Wednesday, September 21, 2005

More Personal Attacks by Anti-Smoking Advocates: Idea that FORCES Represents Legitimate Interests of its Members Seems Too Much to Take

In response to my post of July 25, welcoming FORCES readers to my site and suggesting that its members are not merely tobacco industry fronts, but that they largely represent their own legitimate interests, several anti-smoking advocates have unleashed yet another set of personal attacks.

This time, the recipient of the attacks was not a tobacco industry-funded or pro-smoking advocate, but instead, was ...

A number of anti-smoking advocates questioned my funding source, suggested that the administration of Boston University be asked to investigate my funding source, suggested that the administration of Boston University should intervene to presumably stop what I am doing, once again accused Martha Perske of being a tobacco "industry mole," and accused me of being funded by the Republican party.

They also reiterated the charges that FORCES is merely a tobacco industry front group and that they are lying about where they get their funding.

The Rest of the Story

Clearly, my suggestion that FORCES is not merely a tobacco industry front group but that it truly does represent legitimate interests of its members was too much for a number of anti-smoking advocates to take. But instead of attempting to refute my arguments, they resorted to issuing personal attacks and unfounded accusations.

What surprised me about this is not the attacks, but the fact that I only really said two things in that post which prompted such a vigorous response.

First, I welcomed readers from FORCES, as well as from Reason Online's Hit & Run blog and the Smoker's Club. This seems perfectly appropriate, since I knew that readers from these sites were going to be visiting my blog, as several articles on my blog were linked to from these sites.

Second, I made the daring suggestion that FORCES was not merely a tobacco industry front group, but that its members generally represented their own legitimate interests and are not merely being used by the industry to promote the industry's own goals.

In fact, the evidence demonstrates that FORCES was established independent of the tobacco industry. A 1999 Philip Morris document establishes that the company was not funding FORCES at the time and it was an investigation of pro-smoking groups that brought FORCES to its attention. At least at the time, Philip Morris itself acknowledged that FORCES "does not accept tobacco industry funding."

The only evidence presented to suggest any funding at all from the tobacco industry to FORCES was made by an anonymous commenter, who claimed that FORCES received tobacco industry funding to run an ad campaign on a California ballot initiative. Let's stipulate that's true. It certainly doesn't make FORCES a tobacco industry front group. And it certainly doesn't suggest that its members are merely tobacco industry "moles" who are merely doing the industry's bidding for it and not truly representing their own interests.

But the strongest evidence that FORCES is not a tobacco industry front group is FORCES itself. Its position is that: "The Master Settlement Agreement is a massively corrupt price-fixing scheme contrived between forty-six states and the major American cigarette manufacturers. As this latest challenge states, upon signing the MSA, 'the States became business partners in establishing one of the most effective and destructive cartels in the history of the Nation.' If there is any justice left in the USA these suits shall prevail. The happiest outcome of all would be total bankruptcy of the major manufacturers to the benefit of fair dealers and the public. We have a bottle of Dom Perignon cooling for the day Philip Morris and the rest bite the dust. Big Tobacco's ignominious demise is a dream that really could come true. ... It's going to take years. That's okay. Smokers and all seekers of justice are watching, and strategizing, and we're ready for the long haul."

I hardly think a Big Tobacco front group would call for the demise of Big Tobacco (much less for its ignominious demise).

The web site of Americans for Nonsmokers' Rights still accuses FORCES of being a Big Tobacco front and based on responses I have received on my post, I seem to be the only public health advocate around who sees that the members of FORCES are largely representing their own concerns about government intrusion into their lives and not primarily trying to protect the interests of the large tobacco companies. (Yes - these interests do often coincide but that does not de-legitimize the interests of FORCES members.)

In fact, most of the FORCES members that I know would love nothing other than to see Big Tobacco go under so that some more vigorous price competition can finally enter the market and maybe they won't have to spend so much money on cigarettes.

I think that until anti-smoking advocates start listening to the arguments that smokers' groups are making instead of attacking the individuals who are making these arguments, they are going to remain blind to many of the reasons why it is becoming increasingly difficult to get tobacco control and its funding on the public and political agenda.

While I see no need to defend myself (those who know me well are still laughing at the suggestion that I am being funded by the Republican party), I refuse to allow Martha Perske to be attacked publicly in a defamatory manner.

So let me state that Martha Perske is a remarkable, talented (truly gifted) individual who has tremendous integrity and has made quite incredible contributions to the public's welfare and that she is in no way representing anything other than her own personal interests. She is an independent, private citizen who, far from being on the tobacco industry dole, has put her own time and effort into what she believes is the promotion of societal policy that reflects scientific evidence.

While our interpretation of that scientific evidence has differed, I have the utmost respect for Martha Perske and I think that we have far more common ground than we have differences. What I hope I will be able to one day say is that I share Martha's ability to look into the eyes and heart of each and every individual and see the beauty of that person. So I am happy to be able to now call Martha a friend.

While we in tobacco control talk all the time about the tobacco industry's deception and lies and the impact it has had on the public, I am beginning to see that we seem to have our own blinders on and our inability to look past the dogma we have been exposed to is starting to impair our own ability to see the truth for what it is. I think our view of reality has been severely tainted by the narrow, prescriptive, dogmatic perspective with which we view the world.

If this blog can play any role in helping to broaden that perspective, then I will consider it to have been a success.


Soren Hojbjerg said...

Thank you, Mr. Siegel.

I started smoking tobacco when I was 15 years old. Today I am 43 years old, and I do not regret. Thanks to the efforts of Dr. Brad Rodu, I know that if need be I can switch to smokeless. I use smokeless regularly.

