is built on a foundation of sand. For the simple fact the majority of studys cant even come close to an RR of 1.5 Where it requires at least a 3.0 to even be allowed in a court of law.
You fall back when it concerns deaths to shs/ets as do all the smoke free people because the body bags arent there when you make broad statments that 60,000 a year die….smoke frees defence is to kick back and punt with the excuse its over a lifetime of exposure…….guess how much stuff is in the environment to breathe everyday…….to much of the things in shs/ets are NATURALLY occurring in the air everywhere……Take arsenic its everywhere in the air at recorded levels of 0-29 picograms……then your people move to more scare tactics using NNL n-nitrosomines/arsenic as a headliner of fear to the general public,while hoping nobody catches the insignificance of the claim.They couldnt read anymore nnl in a cigarette than they could in the natural air, nitrosomines for those reading turn into inorganic arsenic in the body. Toxicologists call it ”PEE CANCER”
hense where the tobacco control folks try and claim smoking causes bladder cancer…..it just isnt so.
Lets just be frank here rollo, the truth is that billions have been spent creating a public healthscare and building a mountain out of a mole hill called shs/ets.Where no harm even excists no matter the amount of money spent you still cant prove shs/ets causes harm. If you could prove it so easily then every study ever done would show those conclusions but they dont. Heck thay cant even prove direct smoking causes cancer as per the 2004 cot meeting of toxicologists.
Its all hype and mirrors to create a healthscare so you folks at tobacco control can create a new prohibition.Granted the entire matter is a political one and your people control it in washington working hand in hand with RWJF.
SHS/ETS is a joke. One thing I know for sure is you wont see any anti-tobacco site or group saying the true chemistry of second hand smoke and thats the PR headline that would sink your collective ship in a heart beat…….94% water vapor and ordinary air…….If I had the money to do it That simple PR drive would end these prohibitions faster than a speeding bullet in the publics eye.
good day
Harleyrider: You obviously have no answer to the points I have made about the doctor’s blog, because you completely ignore those issues.
And what you do write is simply an evidence-lite rant.
You have no responce to my points,your science is lame and bought. Their conclusions are at most laughable.
I’m waiting for the tobacco control emails to show up next
proving the collusion of goverment and non-profits along with research groups working together to create the second hand smoke health fraud…….I hope you have a day job.
Well I’m happy to wait for the doctor to respond to my points about his article.
Quite a copout there rollo.The good doctor is probably working for a living instead of promoting smoke free propaganda paid for with taxpayer dollars. You wouldnt want him to miss any work,that might cut your pay rate on the back of the taxpayers back.
Ah, the inevitable claim that I must somehow work for tobacco control. How wrong you are. Again.
Oh my- the points everyone is making. First, I don’t think there is any conspiracy by the government. Second, when it comes to death certificates- I have signed them, and if you think there is a contributing factor to second hand smoke, you can place that on it. That can be heart disease, lung cancer, or any disease.
Here is the bottom line: smoke irritates many people – and if you don’t like to be around it- then don’t be. There is little evidence that it causes the same issues to the same degree as inhaled smoke.
Ah! but yes,the inevitable denial. Maybe maybe not. Your arguments are pro-anti-tobacco. How does it feel supporting lies and deciet. Rollo what your up against is generations of smokers who have first hand knowledge of what smoking is. Your so called evidence doesnt phase them in the least.If smoking killed the smoker within moments it never would have become popular,if it had been seen thru the centuries as a killer of bystanders it would have been rejected. The point is it didnt. Thats why your propaganda studies have no impact except in the political sence where shakedown crews like the ACS ,ALA,AHA can parade their paid PHD’S and professional victim witnesses before these groups.
What you do have in your favor is political plants within local politics that can get these bans thru. The deals are made prior to the public even hearing about a proposed ban.
What we end up with is radical progressives working in unison with far flung religous nuts who have a compassionate hatred of tobacco and its users. These bans wont stand the test of time as political winds blow and common sence once again returns to the country.
Well Doc, if nothing else I give you credit for offering some kind of response. But I have to ask – is that all you’ve got to say?
