Second Hand Smoke is Not a Statistically Significant Public Health Risk


Why I Voted Against the Statewide Smoking Ban
By Tom Neuville
The Senate Business and Jobs Committee, link here, (which I serve on) held hearings on the Statewide Smoking Ban bill. The chief author of the bill is Senator Kathy Sheran (DFL-Mankato). Here is a copy of the bill as it came to our Committee.On Feb. 19th, I voted against the bill, even though it was amended in committee to allow exemptions for bars and restaurants if they install ventilation. This blog entry will explain my position. It will be a long entry, but it’s easier to refer people to this website, than to explain a complicated subject to the many people who have contacted me.


MY BACKGROUND

I grew up in a home with 6 children, and parents who smoked. None of the children in our family smoke today, or have suffered any adverse health impact because our parents smoked. I have tried to discourage my own children and others from smoking. Perhaps in this partisan climate, anyone who opposes more government regulation of smoking, feels the need to make an “up-front” disclaimer. So, I just did. I am no apologist for tobacco.

I am also a scientist. My degree is in Chemical Engineering. I worked at 3M Co. as an advanced research engineer for about 5 years before I moved to Northfield to practice law. I approach issues analytically. I try to challenge scientific claims before I make decisions.

GENERAL COMMENTS (MY OPINION)

About 20-25% of adults smoke today. This is a much lower percentage than 30 years ago. That’s a good thing, and no doubt helps to reduce cancer and cardiac problems. We all know of people who died of cancer or emphysema because of smoking. My law partner’s wife was one of them.

But, if second hand smoke is such a public health hazard, then why don’t we know about more people who died or had heart attacks due to second hand smoke (sometimes called ETS or environmental tobacco smoke)?

Smoking Ban proposals have become too partisan (meaning “a fervent, sometimes militant supporter or proponent of a party, cause, faction, person, or idea”). The science has been compromised, and it is very difficult to make good policy decisions when the facts are so much in dispute.

Smoking is clearly a nuisance for many people who don’t smoke. I accept that second hand smoke is also a health risk for many people who have asthma or allergies. (Just like some people are allergic to cats, peanuts, or barbecue smoke).

But, does secondhand smoke create a health hazard that endangers people if they go to bars and restaurants? Will the “free market” adequately allocate public places for both smokers and non-smokers without the government’s interference? These are the questions for legislators to decide. If I thought that Secondhand Smoke was truly a Public Health Risk, and that people could not avoid the danger, I would support a Smoking Ban.

(Isn’t it odd that we continue to subsidize tobacco, and avoid bills that would ban smoking altogether. Prohibition hasn’t worked for marijuana, alcohol, or methamphetamine. It won’t work for tobacco either).

WHAT DO THE PROPONENTS SAY ABOUT SECOND HAND SMOKE?

The author of the bill, and other proponents of a Statewide Smoking Ban say,

” the research demonstrates that no one is safe from second hand smoke.” They allege that NO amount of second hand smoke is safe and that threshold levels for chemical compounds in second hand smoke aren’t needed. Even a brief amount of exposure to second hand smoke is dangerous.

Proponents rely greatly on: The U.S. Surgeon General’s Report “The Health Consequences of Involuntary Exposure to Tobacco Smoke”. This report was first written in 1986 and updated in 2006. The Report is a “Meta-Analysis”, meaning that the authors of the report did not collect their own epidemiological data, but instead combined the results of previously published studies.

The Minnesota Smoke-Free Coalition web site, linked here, also summarizes much of the testimony and arguments submitted to legislators.

The Surgeon General’s Report relies upon and cites other studies, including:

1. U.S. Environmental Protection Agency (EPA) (Link here) done in 1992. If you want to read the entire EPA Report, you can find it here. Another report called “Setting the Record Straight: Second hand Smoke is a Preventable Health Risk”, is (Linked here).

2. International Agency for Research on Cancer (IARC), (Link here) done in 1998 and 2004

3. California EPA, (Link here) Office of Environmental Health Hazard Assessment ( Link here), done in 1997 and 2005.

The Surgeon General’s report concludes, among other things:

1. “Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer”.

2. “The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke”.

See also, the National Cancer Society informational website on Second Hand Smoking linked Here.

WHAT DO OPPONENTS OF THE SMOKING BAN HAVE TO SAY

A group called Minnesotans against Smoking Bans ( Linked here) have created their own website. It includes information concerning health studies, the effect on Charitable Gambling receipt, and other arguments.

WHAT DO OTHER RESEARCHERS SAY ABOUT THE STUDIES?

1. Dr. Michael Siegel is a medical doctor and public health official who teaches at Boston University School of Public Health. He specializes in preventive medicine, and says:

“The Surgeon General is publicly claiming that brief exposure to second hand smoke increases risk for heart disease and lung cancer. But, no evidence is presented in the Surgeon General’s report to support this claim”


2. Dr. Melvin First, Professor Emeritus of Environmental Health at Harvard, and Dr. Alvin Feinstein, who taught at Yale School of Medicine and has been called “the Father of Clinical Epidemiology”, and Dr. Gary Becker (Linked here), a Nobel Prize winner have all reached different views from the surgeon general’s report.