I started using tobacco on my own accord. Advertisement played no role. Peer pressure played no role. Nobody forced me to use tobacco at gunpoint. I was aware of non trivial risks.

I joined Forces last year. I payed. I made my own web site. I payed. I visited Forces Netherlands this summer. I payed. I write letters to members of parliament. I pay the postage.

If I suffer death or disease from the habit of using tobacco, it is my fault. If I made a mistake, then it’s mine! I won’t sue any tobacco company. Tobacco companies provide me with a product that I choose to use.

I am not an affront of any tobacco company. I am an affront of myself!

Anonymous said...

Mr. Siegel,

I think you are doing a great service in providing intelligent commentaries on this issue.

I wish others were as talented (or honest).

Keep up the good work!

Anonymous said...

I have appreciated your site, you have worked very hard in your field. As a student (albeit an old one at the time) I have read some of your work out of Boston. I was a Human Services student-heavy on the addiction social aspect, until life happened to me. I now take all I read and see with a grain of salt, realizing we all have an "agenda" for ourselves. That goes from the top to the bottom. Looking someone in the eye and accepting them as they are is the most high aspiration one can attain in our lives. I thank you for who you are also (with a grain of salt of course!)
Capri Lione
Madison, WI

Anonymous said...

I appreciate your work.

I am an individual who began smoking at the age of 21, I made the decision. I am a 3rd generation smoker with no family history of heart or lung problems throughout. The only member of my family to die prematurly was my father who died from liver problems earned by his joy in booze and life.

I gave up smoking a few years ago only to restart about a year ago, just in time for the local smoking ban. I am a paid member of various prosmoking groups including Forces. I do not consume products of companies party to the Master Settlement Agreement.

Smoking allows me the capability to read. I did not realsie this until I stopped and investigated why my life fell apart. I investigated what my problem was, what the effect of ADD and ADHD drugs were on the brain and what the effects of nicotine was on the brain. I found smoking a less exspensive alternative to drug therapy, beside I enjoy it.

I am against the smoking bans because the information provided by the anti-smoking groups is invalid. There is NO proof that smoking plays a role in any of the conditions used to create fear in the minds of the public. I supplied concrete information to our City Counsel but they ignored it. The ban they passed means I can no longer work in my home town and I am against it and any other law or ordinance passed based on a PR campaign instead of true facts.

I will continue to smoke regardless of these bans. I will continue to work at home, eat at home, and entertain myself at home.

I do not drink.

I know the effects of smoking on my body and follow a ritual of vitamin suppliments to counteract it's effect on antioxidants daily.

I think the true high cost of health care is because so many people are attending it as a religion.

D. Bruce Fox
Indianapolis, IN

Harry O'Brien said...

Michael Siegel,

You write: “In response to my post of July 25, welcoming FORCES readers to my site and suggesting that its members are not merely tobacco industry fronts....” And in a second place, “Clearly, my suggestion that FORCES is not merely a tobacco industry front group but that it truly does represent legitimate interests of its members....”

Thus you have not only FORCES but its membership as well being not “merely” tobacco industry fronts. I hope that this was insult by inadvertence, and not deliberate.

Michael Siegel said...

Actually this is sarcasm. I am understating the point to emphasize how many of the anti-smoking advocates will not even accept that FORCES and its members are not "merely" tobacco industry fronts, much less that they are simple "moles" for the industry as many of my collegaues have alleged.

I reject the assertion that FORCES or its members are tobacco industry fronts - period.

Please excuse my sarcasm - I can see why you interpreted it as possibly insulting. But I do find what many of my colleagues have written to be insulting. I am rejecting that outright.

Anonymous said...

Dr S

Anti tobacco's blaming the tobacco industry for anything and everything brings to mind a couple of interesting parallels.

I'm guessing that at least 10% of the population smokes marijuana at least occasionally [perhaps you have better figures] But how can this be? There is no "Big Pot" industry. The product is not advertised. It is not attractivley packaged. It is not readily availible at corner stores and gas stations and receives little, if any, glamorization in TV and movies. And yet it is as popular as ever.

On the other hand the liquor industry continues to do precisely what Big Tobacco used to do. Alcohol easily has as great a cost to society as tobacco and yet they market to young people, claim that you can get lots of girls if you drink the right brand of beer and it is readily availible everywhere.

Which would you rather have your children experiment with: a cigarette, a joint or a bottle of vodka?

Why is there no anti-pot or anti-
alcohol lobby of any consequence? Its simple: there's no money in it.


For the record I am a nonsmoking believer in the anti-anti tobacco movement. I became interested in the issue because of the wide ranging implications of this overzealous industry. I applaud your bringing some common sense to this debate.

Also I do drink, but not as much as I'd like to. I just don't have the time.

Cantiloper said...

Mike Siegel said "I reject the assertion that FORCES or its members are tobacco industry fronts - period. "

I can see what Harry thought though. Phrasing and sarcasm and such can be tricky on the net at times. Actually, I believe the official Anti line is no longer to call the opposition "fronts" for Big Tobacco. They've settled into a much more solid position of saying things like "Front Groups and Allies" (or sympathizers or whatever). That way it doesn't MATTER if you prove a group or a person isn't on the PM payroll: the mud will still have been slung, usually with far more visibility than any defense would have, and the slinger can always say, "Well, they ARE an Ally." simply because they agree with some BT positions.

Of course as you've pointed out so clearly here, The Center for Tobacco Free Kids and their ilk can now be considered "Big Tobacco Front Groups or Allies" as well.

Michael J. McFadden
Author of "Dissecting Antismokers' Brains"

Bill Godshall said...

If it weren't for cigarette industry funded front groups, scientists, public relations agencies, coalitions, lobbyists and lawsuits, FORCES wouldn't even exist, as the vast majority of arguments made by FORCES (and its supporters) were originally funded, developed and publicized by cigarette companies.

