SmokeFreeOhio Apparently Decides to Retain Fallacious Scientific Claims

As of this morning, SmokeFreeOhio's website still contained a number of fallacious claims about the acute cardiovascular effects of secondhand smoke. I have outlined these fallacious claims in detail in a previous post, citing the relevant scientific literature to explain why the claims are inaccurate.

Briefly, SmokeFreeOhio is making four claims that I think are inaccurate:

(1) that 20 minutes of secondhand smoke exposure reduces "the ability of the heart to pump" and puts "a nonsmoker at an elevated risk of heart attack";

(2) that 30 minutes of secondhand smoke exposure "can cause narrowing of blood vessels, restricting the flow of blood and contributing to hardening of the arteries.";

(3) that 30 minutes of secondhand smoke exposure causes "building up fat deposits that could lead to heart attacks and strokes"; and

(4) that 120 minutes of secondhand smoke exposure increases "the chance of an irregular heart beat that can itself be fatal or trigger a heart attack."

The Rest of the Story

The rest of the story is that I communicated my concerns directly to SmokeFreeOhio, both by telephone and by email, back on March 21. This means that almost one full month has transpired since the organization was made aware of the inaccuracy of its claims, yet it has failed to do anything (at least so far) to retract, correct, or clarify these inaccurate statements. The public reading its website continues to be deceived, in what I think is both an irresponsible and dangerous manner, about the health effects of secondhand smoke.

I could understand if it took time for an organization to conduct a careful scientific review of the evidence and therefore it took a month to correct the "fact sheet." But you would think that the statements in question would be temporarily removed from the website until a corrected version could be produced. That appears not to be the case, as the "fact sheet" remains unaltered up on the web site.

I'll be honest. I'm getting the impression that the anti-smoking movement, at least in the United States, doesn't care much about the integrity of the science it puts out to the public. The overwhelming concern seems to be the agenda, and if the science needs to be manipulated or distorted in order to advance the agenda, that's apparently fine. After all, the ends justifies the means, and we're doing this for the children.

This is in contrast to our counterparts in Great Britain, where the British Heart Foundation has commendably corrected an inaccurate communication of its own about the health effects of secondhand smoke.

I have been criticized on this blog for having the chutzpah to suggest anything negative about anti-smoking groups in public, rather than keep my feelings to myself and internally communicate my concerns to the relevant groups. The truth is that I have communicated my concerns to some of these groups and the response, so far, has been absolutely nothing. So much for that suggestion.

I don't know, for sure, whether the anti-smoking groups simply don't care about the accuracy of their public statements or whether they actually think they are correct, but either possibility is scary. If they don't care about our scientific integrity, then I think the movement is no longer viable. But if they care, but don't think their statements are inaccurate, then our scientific expertise is clearly lacking, and again, I don't think the movement is viable in its current state.

Ultimately, our credibility is going to fall apart. I realize that this has not happened yet, but we need to be aware that when it happens, it can happen almost over night. I'm doing what I can, but it seems that I'm up against a solid brick wall (at least here in the U.S.).

British Heart Foundation Corrects Inaccurate Claim about Effects of Secondhand Smoke

Apparently in response to criticism from me and others about an inaccurate claim on its website, the British Heart Foundation has changed its web site to correct its assertion that "for every four non-smokers who work in a smoky environment like a pub, one of them will suffer disability and premature death from a heart condition because of secondhand smoke."

That claim has now been eliminated.

The inaccuracy stemmed from confusion about the difference between relative risk and absolute risk. A 25% increased risk of death among bar workers due to secondhand smoke exposure does not mean that 25% of bar workers exposed to secondhand smoke will die from that exposure. The 25% increased risk is relative risk, but the claim that 25% of bar workers will die from the exposure refers to absolute risk.

The Rest of the Story

The British Heart Foundation is to be congratulated for quickly and decisively correcting this inaccurate public claim. It is clear that this organization is concerned about the accuracy of its scientific statements and when the problem was called to its attention, it promptly responded by deleting the incorrect statement.

I only wish that the 44+ anti-smoking groups which have made inaccurate claims about the acute cardiovascular effects of secondhand smoke would follow the British Heart Foundation's lead by retracting or correcting their fallacious statements.

I think we'll see, pretty quickly, in the days ahead, whether or not the anti-smoking movement is truly concerned about its scientific integrity or whether it is simply trying to push its agenda, even at the expense of the accuracy of its reporting of the science.

Claims by ASH and Other Anti-Smoking Groups Lead to Conclusion that 30 Minutes of Secondhand Smoke Triples Heart Attack Risk

According to a newly-released 11-year study of 40,000 persons, smoking more than triples the risk of heart attack.