Your latest message does not address any of the 7 criticisms I levelled at your article. Instead it says just 2 things. One is that doctors can refer to second hand smoke on death certificates if they want to. Okay – but that’s not the point you were trying to argue in your article, when you claimed that something should be considered safe unless it’s explicitly referred to in death certificates. Do you still hold that position? Or should I treat your half-relevant remark as implicit acceptance that you may have been wrong?
The other thing you say is that SHS is less dangerous than active smoking. But again that is a rapid retreat from the point you were trying to make earlier – which was that SHS is not harmful.
Your article is called “The Myth of Second Hand Smoke”. It seems the only myths it contains are claims you make but are clearly unable to defend.
As I said before, people place their trust in you as a medical doctor. It is irresponsible of you to be making statements that SHS is safe in your professional capacity as a doctor, based only on the flimsiest of evidence.
New Surgeon General’s Report on Passive Smoking
By David W Kuneman
June 28, 2006
In typical antismoking activist style, the DHHS has just released a press release http://www.dhhs.gov/news/press/2006pres/20060627.html declaring that secondhand smoke is even more dangerous that previously believed. Yet, in the executive summary, reports that the risk association between secondhand smoke and lung cancer is still 1.2 to 1.3, and heart disease 1.25 to 1.3, which are same values claimed 20 years ago. Since these two diseases encompass most of the alleged deaths, then the content of the report actually says secondhand smoke is no more dangerous than generally believed 20 years ago.
According to the DHHS Press release, “Surgeon General Carmona noted that levels of continine — a biological marker for secondhand smoke exposure — measured in nonsmokers have fallen by 70 percent since the late 1980s, and the proportion of nonsmokers with detectable continine levels has been halved from 88 percent in 1988-91 to 43 percent in 2001-02.” ( The report also says smoke exposure is down 68% in children) yet, the report does not investigate or reveal, if the prevalence of any of the conditions blamed on secondhand smoke have declined accordingly in the USA. In fact, the executive summary declares secondhand smoke still kills about 50,000 Americans/year, the same number which was claimed in the late1980s. How can it be if smoke exposure is down 70%, that secondhand smoke still kills the same number of Americans?, particularly since the executive summary claims many of the effects are immediate. If indeed many of the effects are immediate, then declining smoke exposure should cause immediate declines in the purported deaths. The summary also finds that the majority of remaining exposure is now in the home.
Remember, the bulk of the scientific evidence is that smokers of fewer than 5 cigarettes/day have the same health statistics as nonsmokers. This new report does not answer the question “How is it smokers of fewer than 5 cigarettes/day are as healthy as nonsmokers while those on average, exposed to the equivalent of 1/2 cigarette/day from secondhand smoke are affected?”
The executive summary of the report http://www.surgeongeneral.gov/library/secondhandsmoke/report/executivesummary.pdf
claims brief exposure to secondhand smoke can cause a heart attack, yet in Chapter 8 specifically states ” Studies of secondhand smoke and subclinical vascular disease, particularly carotid arterial wall thickening, are suggestive, but not sufficient to infer a casual relationship between exposure to secondhand smoke and atheriosclerosis”. Since these are the mechanisms by which heart attacks blamed on secondhand smoke occur, then this finding contradicts the claim short term or even longer term exposure can cause a heart attack. Yet, the summary does claim long term exposure is related to heart disease. It is amazing if you actually read the executive summary’s report of the status of conditions usually associated with secondhand smoke, that most are still categorized as “insufficient or inconclusive evidence” and this includes breast cancer and children’s ear infections.
This new report is mostly a rehashment of the 1992 EPA report, using the same arguments, and noting that the Tobacco Industry lawsuit ultimately failed because the EPA never attempted regulatory action. It is noted my, me, that the Surgeon General is also not going to attempt regulatory action, instead leaving it to local governments to risk any resulting lawsuits, because it is obvious if the EPA had undertaken regulatory action after 1992, they would have been found guilty as alleged by the Tobacco Industry, and the DHHS would too.
