Monday, January 15, 2007

Lead Story in Bay Area Sunday Newspapers Features Anti-Smoking Movement's Push for Outdoor Smoking Bans and Questions the Science Behind Them

The lead story in Sunday's edition of a number of (San Francisco) Bay Area newspapers features a discussion of the anti-smoking movement's recent push for complete outdoor smoking bans and questions the science being used to justify these policies.

The story, written by Suzanne Bohan, was published on, and appeared in the newspapers that are part of this conglomerate: The Oakland Tribune, Marin Independent Journal, San Mateo County Times, The Argus, The Daily Review, the Tri-Valley Herald, and the Alameda Times-Star.

The article highlights my own career in smoke-free workplace advocacy, noting that I have been a strong supporter and advocate for smoke-free workplaces, including bars and restaurants, but have argued that broad outdoor smoking bans go too far, risking the loss of credibility and effectiveness of the tobacco control movement by pushing for policies that are not driven by science documenting a compelling public health justification:

"IN THE early 1990s, Dr. Michael Siegel began leading pioneering efforts to ban smoking in workplaces to protect the health of nonsmokers.
Siegel, who got his start in the anti-smoking cause while earning his master's degree at University of California, Berkeley, has written dozens of scientific articles on the dangers of secondhand smoke. His testimony in court and at countless city council meetings also helped push public policy toward tighter restrictions on smoking.

But now Siegel is speaking out against the movement he helped create. Why? Today's anti-smoking crusaders, he says, have lost their moorings in science by advocating smoking bans in the last refuge for smokers — the great outdoors. 'I've been working in this field for 21 years,' said Siegel, who earned an M.D. from Yale University and a master's degree in public health from UC Berkeley. 'The goal was to get rid of smoking in the workplace. I never understood that the goal was to get rid of smoking so that no one even gets a whiff of smoke.' 'It's a grass-roots social movement that's been so successful that it doesn't know where to stop,' Siegel continued. 'It's getting to the point where we're trying to protect people from something that's not a public health hazard.' At risk, he and other like-minded tobacco control advocates assert, is not only the credibility of public health officials, but the undermining of a freedom prized in democracies — do as you wish so long as you don't harm others."

The article cites the recently enacted smoking ban in Calabasas - where smoking is prohibited almost everywhere outdoors - and the proposed smoking ban in Belmont - where smoking is to be prohibited everywhere outdoors - as two examples of the anti-smoking movement's push to ban smoking in the great outdoors.

I am quoted as contesting the science being disseminated by anti-smoking groups, including the Surgeon General's office, that even very brief exposure to secondhand smoke can cause cardiovascular disease and cancer. "'It takes many years for these chronic diseases to develop,' Siegel said in the article. 'We're really risking our credibility (as public health professionals) by putting out rather absurd claims that you can be exposed briefly to secondhand smoke and come down with heart disease or cancer.'"

Countering my argument that these broad outdoor smoking bans are going too far were two anti-smoking researchers.

The first counterpoint came from Dr. Stan Glantz, a professor of medicine at the UCSF School of Medicine. According to the article: "Siegel was once a student of Glantz's, but the two men are now at loggerheads over the direction of the anti-smoking movement. 'He did some very good work, once upon a time,' Glantz said of Siegel."

"Glantz insists there is a health effect worth worrying about with exposure to cigarette smoke outdoors, particularly for those with chronic heart disease. 'It's going to be a very small number, but there is some risk,' Glantz said. 'But that's true of a lot of environmental toxics, like diesel exhaust.' ... Glantz, for example, said even five minutes of breathing tobacco smoke changes blood chemistry and blood vessel function enough to increase the risk of a heart attack in people with severe heart disease. 'So there is some risk associated with brief exposures under some outdoor circumstances,' Glantz said. 'No one has quantified the magnitude of the risk.' ... Nonetheless, even small odds justify legislative action against outdoor smoking, Glantz said. "If you can't be assured the risk is zero, you should act," he said."

The second counterpoint came from Dr. Terry Pechacek of the Centers for Disease Control and Prevention's Office on Smoking and Health (where I worked from 1993-1995): "'We don't have sufficient data to evaluate levels of exposure in outdoor settings,' Pechacek said. ... The CDC's Pechacek also explained the reason for the Surgeon General's warning that even brief exposure could trigger cancer. 'There is some risk that even a very small amount can damage a cell,' he said, setting off a chain reaction that causes cancer.'"

