Thursday, January 31, 2008
I write: "The Calabasas City Council last week gave final approval to an ordinance that expands its existing widespread outdoor smoking ban to regulate smoking in all rental units in the city. This ordinance is an example of a city government that has run amok. It is an example of extremely poor public health policy that not only fails to achieve a significant public health purpose but actually makes the problem much worse that it would otherwise have to be. It intrudes upon landlords' autonomy in the operation of their businesses without any valid public health justification. In Calabasas apartments, smoking is essentially randomly distributed and thus it minimizes the chances that levels of smoke in any particular apartment will be extremely high. However, if smoking units are all grouped in the same area, levels of tobacco smoke in those areas are going to be extremely high. This ordinance maximizes, rather than reduces, the possibility that secondhand smoke is going to become a problem for some apartment residents. ..."
"The nonsmokers are actually better off without this ordinance, because at least there is some possible recourse if smoking in apartments is not regulated. But once the regulations specifically permit landlords to designate 20 percent of their units as smoking units, there is little recourse for nonsmokers who will now almost assuredly be affected by smoke, even if they weren't affected before the ordinance. This ordinance essentially institutionalizes the problem of tobacco smoke exposure among nonsmoking apartment residents."
The Rest of the Story
If you are going to intrude into the autonomy of landlords in terms of how they run their rental operations, then you at least better be doing so in a way that protects the public's health. The Calabasas ordinance accomplishes just the opposite: it virtually guarantees that secondhand smoke will be a problem in Calabasas rental properties, and worse, it takes away any existing recourse that affected nonsmokers have to attempt to mitigate or solve the problem.
It will be interesting to see whether Calabasas policy makers revisit the ordinance now that its completely lack of sense and lack of public health justification have been exposed.
Even more interesting will be to see whether anti-smoking groups are willing to speak out in opposition to this ordinance, which clearly does a tremendous disservice to the cause of protecting nonsmokers from secondhand smoke exposure in their homes.
According to an article at IrishHealth, the chairperson of ASH Ireland indicated that the organization was supporting a ban on smoking in cars with children only as an interim measure; the ultimate goal is to ban smoking in all cars because it is such an unhealthy practice.
The article states: "ASH Ireland wants smoking to be banned in cars carrying children under 16 years of age. ...Dr Angie Brown, Chairperson of ASH Ireland said it would much prefer to have a total ban on smoking in cars as it is such an unhealthy practice. 'As an interim measure we have urged the Minister for Health to ban smoking in cars transporting children under 16 years of age.'"
"'We urge adults who transport children in cars not to smoke either while the children are in the cars or not. Children are unlikely to ask adults to stop smoking, so we must take this important decision out of their hands,' Dr Brown said."
The Rest of the Story
This is an important story because it is the first time I am aware of an anti-smoking group going on the record as supporting a ban on smoking in order to protect smokers from their own "unhealthy practice." Previously, every anti-smoking group I am aware of that has supported smoking bans has done so with the intent of protecting nonsmokers from secondhand smoke.
This represents a significant change in proposed policy because it would ask the government to ban smoking for purely paternalistic reasons. While I believe the government is generally justified in regulating behaviors such as smoking in order to protect nonsmokers from the harmful effects of secondhand smoke, to start banning smoking because it is an unhealthy practice for smokers would be crossing a troublesome line.
After all, if we ban smoking in cars because it is unhealthy for smokers, then why not ban eating trans-fats since it is also an unhealthy practice? Why not ban all sorts of unhealthy behaviors?
There is also a tinge of hypocrisy in ASH Ireland's position. If smoking in cars is such an unhealthy practice that it has to be banned, then isn't smoking in one's home also an unhealthy practice that should be banned as well? People spend a lot more time in their homes than in their cars, so banning smoking in homes would seem to be a greater priority.
There is also inconsistency in ASH Ireland's argument that smoking needs to be banned in cars with children because we must take the important decision of exposing children to tobacco smoke out of the hands of parents. If it it true that "children are unlikely to ask adults to stop smoking, so we must take this important decision out of their hands," then why is it only true in cars, but not in homes. Children cannot ask adults to stop smoking in homes any more than they can do so in cars, so if the decision to expose their kids needs to be taken out of the hands of parents, doesn't it need to be taken out of their hands in their homes as well as in their cars?
Is it really health we are trying to protect, or is it more that we are bothered because we can see the smoking that occurs in cars. The smoking that we cannot see - in the home - does not appear to bother ASH Ireland enough to prompt the group to want to take the decision to expose kids to hazardous tobacco smoke out of the hands of parents. As long as we can't see parents exposing their kids to tobacco smoke, everything is OK.
The position of anti-smoking groups with respect to car smoking bans leads me to question what the true underlying motivation is here. Is it to protect the health of children by removing the leading source of their exposure to hazardous secondhand smoke? Or is it to get the smoking around kids out of our view, so that we can't see it and it doesn't bother us?
Presumably, it is the latter, not the former, because the primary source of exposure to hazardous secondhand smoke for children is the home.
Wednesday, January 30, 2008
Another Canadian Anti-Smoking Advocate Makes Unfounded Accusation that Tobacco Policy Opponents are Big Tobacco Lackeys
Now, about 9 months later, another anti-smoking advocate has published a letter in the Edmonton Journal which, without documentation, accuses a number of individuals who have written letters in opposition to various tobacco policies of being funded by and working in a campaign orchestrated by the tobacco industry.
