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Controversy over harms of passive smoking

In 1986, responding to growing evidence of the harms of passive smoking, the United States Surgeon General issued a report concluding that secondhand smoke was a cause of disease. In the same year, the International Agency for Research on Cancer and the National Research Council also released reports concluding that secondhand smoke was a cause of lung cancer.[1] Over the subsequent 20 years, the accumulation of scientific evidence has led to a scientific consensus that passive smoking is indeed harmful to non-smokers.[2] A U.S. District Court found, in a racketeering case against the tobacco industry, that the industry had internally acknowledged the harmfulness of passive smoking even earlier.[3], pp. 1523–1525 Nonetheless, the tobacco industry has played a central role in generating and sustaining controversy over the effects of passive smoking.[4][5]

Critique of individual studies and epidemiology

A number of studies funded by the tobacco industry have yielded results inconsistent with the scientific consensus, or have criticised the epidemiological approach associated with that consensus.

A 2003 study by Enstrom and Kabat, published in the British Medical Journal, argued that the harms of passive smoking had been overstated.[6] Their analysis reported no statistically significant relationship between passive smoking and lung cancer, though the accompanying editorial noted that "they may overemphasise the negative nature of their findings."[7] This paper was widely promoted by the tobacco industry as evidence that the harms of passive smoking were unproven.[3], p. 1383 The American Cancer Society (ACS), whose database Enstrom and Kabat used to compile their data, criticized the paper as "neither reliable nor independent", stating that scientists at the ACS had repeatedly pointed out serious flaws in Enstrom and Kabat' s methodology prior to publication.[8] Enstrom's ties to the tobacco industry also drew scrutiny; in a 1997 letter to Philip Morris, Enstrom requested a "substantial research commitment... in order for me to effectively compete against the large mountain of epidemiologic data and opinions that already exist regarding the health effects of ETS and active smoking."[9] The study was funded and managed by the Center for Indoor Air Research, a tobacco industry front group, and Enstrom's work was viewed by Philip Morris as "clearly litigation-oriented."[3], pp. 1380–1383

Gio Batta Gori, a full-time tobacco-industry consultant,[10] wrote in the libertarian Cato Institute's journal Regulation 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."[11] Steven Milloy, the "junk science" commentator for Fox News and a former Philip Morris consultant,[12][13] claimed that "...of the 37 studies [on passive smoking], only 7 – less than 19 percent – reported statistically significant increases in lung cancer incidence."[14]

Another component of criticism promoted by Milloy focused on relative risk and epidemiological practices in studies of passive smoking. Milloy argued that studies yielding relative risks of less than 2 were meaningless junk science. This approach to epidemiological analysis was criticized in the American Journal of Public Health:

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."[15]

The tobacco industry and affiliated scientists also put forward a set of "Good Epidemiology Practices" which would have the practical effect of obscuring the link between secondhand smoke and lung cancer. However, this effort was largely abandoned when it became clear that no independent epidemiological organization would agree to the standards proposed by Philip Morris et al.[16]

World Health Organization controversy

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."[17] 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[18] and The Economist,[19] among other sources,[20][21][22] alleged 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 issued a press release stating 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 demonstrating the harms of passive smoking.[23] The study was published in the Journal of the National Cancer Institute in October of the same year. An accompanying editorial summarized:

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.[24]

With the release of formerly classified tobacco industry documents through the Tobacco Master Settlement Agreement, it was found that the controversy over the WHO's alleged suppression of data had been engineered by Philip Morris, British American Tobacco, and other tobacco companies in an effort to discredit scientific findings which would harm their business interests.[25] A WHO inquiry, conducted after the release of the tobacco-industry documents, found that this controversy was generated by the tobacco industry as part of its larger campaign to cut the WHO's budget, distort the results of scientific studies on passive smoking, and discredit the WHO as an institution. This campaign was carried out using a network of ostensibly independent front organizations and international and scientific experts with hidden financial ties to the industry.[26]

EPA lawsuit

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.