As such, FORCES is little more than a mouthpiece of a few dozen selfish cigarette smokers that repeats cigarette industry propaganda ad nauseum.

I'm pleased that this blog has exposed flaws in some claims made by some public health advocates.

But this blog would gain more credibility if also analyzed and critized some of the many absurd claims made by the cigarette industry, FORCES and/or other cigarette promoters and defenders.

Anonymous said...

Again Bill repeats the dogged mantra that Big Tobacco is the root of all evil. A history of lies and deception does not automatically disqualify some of their claims from actually being the truth. It doesn't matter if FORCES is run by the Marlboro Man himself; objective examination of their evidence shows much of it to be true.

On the other hand many of the claims made by anti tobacco are so absurd as to bring in to question the legitimacy of their cause. All of the malarkey surrounding the risks of second hand smoke reminds me of the Y2K scare, and we all remember what a crisis that was. The Helena Montana study, for example is an embarrassing piece of junk science that would taint the credibility of anyone who stands by its findings.

Do they honestly believe that someone smoking next to you on a park bench is a threat to your health? Do they honestly believe that engineers, who can make underground parking garages safe from poisonous car exhaust, are incapable of dealing with cigarette smoke in a restaurant? Going to the bar exposes you to all sorts of risks, but cigarette smoke does not even make it into the top ten.

The tobacco control movement seems to have no room for compromise or reason. Can't they simply ask smokers to respect the fact that many people legitimately find their habit quite irritating and annoying. Can't they encourage smokers to simply try and smoke less rather than quit? Can't they admit that nicotine, in and of itself, is a relatively harmless drug and has many beneficial applications? Does any of the hundreds of millions of dollars spent on tobacco control go into pure medical research as opposed to propaganda and PR campaigns?

I have asked these questions many times on various blogs and chats but never get a straight answer. Some day science will cure cancer and then Tobacco Control will really be in a conundrum. [I get the feeling that if these people were on a sinking ship they would spend all of there efforts criticizing the shipyard and giving swimming lessons rather than simply telling people to get in the lifeboats.]


As I said above in my post of 5:52pm I am not a smoker but have serious concerns with this movement and the consequences that go far beyond smoking and health. I make my posts anonymously simply because I work in an industry where my heretical opinions could have professional consequences.

lockjaw02 said...

Actually, Mr Godshall, most of the resources many of us use to critically examine the work of anti-smoking orgs comes from the very same sources they use, or come from the anti-smoking orgs themselves. It would be too difficult to study "your science" to determine how you came by "your conclusions" unless looking at "your data".

Those sources include both governmental agencies and non-governmental organizations that also provide anti-smokers with statistics, such as those gathered by the NIH through National Survey on Drug Use and Health (NSDUH) and it predecessor National Health and Nutrition Examination Survey (NHANES) or those from the ALA, ACS, and the WHO. Same data, but anti-smokers simply interpret them differently.

I see the poster above mentioned Helena. It was amazing to watch the many iterations come out from the Helena Heart Miracle "study" from the initial briefings announcing their earth-shattering findings to the earlier draft that elatedly posted on their website for a few minutes like it was the smoking gun til they realized or someone told them it wasn't yet a final peer-reviewed paper ready for public consumption. I also enjoyd watching as it went through the process over the next year, with more data gathering and the refiguring of the numbers to get it to say all they could get it to say which wasn't even close to their original guestimates. No matter though, the propaganda only needs the big bang of the original reporting for it to be seared into the minds of the ill-informed, complacent masses for many years even though it had been quickly and thoroughly exposed for what it was.

Harry O'Brien said...

I’m new to this blog, and was pleasantly impressed that it was a blog for grownups until I read Bill Godshall’s brain-fart comment which, presenting absolutely nothing of substance, guttered the whole discussion. FORCES, he whines, is “little more than a mouthpiece of a few dozen selfish cigarette smokers that repeats cigarette industry propaganda ad nauseum.” Golly, is that what it is? If anybody wants to attempt a rational discussion with wankers of Godshall’s ilk, count me out.

Carol AS Thompson said...

"Big Tobacco" has been controlled by the anti-smokers since at least the 1960s - particularly Philip Morris, upon whose board of directors was the stepson of Mary Woodard Lasker, the head of the American Cancer Society.

They let the anti-smokers get away with their scientific fraud of suppressing research and deliberately using defective studies to falsely blame smoking for diseases that are really caused by infection. The tobacco industry collaborated in looting and plundering smokers for the benefit of the health fascists, as well as rich peoples' pet charities such as AIDS and art institutes. Their supposed "fight" was nothing but a sham for appearances' sake.

And, FORCES does nothing but parrot the anti-smoker-approved tobacco industry line. FORCES grandiosely proclaims that the scientific argument is their strongest hand, then they offer only a snivel that most studies show no risk, and a few nit-picks. In fact, the anti-smokers and their friends at FORCES are ignoring infections, whose involvement and mechanisms of carcinogenesis are known, in order to falsely blame smoking.

The History of the Conspiracy Against Tobacco

Anonymous said...

carol as thompson's posting is absurd, but hilariously funny.

Harry O'Brien said...

Bloomberg's latest is that his health commissioner can make the case that the ban and "our dramatic, first-year hike in cigarette taxes" have saved 60,000 lives (no breakdown given between the two!), and that the city has 188,000 fewer smokers. One can’t argue that the coercive hike in cigarette taxes has had an effect and perhaps added 5 or 6 years to the lives of some smokers, who perhaps can henceforth spend a few fruitful extra years being pushed around in wheelchairs in nursing homes, but taxpayers are surely entitled to know how that figure was arrived at. AND the breakdown. AND whether bootlegged cigarettes were figured into the 188,000 figure, since the spirit of Al Capone surely is now stirring in its grave, excited by the possibilities.