Sorry doc I was trying to help here with the kuneman breakdown on shs and the sg2006 study.Read it and it will help……We are in your corner. harleyrider1978 repealthebans@yahoo.com
Rollo,I ask ya what do you think of the tobacco companies be forced in the MSA deal to be gagged against stating anything against what tobacco control may claim in the future. Their is also this tid bit about the WHO world tobacco treaty blackmaling countries to sign onto the anti-tobacco treaty or else lose world bank loans. You might also
be fascinated that epa and osha both list tobacco smoke as a class 3 irritant. If the same standards were applied to other things that they used to make shs/ets a carcinogen even that glass of water you drink would be classified as a human carcinogen……..
New Surgeon General’s Report on Passive Smoking
By David W Kuneman
June 28, 2006
In typical antismoking activist style, the DHHS has just released a press release http://www.dhhs.gov/news/press/2006pres/20060627.html declaring that secondhand smoke is even more dangerous that previously believed. Yet, in the executive summary, reports that the risk association between secondhand smoke and lung cancer is still 1.2 to 1.3, and heart disease 1.25 to 1.3, which are same values claimed 20 years ago. Since these two diseases encompass most of the alleged deaths, then the content of the report actually says secondhand smoke is no more dangerous than generally believed 20 years ago.
According to the DHHS Press release, “Surgeon General Carmona noted that levels of continine — a biological marker for secondhand smoke exposure — measured in nonsmokers have fallen by 70 percent since the late 1980s, and the proportion of nonsmokers with detectable continine levels has been halved from 88 percent in 1988-91 to 43 percent in 2001-02.” ( The report also says smoke exposure is down 68% in children) yet, the report does not investigate or reveal, if the prevalence of any of the conditions blamed on secondhand smoke have declined accordingly in the USA. In fact, the executive summary declares secondhand smoke still kills about 50,000 Americans/year, the same number which was claimed in the late1980s. How can it be if smoke exposure is down 70%, that secondhand smoke still kills the same number of Americans?, particularly since the executive summary claims many of the effects are immediate. If indeed many of the effects are immediate, then declining smoke exposure should cause immediate declines in the purported deaths. The summary also finds that the majority of remaining exposure is now in the home.
Remember, the bulk of the scientific evidence is that smokers of fewer than 5 cigarettes/day have the same health statistics as nonsmokers. This new report does not answer the question “How is it smokers of fewer than 5 cigarettes/day are as healthy as nonsmokers while those on average, exposed to the equivalent of 1/2 cigarette/day from secondhand smoke are affected?”
The executive summary of the report http://www.surgeongeneral.gov/library/secondhandsmoke/report/executivesummary.pdf
claims brief exposure to secondhand smoke can cause a heart attack, yet in Chapter 8 specifically states ” Studies of secondhand smoke and subclinical vascular disease, particularly carotid arterial wall thickening, are suggestive, but not sufficient to infer a casual relationship between exposure to secondhand smoke and atheriosclerosis”. Since these are the mechanisms by which heart attacks blamed on secondhand smoke occur, then this finding contradicts the claim short term or even longer term exposure can cause a heart attack. Yet, the summary does claim long term exposure is related to heart disease. It is amazing if you actually read the executive summary’s report of the status of conditions usually associated with secondhand smoke, that most are still categorized as “insufficient or inconclusive evidence” and this includes breast cancer and children’s ear infections.
This new report is mostly a rehashment of the 1992 EPA report, using the same arguments, and noting that the Tobacco Industry lawsuit ultimately failed because the EPA never attempted regulatory action. It is noted my, me, that the Surgeon General is also not going to attempt regulatory action, instead leaving it to local governments to risk any resulting lawsuits, because it is obvious if the EPA had undertaken regulatory action after 1992, they would have been found guilty as alleged by the Tobacco Industry, and the DHHS would too.