The study, conducted by The National Cancer Center in Japan, concluded that: "Men who smoked had 3.6 times the rate of cardiac infarction compared to male nonsmokers. For women the rate was 2.9 times. The risk increases the more one smokes. For men, smoking between one and 14 cigarettes daily made the risk of heart attack 3.2 times higher than for nonsmokers, 15 to 34 cigarettes increased it to 3.6 times, and more than 34 was 4.4 times riskier."

The Rest of the Story

The story here is not the increased risk of heart attacks among smokers, which has been recognized for many years. The story is the magnitude of the increase in heart attacks among nonsmokers exposed briefly to secondhand smoke, according to a number of major anti-smoking groups.

Action on Smoking and Health (ASH) currently claims that: "breathing drifting tobacco smoke for as little as 30 minutes (less than the time one might be exposed outdoors on a beach, sitting on a park bench, listening to a concert in a park, etc.) can raise a nonsmoker'’s risk of suffering a fatal heart attack to that of a smoker."

Since the risk of suffering a heart attack for a smoker is approximately three times greater, ASH is essentially claiming that a single, 30-minute exposure to secondhand smoke triples your risk of having a heart attack.

Obviously, such a claim is absurd and untrue (chronic exposure to secondhand smoke only increases heart disease risk by about 30%, so a single acute exposure couldn't possibly increase heart attack risk by 200%). But this is precisely what ASH is trying to convince the public.

Many other anti-smoking groups, as I have reported, have put out similar communications indicating that the health risks of a single 30-minute exposure to secondhand smoke are the same as those of active smoking. Not only are these claims highly misleading, if not inaccurate, but they are damaging, because they suggest to smokers that their risk of cardiovascular disease is minimal (equivalent to simply breathing in secondhand smoke for 30 minutes).

The tobacco industry has for years tried to undermine our efforts to impress upon smokers the severe hazards of smoking. We, as tobacco control advocates, should not be doing the industry's work for it.

Undocumented Claims of Wrongdoing Being Used to Hold Up Consideration of Ambassadorial Nomination

According to an article in the New York Times, Senator Dick Durbin (D-IL) is holding up the nomination of Associate Attorney General Robert McCallum to become ambassador to Australia over a claim that he acted improperly in changing the government's requested smoking cessation remedy in its RICO-based Department of Justice (DOJ) lawsuit from a $130 billion backwards-looking program to a $10 billion forwards-looking one.

After the DOJ altered its proposed remedy request to the federal judge hearing the lawsuit against the tobacco companies, several Congressmembers and a number of anti-smoking groups accused McCallum of ethical wrongdoing in becoming involved in the lawsuit and forcing the change in the requested monetary remedy. One of these groups - Americans for Nonsmokers' Rights (ANR) - claimed that McCallum was a "former tobacco industry lawyer" and should therefore be charged with a formal ethics complaint for intervening in the tobacco lawsuit. McCallum, however, was apparently not a former tobacco industry lawyer; instead, he was a partner at a law firm that represented R.J. Reynolds.

According to the article: "Sen. Dick Durbin of Illinois said it was premature to place McCallum in a new position of trust as long as the Justice Department's Office of Professional Responsibility is conducting an ethics inquiry into the handling of the tobacco case. Any senator may place a hold on an executive branch nominee, an act that can be overcome with 60 votes."

"At the end of the tobacco trial last year, the Justice Department bypassed the position of one of its own witnesses and reduced the amount the Bush administration was seeking from the tobacco industry from $130 billion to $10 billion. At that time, McCallum, the No. 3 official at the department, defended the reduction against Democrats and anti-smoking groups who said the Bush administration had caved in to the tobacco lobby. McCallum said lowering the figure was dictated by a court ruling that went against the government."

The Rest of the Story

The problem with all of this is that there is no documentation that McCallum did anything wrong, either in participating in the lawsuit or in requesting a different smoking cessation remedy than was originally suggested. In fact, all of the information that seems to be available suggests that McCallum acted properly in seeking and obtaining clearance from the DOJ Ethics Office before participating in the case, and that the decision to request a more narrow remedy was based on an appellate court decision which precluded forward-looking remedies (which the $130 billion request was).

At the time, I criticized a number of anti-smoking groups for issuing a personal attack on McCallum without having proper documentation that any wrongdoing occurred or that the decision to seek an altered remedy was politically motivated, rather than a legal decision motivated by the appellate court's ruling. In fact, the day the news broke about the altered remedy, I opined that it was likely a strategic decision rather than a politically motivated one.