Bloomberg also says, “When I learned that restaurant and bar workers were 50 percent more likely to get lung cancer, I made up my mind to act.” (Our hero!) Of course, this is the entire basis of his argument, since he knew perfectly well that New Yorkers wouldn’t put up with a ban that has no proven health effect on patrons, given the relatively short time they spend in bars and/or restaurants, and given the fact that they have the absolute constitutional right to stay out of bars and restaurants that would allow smoking.

So all this is nothing but a prelude to a question, since most of us have few independent ways to discover the true facts (and in this case none whatsoever as far as I can see). The question, then: What’s the source of the 60,000 and 188,000 figures, and where did Bloomber get the information that the workers were 50 percent more likely to get lung cancer?

Dr. Siegel? Mike McFadden? I’d love to hear from either or both of you, and I expect others would as well.

Michael Siegel said...

The 50% figure (on the increased lung cancer risk among restaurant workers) actually comes from a study I published in JAMA in 1993 (Involuntary Smoking in Restaurant Workers: A Review of Employee Exposure and Health Effects).

I do not know where the 60,000 lives or 188,000 fewer smokers figures come from. But the only way that the hike/ban could have saved lives at this early point would be from decreases in fatal heart attacks, since any effects on lung cancer would take many years to realize. Since the benefits of quitting smoking on heart disease risk take some time (I think there's about a 50% reduced risk in 2 years or so), it's not clear to me how such a dramatic effect on mortality could be effected so quickly. But I don't know the source of these figures, so it's difficult to comment on their validity.

Harry O'Brien said...

Dr. Siegel, I certainly wouldn’t hold anyone responsible for a study, “Involuntary Smoking in Restaurant Workers: A Review of Employee Exposure and Health Effects,” made as a graduate student a dozen years ago, but I can’t help wondering if you’ve had second thoughts. I’ve just read Martha Perske’s 1997 piece, “Cooking the Books: a Restaurant Study,” which sounds to me like a serious rebuttal, and I know that you do respect her. I’m also aware that were you to disavow that article now, then all the hounds of hell would rise out of the earth to tear at your flesh. And that, I think, we can all understand.

But I think you might agree that when there is more than one serious study where yours is only one of several, then for a mayor to cherry-pick one out of the lot and hold to it tenaciously is simply arrogant. Additionally, he’s been called a “control freak” (“picknose control freak” is the full delicious phrase), so the blending there of what I see as uncompromising arrogance with the need for control, if true, is not what one looks for in a public official. Because, with a public official, it can translate into an abuse of power, which I believe was clearly the case with the New York City smoking ban.

Let me repeat several statements of anti-smoking crusader Dr. Elizabeth Whelan, which I’m sure you’re familiar with: “If, as we suspect, [Bloomberg] is referring to deaths caused by exposure to secondhand smoke in restaurants and bars, the estimate of 1,000 deaths prevented is patently absurd. ... There is no evidence that any New Yorker — patron or employee — has ever died as a result of exposure to smoke in a bar or restaurant.” And further, “The link between secondhand smoke and premature death ... is a real stretch.”

Now that’s from an epidemiologist (she’s also president of the American Council on Science and Health, as you know) who’s certainly as familiar with the epidemiological studies as anyone. And who better qualified to make a pronouncement on the subject?

As for Bloomberg’s recent statement (that the ban and the tax hike “have saved 60,000 lives”) I did not read it as meaning that those lives have already been saved; I gave him the benefit of the doubt on that. But other statements he’s made on secondhand smoke do not inspire confidence, and one can’t help wondering whether the wording was fashioned to serve a political purpose. Besides, even speaking long-term, it’s hard to reconcile the fact, if true, of 188,000 fewer smokers with 60,000 lives saved. What am I missing here? In my arithmetic – which excludes any saving of lives from the effects of secondhand smoke (or, if you object to that, any SIGNIFICANT number of lives saved) – that means that the lives of nearly a third of smokers who have quit will be saved. Taking what I believe to be the usual figure of smoking killing around 10 percent of those who smoke, we have here a figure three times that. Sounds like more Bloomberg bloviating to me.

Michael Siegel said...

Harry -
Despite the fact that I stick by my own study and that I think there is strong evidence that secondhand smoke is a serious threat to the health of bar and restaurant workers, I want to make it clear that I greatly respect Ms. Perske's critique of my study (which I think was indeed very insightful and scientifically meticulous).

I think the fact that I am not renouncing the conclusions I have drawn in the past about the effects of secondhand smoke should make anti-smoking advocates pay even closer attention to the serious issues that I'm trying to raise on this blog.

If I were completely disavowing my previous self, then anti-smoking advocates could simply write me off, saying that I have simply "gone off the deep end" (believe me - there are those who have said that anyway). But I have not. This is a situation where I, as a decidedly anti-tobacco activist with what most would view as strong anti-tobacco beliefs, am seriously questioning and in some cases renouncing the way we seem to be doing things in the anti-smoking movement these days.

Unlike many (?most..?all) of my colleagues in the anti-smoking field, I do have respect for those who take a different opinion than I do on the issue of the health hazards of secondhand smoke. And I don't simply conclude that anyone who has a differing opinion must be on the dole from the tobacco industry or must be a tobacco industry front.

In addition, even with the evidence as I believe it to be, I do not support policies such as those which ban smoking in open, outdoor places, for which I do not think there is any public health justification. Even the most liberal interpretation of the scientific evidence does not, in my opinion, support or justify such policies.