There is some new noteworthy information, of particular interest; a reference to Capes & Hi (2000) found that generally the smaller the study, the higher the likelihood of a positive correlation between secondhand smoke and disease. Epidemiology textbooks all teach that larger studies are more reliable than smaller ones. The Enstrom/ Kabat study, which is the largest of all the studies, of 35,000 nonsmokers found no risk from secondhand smoke exposure. This confirms the findings of Copas and Shi. Yet the executive summary ignores the possibility smaller studies are unreliable and should be questioned. It would be easy to run many small studies, and publish only the ones which found a risk, and this may actually be what has happened. Yet, the executive summary does not even mention the E/K study, which is the only truly “landmark” study released since the last Surgeon General’s report on passive smoking and is also large enough to minimize all the confounding variables discussed more fully below.
Epidemiology text books also teach that cohort studies are more reliable than case-controlled studies. In evaluating the evidence linking secondhand smoke to heart disease, the Surgeon General’s report should have included the findings by Enstrom and Kabat that a metanalysis of all cohort studies did not find a link between secondhand smoke and heart disease. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16399662&query_hl=1&itool=pubmed_docsum
This also should have been included in the section of the executive summary where the Surgeon General pretends to be concerned about bias problems with secondhand smoke studies. Indeed, when case-controlled studies consistently find higher risks than cohort studies, when small studies consistently find higher risks than large ones, positive bias is definitely operating.
The report says nicotine and continene measurements are still the best biomarkers because they are specific for secondhand smoke exposure. The flip side of that coin, is that nothing else in secondhand smoke is specific to secondhand smoke, and present from so many other sources, tobacco smoke exposure cannot be determined by measuring them. This makes it obvious, the report is admitting most of the 5,000 “chemicals” in smoke are too often present from other sources for the elimination of the last traces of secondhand smoke to make any real difference in the public’s assimilation of those other 5,000 chemicals. In fact, the FDA reports http://www.fda.gov/ohrms/dockets/dockets/99n1174/ts00020.pdf that many carcinogens are naturally present in foods, you’ll note many of these are the same as the ones found in tobacco smoke.
The report does a good job describing the problems with measuring the health impacts of secondhand smoke exposure but then glosses over most of the problems, insinuating they are solved, when no conclusive evidence is presented that they actually are solved. The report admits it is plausible nonsmoking spouses of smokers are more likely to be ex-smokers than is usually assumed when studying the health impact of spousal smoke exposure. ( This, alone could explain all the body of evidence they quote from the literature) The report also admits nonsmoking spouses of smokers are more likely to engage in other risky health behaviors than nonsmoking spouses of nonsmokers, and that these could confound many conclusions of studies the report relies on to conclude secondhand smoke is still a serious health problem.
The report says many of these confounding factors are actually more risky than the risks found in the secondhand smoke studies. Apart from misclassification of ever-smoking status, the report recognizes diet and socioeconomic status as potent confounders. The report ignores the fact that smokers and therefore nonsmoking spouses are 1/3 more likely to be urban residents. Urban residency is considered to be a more serious risk for lung cancer and heart disease than secondhand smoke exposure. It is impossible for any secondhand smoke researcher to conclude anything unless urban residency is accurately controlled for. MORE http://kuneman.smokersclub.com/urban.html
Another essential element the Surgeon General missed is the overwhelming evidence that the positive confounders discussed are actually the reason why conclusions that there is no safe level of secondhand smoke exposure exist. If indeed, all the secondhand smoke risk claimed is actually due to the presence of confounders, then the actual amount of secondhand smoke exposure is not related to the rate of outcome of disease, and any secondhand smoke exposure contains all the same confounders at the same prevalence level, causing the study conclusions to be of the same magnitude.
Even distinguished professors not connected to the industry have questioned the claim http://bmj.bmjjournals.com/cgi/content/full/326/7398/1048?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=davey+smith&fulltext=smoke&andorexactfulltext…..
The antismoking activists must be gleeful that the new Surgeon General’s report prepared at taxpayer’s expense follows their previous successful approach of duping the public by selectively considering only evidence supporting the conclusion that secondhand smoke is a health risk. It is obvious the Surgeon General’s office did not do their own research, yet represents that these findings are their own.
David W. Kuneman
Director of Research
There is indeed collusion doc of government and non-profits working in unison.