The truth is that the change in remedy did not weaken the DOJ's case at all. As it stood, the $130 billion requested remedy had zero chance of being ordered by Judge Kessler and upheld by the Appeals Court. It clearly represents a forwards-looking remedy that, in the judgment of the appellate court, is specifically not allowed by the RICO statute. If anything, the change in remedy strengthened the legal case somewhat because it is a narrower remedy that has at least some forwards-looking components (not that I think it has any chance of being upheld either, but it is better from a legal standpoint than the $130 billion request).

Thus, there are not very solid grounds for accusing McCallum of weakening the case.

Neither is there solid evidence to suggest that he committed any ethical wrongdoing. He apparently did not represent R.J. Reynolds in the past (in contrast to what was suggested to the public by ANR) and such a conflict of interest, if it existed, would actually have created a grievance on the part of R.J. Reynolds and the other tobacco company defendants.

The real concern is one of bias on his part. However, he did the appropriate thing which was to disclose the potential problem and seek clearance from the DOJ Ethics Office. Clearance was granted. Thus, I simply do not see any grounds for accusing McCallum of ethics violations.

Sure - an ethics investigation is not unreasonable under the circumstances just to make sure that there was no foul play. But the man should be presumed to be innocent until he is proven guilty or until there is something a little more solid than the completely undocumented accusations that are being made by Durbin and the anti-smoking groups.

The nomination should not be blocked on these weak grounds. As such, it certainly has the appearance that this action is purely politically motivated.

The rest of the story is that while the actions of Associate Attorney General Robert McCallum appear to have been motivated by legitimate legal concerns, the actions of his accusers and attackers (several Congressmembers and anti-smoking groups) appear to be motivated by political concerns and by a lack of understanding of the legal issues underlying the DOJ tobacco lawsuit.

Anti-Smoking Groups Reporting the Opposite of the Science On Acute Cardiovascular Effects of Secondhand Smoke

I have been actively reporting the fallacious claims being made by a large number of anti-smoking groups regarding the acute cardiovascular effects of secondhand smoke (post #1; post #2; post #3; post #4; post #5; post #6; post #7).

Lest readers obtain the impression that these fallacious claims merely represent exaggerations of scientific findings or overstating a case, I here discuss a number of cases where anti-smoking groups present scientific claims that I think communicate the opposite of the findings of the scientific studies upon which they are based.

Let's consider the following three claims:

1. This past Friday, SmokeFree Wisconsin publicly claimed that: "In five minutes of exposure to secondhand smoke, your body starts closing off arteries."

2. The Oregon Department of Human Services claims that: "Experts have found that just 30 minutes of secondhand smoke exposure can impair blood flow to and from the heart in non-smokers."

3. SmokeFreeOhio claims that: "After twenty minutes of exposure to secondhand smoke, a nonsmoker'’s blood platelets become as sticky as a smoker'’s, reducing the ability of the heart to pump and putting a nonsmoker at an elevated risk of heart attack."

The Rest of the Story

1. The SmokeFree Wisconsin claim

The claim here is that 5 minutes of secondhand smoke exposure causes arteries to start to close off. Presumably, this claim is based on an errant interpretation of the study by Stefanidis et al., which showed that 5 minutes of exposure to secondhand smoke decreased aortic distensibility in patients with coronary artery disease (see: Stefanidis S, et al. Unfavorable effects of passive smoking on aortic function in men. Annals of Internal Medicine 1998; 128:426-434).

While this study did demonstrate that the aorta stiffens slightly in response to a brief secondhand smoke exposure, it certainly did not demonstrate that the aorta (or any other artery) starts to "close off."

In fact, the study showed that the aorta actually opened up a bit. The authors reported that: "The mean systolic and diastolic aortic diameters during the study are shown in Figure 5. Both diameters increased with passive smoking over time (peak at 4 minutes, 23.98 mm for systolic diameter [P = 0.04] and 22.53 mm for diastolic diameter [P = 0.001]."

In other words, this study showed that the aorta actually widened slightly in response to an acute secondhand smoke exposure. It did not close off, nor did it even start to close off.

The rest of the story here is that the very study upon which the scientific claim is based actually showed the exact opposite of the claim that is being made.

Now by no means am I suggesting that it would be accurate or scientifically honest to communicate to the public that secondhand smoke exposure improves blood flow by dilating the aorta slightly. This observed effect is not clinically meaningful in terms of the acute health of an individual without severe coronary artery disease. The point is that the acute clinical significance of this finding is essentially nil in an otherwise healthy individual.

The significance of the study's findings is that they demonstrate how an acute exposure affects the function of an artery , decreasing its elastic properties due primarily to increased smooth muscle tone. These changes are important because they explain why chronic exposure to secondhand smoke can result in atherogenic changes. Ultimately, the study helps to provide biologic plausibility for the observed finding of increased heart disease risk among adults chronically exposed to secondhand smoke.

What the study does not show, however, is that 5 minutes of secondhand smoke exposure causes the body to start closing off arteries.