3. The American Council on Science and Health (Linked here) states:

“This ‘no threshold’ proposition cannot withstand scientific scrutiny.” (Referring to reports that there is no safe dose of second hand smoke. Even mainstream smoke, which is 100,000 times more concentrated than second hand smoke, has a threshold. All of the individual carcinogens known - or claimed- to be in second hand smoke all have thresholds.

4. The 1998 report of the International Agency for Research on Cancer (IARC), linked here, commissioned by the World Health Organization, actually found that children were less likely to get lung cancer if both parents smoked than if neither smoked.(The RR was 0.78 for exposure to secondhand smoke during childhood). Apparently, the body has some capacity to develop resistance to smoke, just like being vaccinated.

5.The Enstrom-Kabat Study Kabat, G.I., et.al., American Journal of Epidemiology, Vo1.142, No.2, 1995, p.141-148; Link to article here. which was published in the British Medical Journal, concluded that:

” no significant associations were found for current or former exposure to environmental tobacco smoke and tobacco related mortality”
This study was the largest study ever done, covering 100,000 people over 38 years and was reported and published in 2003.

6. The Journal of the National Cancer Institute published a study ( Linked here) from 7 European countries in 1998 by the International Agency for Research on Cancer (IARC). The study concluded:

“ETS exposure during childhood was not associated with an increased risk of lung cancer. The OR (relative risk) for exposure to spousal ETS was 1.16. …The OR for exposure to workplace ETS was 1.17, with possible evidence of increasing risk for increasing duration of exposure. Ever exposure to ETS from other sources was not associated with lung cancer risk. There was no detectable risk after cessation of exposure.” (underlining added)

7. The Congressional Research Service also published a major review (Linked here) of all research studies.

8. The Journal of the American Medical Association has published a 2006 report Linked here), by Dr. Saverio Stranges, which also suggests that exposure to Secondhand smoke is not as important a risk factor for heart attacks as previously thought.

9. This Web Site summarizes and links to some of the most important studies regarding second hand smoke. Most of the studies and Articles conclude that there is NO public health risk associated with second hand smoke. Here is another Website (Link here) that lists virtually every study ever done concerning the risk of second hand smoke.
ANALYSIS OF THE STUDIES

In order to understand the issue of second hand smoke, you have to understand something about Statistics and Epidemiology. Understanding the Statistical analysis is vital to understanding the public health issue. Here is a great website which helped me understand the statistics of health research studies, and the original 1992 EPA study.

Here is another good Web site for explaining Statistical evidence (for those of us who don’t have formal training in statistics).

And one more good Article explaining how to read “Statistical Studies” is (Linked here).

Here is an article describing the “Limits of Epidemiology”, and another good Article explaining Epidemiology is (Linked here).


I learned that nearly all studies, put the Relative Risk (RR) of second hand smoke at between 0.78 and 1.3. This means that there could be up to a 30% greater chance of getting cancer if you are exposed to secondhand smoke.

However, there is also a statistical chance that exposure to second hand smoke lowers the risk of cancer by 22% (especially in children), since the RR range includes 0.78.

The standard confidence level for statistical studies is usually 95 %. The EPA study was lowered to 90% confidence in order to increase the Relative risk.

Generally, research analysts consider a Relative Risk (RR) of less than 3 to be too subject to bias or chance to have any medical significance. That is, you must have a risk that is 3 times greater than average before most researchers consider it significant.

In contrast, mainstream smoking has an RR of 40. This means that your chance of getting cancer is 40 times greater than average if you smoke. That’s quite a difference from 0.3 times greater if you breathe second hand smoke.

Dr. Eugenia Calle, director of analytic epidemiology for the American Cancer Society, said in 1995, that Relative Risks below 1.3 cannot be reliably identified. When a study showed an RR of 1.5 (50% increase in probability) between abortion and breast cancer, Dr. Calle stated that an RR of 1.5 is too low to call abortion a risk factor for breast cancer.
So how can RR’s below 1.5 be called significant for secondhand smoke, but not for the abortion link to breast cancer? Proponents of smoking bans don’t often discuss the risk ratios, preferring to simply claim that ETS is ” dangerous”, or that the scientific debate is “over”.

Relative Risk (RR) must be at least 3 to 4 before most researchers accept that there is a causal relationship established in health studies. Here is a Link, which includes quotes from several prominent scientists:

“As a general rule of thumb, we are looking for a relative risk of 3 or more before accepting a paper for publication.” - Marcia Angell, editor of the New England Journal of Medicine”

“My basic rule is if the relative risk isn’t at least 3 or 4, forget it.” - Robert Temple, director of drug evaluation at the Food and Drug Administration.

The integrity of the 1992 EPA study was actually litigated in a North Carolina Federal District court in 1998. The decision can be reviewed at this link: Flue Cured Tobacco Coop vs. US Environmental Protection Agency. (Note the court’s conclusion beginning on page 87).


