An article that I published today in the journal Epidemiologic Perspectives & Innovations reveals that anti-smoking groups have been widely disseminating communications which misrepresent the acute cardiovascular health effects of secondhand smoke (see: Siegel M. Is the tobacco control movement misrepresenting the acute cardiovascular health effects of secondhand smoke exposure? An analysis of the scientific evidence and commentary on the implications for tobacco control and public health practice. Epidemiologic Perspectives & Innovations 2007; 4:12).
The article provides a comprehensive review of the scientific evidence relevant to the acute cardiovascular health effects of secondhand smoke. It then evaluates claims made by at least 100 anti-smoking groups that brief exposure to secondhand smoke causes a number of severe health effects - including atherosclerosis, reduced coronary artery flow, heart damage, heart disease, heart attacks, fatal and catastrophic arrhythmias, and strokes - in otherwise healthy individuals (those without severe, pre-existing coronary artery disease).
The article concludes that: "Based on the analysis, it appears that a large number of anti-smoking organizations are making inaccurate claims that a single, acute, transient exposure to secondhand smoke can cause severe and even fatal cardiovascular events in healthy nonsmokers. The dissemination of inaccurate information by anti-smoking groups to the public in support of smoking bans is unfortunate because it may harm the tobacco control movement by undermining its credibility, reputation, and effectiveness. Disseminating inaccurate information also represents a violation of basic ethical principles that are a core value of public health practice that cannot and should not be sacrificed, even for a noble end such as protecting nonsmokers from secondhand smoke exposure. How the tobacco control movement responds to this crisis of credibility will go a long way towards determining the future effectiveness of the movement and its ability to continue to save lives and protect the public's health."
Among the groups implicated in making inaccurate and/or misleading health claims are Americans for Nonsmokers' Rights (ANR), Action on Smoking and Health (ASH), Smoke-Free Ohio, the New York City Department of Health, the Montana Tobacco Advisory Board, TobaccoScam, and the Campaign for Tobacco-Free Kids (TFK).
The article goes on to explain that provision of accurate health information to the public is a core ethical principle of public health practice. The right of the public to accurate and non-misleading health information is supported by the Universal Declaration of Human Rights.
The paper's final conclusion is as follows:
"While there is ample evidence that chronic exposure to secondhand smoke increases the risk of cardiovascular disease, and therefore heart attack risk, and there is some suggestive evidence that acute exposure to secondhand smoke may present some degree of risk to individuals with existing severe coronary artery disease, there appears to be no scientific basis for claims that brief, acute, transient exposure to secondhand smoke increases heart attack risk in individuals without coronary disease, that it increases such risk to the level observed in smokers, that it can cause atherosclerosis, that it can cause fatal or catastrophic cardiac arrhythmias, or that it represents any other significant acute cardiovascular health hazard in nonsmokers."
"In light of this, the claims that are being widely disseminated by a large number of tobacco control groups appear to be scientifically unjustified and inaccurate."
"The dissemination of inaccurate information by anti-smoking groups to the public in support of smoking bans is unfortunate because it may harm the tobacco control movement by undermining its credibility, reputation, and effectiveness."
"While anti-smoking groups may provide a utilitarian-based argument that these inaccurate and/or misleading communications are doing more good than harm in the long run because they are helping to promote smoke-free policies which will protect the public's health and save lives, the problem is that even if this were true, disseminating inaccurate information represents a violation of basic ethical principles that are a core value of public health practice that cannot and should not be sacrificed. The ends do not justify the means, especially when those means are violating principles of autonomy and self-determination that form the essential bases for free societies. These are values which cannot and should not be trodden upon by public health organizations simply to promote a favored policy."
The Rest of the Story
The tobacco control movement now faces a crisis of its scientific credibility. Given the widespread misrepresentation of the science that has taken place, the public may now question even the valid aspects of the communications that the movement is disseminating.
As I stated in the article, I believe that "How the tobacco control movement responds to this crisis of credibility will go a long way towards determining the future effectiveness of the movement and its ability to continue to save lives and protect the public's health."
It is critical that the tobacco control movement and the organizations that have been implicated in this deception respond definitively to this crisis. Otherwise, my fear is that the public may "throw out the baby with the bath water."
In other words, I fear that the public does not have the ability to discern what communications are accurate and which are misleading. Rather than retaining respect for the scientific integrity of the tobacco control movement and simply acknowledging these misrepresentations as an isolated event, the public may well dismiss all statements that tobacco control organizations make.
If the tobacco control organizations involved, especially the leading groups such as Americans for Nonsmokers' Rights, TobaccoScam, the American Cancer Society, ASH, and the Campaign for Tobacco-Free Kids, respond definitively by apologizing for these misleading statements, correcting or clarifying them, and being more careful in the future, then I believe the deception that has occurred will eventually be forgotten.
However, if the organizations do not respond definitively, I fear that the reputation of the movement will be permanently tainted.
I should emphasize, however, that the reputation and future effectiveness of the movement is not my only concern. I believe that truth itself, and the ethical responsibility to provide accurate scientific information to the public, demand that tobacco control groups respond definitively in the way I describe above. It is not a game that we are playing. We have the responsibility to adhere to a certain ethical code of conduct in public health practice. We have veered off the path and are violating those core principles. It is time to get the movement back on track. The public has the right to accurate and non-misleading health information. I do not believe that we have a choice to make. We owe it to the public to do the right thing.
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