It may also be important to point out that this study is really only relevant to individuals with existing coronary artery disease. As the authors themselves point out: "All participants were men, most of whom had coronary artery disease. Thus, we can only speculate about whether aortic function in other groups, such as women or persons without coronary artery disease, responds similarly to tobacco smoke exposure."

2. The Oregon Department of Health Services claim

The relevant claim here is that 30 minutes of secondhand smoke exposure impairs blood flow from the heart.

However, the scientific literature demonstrates that acute secondhand smoke exposure increases blood flow from the heart: specifically, it results in an increase in cardiac output (blood flow from the heart).

For example, Stefanidis et al. found that acute exposure to secondhand smoke increased cardiac output: "The mean heart rate and cardiac index increased over time in the passive smoking group ... Both passive and active smoking caused an increase in heart rate and cardiac output." (see: Stefanidis S, et al. Unfavorable effects of passive smoking on aortic function in men. Annals of Internal Medicine 1998; 128:426-434).

So again, the rest of the story here is that the very studies upon which the scientific claim is based actually showed the exact opposite of the claim that is being made.

Now again, by no means am I suggesting that it would be accurate or scientifically honest to communicate to the public that secondhand smoke exposure improves blood flow from the heart by increasing cardiac output. This observed effect is not clinically meaningful in terms of the acute health of an individual without severe coronary artery disease. Again, the point is that the acute clinical significance of this finding is essentially nil in an otherwise healthy individual.

The significance of the finding, again, is that it demonstrates a mechanism by which secondhand smoke could contribute to the diminishing of aortic elasticity, and ultimately (with repeated, chronic exposure) to disease.

What the evidence does not show, however, is that 30 minutes of secondhand smoke exposure impairs blood flow from the heart.

3. The SmokeFreeOhio claim

The claim here is that 20 minutes of secondhand smoke exposure reduces the ability of the heart to pump.

But here again, the scientific literature demonstrates that acute secondhand smoke exposure increases blood flow from the heart; it increases cardiac output (blood flow from the heart).

Once again, the rest of the story here is that the very studies upon which the scientific claim is based actually showed the exact opposite of the claim that is being made.

Conclusion

What I have shown is that the claims being made by many anti-smoking groups about the acute cardiovascular effects of secondhand smoke are not merely exaggerations or examples of overstating the findings of a scientific study. They are, in fact, complete misrepresentations of the science which in some ways communicate the exact opposite of what the scientific studies actually reported.

From 30 Minutes to 20 Minutes to 5 Minutes: 300 Seconds to Artery Closure from Secondhand Smoke - Can the Claims Get Any More Absurd?

First, it was 30 minutes: Action on Smoking and Health (ASH) claimed that just 30 minutes of secondhand smoke exposure increases a nonsmoker's risk of a fatal heart attack to that of a smoker's.

Then, it was 20 minutes: SmokeFreeOhio claimed that just 20 minutes of secondhand smoke reduces the heart's ability to pump and puts a nonsmoker at increased risk of a heart attack.

Now, it is just 5 minutes.

Yes, that's right.

Just 5 minutes of exposure to secondhand smoke can be fatal. According to SmokeFree Wisconsin, it takes only 300 seconds of secondhand smoke exposure for the body to start closing off arteries.

This past Friday, SmokeFree Wisconsin publicly claimed that: "In five minutes of exposure to secondhand smoke, your body starts closing off arteries."

The Rest of the Story

As a physician, I can tell you that if the body starts closing off arteries, you are at great risk of catastrophic injury or death. It depends what artery you are talking about, but the effects could range from losing a limb to suffering a heart attack or stroke to death.

If SmokeFree Wisconsin's claim were true, I think we would have no choice but to ban smoking just about everywhere. If only 5 minutes of exposure causes nonsmokers arteries to start closing off, then there would simply be no excuse to allow any smoke exposure whatsoever in public places.

In fact, I could easily criticize SmokeFree Wisconsin in this post for not calling on an immediate ban on smoking in all public places, indoors and outside. If they truly believe that 5 minutes of secondhand smoke exposure causes nonsmokers' arteries to become closed off, then there is simply no justification for their not calling for a ban on smoking. This is a level of risk that would be irresponsible for a public health group to accept. And it would be almost criminal for SmokeFree Wisconsin to knowingly ignore these data and allow people to die of artery closure left and right because of secondhand smoke exposure.

The fact is, however, that SmokeFree Wisconsin is not calling on a complete and immediate ban on smoking. Presumably, they are aware that just 5 minutes of secondhand smoke does not actually cause nonsmokers' arteries to close off.

But if that's true, then they are being dishonest in this public communication in an intentionally deceptive way. In other words, they would be lying.

