An article in the February issue of Tobacco Reporter highlights the internal fight going on within the tobacco control movement about whether anti-smoking groups are accurately communicating the acute cardiovascular effects of secondhand smoke (access to the article is free but requires a brief registration).
On one side of the squabble is me, who has been arguing for some time now that anti-smoking groups are distorting the truth and misrepresenting the science by claiming that 30 minutes of secondhand smoke exposure causes hardening of the arteries, fatal or catastrophic arrhythmias, clogged arteries, or heart attacks and strokes in otherwise healthy individuals. On the other side are a number of prominent anti-smoking advocates/researchers who have argued either that these misleading statements were made in published scientific articles or reports (which is not true) or that the omission of important caveats was necessary in order to make the statements understandable to the lay public (which is troubling).
The article, written by John Luik and entitled "All in the Family: A Quarrel Erupts in the Anti-Tobacco Movement About Scientific Accuracy and Telling the Truth," provides numerous examples of misleading statements made by anti-smoking groups suggesting that 30 minutes of tobacco smoke exposure can have fatal or catastrophic consequences, even among those without pre-existing heart disease.
Luik writes: "The anti-tobacco movement, however, has not been satisfied with these claims about ETS [that chronic exposure causes disease] that have had at least some connection, however tenuous, to science. Instead, they have continually pressed to make the “truth” about the risks of ETS more dramatic, more attention getting and more frightening. While part of this is attributable to the movement’s generally low regard for science and accuracy about tobacco risks, it is also driven by the fact that exaggerating the dangers of ETS is the most consistently successful way to push for not only smoke-free public places but private spaces as well. Simple, uncompromising and above all frightening messages about the risks of ETS appear to move even the most skeptical, reluctant and considered of policy makers."
"Consider a couple of examples of this new line of “truth” about the risks of ETS. Several studies have argued that comprehensive public smoking bans have been followed by almost immediate, dramatic and unprecedented declines in heart attack admissions to hospital emergency rooms. Even more dramatically, many anti-tobacco groups have claimed that a single exposure of just 30 minutes to secondhand smoke can increase a nonsmoker’s risk of having a fatal heart attack to that of a regular smoker. As we don’t have space to look at both of these claims, I will concentrate on the 30-minute peril." ...
"If this were the end of the story we could simply put this untruth down to more of the anti-tobacco lobby’s usual tactics of misrepresenting science in order to scare citizens, politicians and regulators into supporting draconian tobacco control policies. But this story has a decidedly different twist, which owes much to the efforts of Michael Siegel and his tobacco policy blog, The Rest of the Story."
"Siegel, who is an anti-tobacco activist at the Boston University School of Public Health and the author of a flawed study on ETS exposure among restaurant employees (Siegel “Involuntary smoking in the restaurant workplace: a review of employee exposure and health effects” JAMA 1993), has used his blog to take aim repeatedly at a variety of activist claims that he considers to be scientifically inaccurate. And at the center of his focus has been the claim about a heart attack risk for nonsmokers after 30 minutes of ETS exposure."
"As he writes in his blog for Dec. 12, 2007: “It is not true that 30 minutes of secondhand smoke exposure causes ANY heart damage, much less damage that is similar to that sustained after many years of active smoking. It is also not true that the hearts of nonsmokers exposed to secondhand smoke for 30 minutes are impaired in their ability to get life-giving blood.”"
"Siegel’s criticisms of the antis’ claims about the risk of a heart attack from a 30-minute ETS exposure have recently attracted considerable attention with an article and editorial in the New Scientist in November criticizing the anti-tobacco movement’s willingness to distort the “facts in order to make their case” about ETS, and also an article in the Wall Street Journal’s “Informed Reader” section."
"In response to these criticisms, ASH’s executive director, John Banzhaf, asserted that the claim was taken from the CDC. But this is not true since the CDC references the Otsuka study, which does not make this claim. Stanton Glantz, an anti from the University of California in San Francisco, rationalizes the misrepresentation by saying that “when you take the science and put it in the public domain you can’t include all the caveats. The messages have to be simplified so people can understand them.”"
"This, of course, is part of the old health promotion line first championed by former Canadian health minister Marc Lalonde, who argued that the public was essentially too stupid to understand the science behind lifestyle issues like drinking, smoking and dieting, so the “truth” necessary to get them to change their ways had to be presented without any troubling uncertainties. What it really says is that lying about the science is fine as long as it is for a good cause like creating a world without smoking and smokers."
"As Siegel noted in reply to Glantz “Are you kidding me? ... Should we also tell the public that drinking three beers causes cirrhosis of the liver, liver cancer, hepatitis, and potentially, death? ... Should public health practitioners therefore be putting out messages in which we remove all the ‘caveats’ and state that drinking three beers puts you at the same risk of death as being a chronic, lifelong alcoholic?”"
The Rest of the Story
The argument that anti-smoking groups can't tell the truth because there is not enough room to provide the necessary caveats is problematic, because if we in tobacco control do not need to be held to high standards of scientific integrity, then how can we argue that the tobacco companies, which don't have a particular responsibility to provide accurate information to the public, must be required to provide all such caveats?
Take, for example, the tobacco industry's use of the term "light" to describe certain brands of cigarettes. If we accept the argument that caveats need to be omitted to simplify communications to the public, then there is really nothing wrong with the industry's use of this term. After all, it is true that light cigarettes produce a lower nicotine yield when measured by a particular machine method mandated by the federal government.
What makes the term "light" deceptive is, in fact, the lack of a caveat to explain that the machine-measured yield has no particular relationship with actual human yields produced by real smoking behavior.
If we excuse ourselves from disclosing the caveats in our public statements, how can we take the tobacco companies to task for failing to disclose caveats in their statements?
In this case, anti-smoking groups attempted to take the tobacco industry to task for the failure to provide the proper caveat to the tune of $130 billion. But for us, failing to provide proper caveats is simply, we are told, an acceptable way of doing business.
I think Luik is right when he argues that what these anti-smoking leaders are saying is that lying is OK if it is done for a good purpose. We've already established that many anti-smoking groups are not telling the truth. The real issue for the movement, it appears, is whether this means (being dishonest with the public) is justified by the good ends of decreasing morbidity and mortality from tobacco products.
When all is said and done, what this "internal squabble" comes down to is the question of whether the ends justifies the means. Is dishonesty in public health communications justified by advancement of public health policies?
I say no. We need to adhere to a basic set of ethical principles.