Norman Temple, a professor at Athabasca University in Alberta, writes in the January 26 issue of the Edmonton Journal: "There appears to be a coordinated campaign across North America on the subject of restrictions on smoking. This campaign has all the hallmarks of being financed and coordinated by the tobacco industry. On Jan. 9, The Journal published my letter on the Alberta government's smoking ban ("'Liberty' argument just smoke, mirrors"). On Jan. 14, two letters were published attacking my views. The writers of both letters live in Ontario. On Jan. 21, The Journal published a letter by Irena Buka on the subject of banning smoking in cars ("Time to ban smoking in cars"). Then on Jan. 25, we find three letters attacking Buka. One of the writers lives in Ontario, one in Winnipeg and one in Philadelphia. How do these writers across North America manage to so quickly discover these letters in The Journal on the subject of smoking? Are there dozens of people across North America who have so much spare time that they can read the Edmonton Journal every morning (and maybe several dozen other papers) and then write letters on the subject? I think not. After all, we never see letters flooding in from across North America on other topics."
"Here is a far more likely explanation. This is a campaign orchestrated by the tobacco industry. ... The tobacco industry wishes to propagate the view that passive smoking is not harmful and that smokers have a right to inflict their poison on those around them. But how can they state this viewpoint when their credibility went up in smoke many years ago? The obvious way is by running a campaign where the activists appear to have no association with the tobacco industry."
Among those accused of being tobacco industry lackeys are Roy Harrold of Edmonton and Michael J. McFadden of Philadelphia.
The Rest of the Story
This story demonstrates the point I made in my April 16, 2007 post that anti-smoking advocates seem to be brainwashed into believing that all opposition to smoking bans is orchestrated by the tobacco industry, and that anyone who either challenges the science connecting secondhand smoke exposure and severe health effects or opposes tobacco control policies is a paid lackey of Big Tobacco.
Here, several writers from across the continent have expressed opposition to a number of policies, including a car smoking ban and a university ban on tobacco company grants. In the eyes of this anti-smoking advocate, this automatically means that the authors of these letters are merely props of the tobacco companies, apparently paid or otherwise persuaded to act in an organized campaign orchestrated by Big Tobacco.
It apparently never occurred to this professor that individuals can be opposed to smoking bans or can oppose the idea of a university refusing to accept tobacco grants without necessarily being mere tobacco industry fronts.
There is no problem in being wrong in one's own opinions about the reasons for an individual's opposition to tobacco policies. However, there is a major problem when one proceeds to make an accusation like this publicly and without documentation.
We in tobacco control have long criticized the tobacco companies for making public statements without sufficient documentation. We should therefore shudder when we see people within tobacco control making personal accusations and attacks like these without any documentation.
If the writer is going to insinuate that McFadden, Harrold, and others who have written letters to the Journal are tobacco industry lackeys who are being paid by, and/or orchestrated by the tobacco industry, then it is his obligation to provide the evidence to back up his claim. Here, the writer provides not a shred of evidence to support his accusation. It is simply a malicious, unfounded attack.
If Dr. Temple wishes to attack the arguments made by those who have expressed support for the University of Alberta accepting tobacco company grants, then that is fair game. But to attack the character of the individuals who have expressed these opinions - without documentation or evidence to back up his attack - is inappropriate.
We need to address issues on their merits, not based simply on speculation that the individual making the argument is somehow affiliated with the tobacco industry. What if the individual is not affiliated with Big Tobacco? Does that automatically validate his argument?
Ironically, it appears that Dr. Temple would probably assume that I am part of the tobacco industry's campaign against smoking bans, since I have publicly opposed car smoking bans and certain outdoor smoking bans. But my opposition to these policies hardly indicates that I am, by definition, accepting tobacco money to express these opinions or that my actions are being coordinated by tobacco companies.
The tactic of making undocumented accusations against tobacco policy opponents - claiming that they are fronts for Big Tobacco - was perfected by, and advanced by Americans for Nonsmokers' Rights (ANR), an organization whose Board I used to sit on. You can read more about some of ANR's unsupported accusations here and here. Americans for Nonsmokers' Rights actually encourages local anti-smoking groups across the nation to insinuate that opposition groups are funded by Big Tobacco even in the absence of evidence.
Tuesday, January 29, 2008
Many British Physicians Call for Refusal of Medical Treatment for Smokers and Others with "Unhealthy Lifestyles"
According to the article: "Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives. Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone. Fertility treatment and "social" abortions are also on the list of procedures that many doctors say should not be funded by the state."
"The findings of a survey conducted by Doctor magazine sparked a fierce row last night, with the British Medical Association and campaign groups describing the recommendations from family and hospital doctors as "outrageous" and "disgraceful." About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt. Managers defend the policies because of the higher risk of complications on the operating table for unfit patients. But critics believe that patients are being denied care simply to save money." ...
"Among the survey of 870 family and hospital doctors, almost 60 per cent said the NHS could not provide full healthcare to everyone and that some individuals should pay for services. One in three said that elderly patients should not be given free treatment if it were unlikely to do them good for long. Half thought that smokers should be denied a heart bypass, while a quarter believed that the obese should be denied hip replacements."
The Rest of the Story
The fallacy in the argument being used to support denial of medical treatment for smokers and others with "unhealthy lifestyles" is that the true incentive to deny care is not a clinical one, but instead is based on either a desire to save money or a moral judgment about individual behavior. Either way, it is a dangerous way of thinking - one that should be universally condemned by all of us in the medical and public health professions.
By definition, physicians who support the denial of medical care on a systematic basis to various groups of people are not basing the decision on clinical judgment. Because by definition, clinical judgment requires that a decision be made on a case-by-case basis, taking the specific details of the individual patient into account.
As soon as we leave the realm of individual clinical decision-making and instead, make decisions based upon policies that apply to groups of people, then we are abandoning the reliance on clinical judgment in favor of making our decisions based on other factors, whether they be financial concerns or an attempt to impose moral judgments on others.
In the case of the denial of "social" abortions (the simple description of abortions as being "social" I find despicable), it is clearly an attempt to impose one's individual morals on the rest of society. There is no place for that in the medical profession.
In the case of the denial of medical treatment to the elderly, smokers, and the obese, it is clearly an attempt to save money for the government - and ultimately, the taxpayer. There is also no place for that in the medical profession.