So which is it? Is SmokeFree Wisconsin serious about the "fact" that nonsmokers exposed to 5 minutes of secondhand smoke suffer closing off of their arteries (and therefore catastrophic events or death)? If so, then how can they justify sitting around and letting all these nonsmokers die (because the prevalence of people being exposed to 5 minutes of secondhand smoke exposure is astronomical)?

Or does SmokeFree Wisconsin know that nonsmokers are not actually suffering artery closure due to 5 minutes of secondhand smoke exposure and therefore there is no need to completely ban smoking? But if this is the case, then are they not lying in publicly claiming that 5 minutes of exposure does lead to artery closure in nonsmokers?

This is a no-win situation for SmokeFree Wisconsin, and I'm afraid it's a no-win situation for the anti-smoking movement. Either we have to immediately call for a complete ban on smoking, now that we have the "knowledge" that just 5 minutes of secondhand smoke exposure is catastrophic, or we have to call for a retraction of this claim and a public apology.

Frankly, this is getting a bit ridiculous. These claims are becoming so absurd that I don't know how the anti-smoking movement thinks it can continue to get away with this. And if we are "caught," is our credibility not going to suffer considerably?

It is difficult to know exactly where this absurd scientific claim comes from, but presumably it is a completely errant interpretation of the study by Stefanidis et al., which showed that 5 minutes of exposure to secondhand smoke decreased aortic distensibility in patients with coronary artery disease (see: Stefanidis S, et al. Unfavorable effects of passive smoking on aortic function in men. Annals of Internal Medicine 1998; 128:426-434).

While this study did demonstrate that the aorta stiffens slightly in response to a brief secondhand smoke exposure, it certainly did not demonstrate that the aorta (or any other artery) starts to "close off."

In fact, the study showed that the aorta actually opened up a bit. The authors reported that: "The mean systolic and diastolic aortic diameters during the study are shown in Figure 5. Both diameters increased with passive smoking over time (peak at 4 minutes, 23.98 mm for systolic diameter [P = 0.04] and 22.53 mm for diastolic diameter [P = 0.001]."

Incidentally, if secondhand smoke caused the aorta to close off, the result would be instant death. People would be walking into bars and dropping dead within minutes. And you would have to dodge all the dead bodies on the gaming floor to play the slots at the New Jersey casinos.

On March 13, I jokingly wrote: "So as we stand today, the claim that 30 minutes of secondhand smoke exposure increases heart attack risk among nonsmokers is a conservative one. Now we're down to 20 minutes. Does any anti-smoking group care to go for 10 minutes? Anybody? Anybody?:

Well Friday, my question was answered. SmokeFree Wisconsin came through. And in a grand way.

They beat 10 minutes, and came in at just 5 minutes.

Does any anti-smoking group want to go for 1 minute?

IN MY VIEW: Why the Tobacco Control Movement Seems Unable to Produce Solid Scientific Communications

In past weeks, I have exposed the story of anti-smoking groups widely disseminating completely false information about the effects of secondhand smoke (ASH fallacious claims; SmokeFreeOhio fallacious claims; ANR fallacious claims; 25 more anti-smoking groups' claims; 16 more groups' claims; British Heart Foundation fallacious claim).

Here I address the question of why it is that the tobacco control movement seems to have lost its ability to screen out inaccurate and misleading public communications about the scientific issues underlying their efforts to promote smoke-free policies.

The Rest of the Story

I think the fundamental reason for the loss of the movement's ability to ensure the scientific integrity of its communications is that it has been overcome by a mentality that has destroyed its internal gatekeeping ability.

Let me explain.

In most areas of public health in which I have been involved, there is a strong system of "checks and balances" by which scientific communications are screened internally both before and after they are made.

Before they are made, health claims of potentially extreme consequence are screened by experts in the field to make sure that they are valid and that there is sufficient documentation to back them up. After they are made, experts in the field feel comfortable refuting the statements if they view them to be false. Thus, there is a constant pressure on advocates to ensure that their statements are accurate before they make them.

This is the situation that I believe existed in the tobacco control movement (and I observed and took part in its existence) up until the past few years. In the past, when I have worked with tobacco control groups, I have observed an extreme level of care and concern in developing public communication materials. Everything had to be well-documented and the mentality was one by which we could not take chances, because the tobacco industry was out there "waiting for us" and would refute any undocumented claims that we made. Everyone seemed to be scared of saying anything that might be inaccurate for fear that the tobacco industry would pounce on us and discredit us.

In fact, in many situations, I felt that the degree of scrutiny was far too strong and that a number of statements that I thought should be made were "toned down" because of fear of a slight possibility of misinterpretation, and therefore attack by the tobacco industry. The fear of being discredited publicly was a paramount concern in everyone's mind.

