Wednesday, June 28, 2006

Surgeon General's report on secondhand smoke -- same-old, same-old

Posted by Craig Westover | 11:20 AM |  

I almost hate to make another reference to it, but once again we have to deal with a little bullsh*t in the philosophical sense. Bullsh*t is not lying. There may even be some truth in it, but to the bullsh*tter truth is irrelevant. His objective is to create an impression that does not necessarily have any connection to reality. That said, let’s look at the latest surgeon general’s comments on secondhand smoke. (My coments are based on the press releases and article below. Comments on the full report to follow.)

First let’s look at the headline as run in today’s Pioneer Press --
Secondhand smoke's dangers spelled out
Study says it kills 50,000 people a year; no exposure to it is safe
The subhead cites a “study,” which would lead one to believe that there is new evidence. We’ve found the silver bullet in the “mountains of evidence” folks like Bob Moffitt of the American Lung Association is always citing but never producing. Well, not exactly. In fact, No, not at all. The “study” is not a “study” at all, but a report. As the story states (but not until the last paragraph).
The findings of the new report will come as no surprise to scientists and physicians. It is simply a compilation of research that has been conducted over the past two decades.
So we are not dealing with new data or new findings. Some new people are looking at the data and drawing conclusions. The data hasn’t changed. So, let’s look at those conclusions.
There is no level of exposure to smoke that is safe and the children of smokers are at special risk, Surgeon General Richard Carmona said in releasing the new report.

"I am here to say the debate is over, the science is clear," Carmona said during a televised news conference from Washington. "Secondhand smoke is not a mere annoyance. It is a serious health hazard."
The first sentence is a compound sentence. The first clause is utter b.s.; the second is scientifically defensible, as I’ll discuss later. What does “there is no level of exposure to smoke that is safe” mean? Does it mean one inhalation an I’m dead? Does it mean one inhalation and the affects stay with me for life? Or is a clever way of avoiding the real question -- At what level of exposure does secondhand smoke become dangerous?

The phrase “there is no safe level of secondhand smoke” is a political statement, not a scientific one, which is a key point of discussion. Also a political point is Carmona’s statement, "I am here to say the debate is over, the science is clear." That’s a political statement, not a scientific statement. Science is a continual process, not one that ever arrives at conclusive proof. Take the well-documented and statistically valid connection between active smoking and lung diseases. Even today questions continue as why many smokers get lung cancer, for example, but other heavy smokers don’t.

Policy makers, by necessity must reach a conclusion in order to implement policy. Scientists are not bound by that restriction. So, understand Carmona’s statement for what it is -- a political statement, not a scientific one.

That said, the job of the policy maker is to look at the evidence and determine a policy that achieves the objective of public health in the least restrictive manner. The phrase “in the least restrictive manner” is not irrelevant in a free society. With that in mind, consider Carmona's statement.
The only way to combat the heath threat, he said, was to ban all smoking in public buildings.
No, that is hardly the only way. What is the objective here? It is to prevent people from involuntary exposure to secondhand smoke? Why not the extreme solution and prohibit smoking entirely? Or why not ban smoking in private homes where children are present? Those are ways to combat the threat. They are not taken, of course, because they are overly restrictive. From the article --
Although government cannot ban smoking in private homes, Carmona added, he strongly encouraged parents to step outside before lighting up in order to protect the health of their children.

For everyone else, Carmona said, the best advice is simply "stay away from smokers."
Let’s look at those comments. First, government can ban smoking in private homes. We ban meth consumption in private homes. We ban marijuana consumption in private homes. What Carmona is really saying is we don’t want to ban smoking in private homes. We don’t have the will to ban smoking in private homes. In other words words, even when we know scientifically there is a danger to children, we’re willing to back off the “no safe level of exposure" threat.

Further, Carmona’s recommendation is to “stay away from smokers.” Well, I used to be able to do that if I so chose. Now, I can’t walk past any public building or down the sidewalk past any bar without being involuntarily exposed to secondhand smoke. I don’t mind, but if you tell me there is no safe level of secondhand smoke, then smoking ban laws are actually putting me in more danger than I was before by driving smokers out on the street. Where is the cry for banning smoking anywhere in public?

The point is, while shouting "there is not safe level of exposure to secondhand smoke,” the actions of smoking ban advocates indicate they know that is b.s. The poison is, as it always has been, in the dosage.