My hope would be that anti-smoking groups would immediately and publicly condemn these proposed policies. Unfortunately, I doubt any anti-smoking groups will speak out on this issue. If they are not even willing to oppose the idea of taking away the legal recourse of nonsmokers to seek accommodation if their health is being affected by tobacco smoke from neighboring apartments, then I can't imagine that these groups would speak out against the maltreatment of active smokers.
Monday, January 28, 2008
IN MY VIEW: Calabasas Apartment Smoking Ordinance Reveals Lack of Public Health Principles and Loss of Integrity in Tobacco Control
A landlord in Calabasas owns a multi-unit rental property consisting of 4 buildings with 8 units per building. He wishes to retain the maximum allowable number of smoking units so that he does not jeopardize his ability to rent these units.
According to the new law in Calabasas, he can designate a maximum of 20% of his 32 rental units, or 6 units, as smoking units. Furthermore, all 6 smoking units have to be in the same building.
Thus, the landlord has no choice but to designate 6 of the 8 units in one if his buildings as smoking units. This means that the poor nonsmokers who live in the other 2 units in that building are going to be completely surrounded by apartments in which smoking takes place.
What may not have been a problem originally is now certain to be a problem. There are going to be nonsmoking tenants who most likely are going to face a problem with secondhand smoke exposure in their homes.
This thanks to a City Council which is trying to present itself as being a leader in the movement to protect people from the extreme hazards of secondhand smoke. This from a City Council which apparently views secondhand smoke as such a hazard that it outlawed smoking everywhere outside - including parks, parking lots, streets, sidewalks, and alleyways - unless a smoker can ensure that no nonsmoker will come within 25 feet, even transiently.
To make matters much worse, the new ordinance makes it virtually impossible for nonsmokers whose health is being adversely affected by secondhand smoke attributable to their neighbors' smoking to have any recourse. Prior to the ordinance, a nonsmoker who was suffering due to tobacco smoke exposure could complain to the landlord and demand an accommodation to mitigate the exposure in some way. Now, the tenant really has no standing upon which to demand an accommodation, as long as the landlord is in full compliance with the law.
But full compliance with the law does nothing to ensure protection of nonsmoking tenants. In fact, as I have described above, it actually ensures that the problem will be much worse for many Calabasas residents.
If the principle of public health protection actually meant anything, then why in the world would the City Council have grandfathered in existing smoking units? Does secondhand smoke somehow know the difference between an existing smoking resident and a future smoking resident? Will the smoke of existing residents somehow know to stop before it enters the apartment of a nonsmoker? Is the City Council really saying that existing exposure of nonsmokers is acceptable, but that they just do not want to create "new" exposure?
The Rest of the Story
What I honestly see here is a City Council policy that has completely lost regard for public health principles and has instead wandered into the realm of a purely political maneuver. The policy appears designed to make it look like the Council is addressing a serious problem, when the truth is that the policy not only makes no sense and is unduly intrusive into the autonomy of landlords, but it also institutionalizes the very problem that it pretends to solve.
But what is most troubling to me is not the fact that these policy makers are acting purely like politicians. After all, they are politicians.
What troubles me is that public health groups appear to be supporting this policy. Groups like Smokefree Pennsylvania have publicly defended the policy and to the best of my knowledge, no anti-smoking group has yet to publicly criticize the policy.
And you know what? I don't think any anti-smoking group will publicly criticize this policy. As I have learned, it is sacrosanct for a tobacco control group or advocate to criticize a secondhand smoke statement or policy. In this case, anti-smoking groups are going to be loathe to take any action that in any way criticizes a City Council that in their minds is leading the way to the next frontier in secondhand smoke regulation - banning smoking virtually everywhere.
Of course, the irony is that Calabasas is setting a terrible example by instituting policies that are largely window dressing. They look good in the papers, but when it comes down to it, they do little to protect people who need it the most and they actually institutionalize rather than prevent, significant secondhand smoke exposure.
As I argued previously, Calabasas may be protecting nonsmokers from secondhand smoke exposure in remote areas of parking lots, but they are not ensuring protection for smokers in the crowded (and lucrative) Calabasas Commons shopping area.
Calabasas is an example not of what should be a trend-setter in smoke-free policies, but of what should be shunned. It is an example of politics winning out over public health. It is an example of talking the talk, but not being willing to walk the walk.
I believe that there must be a solid justification for the government to intervene into the way in which landlords operate their businesses. If you are going to intrude to this degree, setting up a quota system telling landlords how they must allocate the space in their apartment buildings, then you better have a very good public health justification for doing so. In this case, there is no public health justification. If anything, the ordinance creates a problem where one may not have existed. At very least, it takes a problem and makes it much, much worse.
There is a better way. For one thing, if Calabasas were serious about tackling the problem of secondhand smoke in rental units, it could simply have enacted an ordinance which makes it a nuisance condition when secondhand smoke from someone else's apartment enters your apartment and causes significant acute health impairment. This would give nonsmoking tenants the power they need to force landlords to address the problem. Landlords could be required to make reasonable accommodations for nonsmoking tenants whose health is significantly affected by tobacco smoke and this could be done on a case-by-case basis. This is probably the most efficient way of tackling this problem.
Alternatively, if the City Council is so serious about the extreme hazards of secondhand smoke, then why didn't it simply ban smoking in apartments where there is the possibility of tobacco smoke entering a nearby rental unit? It's not clear to me whether such a sweeping approach is necessary, as opposed to the case-by-case approach I outline above, but at least it would have represented the ability to stick to some sort of public health principles.
The Calabasas story is an excellent illustration of why I am so frustrated by the lack of integrity in tobacco control that I observe today. There is simply too much politics nowadays and not enough sticking to principle. That may be OK for politicians, but I don't view it as being OK for groups that are entrusted with (or have entrusted themselves with) the protection of the public's health.