In addition, most of the people working at the organizations with which I collaborated were life-long advocates, mostly unpaid volunteers. They were not particularly skilled at (or slick) public relations, and therefore, almost all potential communications were reviewed by experts in the field before they went public.

But three major changes have taken place in recent years.

The first is the tobacco industry's fall from grace and loss of its ability to effectively discredit tobacco control groups. Largely due to its own legal problems and the fact that it started losing tobacco lawsuits and was forced to release millions of damning internal documents, the tobacco companies were put on the public relations defensive, rather than the offensive, and the threat of being discredited by tobacco companies was all but removed from the picture. In addition, I believe the tobacco companies have made a decision to be far less aggressive in intimidating and threatening tobacco control groups and have largely been leaving groups to conduct their business without interference.

The second major change is the conversion of the movement from a grassroots (and largely volunteer), social movement to a highly institutionalized, heavily-funded, and overly centralized establishment. Our public relations capacity greatly increased and we now have professional (and slick) public communications expertise. The focus has thus shifted from the integrity of the science to the impact of the potential communications. The priority is to put out the most dramatic, striking, and impactful communication rather than the most accurate, sound, and unassailable scientific statements.

The third change, and the most important in my opinion, is the development of a new mentality - one by which dissent is not allowed and there is no room to disagree with or challenge any of the established dogma of the movement. But what constitutes the "established dogma" of the movement is simply anything that any tobacco control group has stated. If even one group makes a health claim, that becomes the "established dogma" and it cannot be challenged internally.

There is truly no room for any dissent. Anyone who challenges the established dogma is instantly accused of being a tobacco industry mole, a traitor, or a lunatic who has gone over to the "dark side." Advocates are afraid of speaking out to voice any criticism or disagreement with the dogma of the movement specifically because they are afraid they will be viewed negatively. And their fear is probably a well-founded one, based on my own experience.

In this way, the movement has lost its internal gatekeeping mechanism. You can't have an internal gatekeeping ability or any semblance of checks and balances when it is literally impossible for anyone within the movement to challenge a public statement once it has been made.

I cannot tell you how many times advocates have responded to my challenging of inaccurate scientific claims not by discussing the validity of those claims, but by castigating me personally for bringing the truth to the attention of the public. Apparently, the appropriate procedure in the movement is to quietly, secretly, and individually send a note to the relevant groups (even though that would take no less than 45 different letters I'd have to write) to suggest that perhaps they might have made a slight overexaggeration, and then to forget about it and move on to more important things. And that's the response I get from those who do not accuse me of being a traitor or tobacco stooge or having "changed" or gone to the dark side, or being a discredit to the movement.

The internal gatekeeping function of a movement is lost when there can be no internal challenge to the doctrine. Because criticizing a group within the movement is viewed as being traitorous, all it takes for a particular health claim to become doctrine is to make the claim publicly once. Thus, when one group of researchers made the absurd and completely implausible claim that a smoking ban reduced heart attacks by 40% within 6 months, that instantaneously became the prevailing wisdom of the movement, and any challenge to that wisdom instantly became prima faciae evidence of disloyalty to the movement.

Similarly, when a couple of anti-smoking groups completely botched the interpretation of the Otsuka study and mistakenly claimed that it showed that 30 minutes of secondhand smoke exposure could cause atherosclerosis and heart attacks in healthy nonsmokers, this claim became the dogma of the movement, and no longer subject to questioning from within.

I believe that the combination of these three factors has led to the near complete destruction of the tobacco control movement's ability to regulate its own scientific claims.

Whereas the threat of being discredited by the tobacco industry was previously a strong force helping to ensure accuracy in our communications, that force is now all but gone. And there is no threat of being discredited from within because the movement has removed that threat by creating a climate in which no dissent can be expressed from inside the movement without severe repercussions. The only check remaining in the system is the possibility that some external group might put up a fuss, but that's hardly a problem since that group will simply be dismissed as a tobacco industry front group anyway.

The end result: there is really nothing to keep the system in check. It is basically a free for all. Groups can say just about anything they like and they are essentially protected from being held responsible for any inaccuracies, due to an intricate, yet well-functioning system of group-think by which there cannot be any internal wrongdoing (or if there is, it can just be dismissed and the attack will be re-directed towards the individual making the claim of inaccuracy).

Something needs to be done to fix this system. While my priority right now is to try to get groups to correct the inaccurate claims and apologize for misleading the public, in order to save the credibility of the movement, my hope is that some critical attention will be given to reforming the mentality of the movement and confronting the factors that have made this breach of the public's trust possible.

