Wednesday, February 07, 2007

Question of the Day: Why Did Anti-Smoking Groups Choose Not to Qualify their Sudden Death Claims?

Yesterday, I discussed what I consider to be the most misleading health claim being made by anti-smoking groups regarding the acute cardiovascular effects of secondhand smoke: the claim that 2 hours of exposure increases a nonsmoker's risk of sudden death from a fatal cardiac arrhythmia.

Groups like TobaccoScam and the American Heart Association have outlined a number of acute effects of brief secondhand smoke exposure. According to these groups:
  1. 20 minutes of exposure to secondhand smoke increases the risk of a heart attack by activating platelets;
  2. 30 minutes of exposure to secondhand smoke causes stiffened arteries that increase risk of heart attack; and
  3. 2 hours of exposure puts nonsmokers at risk of sudden death due to fatal cardiac arrhythmias.
According to both of these groups: "All of these effects not only increase the long term risks of developing heart disease, but also increase the immediate risk of heart attack."

Thus, these communications imply that if you are a nonsmoker and are exposed to secondhand smoke for between 20 minutes and 2 hours, you are at increased risk of a heart attack and/or of sudden death.

There is no truth to these claims as they apply to a person without severe heart disease. However, there is some truth to the notion that a nonsmoker who has severe, pre-existing coronary artery disease could potentially be at risk of having a coronary event (i.e., a heart attack or arrhythmia) triggered by exposure to secondhand smoke, because of tobacco smoke's observed effects on platelet activation, endothelial dysfunction, artery elasticity, and cardiac autonomic function.

These anti-smoking groups, as well as nearly 100 more which have made similar claims, had a choice to make in presenting this "scientific" information.

OPTION A: The first option was to present this information as applying to anyone exposed to secondhand smoke. Presenting the information in this way would lead anyone to believe that they are personally at risk of a heart attack or sudden death from a short secondhand smoke exposure. This option would imply that even a healthy nonsmoker could suffer a heart attack or die suddenly due to a brief exposure. This option, therefore, would represent a very deceptive and misleading depiction of the scientific evidence.

OPTION B: The second option was to qualify the communications to make it clear that any risk of an acute coronary event applies only to individuals with pre-existing, severe coronary artery disease (who are basically heart attacks waiting to happen and for whom a number of exposures that affect endothelial function and platelet activity - such as eating a high-fat meal - could also potentially trigger a coronary event). Presenting the information in this way would have made it very clear to the public that an otherwise healthy nonsmoker is at no risk of dropping dead of a heart attack or a fatal cardiac arrhythmia due to a brief secondhand smoke exposure. This option would represent a reasonably accurate depiction of the scientific evidence.

Clearly, option A would present the information in a way that, although very misleading, would scare the public and sensationalize the severity of the acute effects of even a brief secondhand smoke exposure.

Option B would present the information in a reasonably accurate way, but would not have the kind of sensational and emotional impact as option A.

The Rest of the Story

The rest of the story is that faced with this option, nearly 100 anti-smoking groups have chosen option A.

To me, this is what, above and beyond the misleading claims themselves, signals a crisis of credibility and integrity in the tobacco control movement.


Because the fact that the groups had a choice, but decided to go with the option that sacrificed accuracy and clarity for emotional impact, suggests that the decision to mislead the public was an intentional one, not an accident.

Assuming that the anti-smoking groups know what they are talking about (and if they do not, then I think it is highly irresponsible of them to be communicating important health information like this to the public), these groups had the option of presenting the information accurately, or presenting it in a misleading way. Nearly 100 of these groups have chosen to present the information in a misleading and deceptive way. I can only conclude that this decision was intentional, since it must have occurred to these groups that both options were available.

Essentially, it appears that what anti-smoking groups are doing is exactly what we constantly accuse the tobacco companies of doing: distorting the science just enough so that their communications grossly mislead people, but fall just short of representing blatant or outright lies.

Leaving out the important fact that a brief secondhand smoke exposure poses no acute cardiovascular risk to a healthy nonsmoker is a sly tactic that completely distorts the communication to the public in a way that grossly misrepresents the science and deceives and misleads people, but falls short of constituting an outright lie because there is a specific context in which the statement has some degree of potential correctness.

But as public health practitioners, I find it unethical for us to be using sly tactics that distort the science in order to grossly misrepresent the scientific evidence and deceive and mislead people, even if we cannot be properly accused of lying.

This is precisely what we are doing - and we should be ashamed of it. It is unbefitting of public health organizations. It is irresponsible. And most importantly, it is unethical.

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