So let’s summarize what we have so far. The government's report contains no new data. While making the claim that there is “no safe level of secondhand smoke” and calling for a smoking ban in all public buildings as the only solution, it accepts that young children and the rest of us may still be exposed to secondhand smoke. But if there is no safe level, how can that be acceptable?

Let’s move on and once again look at the (old) data.
Exposure of nonsmokers to tobacco smoke increases their risk of heart disease and cancer by as much as 30 percent.
That's a really misleading statistic. Let’s take a look at in the context of actual data.

I’ve asked Bob Moffitt of the American Lung Association to provide some statistical basis for this and other such claims. He has consistently declined to provide even a single study of his choice from the mountains of evidence. So I went out and found some.

A connection between lung cancer and secondhand smoke with a 30 percent increased risk can be found in two reports cited by the California EPA in study they did with the intent of proving evidence tht secondhand smoke is toxic environmental contaminant and smoking should be banned outdoors in public places. So this is not exactly a smoker-friendly study. I posted about it here; here’s a summary.

One can arrive at a 30 percent increase risk from two studies that tracked the incidence of lung cancer in non-smoking spouses of smoking spouses and non-smoking employees in smoking environments. What these two studies show is that the longer the duration of exposure to secondhand smoke, the greater the risk of lung cancer. But here’s the kicker for a policy maker -- in the case of souses, the required duration of exposure before there was a correlation greater than 1.0 (1.0 means no connection) was after 29 years of exposure. In the case of an employee in a smoking establishment, the required exposure to exceed a risk of 1.0 was 21 years.

At 29 and 21 years respectively, the 95 percent confidence interval for the increased risk ranged from 1.03 to 1.50 -- an increased risk of 3 percent to 50 percent. The 30 percent figure in the article is pretty close to the mean of that distribution. What the full confidence interval indicates is that for these studies, there is as much likelihood that the real increased risk of secondhand smoke is 3 percent as it is 50 percent as it is 30 percent. In other words, to state there is 30 percent increased risk implies preciseness not supported by the data.

Let’s take it the next step. Fifty-percent, even 30 percent sounds pretty scary. But what does that mean in terms of real numbers. The rate of lung cancer among non-smoking individuals is about 10 in 100,000 people. If you’re a non-smoker, that’s your odds of getting lung cancer. If your spouse smokes, and you’ve been married 29 years or more, and we use the government’s 30 percent figure, your odds are now about 13 in 100,000. If you’re a non-smoker and you’ve worked in smoking environment for 21 years, you odds of getting lung cancer are about 13 in 100,000.

And those are general population statistics. If you otherwise take care of yourself, have regular check-ups, you odds are even better. If there's a predilection for cancer in your family, your odds a probably worse.

One final point. Generally epidemiologists require a risk factor greater than 2.0 to consider a correlation exists between a casual factor and an outcome. 3.0 to 4.0 is generally required to assume actual causation. Some epidemiologists I’ve talked with are willing to accept a 2.0 level for a correlation between secondhand smoke and lung cancer given the direct link of inhaling it into the lungs. Note that the government number, 1.30, doesn’t even reach this minimal threshold. These same epidemiologists require a higher risk ratio to associate secondhand smoke with diseases like heart disease where the physical connection is more tenuous.

[I’ve only seen a few studies, among them findings that the risk ratio for SIDS in homes where one or both parents smoke is about 4.0 -- strongly indicating a causal relationship with secondhand smoke. This is worth further study, and from the standpoint of protecting public health ought to be of greater concern than smoking bans in bars and restaurants.]
Even a brief exposure to tobacco smoke can increase risk, especially for people with heart and respiratory diseases.
Increase risk of what? Contracting lung cancer in 29 years? To be fair and not use the tactics of smoking ban proponents and twist statistics, I think this is just a bad statement of the notion that a person with existing health problems is more affected by secondhand smoke than others. Duh? These people are also at a greater risk from auto emissions, and the noxious odors from, say an ethanol plant. Again, the question is what are the policy implications of that statement?
Segregating smokers is not an effective technique for preventing exposure of nonsmokers, and even the best available technology does not cleanse the air adequately.
Again, the use of compound sentence where half has some basis in fact and half is pure b.s. It would stand to reason that the further away from a smoker one is, the less the impact of secondhand smoke, but again to be fair, there is some still some exposure. But the statement that even the best available technology does not cleanse the air adequately is absolutely misleading.