Friday, January 25, 2008
According to an article in The Acorn, the ordinance "requires that at least 80 percent of apartment buildings be permanently designated as nonsmoking units by Jan. 1, 2012. Landlords are required to submit annual reports detailing the number and location of the units, beginning this July." In the article, Calabasas Mayor Pro Tem Sue Maurer was quoted as saying: "This ordinance is a perfect example of good government working in collaboration with business interests, health advocates and residents."
By my reading of the ordinance, it does indeed require that 80% of the units in all apartment buildings be designated as non-smoking. The remaining 20% may be designated as smoking units. However, it should be noted that any tenant who now occupies a rental unit may request that his or her unit be designated as a smoking unit, and that unit will not be counted toward the 20% maximum smoking units.
Most importantly, the ordinance makes the presence of secondhand smoke in a nonsmoker's apartment a nuisance and a trespass, but only if the transgression occurs in violation of the smoking ordinance.
The Rest of the Story
In my opinion, this ordinance is an example of a city government that has run amuck. It is an example of extremely poor public health policy that not only fails to achieve a significant public health purpose, but actually makes the problem much worse that it would otherwise have to be. It intrudes upon landlords' autonomy in the operation of their businesses without any valid public health justification. In fact, it ensures that secondhand smoke in apartment buildings, which may previously not have been much of a problem, now becomes a significant problem.
The stupidity of this ordinance can be understood by an analogy to a similar law that segregates smoking in a restaurant to a smoking and non-smoking section. If allowed to smoke randomly throughout a restaurant, the smoke will tend not to be heavily concentrated in any one area. However, by setting up a designated smoking section, the smoke in that area will be very concentrated. Thus, any nonsmoker sitting in the nonsmoking area adjacent to the smoking section will experience extremely high exposure to secondhand smoke. If a restaurant owner is not going to eliminate smoking in a restaurant, it makes little sense to restrict smoking to a particular area of that restaurant located in the same ventilated air space.
Under current conditions in Calabasas apartments, smoking is essentially randomly distributed and thus it minimizes the chances that levels of smoke in any particular apartment will be extremely high. However, if smoking units are all grouped in the same area, levels of tobacco smoke in those areas are going to be extremely high. This ensures that smoke in adjacent nonsmoking apartments is going to become a problem.
In other words, this ordinance maximizes, rather than reduces, the possibility that secondhand smoke is going to become a problem for some apartment residents.
Why would any nonsmoker want to live adjacent to the heavily concentrated smoking units in an apartment complex? But by definition, someone has to. For those people, there is going to be a problem with secondhand smoke, where one may very well not have existed before.
To make matters even worse, the ordinance specifically does not allow a nonsmoker any recourse if smoke does become a major problem due to his location adjacent to the smoking wing of an apartment building. While the ordinance may have, alternatively, declared secondhand smoke to be a nuisance and thus allowed some recourse - on a case by case basis - to nonsmokers affected by tobacco smoke from other units, it now precludes that possibility by declaring that smoke entering apartments from the designated smoking units is not a nuisance.
This makes it extremely difficult, if not impossible, for a nonsmoker who is suffering due to secondhand smoke in adjacent smoking units to do anything about it. If the nonsmoker complains to the landlord, the landlord can simply dismiss the complaint, noting that the landlord is in full compliance with city law and that city law does not consider the smoke entering the nonsmoker's apartment to be a nuisance.
The nonsmokers are actually better off without this ordinance, because at least there is some possible recourse is smoking in apartments is not regulated. But once the regulations specifically permit landlords to designate 20% of their units as smoking units, there is little recourse for nonsmokers who will now almost assuredly be affected by smoke, even if they weren't affected before the ordinance.
Another problem with the approach taken by this ordinance is that it doesn't allow flexibility for the landlord to alter the number of smoking units based on resident demand. The landlord has to submit an annual document to the city which specifies the smoking and nonsmoking units. It is not clear that the landlord can modify this document.
For example, what if there is a high demand for nonsmoking units and none are available. Can the landlord change a smoking unit into a nonsmoking unit? Does that unit have to remain unoccupied, and the landlord lose money, until he can find a smoker to occupy that unit?
What if the smoking units are filled up and a smoker wants to rent an apartment? Can the landlord notify a smoker that his unit is being changed to a nonsmoking unit so that he can accommodate the new tenant and maximize the occupancy? Can the landlord then cite the tenant for a violation if he continues to smoke?
And what incentive is there for a landlord not to simply go through the motions of notifying the smoker that he can no longer smoke in his apartment? According to the ordinance, as long as the landlord sends a note to the tenant stating that he cannot smoke, the landlord cannot be found in violation of the law.
If I were a landlord in Calabasas, I would get around this ordinance by simply designating 20% of my units as smoking and then whenever a new smoker wanted to rent, I would tell her that I would designate her unit as smoking and reclassify an existing smoker's unit as nonsmoking. Then, when the smoker continued to smoke, I would simply send the required notices and then forget about it. Since residents would already be used to smoking in that apartment, there would likely be no complaints.
This ordinance is not only insanity, but more importantly, it is completely unjustified on public health grounds. It ensures that tobacco smoke exposure of nonsmokers in apartment buildings is going to become a significant problem, and it deprives these nonsmokers of any recourse to redress the problem. Essentially, it institutionalizes the problem of tobacco smoke exposure among nonsmoking apartment residents.
Far from being a "perfect example of good government working in collaboration with business interests, health advocates and residents," this ordinance is a perfect example of out of control government which is so obsessed with the need to look like it is health conscious that it is actually institutionalizing the very problem that it claims to be trying to solve.
Thursday, January 24, 2008
Canadian Anti-Smoking Advocates Following U.S. Counterparts and Making False or Unsubstantiated Secondhand Smoke Claims to Support Car Smoking Bans
In a press release issued last month, Sault Ste. Marie MPP David Orazietti - the sponsor of the legislation - stated: "This bill is important because research shows young people are especially susceptible to the harmful effects of second hand smoke and as a result they are more likely to suffer from cancer, heart disease, asthma and a number of other respiratory problems."