A United States District Court ruled in favor of the tobacco industry in 1998, finding that the EPA had failed to follow proper scientific and epidemiologic practices and had committed to their conclusions in advance.[27] In 2002, the EPA successfully appealed this decision to the United States Court of Appeals for the Fourth Circuit. The EPA's appeal was upheld on the preliminary grounds that their report had no regulatory weight, and the earlier finding was vacated.[28]

Tobacco-industry funding of research

The tobacco industry's role in funding scientific research which "exonerates" passive smoking has been controversial, although a focus on the funding source of studies has been criticized as ad hominem.[29] A review of published studies found that tobacco-industry affilation was strongly correlated with findings exonerating passive smoking; researchers affiliated with the tobacco industry were 88 times more likely than independent researchers to conclude that passive smoking was not harmful.[30] In a specific example which came to light with the release of tobacco-industry documents, Philip Morris executives successfully encouraged an author to revise his industry-funded review article to downplay the role of secondhand smoke in sudden infant death syndrome.[31] The 2006 U.S. Surgeon General's report 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.

This strategy was outlined at an international meeting of tobacco companies in 1988, at which Philip Morris proposed to set up a team of scientists, organized by company lawyers, to "carry out work on ETS to keep the controversy alive."[5] All scientific research was subject to oversight and "filtering" by tobacco-industry lawyers:

Philip Morris then expect the group of scientists to operate within the confines of decisions taken by PM scientists to determine the general direction of research, which apparently would then be 'filtered' by lawyers to eliminate areas of sensitivity.[5]

Philip Morris reported that it was putting "...vast amounts of funding into these projects... in attempting to coordinate and pay so many scientists on an international basis to keep the ETS controversy alive."[5]

Public opinion

Recent major surveys conducted by the U.S. National Cancer Institute and Centers for Disease Control have found widespread public acceptance of the harms of secondhand smoke. In both 1992 and 2000 surveys, more than 80% of respondents agreed with the statement that secondhand smoke was harmful. A 2001 study found that 95% of adults agreed that secondhand smoke was harmful to children, and 96% considered tobacco-industry claims that secondhand smoke was not harmful to be untruthful. A 2004 Gallup poll found that 86% of respondents felt that secondhand smoke was "very harmful" or "somewhat harmful", while 4% felt that it was not harmful at all.[32], p. 588 Smoking bans had somewhat less support; the 2004 Gallup poll found 58% in favor of total smoking bans in workplaces, restaurants, and bars, while 40% opposed such across-the-board bans.[32], p. 589

Current state of controversy

Currently, there is widespread scientific consensus that exposure to secondhand smoke is harmful.[3] The link between passive smoking and health risks is accepted by every major medical and scientific organization, including:

While there is scientific agreement regarding the existence of a link between passive smoking and heart disease, the magnitude of the increased risk remains debated by a minority of epidemiologists.[46] For example, John Bailar of the National Academy of Sciences questioned the proportionality of the passive smoking risk, stating:

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?

One proposed explanation is that secondhand smoke is not simply a diluted version of "mainstream" smoke, but has a different composition with more toxic substances per gram of total particulate matter.[46] The more toxic makeup of secondhand smoke was first recognized in the tobacco industry's own research, though it never published its findings.[47] Some scientists believe that the risk of passive smoking, in particular the risk of developing coronary heart diseases, may have been substantially underestimated.[48]

The health benefit to non-smokers of smoking bans has also been disputed by a small number of epidemiologists, who call for a prospective trial to more accurately determine the benefit. These epidemiologists advocate indoor smoking bans, but express a concern that widespread outdoor smoking bans, as implemented by some towns in the U.S., may be unsupported by the evidence available thus far.[46]