What the hell does “adequately” mean? To those who believe in abstinence only when it comes to smoking, “adequate” means “zero.” To the folks at OSHA and people in the real world, one measures contaminants in parts per million. OSHA has established safe-level standards for the various chemicals found in tobacco smoke. Various studies, including studies conducted by government agencies, find that ventilation can take contaminants hundreds of times lower than required by OSHA. Again, what are the policy implications?
Tobacco smoke contains at least 50 separate carcinogens and toxins, experts noted. Someone in a closed space with a smoker breathes in exactly the same chemicals as the smoker does. The fact that the nonsmoker is breathing in less of them than the smoker reduces the risk, compared to smoking, but does not eliminate it.
Again, this is a misleading statement that ignores the “poison is in the dosage” rule. It is also self-contradictory.

Are there 50 separate carcinogens and toxins in tobacco smoke? Probably, you can find smoking ban proponents throwing around numbers in the hundreds, which tends to question their dedication to the truth, but let’s accept 50. It passes the smell test. Many of these same carcinogens are also found in nature. The danger is not in the substance itself, but in the exposure. Never encountering secondhand smoke does not eliminate exposure (which means one could say “there is no safe level of exposure to life”).

Of course, exposure to secondhand smoke increases the one’s over all exposure to these carcinogens and toxins. But because one is also exposed simply by breathing the air on a busy street, we know that there is a level at which exposure is not dangerous. The scientific question then becomes at what level and what degree of exposure to secondhand smoke reaches that level.

We’ve already seen that in order to reach any correlation (to low statistically to establish causation) between secondhand smoke and lung cancer the required duration of exposure is 21-29 years for specific higher-risk subgroups of the population. But what about exposure to individual chemicals.

These statistics have also been calculated and the results are ridiculous in the extreme. To reach deadly levels of the toxins in tobacco smoke, one would have to be in a tightly enclosed area inhaling the smokes from, in some cases, thousands of cigarettes per hour. If that is true, is it even logical to assert that ventilation can not reduce real risk to virtually zero?

Then there’s this -- The fact that the nonsmoker is breathing in less of them than the smoker reduces the risk, compared to smoking, but does not eliminate it

This is the statement of a person that said there is no safe level of exposure to secondhand smoke. There’s no safe level, but now you’re saying there are degrees of risk. What does that mean? The scare phrase “no safe level of exposure” constantly conflicts with not only real science, but the b.s. of smoking ban proponents themselves.

And that’s the real point. There is no interest in the truth, scientific or otherwise on the part of these people. They want to live in a smoke-free world, and will settle for nothing else. That’s an admirable goal; we all would be better off if no one smoked (except of course for the bureaucrats whose jobs depend on tobacco taxes, but that’s another issue). But as admirable as that objective is, it does not justify any and all means to achieve it.

That brings us back to the policy maker as opposed to the scientist. Based on real data, the decision for a policy maker considering a smoking ban in private bars and restaurants is “Is a smoking ban in bars and restaurants warranted?” “Is it the least restrictive means of achieving the public health goal or reducing exposure to secondhand smoke.?

Looking at the first question. To answer “yes” based on the data, one is concluding that given a statistically insignificant correlation that even if accepted increases an employee’s risk of lung cancer from 10 in 100,000 to between 10.3 and 15 in 100,000, but only after 21 years of exposure, it is in the public interest to deny bar owners the right to permit people that voluntarily choose to do so to smoke on private property. It is in the public interest to effectively close down otherwise viable businesses that cater to smokers. It is in the public interest to cause people to lose their jobs to dubiously protect their health.

To answer “yes” to the second question, the policy maker must deny that people have the free choice to determine what they want in the form of entertainment. He must assume people should not be free to independently contract and choose where they work. He must decide that hundreds of times lower than OSHA safety standards is not “adequate” removal of smoke particles from the air.

But public health is not the objective. Banning smoking is. If this were a question of public health, we'd be talking about air quality standards like we do for every other type of air pollution. It's a bout a group of people using government's legitimate publich health authority to illegitimately impose their chosen lifestyle on everyone else.

In short, while smoking ban proponents will crow about the “new” report, it is simply more of the same-old, same-old. I’ll ask Moffitt for some supporting data; he’ll simply say this is another rock on the mountains of data and not supply any. Dave Thune will read the article and despite admitting he has no understanding of statistics will say, see the proof is irrefutable.

And more bars will go out of business and more employees will be out of jobs, but bars and restaurants will be smoke-free. All we have to do is wade through the toxic b.s. to get to them.