Wednesday, October 15, 2008

IN MY VIEW: CDC and Surgeon General Deceptively Tried to Convince the Public that a Brief Exposure to Tobacco Smoke Puts People At Risk of Lung Cancer

The 2006 Surgeon General's report on secondhand smoke concluded that chronic exposure to tobacco smoke (such as that which occurs with living with a spouse who smokes or working in a workplace that allows smoking) significantly increases the risk of lung cancer among nonsmokers. Apparently not satisfied with the urgency and appeal of this message, the CDC and the Surgeon General attempted to hype this message by convincing the public that even a brief exposure to secondhand smoke puts them at risk of lung cancer.

In the draft version of a fact sheet entitled "There is No Risk-Free Level of Exposure to Secondhand Smoke" (see final version here), the CDC and Surgeon General included the following "fact":

"Inhaling even a small amount of secondhand smoke can damage your cells and set the cancer process in motion."

While this "fact" did not make it into the final fact sheet, it did appear in the Surgeon General's remarks about the report, in which he stated: "Breathing secondhand smoke for even a short time can damage cells and set the cancer process in motion." It also appeared in a presentation that the CDC gave about the report, in which the CDC states: "Inhaling even a small amount can damage your cells and set the cancer process in motion."

The Rest of the Story

The clear implication of "setting the cancer process in motion" is "causing you to get cancer." People are going to naturally interpret this statement as implying that since the cancer process has been set in motion, it is going to inevitably lead to cancer. In other words, the statement is going to be interpreted (rightly so) as an assertion that even a very brief exposure to secondhand smoke can cause lung cancer.

I am aware of no actual scientific evidence that this assertion is true. Moreover, I think it is very deceptive to try to convince people that they have a substantial risk of developing lung cancer if they are exposed to secondhand smoke even briefly.

This is problematic not only because it is deceptive, but because it unnecessarily scares people and it undermines the message that people need to take away: that they should try to minimize their exposure to secondhand smoke. By trying to convince people that even a brief exposure sets the cancer process in motion, the Surgeon General and CDC are essentially telling people not to make any effort to limit their exposure, because it's too late - they are already on the road to lung cancer. If a brief exposure has already started the cancer process, then why bother to protect yourself from tobacco smoke in the future? It's too late: the cancer process has already started.

This type of hysteria is not only a distortion of the science, but a deception of the public. It is not only an exaggeration of the science, it is a disservice to the public.

If the Surgeon General and CDC are going to tell the public that even a brief exposure to secondhand smoke sets the cancer process in motion, then it is also true that even a brief exposure to sunlight sets the cancer process in motion. So does getting a chest X-ray. But no public health official in his or her right mind would start warning the public that getting a single chest X-ray or being in the sun for one minute will set the cancer process in motion.

Can you imagine if CDC or the Surgeon General used the same hype with some of these other exposures? Suppose that they put out a press release stating that "Inhaling even a tiny amount of radon for five minutes can set the cancer process in motion." It would be very clear that they were being irresponsible and that they were trying to hype the message and deceive the public into a state of unnecessary panic.

Apparently, the actual conclusions of a comprehensive 727-page report which documents all kinds of adverse health effects of secondhand smoke were not sensational enough for the Surgeon General's office and for CDC. In what seems to be a contagious phenomenon which has now infiltrated a federal tobacco control organization, public health groups that report the science of secondhand smoke do not seem able to accurately report the science to the public.

Rather than sticking to the carefully-reviewed science in the detailed and thorough report, the press release and other related communications of the Surgeon General regarding the findings of his report were sensationalized in a way that makes these communications quite misleading.

The report documents an increased risk of heart disease and lung cancer among nonsmokers who are chronically exposed to high levels of secondhand smoke. However, instead of simply reporting that finding to the public, the Surgeon General and CDC distorted the science to communicate to the public that brief exposure to secondhand smoke can increase heart disease and cancer risk.

I need to make it clear that none of these misleading and inaccurate scientific claims are made in the Surgeon General's report itself. What appears to be going on here is very similar to the "20-minute" and "30-minute" claims about which I have written extensively: the science is simply being distorted to sensationalize the findings, resulting in assertions that are misleading, inaccurate, absurd, unsupported by scientific evidence, and inconsistent with the findings of the report itself.

It appears to me that tobacco control organizations of all kinds and at every level are simply unable to accurately and honestly communicate the science of secondhand smoke to the public. For some reason, there appears to be a need to distort the science in an effort to sensationalize it and increase the emotional impact of the communication. The end result is to produce public claims that are inaccurate and which mislead the public.

It is important to understand that while the Surgeon General's report itself underwent rigorous scientific review, and thus does not make any outlandish claims, the communications put out by the Surgeon General reporting the findings of the report did not undergo independent scientific review. And it really shows. The difference between the press release and related communications and the Surgeon General's report itself are striking.

What has gone wrong?

I worked for two years at the Centers for Disease Control and Prevention, in the Office on Smoking and Health, which is the office that usually leads the review of the Surgeon General's report. So I'm quite familiar with the level of scrutiny that is usually applied to any communications by the Surgeon General, but especially with regards to what is viewed as the rather "controversial" issue of secondhand smoke.

We remained highly vigilant and very careful about our public communications about the effects of tobacco smoke and those of the Department of Health and Human Services, because there was a huge perceived tobacco industry presence that would scrutinize our claims and call us to task if there were any inaccuracies, even if they were slight and not particularly meaningful.

But now, with the tobacco companies having largely abandoned this "oversight" role and playing a back-seat role (their main comment on the report was something to the effect of "We haven't fully reviewed it yet"), there is apparently nothing to stop us from making just about any claims that we want to make.

So if we want to impress the public with the magnitude of the secondhand smoke hazard by trying to convince them that even a brief exposure can cause heart disease and lung cancer, so be it. The tobacco industry is not going to get in our way any more. Why should the science?

NOTE: Since a large number of readers of this particular post are likely not to be regular readers of this blog, I want to make it clear that I agree with most of the conclusions of the Surgeon General's report itself and that I certainly (and have for many years) believed that chronic secondhand smoke exposure is a cause of heart disease and lung cancer. I believe that the conclusions of the Surgeon General's report are sufficient to justify smoke-free workplace laws. But I think that the truth is enough. I don't see why we need to distort and sensationalize the science in order to increase the impact of these findings and attempt to advance the agenda. In my view, it greatly harms public health by threatening the very credibility of tobacco control and public health practitioners and organizations. In the long run, this is going to harm the public health cause more than any fleeting publicity gains to be obtained from trying to convince people that breathing drifting tobacco smoke for a half hour is going to cause you to have a heart attack, develop atherosclerosis, or come down with lung cancer 30 years later.

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