Thursday, June 29, 2006

Surgeon General’s secondhand smoke report -- It's politics, not science (updated)

Posted by Craig Westover | 9:45 PM |  

Moved to top. Some interesting updates within and at the end of the post.

I just downloaded the complete report. I’m not going to wait for Bob Moffitt, American Lung Association blogger, to provide an analysis. The report is 727 pages and, just browsing through it, I noticed some math.

To be honest, there’s lots in it that I’m going to have spend some time with before commenting on, but even a quick perusal indicates the report is politics, not science.

As I note in this post, Surgeon General Carmona’s statement, "I am here to say the debate is over, the science is clear" is a political statement, not a scientific statement. If further evidence that the Surgeon General’s report is a political document is necessary, it is found on page 28 under “Definition and Terminology.”

This report uses the term secondhand smoke in preference to environmental tobacco smoke, even though the latter may have been used more frequently in previous reports. The descriptor “secondhand” captures the involuntary nature of the exposure, while “environmental” does not. This report also refers to the inhalation of secondhand smoke as involuntary smoking, acknowledging that most nonsmokers do not want to inhale tobacco smoke. The exposure of the fetus to tobacco smoke, whether from active smoking by the mother or from her exposure to secondhand smoke, also constitutes involuntary smoking.
That is laughable as an objective scientific statement. Whether one calls it “environmental tobacco smoke” or “secondhand smoke is irrelevant. If one is scientifically studying the impact of tobacco smoke inhaled by non-smokers in the presence of smokers, the attitude of the non-smoker is irrelevant. The fact that I don’t mind sitting in a bar next to a cigar smoker doesn’t mean the smoke I’m inhaling will affect my health less than someone that objects.

The scientist is interested in determining how Factor X relates to Outcome Y. The policy advocate is out to prove that Factor X is evil. When the role is flipped, when “Big Tobacco” does a study showing that the dangers of secondhand smoke are not significant, it’s called “bias.” I’ve read some tobacco studies, some I consider biased, but never have I read such a blatant statement of prejudice and perversion of objectivity in a scientific study.

The surgeon general's report is not about science. The quote above makes unabashedly evident that how tobacco smoke is labeled makes a difference in how it is perceived, and for the purposes of this report it will be portrayed as negative -- not necessarily based on data , but necessarily on language. Before one shred of evidence is presented in the 727 page report, the paradigm is set that, by whatever name, secondhand smoke is evil. That is a political statement, not a scientific hypothesis to be tested.

Science is a continual process, not one that ever arrives at conclusive proof. In that context, further study of the affects of secondhand smoke is welcome. A quick survey of the Surgeon General’s report promises some interesting insight into the impact of secondhand smoke on pregnant women and developing children, despite the explicit prejudice of the report itself. Data is data.

Update: Dr. Michaael Siegel, a physician that specializes in preventive medicine and public health with 20 years of experience in tobacco control, primarily as a researcher, makes a similar observation that there are some valid insights in the surgeon general's report plus he adds a pwerful insight --
In some ways, I believe that the basic message here - everyone is at risk and the dose doesn't matter; no matter how small the dose, you are still at risk - may be a counter-productive one. Or at least it may undermine some of the very important findings of the Surgeon General's report. The report reviewed, for example, the levels of secondhand smoke exposure among different population groups and came to some conclusions that should guide policy makers. But those conclusions are completely obscured by the all-out emphasis on the absence of any safe level of exposure.
And that ultimately is the point. If government officials Like Dave Thune are going to make policy based on the surgeon general's report, and advocates like Bob Moffitt are going to push for policy based on the report, and columnists like Laura Billings are going to stump for a statewide smoking ban based on the report, then they best make some attempt to understand the data behind the report’s conclusions. Not all of it, not even most of it, but certainly enough to be able to point to a study they do understand (not a single statistic) and say, yes, that’s why it is necessary to ban smoking in privately owned bars and restaurants.

Public health policy requires a scientific basis for action, but specific actions, like smoking bans, ought be based on real data, not political statements, and consider the least restrictive means of achieiving public health objectives.

Previous studies indicate that you have a 99.99 percent better survival rate breathing secondhand smoke than you do holding your breath waiting for Thune or Moffit to produce a scientifically valid rationale for imposing a smoking ban on private bars or restaurants.

Update: Before the Moffits of the world start in on Dr. Siegel quoted above as a "minion of Big Tobacco" or being "Pro-Smoke," they might want to consider a little context-- Siegal supports smoking bans as legitimate use of police power. He doesn't support the abuse of science. From Dr. Siegel --
The misrepresentation by the Surgeon General's office of the science of the acute cardiovascular and carcinogenic effects of a brief exposure to secondhand smoke suggests to me that there is a dire need for more open discussion of scientific issues within the tobacco control community.

This misrepresentation of the heart disease risk attributable to a brief secondhand smoke exposure comes many months after I began to gradually reveal more than 80 anti-smoking groups making similar claims, explained why I view these claims as misleading, and attempted to initiate, within the movement, a discussion about the scientific validity of these assertions.

Unfortunately, rather than engaging in a discussion of the scientific issues, the tobacco control list-serves on which I had begun to communicate my concerns to thousands of scientists and advocates decided to throw me out and to stifle any further discussion. Actually, that's misleading. There was no discussion to begin with. The response I engendered was not arguments about the validity of my reasoning; it was personal attacks about my honesty, character, and funding. But my expulsion from the movement's communication infrastructure did stifle any possible future discussion of these issues; I'm confident that with time, advocates' defensive reactions would eventually have given way to a serious consideration of the scientific issues at hand.

By taking this issue off the table for discussion, it made it impossible for the Surgeon General's office to become aware of the importance of carefully considering the differences between the physiologic phenomena of transient changes in endothelial function, platelet activation, lipid metabolism, artery elasticity, and cardiac autonomic tone that follow a brief secondhand smoke exposure and the actual risk of developing heart disease or suffering a heart attack due to that brief exposure.

The lesson here, for me, is that the tobacco control movement needs to find ways of opening up scientific and policy discussion, rather than closing it off. The movement needs to find ways of making individuals more comfortable to share their opinions about our agenda, our tactics, our actions, and our public statements, not to create an atmosphere where people are afraid to speak out lest their careers be threatened or destroyed.

Only a major change in the way in which the movement operates will allow this problem to be corrected so that it does not recur in the future. But that change is not so radical - what it simply requires is a willingness to consider alternative viewpoints and to address arguments on their merits. It's time to drop the defensive posturing that treats any criticism of the anti-smoking movement as a heretical violation of some sacred code and elicits an offensive attack on the perpetrator of this heinous crime of dissent. Tolerating dissent and taking the time to consider the opinions of others, even if those opinions challenge the prevailing dogma, can only help the movement in the long run. And it could probably prevent the massive misleading of the public that occurred yesterday.
Update: Michael Fumento checks in -- Killing the passive smoking debate
“Secondhand smoke debate ‘over.” That’s the message from the Surgeon General’s office, delivered by a sycophantic media. The claim is that the science has now overwhelmingly proved that smoke from others’ cigarettes can kill you. Actually, “debate over” simply means: “If you have your doubts, shut up!”

But you definitely should have doubts over the new Surgeon General’s report, a massive 727-page door stop. Like many massive reports on controversial issues, it’s probably designed that way so nobody (especially reporters on deadline) will want to or have time to read beyond the executive summary.