Architect of New Jersey Smoking Ban Admits that Ban Supporters Cowered Down to Economic Interests of Casino Industry

In an interview with ABC News, former New Jersey acting Governor Richard Codey defended the exemption of casinos from the recently-implemented state smoking ban by arguing that it is acceptable to give political favors to influential industries.

According to Codey: "I don't think it's really any different than when you have, for example, a Boeing company in Washington, and legislators who are always trying to help that industry, the airplane industry, because it's a large employer within their state."

Codey defended the ban against complaints by some bars and strip clubs that they would lose business due to the loss of smoking customers: "Where else are the customers going to go? You just have no place to go unless you want to stay at home and have your wife provide that entertainment for you."

The article explains that the health of 50,000 casino workers is compromised by the legislation, which fails to afford them the same protection it provides to bar and restaurant workers in the state.

The article concludes: "But no matter how you try to explain it, tens of thousands of casino employees -— and millions of tourists -— were essentially told by state politicians that their health ain't worth craps."

The Rest of the Story

This story confirms what I suggested in an earlier commentary on the New Jersey smoking ban: this is not a rational public health piece of legislation. It is simply an example of both health groups and politicians cowering down to appease a powerful lobby for purely political reasons.

And the real losers here are the thousands of casino workers who now have to continue suffering the devastating health effects of their exposure to tobacco smoke in their places of employment. And most likely, the exposure will be even higher, as smokers shift from local bars where they can't smoke into the casinos where they can.

Codey has now admitted that the measure was a purely political one and that it was simply a case of politicians cowering down to a powerful political lobby.

What is appalling, however, is the fact that he defends the bill on this basis. Apparently, he sees nothing wrong with doing that.

It appears that in his view, it is perfectly acceptable for powerful political lobbying groups to dictate the health of citizens in his state. I don't know about you, but I don't what purely political interests determining my health. And I don't want my elected officials to cower down to big business and compromise my health because of it. If they're not willing to stand up to big business to protect health, then sit down - somewhere other than the legislative chambers.

While Codey has a response to the concerns of bar and strip club owners that the ban will cost them business ("No it won't because where else are people going to go to drink and to see naked women"), apparently the same argument does not apply to casinos ("Where else are people going to go to gamble?") This is classic politician double-speak and hypocrisy.

What I find most disappointing, however, is not the attitude of these policiticians. I have come to expect this type of attitude and behavior from them. What is most disappointing to me is the fact that the New Jersey health groups were behind the politicians all the way. They supported the compromise; they participated in the cowering down to the casino lobby.

Even the somewhat radical national anti-smoking group that I have criticized for its inappropriate aggressiveness - Americans for Nonsmokers' Rights (ANR) - cowered down to these powerful political interests, going so far as completely misleading its constituents into thinking that the measure protected casino workers.

Sure - anti-smoking groups are busy at work now trying to amend the just-enacted bill to strengthen it to include casinos. But that's going to be far more difficult than it would have been to simply insist on a level playing field to begin with.

If the politicians are going to make these compromises, fine, we may have to live with it. But there's no reason why public health groups should compromise the public's health.

Another Inaccurate Scientific Claim Regarding the Health Effects of Secondhand Smoke

An anti-smoking health group is publicly claiming that 25% of all bar workers exposed to secondhand smoke will die of heart disease caused by that tobacco smoke.

If true, this means that about 100,000 of the 474,000 bartenders in the U.S. will die of heart disease due to secondhand smoke exposure at their workplaces. It also means that bar workers face an astronomically high mortality rate (1 in 4).

According to the British Heart Foundation: "We know that regular exposure to secondhand smoke increases the chances of developing heart disease by around 25%. This means that, for every four non-smokers who work in a smoky environment like a pub, one of them will suffer disability and premature death from a heart condition because of secondhand smoke. No responsible government could allow such an appalling public health anomaly to continue."

This statement was also carried to the public in at least one newspaper article. This is North Scotland quoted the Foundation as stating that: "for every four non-smokers who work in a smoky environment like a pub, one of them will suffer disability and premature death from a heart condition because of second-hand smoke."

These claims were apparently made in support of the recently implemented ban on smoking in Scotland pubs and restaurants.

The Rest of the Story

This claim about the health impact of secondhand smoke exposure among bar workers is blatantly false. It stems from a confusion between relative risk and absolute risk of disease.

Relative risk is the difference in risk of disease between individuals exposed to a particular hazard and those not exposed. The relative risk of heart disease death in pub workers due to secondhand smoke is reported here as being approximately 1.25, which means that pub workers are 25% more likely to die from heart disease than they would be if there were no smoking in pubs.

Absolute risk refers to the actual risk of developing a disease if one is exposed to the hazard. A 25% absolute risk of dying prematurely from heart disease among bar workers would mean that 1 in 4 bar workers would be expected to die prematurely from heart disease.