The claim in question here is that "young people ... are more likely to suffer from ... heart disease" as a result of exposure to secondhand smoke.
Also last month, the Canadian Cancer Society stated that secondhand smoke exposure among children is related to "childhood leukemia, lymphomas, and brain tumours." This statement was also made in support of legislation to ban smoking in cars with children present.
The Rest of the Story
The rest of the story is that the claim by Mr. Orazietti is false and that by the Canadian Cancer Society is premature - it is not yet conclusively demonstrated by the scientific data.
To be sure, the first problem is far worse. The claim that secondhand smoke exposure causes heart disease among children/young people is simply false. Even among heavy active smokers, heart disease does not generally develop until a person reaches their 40's. It generally takes at least 20 years of exposure before someone who starts smoking during childhood will develop heart disease. We almost never see cases of heart disease among young people that are due to tobacco smoke exposure, even among individuals who are active smokers who started smoking at a very early age. So it is factually inaccurate to state that young people are more likely to suffer from heart disease due to secondhand smoke exposure.
While the second claim is not as bad because there is at least some suggestive evidence to support it, I believe that it is premature and unwarranted because the evidence is not yet sufficient to warrant a causal conclusion. Both the United States Surgeon General and the California Environmental Protection Agency reviewed the issue of the relationship between childhood secondhand smoke exposure and childhood leukemia, lymphoma, and brain tumors. Both concluded that while there is some evidence suggestive of a causal relationship, there is not enough evidence to conclude that a causal relationship exists.
The Surgeon General concluded: "The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood cancer. ... The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke during infancy and childhood cancer. The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood leukemias. The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood lymphomas. The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood brain tumors."
In other words, the evidence is not sufficient to conclude that there is a causal relationship between secondhand smoke exposure and childhood cancers, leukemia, lymphoma, or brain tumors.
The California Environmental Protection Agency also concluded that the evidence linking secondhand smoke exposure and childhood leukemia, lymphoma, and brain cancer was suggestive, but not sufficient to conclude that there is a causal relationship. Of note, the report clearly stated that the link between secondhand smoke and childhood leukemia, even if causal, is due to pre-conceptual paternal smoking, not secondhand smoke exposure. Similarly, the report noted that even if causal, the relationship between tobacco smoke exposure and childhood brain tumors may be due to pre-conceptual sperm damage, rather than childhood secondhand smoke exposure.
In the first case, I find the communication to be unethical and irresponsible, because I don't think it is appropriate to make false statements to the public in order to promote public policies.
In the second case, I don't think it is an issue of ethics or responsibility; instead, I think it is more of a strategic mistake. If tobacco control groups are too quick to pull the trigger and communicate to the public that there is a causal relationship between secondhand smoke and a particular disease when there is only suggestive evidence, then it becomes much more difficult for these groups to convince the public that their conclusions are sound. Because their scientific reputations need to be beyond reproach, these groups should not disseminate to the public definitive causal conclusions until there is sufficient evidence to draw such causal conclusions.
Finally, let me address the potential argument that I should not be criticizing either of these groups because while they were wrong or premature with their conclusions about one disease, they were correct with respect to other diseases. For example, it is true that childhood exposure to secondhand smoke increases the risk for asthma and other respiratory problems.
The problem is that this is like the Boy Who Cried Wolf. If an anti-smoking group is wrong about one disease, what reason does the public have to believe that they are right about a different disease? Once you have demonstrated that you are willing to make false statements of scientific fact to support your cause, the public may never believe anything you have to say ever again, even if it is on solid scientific ground.
I don't know why the Canadian anti-smoking groups need to follow the U.S. groups' pattern of exaggerating and misrepresenting the scientific evidence. That's one thing I don't want to see us export to other countries.
Tuesday, January 22, 2008
IN MY VIEW: Why Washington State Anti-Smoking Groups' Support of Car Smoking Ban Bill is Hypocritical
First, a critical point about the legislation is that it makes smoking in a car with children a secondary offense. This means that a car cannot be pulled over if someone is smoking and children are present. A citation can only be given if a car is pulled over for some other reason, and incidentally, someone is found to be smoking with a child present.
The sponsor of the House bill claimed that its purpose was to protect children who are "reeking of tobacco and coughing of asthma." More generally: "The proposals are aimed at protecting kids from secondhand smoke, which has been linked to asthma, cancer and other ailments."
The Rest of the Story
There are two reasons why the anti-smoking groups' support of this legislation is hypocritical.
First, if the problem of secondhand smoke exposure of children is really as terrible as these groups make it out to be, then why in the world would they support a bill that specifically does not allow for the enforcement of the law? If kids are truly reeking of tobacco and coughing of asthma, then what sense does it make to tell the police: "If you see a kid in a car who is coughing of asthma because she is suffocating in smoke, you can't do anything about it."
I believe it is hypocritical to say, at the same time:
1. Kids are suffering in cars due to secondhand smoke and the government must intervene to protect those kids; and
2. Kids are not suffering so much that we have to actually enforce the law intended to protect them.
I find that to be a highly hypocritical stance. Make up your minds. Is the problem severe enough so that we have to intervene into parental autonomy and privacy? If so, then have the courage to support the enforcement of the law. Passing the law itself may make these groups feel good, but without the ability to enforce the law, the evidence shows that these laws will not be effective.
For example, the experience with secondary enforcement of seat belt laws is quite dismal. The National Highway Traffic and Safety Administration has made it a legislative priority to wipe out all the state secondary enforcement laws and replace them with laws that actually have some teeth: primary enforcement laws.
Second, these groups' stance is hypocritical because the primary and overwhelming dominant source of morbidity among children due to their parents' smoking is secondhand smoke exposure in the home, not the car. The duration of tobacco smoke exposure in cars is absolutely dwarfed by exposure in the home. Exposure in the home, not the car, is the primary source of the childhood morbidity that is attributable to parental smoking.