In this case, a Federal Judge found:

1. EPA publicly committed to a conclusion before research had begun; excluded the industry by violating the Act’s procedural requirements; adjusted established procedure and established 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 intended to restrict Plaintiff’s products and to influence public opinion,”

2. EPA’s findings were based on insufficiently rigorous statistical tests and were therefore invalid. EPA, he noted, “disregarded information and made findings based on selective information . . . ; deviated from its risk assessment guidelines; failed to disclose important [opposition] findings and reasoning; and left significant questions without answers.”

Another article about the Judge’s decision can be found here.(Heartland Institute) and here (Frasier Institute in Canada). The fourth circuit Federal Court of Appeals later overruled the District court’s decision on jurisdictional grounds, but did not overrule the substantive findings of the Judge.

This case is important because the Surgeon General’s report is largely based upon this 1992 EPA study.

OTHER INTERESTING ARTICLES AND STUDIES


1. An environmental consultant named Ed Contoski has studied the issue of Secondhand Smoke. He has written to me this year, and I assume, other legislators. Attached is an article by columnist Craig Westover which includes the entire letter from Mr. Edmund Contoski to State Representative Doug Meslow in Nov. 2004. I have reviewed the arguments and citations of Mr. Contoski, and they seem persuasive.

2. Here is an article summarizing studies involving OSHA (Occupational Safety and Health Agency). As for second hand smoke in the air, OSHA has stated that:

“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, Acting Ass’t Sec’y, OSHA, To Leroy J Pletten, PHD, July 8, 1997

3. Here is an interesting study done by the National Cancer Institute which shows:

A recent meta-analysis based on 4626 cases concluded that the relative risk of lung cancer in lifelong nonsmokers who lived with a smoker was 1.24 (95% confidence interval [CI] = 1.13-1.36) (1). Subsequently, we reported in the Journal the results from a large case-control study of environmental tobacco smoke (ETS) and lung cancer based in 12 European centers. This study provided an odds ratio (OR) for lung cancer of 1.14 (95% CI = 0.88-1.47) for spousal and workplace exposure to ETS;

In other words, if a lifetime nonsmoker lived with a smoker, their risk of cancer from the second hand smoke increased by 14%. This is well below the statistically significant level (see the discussion above)

4. Here is an article, by Michael Siegel, summarizing studies which show that heart attacks actually had smaller declines in States with Smoking Bans than in the rest of the country. A similar article at Townhall.com is linked here.

5. Is there a bias in even getting your study published, if you conclude that second hand smoke is not a health risk. Here is an article which says that bias does exist.

6. Townhall.com has this Article commenting on the politics of the Surgeon General’s 2006 report on Second hand smoke. (See Link to article here).

7. An article by the Oak Ridge National Laboratory, linked here, managed by the Dept. of Energy, summarized:

” The study, which involved 173 people employed at restaurants or taverns of varying sizes in the Knoxville area, concluded that exposures to respirable suspended particulate matter (RSP), for example, were considerably below limits established by the Occupational Safety and Health Administration (OSHA) for the workplace.”


8. A interesting article published in by the Cato Institute is (Linked here). The Article concludes:


“With its document on passive smoking, the EPA disregarded the suggestions of its own review. Scientific integrity was compromised, if not outright abused, by the manner in which this risk assessment was generated. Abusing scientific integrity and generating faulty “scientific” outcomes through manipulations, assumptions, and extrapolations leads to the development of mistaken programs at enormous cost to our government and to taxpayers. Indeed, the cost to the scientific process itself is even greater. Science should dictate what policies need to be established; predetermined policies should not dictate how science should be interpreted”.


9. Some people claim that any scientist or researcher who has ever been funded by a tobacco company or affiliate, is automatically not credible. Nobody asks if the foundations, government agencies or corporations which fund the advocacy and reaserch in favor of Smoking Bans, have any bias. Here is an interesting article by Dr. Elizabeth Whelan, who has been accused of bias, on the question of whether such corporate “connections” should disqualifiy research from consideration.


CONCLUSION

It is hard for legislators to make good decisions when the information we get is conflicting, exaggerated, or manipulated. That has happened with the Smoking Ban proposals. Unfortunately, the misrepresentation of scientific data by proponents has damaged the credibility of the anti-smoking movement.

I am also concerned that the Statewide smoking ban can’t be enforced at Indian Casinos. This would create an unfair advantage for casinos, and cause private bars and restaurants within 50 miles of a casino to lose business.

Allied Charities and several bar owners also testified that profits from charitable gambling declined significantly (up to 2/3 reduction) in Minneapolis and St. Paul, when those cities established a smoking ban .

Finally, private business owners have a property right that government should not take away lightly.

I still oppose smoking. But, the statewide Smoking Ban is an over-reaction to a problem which is more of a nuisance, than public health issue. Adults can choose to enter or avoid a bar or restaurant that allows smoking. Citizens also have a right to know the truth about the scientific studies. In my view, those studies show very weak relationships between cancer or heart attacks and second hand smoke.


Posted in Legislation

I'd love to send that to the Governor of Virginia (and a few others) before he decides to "amend" the smoking bill before him now. Do you have an actual link to it?

Here ya go

http://tomneuville.com/archives/101#comments

Great! Thanks!