Since 1981 there have been 148 reported studies on ETS, involving spouses, children and workplace exposure. 124 of these studies showed no significant causal relationship between second hand smoke and lung cancer. Of the 24 which showed some risk, only two had a Relative Risk Factor over 3.0 and none higher. What does this mean. To put it in perspective, Robert Temple, director of drug evaluation at the Food and Drug Administration said “My basic rule is if the relative risk isn’t at least 3 or 4, forget it.” The National Cancer Institute states “Relative risks of less than 2 are considered small and are usually difficult to interpret. Such increases may be due to mere chance, statistical bias, or the effect of confounding factors that are sometimes not evident.” Dr. Kabat, IAQC epidemiologist states “An association is generally considered weak if the relative risk is under 3.0 and particularly when it is under 2.0, as is the case in the relationship of ETS and lung cancer. Therefore, you can see any concern of second hand smoke causing lung cancer is highly questionable.” Note that the Relative Risk (RR) of lung cancer for persons drinking whole milk is 2.14 and all cancers from chlorinated water ranked at 1.25. These are higher risks than the average ETS risk. If we believe second hand smoke to be a danger for lung cancer then we should also never drink milk or chlorinated water.
Nothing like a good lesson in statistics to see that in scientific journals, there can be debate over findings.
To make broad public policy statements based on “what we think” and poor statistics after, is not a wise use of tax payer resources. I suspect those who promoted the idea of second hand smoke were more interested in public exposure for their careers than public exposure to second hand smoke.
As a born skeptic, I am not convinced by the data — should there be data — reproducible data- with well thought out studies- then I would change my mind.
I don’t like cigarettes – I don’t smoke them, and avoid places where the smoke is present. I find it noxious to me, personally — but that should not effect or affect my views, or change the basic religion of the skeptic– the scientific method.
I’ll put this as politely as I can, Doc. But your article is not the work of a “skeptic” which you claim to be, nor of someone who adheres to “scientific method”. Remember that a skeptic is someone whose behaviour is to question, challenge or doubt a stated position. It is not the description of someone who makes ill-founded claims in another direction.
Your first claim about death certificates is an ill-based claim, not the statement of a skeptic. It does not properly reflect the various ways in which scientific method helps us understand what is harmful to people.
Your next claims (about the EPA report, the CRS and Osteen) are not the statements of a skeptic either. If you had been truly sceptical and questioned the very lines you’ve pushed (which were claims the tobacco industry raised in the 1990s), you would have discovered how many holes they contain. And you would not have treated as fact these claims whose relevance is so out-of-date in any case. As for applying scientific method, you simply don’t. You focus on the 1992 EPA report, instead of more recent and comprehensive meta-analyses and overall assessments of available evidence. And you rely on an incomplete and dated picture painted by the CRS about numbers of deaths related to SHS exposure.
It is not proper “scientific method” to cherry-pick two scientific studies (Boffetta and E&K) to try to build a case which is different from what the evidence as a whole tells us. And it is most certainly not proper scientific method to use these studies to build a claim that SHS does not cause harm, when in fact neither of the studies reaches that conclusion! A true skeptic would not behave in that way.
And it again is not the work of a skeptic to materially misquote an author, as you did in making claims about the Watchman letter. That is the product of either poor research or a deliberate and cynical intent to deceive.
Doctor – being sceptical means questioning EVERYBODY’S claims. It is not the work of someone who unquestioningly laps up the often very dubious arguments produced by the tobacco industry and opponents of restrictions of smoking in enclosed public places.
Rollo its about time you posted your supposed new evidence buddy. I will be waiting and be sure to include the RR’s.
I suggest you quit drinking so much koolaide and tap water
its just as cancerous as that bad old second hand smoke.
Rollo the overwhelming evidence is against your claims. the doc put out those 2 studies because they were the most comprehensive ever done.
Corrupt science has two salient characteristics. First, instead of starting with a hypothesis and data and deriving from that a conclusion, it does just the opposite: starting with a desired conclusion, it then selects data in order to support the hypothesis. Second, it stifles dissent by excluding dissenters from the process of review and by using ad hominem arguments to question their character and motives. The EPA is guilty on both counts.