So I find it hypocritical to talk about how criminal it is for parents to expose their kids to secondhand smoke and then to support a policy that forbids parents from doing so only in their cars, but not in their homes.
Sure - it may be more visible to people when parents smoke in a car and so eliminating that may make us feel better, but the truth is that it is the exposure that we don't see (in the home) that is causing most of the illness attributable to secondhand smoke among children.
More generally, what troubles me about the position of these anti-smoking groups is that they don't seem willing to stand up for any principles. Everything seems to have deteriorated into a simple game of politics and public image. It appears to me that these groups are more concerned about being able to say that they did something than to actually do something that would offer significant protection to the children who need it the most.
Let me close by noting that it is not the anti-smoking groups' support for this policy - in and of itself - which makes their actions hypocritical. If the groups told the truth, and admitted that they realized that this proposed policy would not make too much of a difference, but that for political reasons they were supporting it as a good start, then I would respect their position (although still disagree with it). However, the lack of honesty and forthrightness among these groups is what truly makes their actions hypocritical. They are saying one thing out of one side of their mouth, and doing just the opposite out of the other side of their mouth.
I'm sorry, but that is the definition of hypocrisy.
As much as I support the general intention of these groups to protect children from secondhand smoke exposure (which I think is an important public health priority), I must call a spade a spade. The actions of these anti-smoking groups are hypocritical.
Monday, January 21, 2008
Washington State Anti-Smoking Groups Supporting Feel Good Measure that Protects Nobody; Hypocrisy Running Rampant
According to an article in the Seattle Times: "Some lawmakers want to extend the state's smoking ban to inside your car — at least when children are there. Two bills in the Legislature would make it a traffic infraction to smoke in a car carrying children. House Bill 2519 would outlaw smoking around passengers younger than 18, while Senate Bill 6287 sets the age limit at 13 or younger. The proposals are aimed at protecting kids from secondhand smoke, which has been linked to asthma, cancer and other ailments. ... Both bills would make the infraction a secondary offense, meaning a law-enforcement officer would have to stop a driver for another infraction, such as speeding, before issuing a smoking citation. The smoking infractions wouldn't become part of the driver's record or be made available to insurance companies or employers. The legislation has widespread support, including from the American Cancer Society, American Heart Association and American Lung Association."
The Rest of the Story
The anti-smoking groups' support for this measure is one of the most hypocritical stances I have observed in the tobacco control movement. These groups are taking the position that exposing children to secondhand smoke in a car is intolerable and must be strictly regulated by the government. However, it is apparently not so bad that we would want to actually be able to enforce the law.
The American Cancer Society, American Lung Association, and American Heart Association should make up their minds. If secondhand smoke exposure of children is really so unacceptable that we need to intervene in private cars to regulate this risk, then they should support legislation that allows for the enforcement of the law. And for that matter, they should promote legislation which bans smoking in homes with children present, since that is the primary source of tobacco smoke exposure for children.
The current stance of these groups appears to be merely a feel-good one: they can feel good about doing something and tell their constituents that they have achieved legislation, but in reality, the legislation does nothing to protect anyone.
On a broader note, it is really disillusioning to me that there appears to be such a lack of principle in the anti-smoking movement today. Don't these groups actually stand for something anymore? Aren't there principles that these groups are willing to support? Or has it all deteriorated into a hypocritical game that is motivated more by politics than by science and public health principles?
Friday, January 18, 2008
According to the article, since enforcement of the law began in August, more than 300 people have been cited for smoking in downtown Burbank. At an average cost of $100 per fine, this amounts to $30,000 in revenue, which is apparently split between the city courts and other city departments.
Signs on business windows throughout the downtown read: "No smoking in downtown Burbank."
The Rest of the Story
This is exactly the type of fanaticism that gives the anti-smoking movement a bad name. In my opinion, this is going to hurt efforts to protect people from secondhand smoke much more than it is going to help. The reason? Because it does little to protect the public from any real health threat, yet it promises to undermine future anti-smoking efforts by painting those of us working to protect nonsmokers as being zealots and fanatics.
Thursday, January 17, 2008
Car Smoking Ban Being Promoted on the Grounds that Children Have the Right to Breathe Clean Air; Fundamental Question Remains Unanswered
The legislation in question would ban smoking in cars with children ages 9 and under. The fine for violation of the law would be $100. The article reports that Senator Joel Lourie, one of the bill's lead sponsors, justified the proposal as follows: "Cars where adults are smoking are just smoke-filled traps. It’s just as if the child him- or herself was smoking, and young children have rights, too. They have the right to breathe clean air. It’s not as if the child can get away.”
The article reports that the legislation is being supported by the South Carolina chapter of the American Lung Association.
The Rest of the Story
The problem is this: what if you substitute the word "homes" for the word "cars" in Senator Lourie's justification of this policy proposal?
"Homes where adults are smoking are just smoke-filled traps. It’s just as if the child him- or herself was smoking, and young children have rights, too. They have the right to breathe clean air. It’s not as if the child can get away.”
If one is compelled by the argument that government must intervene in the private car in order to protect the right of children to breathe clean air, then certainly one must also be compelled by the argument that government should intervene in the home to protect that same right. If anything, the justification for interfering in the home is much stronger, because the prevalence and duration of exposure in the home is orders of magnitude higher than exposure in the car. The degree of public health burden (i.e., morbidity) caused by children's exposure to secondhand smoke in the home is far greater than that caused by exposure to secondhand smoke in cars.
Thus, by the arguments of these car smoking ban proponents, there is no valid justification for failing to ban smoking in private homes as well as private cars.
I am still waiting for the groups supporting these car smoking bans to address this basic conundrum. If the primary concern is the health effects of secondhand smoke on children, then why fail to address the primary source of that exposure? If the primary concern is that children have the right to breathe clean air, then don't those children have the right to clean air in their own homes? Why would we only protect kids' right to clean air during the few hours of the day that they are riding in a car? What about the many hours of a day when they are "trapped" in their smoke-filled homes?