References

  1. ^ From The Health Consequences of Involuntary Exposure to Tobacco Smoke, a report of the U.S. Surgeon General. See Executive Summary, p. 4. Accessed September 11 2007.
  2. ^ Currently the health risks of passive smoking are accepted by every major medical and scientific organization, as detailed elsewhere in this article. Specific descriptions of the development of scientific consensus on the topic can be found here:
  3. ^ a b c d United States of America v. Philip Morris et al., Final Opinion of Judge Gladys Kessler, United States District Court for the District of Columbia. Accessed July 29 2007.
  4. ^ According to the United States Surgeon General's 2006 report on passive smoking, "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... and attempted to sustain controversy even as the scientific community reached consensus." As quoted in the Washington Post: U.S. Details Dangers of Secondhand Smoking, by Marc Kaufman. Published June 28 2006; accessed July 25 2007.
  5. ^ a b c d Minutes of a meeting of Philip Morris with British tobacco companies to discuss tobacco-industry strategy on passive smoking. Accessed August 27 2007.
  6. ^ Enstrom JE, Kabat GC (2003). "Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98". BMJ. 326 (7398): 1057. doi:10.1136/bmj.326.7398.1057. PMID 12750205.
  7. ^ Davey Smith G (2003). "Effect of passive smoking on health". BMJ. 326 (7398): 1048–9. doi:10.1136/bmj.326.7398.1048. PMID 12750182.
  8. ^ American Cancer Society Condemns Tobacco Industry Study for Inaccurate Use of Data: A press release from the American Cancer Society. Dated May 15 2003; accessed August 29 2007.
  9. ^ PROPOSED RESEARCH ON THE RELATIONSHIP OF LOW LEVELS OF ACTIVE SMOKING TO MORTALITY: Letter from James Enstrom to Philip Morris Scientific Affairs office, dated January 1 1997. Accessed August 29 2007.
  10. ^ ETS / IAQ SCIENTIFIC CONSULTANTS, from the Legacy Tobacco Documents Archive. Accessed July 19 2007.
  11. ^ www.cato.org/pubs/regulation/regv30n1/v30n1-5.pdf
  12. ^ Smoked Out: Pundit for Hire, by Paul D. Thacker. Published in The New Republic on January 26 2006; accessed August 22 2007.
  13. ^ Philip Morris budget for "Strategy and Social Responsibility", listing Milloy as a paid consultant. Accessed August 22 2007.
  14. ^ "Secondhand Joking", by Steven Milloy. Accessed August 22 2007.
  15. ^ Samet JM, Burke TA (2001). "Turning science into junk: the tobacco industry and passive smoking". American journal of public health. 91 (11): 1742–4. PMID 11684591.
  16. ^ Ong EK, Glantz SA (2001). "Constructing "sound science" and "good epidemiology": tobacco, lawyers, and public relations firms". American journal of public health. 91 (11): 1749–57. PMID 11684593.
  17. ^ Boffetta P, Agudo A, Ahrens W; et al. (1998). "Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe". J. Natl. Cancer Inst. 90 (19): 1440–50. PMID 9776409. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  18. ^ "Passive Smoking Doesn't Cause Cancer —Official".
  19. ^ "Smokescreens - The World Health Organization is showing signs of allowing politics to get in the way of truth. The Economist March 14th, 1998" (PDF).
  20. ^ Le Grand C. Anti-smokers blown away by study. Australian 1998, March 10.
  21. ^ WHO Rejects smoking link with lung cancer. Zimbabwe Independent 1998, Oct 23.
  22. ^ No Link Between Passive Smoking and Lung Cancer. The Times 1998, March 9.
  23. ^ "Passive Smoking Does Cause Lung Cancer, Do Not Let Them Fool You".
  24. ^ "Passive Smoking and Lung Cancer Risk: What is the Story Now?".
  25. ^ Ong EK, Glantz SA (2000). "Tobacco industry efforts subverting International Agency for Research on Cancer's second-hand smoke study". Lancet. 355 (9211): 1253–9. PMID 10770318.
  26. ^ "Tobacco Companies Strategies to Undermine Tobacco Control Activities at the World Health Organization" (PDF).
  27. ^ "The Osteen Decision".
  28. ^ "Flue-Cured Tobacco Cooperative vs. EPA" (PDF).
  29. ^ "Tobacco industry publishes disinformation".
