Talk:Passive smoking/Controversy draft

Working Draft

As of August 6, 2007, this is a working draft of the section on passive smoking in an attempt to craft a compromise to the current dispute. Please do not edit until further notice. Chido6d 23:36, 6 August 2007 (UTC)

Prior commentary has been removed as we now appear to be at a stage of evaluation and comparison. Minor edits have been incorporated. Chido6d 02:52, 31 August 2007 (UTC)

Controversy over the risk posed by exposure to ETS

While there is general, widespread scientific agreement regarding the existence of a link between passive smoking and disease, the magnitude of the increased risk remains debated by some scientists and epidemiologists. Criticism has focused on interpretations of relative risk estimates, statistical significance and confidence intervals. Some controversy has also attended certain studies, events, and litigation.

Critique of Science and Reasoning

Gio Batta Gori, a former deputy director of the National Cancer Institute who more recently did consulting work for the tobacco industry, observed that "...of the 75 published studies of ETS and lung cancer, some 70 percent did not report statistically significant differences of risk and are moot. Roughly 17 percent claim an increased risk and 13 percent imply a reduction of risk." In January, 2007, he also wrote a piece in The Washington Post that was highly critical of the epidemiology and methodology commonly utilized in estimating the dangers of passive smoking.

There have also been questions raised about the proportionate risk that many claim passive smoke poses. For example, John Bailar of the National Academy of Sciences asked, "Regular smoking only increases the risk of cardiovascular disease by 75%, so how could second-hand smoke, which is much more dilute, have an effect one-third that size?"

World Health Organization Report (1998)

A 1998 report by the International Agency for Research on Cancer (IARC) on environmental tobacco smoke (ETS) found "weak evidence of a dose-response relationship between risk of lung cancer and exposure to spousal and workplace ETS" and “no association between childhood exposure to ETS and lung cancer risk.” The study also found “no detectable risk after cessation to exposure” to ETS." In March of 1998, before the study was published, reports appeared in the media alleging that the IARC and the World Health Organization (WHO) were suppressing information. The reports, appearing in the British Sunday Telegraph and The Economist, among other sources, claimed that the WHO withheld from publication its own report that supposedly failed to prove an association between passive smoking and a number of other diseases (lung cancer in particular).

In response, the WHO quickly issued a press release denying the allegations, saying that the results of the study had been completely misrepresented in the popular press and were in fact very much in line with similar studies. The WHO also said that they had sent the paper for peer review the previous month.

The study was published in the Journal of the National Cancer Institute in October of the same year. An accompanying editorial stated: "When all the evidence, including the important new data reported in this issue of the Journal, is assessed, the inescapable scientific conclusion is that ETS is a low-level lung carcinogen.

In 2000, an article in the Lancet reported that Philip Morris and other tobacco companies monitored the study while it was in progress as part of a strategy to discredit any findings which may have harmed their economic interests -- particularly the prospect of increased smoking restrictions in Europe. It was also reported that British American Tobacco helped to fuel the story by issuing press releases. The authors of the article described this as part of a larger, overall effort to subvert efforts to control tobacco use. A WHO report issued that same year agreed with and expounded upon this assessment.

1993 EPA Report (The Osteen Decision)

In 1993, the United States Environmental Protection Agency (EPA) issued a report estimating that 3,000 lung cancer related deaths in the U.S. were caused by passive smoking annually. Philip Morris, R.J. Reynolds Tobacco Company, and groups representing growers, distributors and marketers of tobacco took legal action, claiming that the EPA had manipulated this study and ignored accepted scientific and statistical practices.

United States District Court Judge William Osteen vacated this study in 1998, finding that the EPA had, among other things, publicly committed to a conclusion before research had begun, "cherry picked" evidence to support their pre-announced conclusion, deviated from its own risk assessment guidelines, and engaged in a scheme to influence public opinion.

In 2002, the EPA successfully appealed Judge Osteen's decision to the United States Court of Appeals for the Fourth Circuit on the basis that the EPA was an advisory body and not regulatory (therefore not liable). The Court also found that the plaintiffs were not eligible to challenge the EPA report, and that the District Court exceeded its scope of judicial review.

Enstrom and Kabat

Two studies by Enstrom and Kabat suggest that previous studies may have overestimated the effect of environmental tobacco smoke (ETS) on both lung cancer and heart disease. The first, a cohort study spanning 39 years, appeared in the May 17 2003 issue of the British Medical Journal (BMJ). The study concluded that "The results do not support a causal relation between environmental tobacco smoke and tobacco-related mortality, although they do not rule out a small effect. The association between exposure to environmental tobacco smoke and coronary heart disease and lung cancer may be considerably weaker than generally believed." The BMJ was harshly criticized for publishing the study. Editor Richard Smith defended the publication, explaining that the study was "a useful contribution to an important debate... We must be interested in whether passive smoking kills, and the question has not been definitively answered."

Enstrom and Kabat's second contribution was a 2006 meta-analysis, published in Inhalation Technology, which came to similar conclusions.

The study was criticised by the American Cancer Society, claiming misclassification of exposure and labeling the study as disinformation. It was also pointed out that the study was completed with research funds from the tobacco industry. Other criticisms were made on methodological grounds.

Role of the Tobacco Industry

The tobacco industry's role in funding scientific research has been controversial, although a focus on the funding source of studies has been criticized as ad hominem. The influence of tobacco funding on studies of passive smoking was investigated in a literature review by Barnes & Bero, who determined that the only factor associated with concluding that passive smoking is not harmful was whether an author was affiliated with the tobacco industry. The former U.S. Surgeon General criticized the tobacco industry's role in the scientific debate: "The industry has funded or carried out research that has been judged to be biased, supported scientists to generate letters to editors that criticized research publications, attempted to undermine the findings of key studies, assisted in establishing a scientific society with a journal, and attempted to sustain controversy even as the scientific community reached consensus."

The tobacco industry's approach to epidemiology, involving efforts to discredit individual studies, has also been widely criticized. The American Journal of Public Health expounded:

A major component of the industry attack was the mounting of a campaign to establish a "bar" for "sound science" that could not be fully met by most individual investigations, leaving studies that did not meet the criteria to be dismissed as "junk science." The campaign also included attempts to characterize relative risks of 2 or less as highly questionable and not amenable to investigation by epidemiologic methods.

It was also reported in the American Journal of Public Health that Philip Morris had launched a public relations campaign to "shape the standards of scientific proof to make it impossible to 'prove' that secondhand smoke... is dangerous."

Finally, many claim that a scientific consensus now exists concerning passive smoking. U.S District Court Judge Gladys Kessler wrote in her Final Opinion in the case United States of America v. Philip Morris et al.:"...the scientific community had reached a consensus on ETS as a cause of disease by 1986... most significantly, Defendants themselves had determined by the 1970s that ETS was harmful to nonsmokers."