What are 3 year-olds supposed to do? Just walk out of their homes and out into the street? Hang with their 3-year-old friends at the local convenience store for as long as they can, before having to return to their smoke-filled homes? How are they supposed to escape the secondhand smoke at night? Call a cab and get a ride to the nearest motel? After all, don't these kids have a right to breathe clean air. And it's not like they can get away.
I would actually have more respect for the proponents of car smoking bans if they were also calling on bans on smoking in the home. At least then the policy would be consistent and they would be standing for the basic principles of protecting the health of our children.
But as it stands, it seems that they are sacrificing the protection of children's health for basically a feel-good policy that fails to address the primary cause of health effects among tobacco smoke-exposed children but allows policy makers to feel good that they have done something to address the problem. To me, that's more politics than it is sound policy. It's politics and cowardice, not showing courage and adherence to principle.
Don't get me wrong. If anti-smoking groups were pushing for smoking bans in the home to protect children, I would not support those proposals because I do not believe the government should intervene in the home in order to regulate merely health risks.
So I'd be very curious to hear how the American Lung Association or other anti-smoking groups which are supporting car smoking bans would address this conundrum.
Wednesday, January 16, 2008
The Campaign is using Kick Butts Day to try to get youths to write letters to Congress in support of the FDA legislation and to organize activities that will recruit members of the public to do the same. The Campaign is also encouraging youths to write letters to the editor and op-eds in support of the proposed FDA tobacco legislation, and to generate media attention in support of the bill.
The Rest of the Story
There's just one problem. Nowhere in the Kick Butts Day manual does it inform youths that the proposed FDA tobacco legislation is the chief legislative priority of the nation's leading cigarette manufacturer. Nowhere does it inform youths that Philip Morris supports and is vigorously lobbying for this legislation.
So while "Kick Butts" Day implies activities to fight Big Tobacco, it is actually highlighting as its chief component an activity that will help the largest company within Big Tobacco: Philip Morris.
In other words, Kick Butts Day is little other than a thinly veiled attempt by the Campaign for Tobacco-Free Kids to take advantage of youths by exploiting their services in lobbying for the FDA tobacco legislation, and without their knowledge or consent.
Kick Butts Day is essentially a part of the Campaign's lobbying efforts for the FDA legislation. It is a way to garner youth support for the legislation and to make it appear that youths are behind the legislation, when in reality, these youths don't have a clue what the legislation is all about, who supports it, and what effect it would have on the tobacco companies.
I find it highly unethical for the Campaign to be misusing kids in this way. It is a basic ethical violation to exploit children by using them as pawns in a political game without their informed consent. And there is no way that youths can be said to be informed about the FDA legislation if they are not told that Philip Morris supports it. This is especially true since the Campaign is implying that the legislation is a method of fighting Big Tobacco and kicking their butts. That's hardly the case if the nation's largest cigarette company desperately wants the legislation to pass.
I am feeling ashamed to be working alongside an organization that is exploiting young people in this way. Kick Butts Day 2008 is a violation of basic ethical principles of public health conduct and should have no place in the tobacco control movement.
Tuesday, January 15, 2008
In a column published Sunday in the Charlotte Observer, the coalition writes that: "Spending just 15 minutes in a restaurant where people are smoking can activate blood cells called platelets, which can trigger blood clots. Clots in arteries feeding the heart muscle cause heart attacks."
In the column, the coalition supports smoke-free ordinances in Rock Hill and York counties.
The Rest of the Story
It is beyond me why the coalition would need to resort to misleading the public in order to promote workplace smoking bans. What is the need to scare the public into thinking that they are going to drop dead from a heart attack merely from walking into a smoky restaurant for 15 minutes, when there is no evidence that this is true?
While it is true that 15 minutes of secondhand smoke exposure does activate platelets, there is no evidence that this transient activation of platelets results in blood clots in the coronary arteries, or anywhere else. Unless you are talking about someone with extremely severe pre-existing coronary artery disease, a mere 15 minutes of secondhand smoke exposure is not going to trigger a heart attack. And if this article is referring only to people with severe coronary artery stenosis, then why not state that? Why grossly mislead the public into thinking that anyone who walks into a smoky restaurant for 15 minutes may end up suffering a heart attack due to smoke-induced clogging of their coronary arteries?
Even if the group is talking about people with severe coronary artery stenosis, I'm not aware of evidence documenting that the platelet activation caused by 15 minutes of secondhand smoke exposure actually does cause heart attacks. So at best, the column is grossly misleading. At worst, it's inaccurate.
Unfortunately, I seem to be watching the scientific integrity of the tobacco control movement degrading before my very eyes. And it doesn't appear that there's anything I can do to stop it. It's truly sad to see.
While in the short run, this sensationalism may help win a few battles, in the long run, I am convinced it is going to destroy the credibility of the tobacco control movement.
Now, does any anti-smoking group want to suggest that 10 minutes of tobacco smoke exposure causes heart attacks? As long as we've moved away from solid science and into the realm of making up our claims, why stop at 15 minutes?
(Thanks to Rufus Trotman for the tip).
Monday, January 14, 2008
According to CASE: "The same half hour of secondhand smoke can cause atherosclerosis (hardening of the arteries) which leads to heart attacks and strokes."
The Rest of the Story
This claim appears on the organization's "Get the Facts" web page. Unfortunately, if you want to get the actual facts, you'll have to turn somewhere other than this web page. Because 30 minutes of secondhand smoke exposure cannot possibly cause atherosclerosis. Even in active smokers, it takes many years of tobacco smoke exposure before hardening of the arteries occurs. You cannot develop atherosclerosis in 30 minutes!
This claim is so blatantly false - on its face - that it is really hard to imagine that CASE actually believes the statement is true.
