The Surgeon General's Report: selective science at it again
In typical antismoking
activist style, the DHHS has just released a press release Read declaring that secondhand smoke is even more dangerous than 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 Read 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 atheriosclorosis". 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 by, 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 & Shi
(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 Capes and Shi. Yet the executive summary
ignores the possibility smaller studies ,which represents most of the studies
used, 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 minimumize 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.
Read 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 cotinine 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 it to be possible 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 Read 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 Read
Another essential element the Surgeon General missed is the
overwhelming evidence that the positive confounders discussed are actually the
reason why the conclusion that there is no safe level of secondhand smoke
exposure is made. 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.
This report is just another example of ignoring all
the available evidence good science would consider if it really wanted to find
the truth. To further illustrate this point, the claim in the executive
summary that smoking bans do not harm business is something the Surgeon
General's office has the resources to verify independently instead of relying
on antismoking activists claims. Newspapers and state departments of revenue
data Read, testimony to government agencies Read, U.S. Department of Commerce data Read ,
studies by restaurant associations Read, and even distinguished economists Read all raise the
possibility that bans do hurt business. The Surgeon General's office has
the resources to contact some of these sources and do it's own investigation.
The fact that it obviously did not, only serves to prove the report is just
serving as a sounding board for outrageous antismoking activist's claims
without any regard for the truth.
Lastly the executive summary employs
the same tactic used by antismoking activists to classify all claims that
secondhand smoke is not dangerous, as tobacco industry claims. The Surgeon
General's office has to know the Library of Congress biostaticians still
believe secondhand smoke cannot possibly cause all the disease the executive
summary claims Read, and they must know the Library of Congress is not an industry front
group. Further, that OSHA has done it's own evaluation of the issue ,if there
is no safe level of secondhand smoke, and has found that low levels are
probably safe Read and of course, that OSHA is not an industry front group. Even
distinguished professors not connected to the industry have questioned the
claim Read and this list is by no means complete.
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 these
findings as their own.
David W. Kuneman Dir of Research The
Smoker's Club, Inc.