Of the 30 studies on spousal smoking referred to in the EPA report, only 6 found any statistically significant association between ETS and cancer in nonsmokers married to smokers, and none found a strong relative risk. The studies actually used by the EPA were limited to 11 studies done in the United States. Using the EPA’s own Guidelines for Carcenogenic Risk Assessment, none of these showed a statistically significant risk. These guidelines call for a 95% Confidence Interval. By lowering it to 90%, only one of the 11 studies showed a statistically significant risk. More importantly, the two largest and most recent studies, one of which was partially funded by the National Cancer Institute, were omitted from consideration altogether. Had these two been included, no statistically significant risk would have been found even after lowering the Confidence Interval to 90%. Even after violating its own guidelines, in other words, the EPA could still show no statistically significant risk without selecting data to fit its hypothesis. This cooked data is the EPA’s only basis for declaring ETS to be a “Group A” carcinogen.(“Group A”, incidentally, does not mean “extra deadly”. It simply means “human”.)
The EPA’s studies on ETS operate under a “zero threshold” hypothesis, or the assumption that if huge quantities of something are dangerous, then microscopic quantities are dangerous also. The data they used, however, fails to bear this out: virtually all of the studies used either found no risk at all or a risk so weak that it would not be considered significant if applied to other subjects.
Rollo, I think what he is saying if second hand smoke kills 30,000 a year or whatever number is claimed then each year there should be 30,000 death certificates that have this stated on it.
If second hand smoke really does kill or increase cancer risk then wait staff, and people that work at bars should have a higher rate then others, and they really don’t.
Plx, just stay in your house, you have a 0.00000001% chance of being hit by a car if you don’t.
HarleyRider and Mast3r_Shake make points which I’ve already addressed in this thread, if they care to look.
Mast3r_Shake – The Doc’s original position did indeed appear to be that the number of references on death certificates can tell you how many people die from something. But he appears to have retreated his position under challenge. And it is right that he should. As I mentioned earlier, radon gas and vehicle exhaust emissions are accepted as causal factors for lung cancer. But you’re unlikely to find them often referred to on death certificates. You’ll also unlikely to see many references made in death certificates to speeding and reckless driving as causal factors behind fatal road traffic accidents. Yet we accept that they are harmful too.
It’s perfectly clear why HarleyRider isn’t keeping up with the debate – he’s copying and pasting other people’s material without thinking about its relevance to this discussion. He still tries to imply that “not statistically significant” means the same as “not harmful”, without any evidence to justify his claims. He still blindly bases his arguments around the 17 year old EPA report – why? The scientific understanding about SHS has progressed a long way since then. He does of course copy and paste Kuneman’s critique of the US Surgeon General’s 2006 report. But that was written as a biased polemic and was not subject to peer review. For instance, Kuneman waxes lyrical about references in the report and Davey Smith’s article to confounders which might overstate risk. But he conveniently downplays (or ignores altogether) the equally valid references to confounders which can artificially understate risk.
And as for Relative Risk – please! HarleyRider’s comments show the same deceitful misquoting of professionals as the Doc exemplified in his reference to the Watchman letter. I don’t think HarleyRider deliberately intended to deceive – judging by his tendency to copy and paste other people’s comments, I think he just fell for someone else’s deceit. The fact of the matter is that a Relative Risk of 2 or more is only required where a researcher is seeking to demonstrate a finding following novel research. That was the context in which Temple and the NCI made their comments. They were not stating that the same rule should apply to a situation where a large body of evidence exists, such as in relation to SHS and lung cancer/heart disease. I’ve never been able to find where the Kabat quote comes from (can HarleyRider help me?). But it is certainly not consistent with Kabat’s – sourced – quote that “As a cancer researcher who has published extensively on the harmful effects of smoking, I am in favor of vigorous smoking bans and feel there is no justification for nonsmokers to have to breathe air polluted with tobacco smoke.”
Rollo its quite simple, they cant repeat the same findings over and over again in a lab…These cherry picked studies that the surgeon general used still couldnt prove anything.