The research article upon which this claim is based demonstrates that 30 minutes of secondhand smoke exposure increases platelet activity. Somehow, the facts got lost in the translation. Instead of stating that 30 minutes of secondhand smoke activation causes platelet activation in nonsmokers, CASE instead embellished this to state that 30 minutes of smoke exposure causes hardening of the arteries. Unfortunately, the embellishment changed an accurate scientific finding into a false representation of the science.
I feel it is important that public health groups accurately represent science to the public. Studies such as the one by Burghuber et al. are difficult for the public to understand and people depend upon public health groups to accurately interpret and present scientific findings.
My hope was that 2008 would bring greater scientific accuracy in the tobacco control movement. Unfortunately, so far we are headed in the opposite direction.
Thursday, January 10, 2008
No surprise there.
In a communication sent to its constituents, the Campaign for Tobacco-Free Kids warned that Philip Morris might "unleash the beast" in 2008 and create a menthol cigarette brand that might compete with Newport for market share among African American smokers.
The Campaign for Tobacco-Free Kids, in an appeal for donations, warns its constituents that: "While you are ringing in 2008 with family and friends, Big Tobacco is unleashing a beast - a beast that could wreak havoc on the health of youth and adults across the U.S. ... Just read what Wall Street tobacco industry analyst Bonnie Herzog had to say about the Black & Mild cigar brand, newly purchased by Altria: "[It] has done very well in parts of the inner cities, and there's always an opportunity to extend that brand and possibly create a menthol cigarette to compete with the very, very successful Newport brand... These are the types of things that I'm referring to when I say 'unleash the beast.'" Beating the beast of Big Tobacco in every city, every state and every venue will be an enormous and expensive undertaking. That's why it's crucial that we build our arsenal now to prepare for the fight ahead."
Approximately 70% of African American youth smokers smoke Newport cigarettes. The concern being expressed by the Campaign for Tobacco-Free Kids is that if Philip Morris develops a menthol brand, it could attract youth smokers, especially African Americans. Only about 8% of African American youth smokers smoke Marlboro cigarettes.
The Rest of the Story
The rest of the story is that at the same time that the Campaign for Tobacco-Free Kids bemoans the possibility that Philip Morris might develop a new brand that could attract youth smokers through the addition of menthol flavoring and asks for donations to help ensure that doesn't occur, the Campaign opposed an amendment to the FDA tobacco legislation that would have prevented tobacco companies from recruiting youth smokers by adding menthol to their cigarettes.
Regardless of how one feels about the addition of menthol to cigarettes and whether that should be allowed or not, one has to be troubled by an organization that out of one side of its mouth asks people for donations to help it fight the addition of menthol to cigarettes and out of the other side of its mouth lobbies in Congress to protect the ability of the cigarette companies to add menthol to cigarettes.
What kind of integrity must you have to ask people to donate money to help you achieve a goal when your organization is actively fighting against that goal?
How much more disingenuous can you possibly be?
Is there any limit to the hypocrisy that an anti-smoking organization can display?
I chose not to make a contribution to the Tobacco-Free Kids Action fund specifically because this appeal was disingenuous. You don't come to me asking for money to support a cause if you have actively worked against that cause. Frankly, I think that is dishonest, unethical, and unfair to one's constituents.
So far, it is not looking like 2008 has brought any changes to the anti-smoking movement. Apparently, being honest was not one of the New Year's resolutions that the Campaign for Tobacco-Free Kids made.
Wednesday, January 09, 2008
According to the Breathe California of Sacramento-Emigrant Trails web site: "Smoking kills about 340 young people a day."
According to Jacob Sullum's commentary yesterday at Reason Magazine's Hit & Run blog, ASH issued a press release yesterday stating: "A man's home may be his castle, but that doesn't mean he is free to abuse his children inside it by unnecessarily subjecting them to a substance which is known to cause cancer, and which kills thousands of children every year."
While the ASH claim that thousands of children die each year from secondhand smoke appears to be new, the claim by Breathe California of Sacramento-Emigrant Trails that 340 young people die each day from smoking has been on its web site for months, despite my having contacted the organization two months ago to point out the inaccuracy of the claim. The organization responded by suggesting that it might fix it but had to wait until the web master returned from vacation.
The Rest of the Story
Apparently, the web master is on a long vacation. All efforts to contact him or her have been unsuccessful. Even a beach towel to beach towel search in Tortola was apparently unsuccessful in locating this guy.
Perhaps the web master is on a two-month vacation. But is it not also possible that Breathe California of Sacramento-Emigrant Trails doesn't really care about the fact that for the past several months, its web site has contained a blatantly false statement? I'm beginning to think so.
ASH's claim that thousands of children die each year from secondhand smoke is equally inaccurate. At very best, ASH could contend that thousands of infants die each year from SIDS caused by secondhand smoke. Even that claim would be suspect, although at least there is some scientific evidence to support it. But to claim that thousands of children die each year from secondhand smoke is ridiculous. There is no evidence at all I am aware of that thousands of children die from secondhand smoke.
While it is true that secondhand smoke causes thousands of respiratory and ear infections and hundreds of thousands of asthma exacerbations among children each year, I have seen no evidence that this is resulting in thousands of deaths among these children. Thousands of hospitalizations - yes. Thousands of deaths - fortunately, no.
Given the fact that I am a strong proponent of workplace smoking bans and of educational efforts to protect children from secondhand smoke, my point is obviously not to challenge the evidence that secondhand smoke is a severe health hazard. In fact, quite the opposite. By making ridiculous statements like this, anti-smoking groups are risking undermining of the public's appreciation of the hazards of secondhand smoke. If people find that anti-smoking groups are distorting and exaggerating their claims, people may end up dismissing all anti-smoking claims, even legitimate ones regarding the real health effects of secondhand smoke.
Why do these anti-smoking groups need to distort the truth? Why is the truth not enough? Why risk the entire credibility and reputation of the tobacco control movement simply to be able to make more outlandish statements? And most ironically, why distort the truth when anti-smoking groups spend so much time criticizing tobacco companies for doing just that?