  30. ^ Barnes DE, Bero LA (1998). "Why review articles on the health effects of passive smoking reach different conclusions". JAMA. 279 (19): 1566–70. PMID 9605902.
  31. ^ Tong EK, England L, Glantz SA (2005). "Changing conclusions on secondhand smoke in a sudden infant death syndrome review funded by the tobacco industry". Pediatrics. 115 (3): e356-66. doi:10.1542/peds.2004-1922. PMID 15741361.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  32. ^ a b The Health Effects of Involuntary Exposure to Tobacco Smoke, Chapter 10. Accessed September 11 2007.
  33. ^ Tobacco Smoke and Involuntary Smoking, a monograph of the World Health Organization and International Agency for Research on Cancer. Accessed August 27 2007.
  34. ^ "Environmental Tobacco Smoke" (PDF). (219 KiB). From the 11th Report on Carcinogens of the U.S. National Institutes of Health. Accessed August 27 2007.
  35. ^ Secondhand Smoke Fact Sheet from the U.S. Centers for Disease Control and Prevention. Accessed August 22 2007.
  36. ^ The Health Consequences of Involuntary Exposure to Tobacco Smoke, from the United States Surgeon General. Accessed August 27 2007.
  37. ^ Health Effects of Exposure to Environmental Tobacco Smoke, from the U.S. National Cancer Institute. Accessed August 22 2007.
  38. ^ Health Effects of Exposure to Secondhand Smoke, from the United States Environmental Protection Agency. Accessed September 24 2007.
  39. ^ The Truth about Secondhand Smoke, from the American Heart Association. Accessed August 27 2007.
  40. ^ Secondhand Smoke Fact Sheet, from the American Lung Association. Accessed September 24 2007.
  41. ^ Secondhand Smoke, from the American Cancer Society. Accessed August 27 2007.
  42. ^ AMA: Surgeon General's secondhand smoke report a wake-up call to lawmakers. A press release from the American Medical Association. Accessed August 27 2007.
  43. ^ National Response to Passive Smoking in Enclosed Public Places and Workplaces, from the Australian National Public Health Partnership; see p. 6. Released November 2000; accessed September 11 2007.
  44. ^ Two relevant reports have been published by the Scientific Committee:
    • A 1998 report of the SCOTH concluded that passive smoking was a cause of lung cancer, heart disease, and other health problems.
    • A 2004 update by the SCOTH, reviewing new evidence published since the 1998 report, found that recent research had confirmed the initially reported link between passive smoking and health risks.
  45. ^ The Framework Convention on Tobacco Control Part III, Article 8. Accessed September 19 2007.
  46. ^ a b c Passive Smoking: Out from the Haze, by Kris Novak. Nature 2007 Jun 28;447(7148):1049-51. PMID 17597735.
  47. ^ Several medical journal articles have described both the more toxic composition of secondhand smoke and the tobacco industry's unpublished research confirming this. For example, see:
    • Schick S, Glantz S (2005). "Philip Morris toxicological experiments with fresh sidestream smoke: more toxic than mainstream smoke". Tobacco control. 14 (6): 396–404. doi:10.1136/tc.2005.011288. PMID 16319363.
    • Schick S, Glantz SA (2006). "Sidestream cigarette smoke toxicity increases with aging and exposure duration". Tobacco control. 15 (6): 424–9. doi:10.1136/tc.2006.016162. PMID 17130369.
    • Schick SF, Glantz S (2007). "Concentrations of the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone in sidestream cigarette smoke increase after release into indoor air: results from unpublished tobacco industry research". Cancer Epidemiol. Biomarkers Prev. 16 (8): 1547–53. doi:10.1158/1055-9965.EPI-07-0210. PMID 17684127.
    • Diethelm PA, Rielle JC, McKee M (2005). "The whole truth and nothing but the truth? The research that Philip Morris did not want you to see". Lancet. 366 (9479): 86–92. doi:10.1016/S0140-6736(05)66474-4. PMID 15993237.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  48. ^ "Passive smoking danger was underestimated, by Gaia Vince New Scientist 2004 June 30". Retrieved 2007-07-24.
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