Your trying to defend a causation where the threat is so insignificant it doesnt even matter. The day I saw that water vapor and air were the main components of shs/ets and I saw osha’s findings it confirmed what I had always thought. Its all lies. I will say you guys have sure done a thorough job and wasting billions of dollars to get the general public to believe in your HYPE. All you really have going for your side is the political will of government right now.Bush kept your agenda stuck in the mudd for years.
What you really have pushing your sides agenda is the vast amount of former clinton people in government positions and the vast numbers of public health officials in government closely connected to the anti-tobacco movement. From these positions in CDC,NIH and others they are able to basically rubber stamp anything thrown at them by non-profit groups and put the endorsement of the us govmnt on them.Its a nice play for the tobacco control groups to use in its media campaign to refer to these govmnt agencies as endorsements to their claims……..Guess what gives it all away, the cdc shs page is a carbon copy of the ACS page on shs….when you see that Carmona uses continine blood markers as a bio-marker for being around shs and you see that being used by the smoke free groups everywhere as part of their propaganda campaign it doesnt take much to put the two together….I would have to agree with kuneman that the SG 2006 report was written by tobacco control and he just put his name to it, Why else would so much of tobacco controls campaign be in it. Especially when you see that true neutrality for that report would have been inclusive of all the relevant data/studys not just those that had the best chance to create a close causation but still fell short……….
hey ROLLO, psst it takes an RR over 3 before a judge will even listen to it…..thats the magic number.If you cant produce an overwhelming majority over 3 and higher….your gonna be laughed out of court,lucky for you the court of public opinion doesnt need that. They only require a media blitz for years and billions of dollars to create a FACADE.
Rollo prohibition didnt work before even with a constituional amendment…The people revolted, crime became king and right now smoking rates are climbing,bootlegging is at all time highs around the world……..goverments are in need of revenues and the smoke free groups are the first money the governments take from. So how long do you really think tobacco prohibiton will last?
He still tries to imply that “not statistically significant” means the same as “not harmful”, without any evidence to justify his claims. He still blindly bases his arguments around the 17 year old EPA report –
Rollo,since when has shs/ets changed ever in 400 years.The point is it hasnt.
lets see here
Milk-RR of 2.14
tap water-RR of 1.25
Second hand smoke- RR of 1.14 averaged of all studies to date.
The point is when compared to other things in the environment that we injest everyday,trying to take away an insignificant item such as second hand smoke isnt really going to change anything.
Greg watchman has even stated that if shs/ets bothers you simply open a window. A class three irritant isnt much of a threat to anyone.
When I take a look at how they went about classifying shs as a carcinogen its a laugh. Why isnt milk or tap water made carcinogens by the same criteria……oh thats right they set dose makes the poison levels to them was it.
Seems osha did that too,you know the ones in charge of indoor air,unlike epa who is in charge of outdoor air.
Those dog gone pel’s, its not that osha didnt want to go right along with the tobacco control folks its just that the science wasnt there to back it up and still isnt.
You’d think that after nearly 40 years of testing. This entire argument would be a done deal in favor of public smoking. Smoking sections worked fine for everybody,it was a compromise that worked well. But as I said back then,it was a gateway to prohibition……I was right
HarleyRider: Would you kindly care to substantiate these wild claims you’re making?
Kindly list all those numerous published studies which the US Surgeon General supposedly excluded from his report as a result of “cherry-picking”.
Where exactly is it stated that “it takes an RR over 3 before a judge will even listen to it”?
When exactly did Watchman say “if shs/ets bothers you simply open a window”?
When are you going to accept that OSHA is concerned about the health effects of SHS even though individual PELs are not exceeded?
Are what do your Relative Risk figures for whole milk and water refer to? Which diseases? From any consumption or from a particular volume? How many people are potentially affected? And how many people are at risk because people around them are drinking tap water or whole milk?
The 20-30% additional risk of heart disease or lung cancer from exposure to SHS is enough to cause thousands of premature deaths each year. In the UK (and I suspect the US too) there are estimated to be more than twice as many premature deaths attributable to exposure to SHS than there are deaths from road traffic accidents.
So much for your claim that SHS “isn’t much of a threat to anyone”.