As far as the claim that 188,000 smokers have quit and 60,000 lives saved as a result of NYC's policies, if these figures are correct, I think you make an excellent point that they don't seem plausible. Could it really be the case that without those policies, one-third of the smokers who quit smoking would have died by now? Unless the claim is that these 60,000 people are individuals whose lives will be saved in the future - that is, they would have died in the future from a smoking-related illness but will not now.

Again, it's difficult to evaluate the validity of the claim without knowing the specific argument being made and what it is based on, but your simple analysis does seem to cast serious doubt on it, as it seems implausible that one-third of the smokers who quit in the past year would have died had it not been for the policies.

Michael J. McFadden said...

Dr. Siegel, when you speak of your previous study I'm assuming it's the one that Antismokers claim as a base argument in saying that bar-restaurant workers have 50% greater levels of lung cancer due to secondary smoke exposure.

Now as I'm sure you're aware, claims ABOUT studies are often quite different than the substance of the studies themselves. Would I be correct in saying that you yourself at this point would NOT try to claim that the increased rate was solely due to smoke exposure? Would I also be correct if I went further and said that your study actually did not show in any definite fashion that ANY significant amount of that increased lung cancer WAS due purely to smoke exposure?

Note: I am not asking you to affirm that NONE of the cancer increase came from smoke, but simply to clarify whether your study actually clearly showed that ANY of it did.

Michael J. McFadden
Author of "Dissecting Antismokers' Brains"

Michael Siegel said...

You are correct in noting that the study itself was not able to definitively determine the cause for the increased lung cancer mortality observed among bar and restaurant workers. That requires judgment.

In my judgment, I would assert that the bulk of this increased risk (although perhaps not all of it) is most likely due to secondhand smoke exposure because I simply cannot think of any other carcinogens to which these workers would be exposed at levels higher then all other workers (note: cooking fumes were able to be ruled out as a cause, as explained in the paper).

However, with that said, because it does require scientific judgment to assess the reason for the observed increase in lung cancer mortality among these workers, I would not disagree with your statement that the study did not show in any DEFINITE fashion that the increased risk was due purely to smoke exposure.

In fact, I believe I stated in the study that the observed increase in lung cancer mortality among these workers MAY be IN PART attributable to secondhand smoke exposure.

Again, my own professional judgment supports a conclusion that the risk is largely due to secondhand smoke (because that is the major source of carcinogenic exposure that these workers would be exposed to compared to the comparison group of all other workers), but it does require judgment to draw this conclusion - the study itself does not prove that secondhand smoke is the cause.

Partly for this reason, I respect those who disagree with my judgment and do not attack them as automatically being tobacco industry moles or front groups.

Cantiloper said...

Dr. Siegel, you are quite correct in that you did indeed clearly state that secondary smoke "may in part be responsible." I think it's quite significant to note the automatic corollary to that statement though: namely that "secondary smoke may NOT in part be responsible."

Two quick questions:

1) Are you absolutely certain you ruled out the effects of such things as cooking fumes or other hospitality specific confounders (e.g. perhaps increased exposures to pesticides for roach control or increased exposures to certain disinfecting agents used in cleaning processes) ?


2) Do you really feel confident that the studies you looked at actually controlled and corrected for the lifestyle characteristics so often associated with those in "the trade." Such things as drinking, smoking pot, and various other related activities seem, in my experience, to be much higher among hospitality workers and would also be VERY difficult to control for unless all subjects were given blood tests covering the study periods.

If indeed it's simply a matter of opinion/judgement whether to blame secondary smoke or other factors for the observed increase then it's important to always note the "In My Opinion" aspect when discussing results of such a study. I believe you are far more conscientious in this regard than many of your compatriots... now if only we could get the news media to be so responsible!

Michael J. McFadden
Author of "Dissecting Antismokers' Brains"

Harry O'Brien said...

Dr. Siegel, I think Mr. McFadden made some interesting and important points in his last posting. But there's another question I have. If people who quit smoking put on weight (a well-known effect), then does that added weight in some measure cancel out the benefits of smoking cessation, when it's claimed that fatter people are unhealthier people with more health problems? (No, I'm not trying to be a wise guy.) And if so, has anyone tried to quantify it?

Michael Siegel said...

I have to be honest and say that when I first found the increased lung cancer risk among bar and restaurant workers, my first thought was not - secondhand smoke must be the responsible factor - but instead, I thought it might be due to cooking fumes.

However, this explanation didn't seem to pan out. I think, at this point, it is pretty clear that a hospitality-specific confounder is not the explanation for the observed increased lung cancer risks among restaurant and bar workers. The main reason is that the lung cancer rates are not any higher among cooks and kitchen staff. If something like cooking fumes, pesticides, etc. were the carcinogen responsible, then one would expect the cooking staff to have higher lung cancer rates, and to see much less of an effect upon the waitstaff. But there is no observed increased risk among the kitchen staff, so that seems not to be a likely explanation.

As far as lifestyle characteristics that could confound the studies, alcohol is not really a concern because it doesn't seem to be a cause of lung cancer. Marijuana use could be a confounder since it is associated with lung cancer risk. However, I have no reason to believe that bartenders and waitstaff have higher rates of marijuana use.

Do you have any suggestion that marijuana use is higher among these workers? If so, then that could be a consideration, but I'm not aware of any data to suggest that its use is particularly high among this group.

Outside of that, I can't think of a whole lot of lifestyle factors that would cause lung cancer. Radon exposure is certainly one, but again, I can't think offhand of a reason that bar and restaurant workers would have increased exposure to radon.

Ultimately, you are right that it comes down to a scientific judgment whether to attribute the observed excess lung cancer risk to secondhand smoke or other factors (or both). And because it is a judgment, I think there is room for alternative opinions (even if I disagree with them) and therefore, I don't have any less respect for anyone who happens not to accept my particular opinion on this question.