The Rest of the Story

Once upon a time...

Apparently, I once was a competent scientist, researcher, and epidemiologist who did some very good work, but now, suddenly, I am incompetent.

Once upon a time there was a tavern
Where we used to raise a glass or two
Remember how we laughed away hours
And dreamed of all the great things we would do.
(lyric credit to Gene Raskin)

Odd, isn't it? Usually, as we get more experienced and knowledgeable in our careers, we get better at we do, not worse. Apparently, my very good work came when I was merely a student. Having subsequently completed an epidemiology fellowship at CDC and worked for 11 years as a tobacco control researcher at Boston University, progressing to become a full professor, I have now lost my ability to interpret scientific and medical literature.

I'm not half the man I used to be
There's a shadow hanging over me
Oh yesterday came suddenly.
(lyric credit to John Lennon and Paul McCartney)

Of course, what it really looks like is that when my review of the literature produced a conclusion favorable to the pre-ordained agenda of the anti-smoking movement, it was considered to be very good work, but now that my (even more rigorous and informed) review of the literature produced a conclusion that anti-smoking groups are exaggerating their public claims, my work is no longer any good.

You've lost that lovin' feelin'
Woh oh that lovin' feelin'
You've lost that lovin' feelin'
Now it's gone, gone, gone.
(lyric credit to Phil Spector, Barry Mann, and Cynthia Weil)

As I've learned, in the tobacco control movement, when they talk about the quality of your work, what they are really talking about is the perceived favorability of your conclusions to the established anti-smoking dogma - not the scientific quality of your work, which for me, has obviously improved with experience, knowledge, and expertise.

Once I could see, once I could feel
Now I am numb, I've become unreal
I walk the night, without a goal
Stripped of my heart, my soul.
(lyric credit to Carl Sigman [original French lyrics by P. Delaoe])

Actually, there really doesn't seem to be any scientific disagreement at all among the tobacco control researchers who were interviewed for this article:

I believe there is not sufficient scientific evidence to conclude that there is any substantial public health risk posed by allowing smoking in most open outdoor environments where people can move freely about.

Dr. Glantz believes that the risk is very small, just like outdoor exposure to diesel exhaust, and that no one has quantified the magnitude of this small risk.

Dr. Pechacek believes that we don't have sufficient data to evaluate levels of exposure in outdoor settings, so there is no documentation of any serious public health threat.

So if there is no disagreement about the science, then why are we "at loggerheads?"

The answer appears to be, at least in part, our beliefs about the levels of risk that justify public health legislation to protect people from environmental hazards. Drs. Glantz and Pechacek appear to be arguing that any risk, no matter how small, is sufficient to justify legislated bans on a behavior. Even brief exposure to secondhand smoke might damage a cell, leading to cancer, so we apparently need to eliminate this possibility altogether. There is no risk-free level of exposure, so we need to completely eliminate exposure in order to eliminate risk.

On the other hand, I seem to have a higher threshold for invoking government legislative intervention. I would like to see a substantial level of risk before I advocate for coercive policies as a public health intervention. I don't believe that we necessarily have to reduce all environmental health risks to zero.

The answer also appears to be, at least in part, our beliefs about the levels of scientific evidence needed in order to justify legislated bans. Drs. Glantz and Pechacek appear to believe that legislated bans are justified even in the absence of scientific evidence that there is a substantial public health problem.

I, on the other hand, believe that we need to have solid scientific documentation of a substantial public health problem before we ask the government to intervene coercively to regulate the hazard.

I am not sure about this, but possibly another reason for being "at loggerheads" is the possibility that other anti-smoking advocates are not willing to criticize tobacco control groups for making misleading or inaccurate statements, (or to even admit that is possible?). Frankly, this is the only reason I can think of to explain the defensive posture of these researchers, rather than their simply admitting that yes - anti-smoking groups have been misleading the public by suggesting that brief secondhand smoke exposure can lead to heart disease.

I'm glad that this issue and the scientific and policy discussion has been prominently brought to the public's attention. Ultimately, it is the public who will serve as the final judge of whether, in its zeal to eliminate any possible risk of exposure to secondhand smoke outdoors, the anti-smoking movement is going too far, whether our claims about the chronic health hazards of merely brief, acute exposure to secondhand smoke are exaggerated, and whether the current state of the tobacco control movement is such that we can retain our credibility and our reputation as being a movement motivated by science and possessing some good sense and reason.

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