You are correct in stating that those who quit smoking do, on average, gain weight, which may have some adverse health effects in itself. However, the amount of weight gain is rather small (on average, about 4 pounds), so I don't imagine that the adverse effects of the weight would "outweigh" the beneficial effects of quitting smoking. I'm not aware, however, of any attempt to actually quantify the 'trade-off' between the weight and the cessation.

Harry O'Brien said...

Dr. Siegel,

The American Cancer Society states on its website several amazing things. It states that 3,000 Americans die each year from lung cancer, and I take that to be the EPA’s figure that was totally demolished by Federal Judge William Osteen – eight year ago. The ACS states as well that “Ventilation systems to take the poisons of secondhand smoke out of the air would have to have hurricane force.” The ACS also cites the Helena study, even though it too has been thoroughly discredited: “A study in the British Medical Journal found the number of heart attack victims at local hospitals in Helena, Montana, fell 60% in the six months after a clean air law took effect in 2002. When the law was repealed, heart attack rates returned to previous levels. As a result of the study, the CDC is warning all of those at risk for heart disease to avoid all buildings that allow indoor smoking.”

Now I don’t know whether or not the CDC issued a warning on the basis of the Helena study, nor whether the BMJ published it. But I suppose they must have. So what does that say for those two organizations?

Everyone knows that it’s open season on smokers. But who would have thought it was open season on truth as well?

So please help us. What’s going on in this country of ours? Are we no longer to believe that God hates liars? Has God now amended his original sentiment in the interests of an unscrupulous and deceitful Public Health?

Bill Godshall said...

Harry O'Brien is incorrect in his assertion that Federal Judge William Osteen (who was previously a tobacco industry lawyer) demolished the EPA's conclusion that secondhand smoke causes 3,000 lung cancer deaths annually.

In fact, Osteen's ruling was later tossed out by the federal courts, and the EPA report was exhonerated on its secondhand smoke report.

Michael J. McFadden said...

Bill is being disingenous here, and given his involvement with the issues it is hard to believe it is innocent.

He plays the ad hominem card on Osteen, completely neglecting to mention that Osteen had also ruled very firmly AGAINST Big Tobacco on FDA jurisdiction. He also mis-states the actuality of what happened to Osteen's decision in the appellate court: it was not "tossed out" in the sense of exonerating the EPA's characterization of secondary smoke, it was ruled invalid because Osteen technically did not have proper jurisdiction over the EPA Report since it was not officially binding upon anyone.

And, while I am not certain of this, I believe that the higher court ruling may have specifically pointed out that it was leaving the crtical substance of Osteen's criticisms fully intact.

As Bill should know full well, as Executive Director of SmokeFree Pennsylvania, Osteen's demolishing of the EPA's figures was never undone in any sense other than a technical one of his court not having proper jurisdiction.

Harry, I should point out one other thing though as regards Helena. The presentation of the Helena study was an outright fraud in that the authors and other Antismoking luminaries did their best to portray it as condemning secondary smoke. That was a fraud, plain and simple for all who bothered to read the study itself to see. However the study DID show that when you ban smoking in a small town and smokers do such things as quit or cut down and also go out of town to party and have heart attacks that the numbers of heart attacks within that town DO go down... at least for a while.

The deliberate fraud lay in the misrepresentation of the meaning of the study to the public.

Michael J. McFadden
Author of "Dissecting Antismokers' Brains"

Harry O'Brien said...

I’d like to apologize to Bill Godshall for thinking his comments on this blog were an impartial involvement in a discussion on secondhand smoke, since Michael informs us that Bill is Executive Director of SmokeFree Pennsylvania. I hadn’t know that. So, sorry, Bill, for my ignorance.

I do have a question, though, for Mr. Godshall. Judge Osteen said among other things that the EPA publicly committed to a conclusion before research had begun; excluded industry by violating the act's procedural requirements; adjusted established procedure and 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. And in conducting the ETS Risk Assessment, that “The EPA disregarded information and made findings on selective information; did not disseminate significant epidemiologic information; deviated from its risk assessment guidelines; failed to disclose important findings and reasoning; and left significant questions without answers. ... While so doing, EPA produced limited evidence, then claimed the weight of the agency's research evidence demonstrated ETS causes cancer." I note as well – and I think I’m correct here – that Judge Osteen took this under advisement for a 5-year period. So it certainly wasn’t a shoot-from-the-hip decision.

So, Bill, what in all that do you dispute, may I ask? So far, the only thing we’ve gotten from you is the ad hominem statement that previously Judge Osteen was (parenthetically) “a tobacco industry lawyer.” Which, of course, invites the question whether your job as Executive Director of SmokeFree Pennsylvania is a paid position, or whether you’re strictly an unpaid volunteer for the cause?

Additionally, I’d like to commend Michael for writing that “Bill is being disingenuous here.” I know that word ‘disingenuous.’ Actually, it’s often a polite – very polite – synonym for something far less appetizing. But since this is Dr. Siegel’s site, and Dr. Siegel is a gentleman, we must by all means observe the proprieties. But we all have our private thoughts now, don’t we?

Bill Godshall said...

Now I'm accused of being disingenuous for correcting an incorrect statement.

And my correction is being called an ad hominum attack because I pointed out that Judge Osteen (who has no background in epidemiology or biostatistics) was formerly a tobacco industry lawyer.

BTW I forgot to point out that cigarette companies only challenged a small portion of that lengthy EPA Report, and that Philip Morris now endorses the findings of public health officials that secondhand smoke is a public health hazard.

Harry O'Brien said...

Dr. Siegel,

Just a light follow-up to your statement that those who quit smoking gain on average about 4 pounds. It reminded me for some reason of the guy who couldn’t understand how someone could possibly drown in a river the average depth of which was only two feet. I think you get the point, and wonder if there are any statistics other than average weight loss which might influence the discussion.

Harry O'Brien said...

This is planet earth, Bill; we’re not all from a galaxy far away.

First of all, what have the cigarette companies or Philip Morris to do with what we’re discussing? (If you want to discuss Philip Morris, we can have a LONG discussion on that.) What we’re discussing is the Osteen decision. What I said was that the EPA’s figure of 3,000 annual deaths from lung cancer due to secondhand smoke “was totally demolished by Federal Judge William Osteen,” and in my second posting I quoted some of the text that illustrated some of the facts behind the demolishment. (Or do you refuse to acknowledge them as facts?) But you said I was ‘incorrect.’ So, what did you object to, my use of the word demolish? You didn’t say that; instead, you said that I was “incorrect.” Well, how ‘incorrect’? Because Judge Osteen was previously a tobacco industry lawyer or that later his decision was thrown out on strictly technical grounds having nothing to do with his indictment of the EPA? Because Judge Osteen has no background in epidemiology or biostatistics? Let’s get real. Here’s what he concluded about the EPA: 1. It started with a conclusion. 2. It cherry-picked the studies it would include in its analysis. 3. When even the cherry-picked studies failed to show a statistically significant correlation, it changed its methodology from the standard 95 percent to 90 percent. 4. Even by the bogus 90 percent standard, the cherry-picked studies showed only a very small risk 5. It hid from the public the information that it was supposed to make available. 6. It lied about why it changed the standard.

Again, just exactly what did the Judge have to know about epidemiology or biostatistics to reach those conclusions? After studying the case for five years, let it be remembered, during which time I’d guess he learned a lot about both topics as well. You don’t like Michael’s characterization of your reply as “disingenuous”? Would you prefer a stronger word, perhaps?

Finally, since you brought up Judge Osteen’s past history, how about Godshall’s present history? Again, I ask: Are you getting paid in your position as Executive Director of SmokeFree Pennsylvania, or are you an unpaid volunteer? In other words, are you a paid mouthpiece for SmokeFree Pennsylvania or are you not? You can see how an ad hominem argument, if you want to play that game, can turn around and bite you in the backside. First Judge Osteen’s past history and now Philip Morris! I have to repeat: I thought this was a blog for grownups. Apparently I was wrong.

Harry O'Brien said...

Found on the web, a nice fat letter from Bill Godshall to members of Congress dated Sept. 20, 2004, in which he states: "Cigarettes kill 50% of addicted smokers, and up to 63,000 American nonsmokers annually (from secondhand smoke and fires).

Question: Is Godshall making some kind of distinction between smokers and ADDICTED smokers? Because otherwise it's hard to understand where he got that eyepopping 50% figure.

But I like the deaths from fires bit. Anything to add to the pot

Bill Godshall said...

Those figures are from various peer reviewed studies, and were cited by US Surgeons General years ago.

Michaael J. McFadden said...

Bill, you say you are being called disingenuous for "correcting an incorrect statement." Harry's statement was that Osteen demolished the EPA's conclusion about secondary smoke and lung cancer. From the looks of Harry's posting however he seems to quite clearly have defended the correctness of his claim... and from the looks of your follow up posting you seem to fail to address that.

I'm not sure just what the proper word would be to characterize that failure, or the failure to address Harry's other points. I thought disingenuous seemed proper... is there a better word?

Michael J. McFadden
Author of "Dissecting Antismokers' Brains"

Harry O'Brien said...

Then what’s the definition of ‘addicted smoker’? Has it been quantified in terms of minimum number of cigarettes smoked per day? Or were the smokers themselves just asked whether they were ‘addicted’? Or is there a scientific method of determining whether or not a person is ‘addicted’?

Sounds all very unscientific to me unless numbers were put to it. But then, if it WAS quantified, why add the gratuitous qualifier ‘addicted’?

Anonymous said...

Questions for Bill Godshall and Dr. Siegel.


In a post above I listed a few questions that tobacco control activists never seem to get around to answering.
As card carrying members of the anti-tobacco movement let me, with all due respect, ask you directly...
-Do you honestly believe that someone smoking next to you on a park bench is a threat to your health?
-Do you honestly believe that engineers, who can make underground parking garages safe from poisonous car exhaust, are incapable of dealing with cigarette smoke in a restaurant?
-Which would you rather have your children experiment with: a cigarette, a joint or a bottle of vodka?

I sincerely look forward to your answers.

Michael Siegel said...

My answers are:
1) No - unless you have severe asthma
2) No
3) A joint

My reasoning is:
1) I don't think that a short-term exposure to someone smoking on a park bench next to me represents a serious threat to my health. An exception would be if I had severe asthma.
2) I think that engineers could deal with the particulate phase of tobacco smoke, but it's unclear to me how they would deal with the vapor phase components.
3) Probably the least toxic and addictive.

Harry O'Brien said...

It seems to me that you can look at ventilation in bars and restaurants that allow smoking in at least three ways: 1) ventilation isn’t necessary in the first place because secondhand smoke hasn’t been proven to be a health risk; 2) if a health risk is even THOUGHT to exist, then proper ventilation equipment will take care of it; and 3) proper ventilation equipment will not only make the air in a bar or restaurant safe to breath, but will make it SAFER to breath than air in a bar or restaurant that doesn’t allow smoking.

Now the last is actually the contention of actual live people who have installed the equipment and tested the results. So is the health industry, in consideration of the health of the wait staff, screaming that such equipment should be installed? Certainly not! Instead they lie through their collective teeth by saying that 1) there’s no safe level of secondhand smoke (jumpin’ jeepers, no safe level – REALLY?), and 2) that it would take typhoon-force winds blowing through a bar to make the air safe to breath (jumpin’ TRIPLE-X jeepers!).

I had a brief correspondence in February of this year with a Maryland state representative after a newspaper article quoted a colleague of hers as saying that the bill she proposed in the Maryland state legislature does not exempt restaurants that have installed ventilation systems to keep smoky air from nonsmoking sections because "It has been proven that those ventilators will not help the quality of the air." (What, not help in the slightest?) (She also said that "Second-hand smoke is the third leading cause of preventable death." Hmmm, I think I heard that one before. In fact, I think I could get a parrot to repeat that sentence on cue if I cued him with a cracker every time.)

Here’s what the state representative said regarding filters:

“We have been told for a couple of years that the American Society of
Heating, Refrigeration and Air Conditioning Engineers [ASHRAE] will no
longer certify any ventilation system as safe in the presence of ETS. The
reasons for this are that any ventilation system relies on filters to remove particles from the air. The particles carry the odor of tobacco smoke. However, these filters WILL NOT remove the gaseous elements of ETS, such as Benzene, which are known carcinogens. What is left after the air passes through the filter is good smelling poison, but it is still poison. We did not make up the engineers' statements, but we do believe they are valid.”

And when I asked for a comment on this from a certain party, here’s the reply I received (I won’t include here the author’s name without his permission, although I’m sure he would readily give it):

“I have particular knowledge on that subject [indoor air system technology as applied to ETS] because my company did such a study, which analyzed our Indoor Air Quality system. ... “our system has HEPA filters and activated charcoal beds. The charcoal does address gaseous constituents of ETS, as our study clearly shows. We wound up with indoor air at our facility that was superior to outdoor air on both a gaseous and particulate basis with smoking permitted at work stations.

“And, indeed you are correct that facilities with comprehensive air quality systems to address ETS can be healthier than those without such
capabilities. The same system that addresses ETS also reduces levels of
carbon monoxide and many other gasses (such as off-gassing fluorocarbons),
pollens, dust, airborne bacteria, and other harmful constituents while it
addresses ETS.

“Those who irresponsibly claim such air systems merely create indoor air of
quality that ‘What is left after the air passes through the filter is good
smelling poison, but it is still poison’ are not only ill-informed, they
also display ignorance about genuine Indoor Air Quality subjects and
related technology.

“Leave substituting political slogans such as ‘What is left after the air
passes through the filter is good smelling poison, but it is still poison' to those who chose to publicly display their ignorance. They merely present the opportunity for responsible adults to demonstrate how incorrect and
false their mantras really are.”

And I think Michael McFadden can address this subject as well from a different perspective, that of TVL/PEL figures, which indicate that 1) above is the real-world situation.

Anonymous said...

Dr. S

Thanks for the straight forward and honest answers to my three questions of a few days ago. [Bill I'm still waiting to hear from you.]

Let me ask one follow up question: Do you think that we [we being politicians, health officials, special interest groups etc.] can deal with the smoking issue with reason and common sense rather than with hysterics and extremism?

Most of the other "elective hazards" [drinking, eating red meat, riding motorcycles, casual sex etc.] do not attract anywhere near the attention that tobacco does. Everyone who smokes knows, to the Nth degree, what its risks are. I suggest that anti-tobacco leave them alone and turn their attention to being "pro-health" rather than trying beat each and every one of them into submission.

In order to differentiate myself from the other anonymous posters I will from now on use the moniker "Chunk"

Michael Siegel said...

Anonymous (Chunk) -
First of all, let me say that I think it is important that people who are in public health (and especially those who are advocating for policies that will affect the whole population) should be willing to answer questions about their positions and the reasons for them. I think we should be upfront and forthright about our positions and the rationale for them. Even if people disagree over an issue, it helps to understand each other's reasons for feeling the way one does. So I'm happy to answer your most fair and important questions.

As far as trying to shift from a climate in which the public health movement is "anti-smoker" to one where it is "pro-health," I think you have accurately and succinctly summarized the feeling that I have come to over the past months, and what I am trying to accomplish here with this blog.

While as a public health advocate, I do think there is some degree to which it is appropriate for us to try to encourage people to change unhealthy behaviors, I do believe that the anti-smoking movement is now crossing the line into what may be called unjustified paternalism (see my recent post on the NYC CLASH letter to Judge Kessler for some specific examples of what I mean).

Chunk said...

Dr S

Most lawmakers and government health officials have lost all perspective on making this world a safer place to live in.

Some examples:

As a physician you are probably aware that one of the biggest killers of the elderly is not just cancer and heart disease but influenza. Those who may already be in frail health often cannot survive the trauma that is merely an inconvenience to the rest of us. A simple regulation requiring everyone visiting an elderly person in a hospital or retirement home during flu season to wear surgical masks would likely save thousands of lives. The costs are tiny, economic ramifications are only positive and nobody’s rights would be violated. And yet the Mayor Bloomberg’s of this world ignore it and California bans smoking on beaches because it’s killing people like flies.

A friend of mine coaches wheelchair sports and tells me that half of the kids in his program are there because of motorcycle accidents. Why not raise the legal age for a motorcycle license to 25?

You can’t light up a cigarette in a bar but kids in their late teens and early twenties can do a dozen jello shots in an hour and nobody bats an eye. The only “health warning” is a sign over the urinal reminding them to take a cab home.

Nobody has any interest in dealing with mundane hazards that have simple solutions. Like Deep Throat said “Follow the Money.” Does anyone know where I can get a grant to lobby for common sense?