The problem is that the British Heart Foundation statement equates absolute risk with relative risk. While the relative risk of heart disease among exposed nonsmokers is about 1.25, meaning that exposed bar workers are 25% more likely to die from heart disease due to their exposure, the absolute risk of a bar worker dying from heart disease attributable to secondhand smoke exposure is nowhere close to 25%.

The shame here is not merely that an anti-smoking group is using false scientific claims to support public policy but that it is completely unnecessary to do so. There is enough evidence, I believe, of the hazards of secondhand smoke exposure for bar and restaurant workers that we can promote policies to protect the health of these workers without having to resort to misleading and inaccurate public statements and the blatant distortion of the truth.

I think we can effectively promote responsible public health policies while at the same time being truthful. And to be honest, I think we'd be a lot more effective if we did so.

After all, eventually all of these fallacious claims that we're making are going to tip off the public and the media to the fact that we can't be trusted to accurately present the science. And then it's going to become impossible to convince them of the legitimate facts about secondhand smoke - facts that need to be communicated to the public, and for which we need the public's trust.

What's at stake is simply too important to throw it all away just so that we can make some claims that sound very dramatic and alarming.

The truth is enough to support the policies that most of us in tobacco control are working towards. There's no need to go beyond simply telling the truth. And if we don't stop doing it, it's going to destroy our credibility. Then we won't be able to convince anyone of even the true facts about the dangers of secondhand smoke.

International Tobacco Control Conference Brought to You By ... Big Pharma

This coming July, tobacco control researchers and advocates from all over the world will convene in Washington, D.C. to discuss the latest science and policy aspects of tobacco control.

Among the goals of the conference are the following:

• Provide relevant new data on addiction, cessation, public policy, second-hand smoke, smokeless tobacco and other tobacco products, and various epidemiologic issues.
• Examine the impact of the Framework Convention on Tobacco Control.
• Review the status and impact of new tobacco marketing efforts.
• Facilitate the sharing of successful tobacco control efforts, best practices, and effective intervention techniques from around the world.
• Strengthen and expand global leadership and increase the number of organizations and individuals engaged in the fight against tobacco.
• Promote ideas and strategies to create societal, political, and economic change that will help reduce tobacco use and exposure throughout the world.
• Promote the importance and strengthen the understanding of tobacco policy changes, and share strategies to promote such change.

One of the specific topics that will be addressed at the conference is: "individual- and population-based approaches to helping people quit smoking."

One symposium session is entitled "Population Impact of NRT Use." A workshop session will be held on "Effective National Strategies for Tobacco Use Cessation." Another major topic of discussion will be tobacco product regulation. Another presentation will be entitled "Tobacco Industry Sponsored Research: The Fox in the Hen House."

The Rest of the Story

There's just one problem with the conference, and you won't notice it unless you examine the list of sponsors.

Two of the lead sponsors are Pfizer and GlaxoSmithKline.

In and of itself, that is not a problem.

But consider that Pfizer:

• is the manufacturer of Nicotrol, a nicotine patch being promoted by the company as a smoking cessation aid;
• apparently funds research on the use of chest CT screening to scare smokers into quitting smoking (and thus increasing the pool of potential nicotine patch users); and
• has an FDA application in regarding a new smoking cessation medication;

And consider that GlaxoSmithKline:

• is the distributor of Nicoderm CQ, a nicotine patch;
• is the distributor of Nicorette gum;
• produces Wellbutrin, which is used in smoking cessation; and
• apparently is researching new potential smoking cessation pharmaceutical aids.

Also consider that a major debate raging in the tobacco control community is the effectiveness of, and the appropriate role of, smoking cessation pharmaceutical aids as a tobacco control strategy.

How can you objectively discuss the population impact of NRT (nicotine replacement therapy) use at a conference sponsored by two of the leading nicotine replacement therapy drug companies?

How can you objectively discuss effective national strategies for smoking cessation at a conference sponsored by two of the leading nicotine replacement therapy drug companies?

How can you objectively discuss tobacco product regulation (which has major implications for the way in which nicotine replacement therapy products are marketed) at a conference sponsored by two of the leading nicotine replacement therapy drug companies?

How can you objectively discuss all aspects of individual and population-based approaches to helping people quit smoking at a conference sponsored by two of the leading nicotine replacement therapy drug companies?

The answer, in my opinion, is that you can't.

You can't objectively discuss the appropriate role, if any, of nicotine replacement products in a global smoking cessation strategy when the very conference you are attending is being sponsored by perhaps the two leading companies that have a great financial interest in the results of that discussion.

So the upshot is that the World Conference on Tobacco or Health will not offer an objective consideration of the potential role of nicotine replacement products in a national and global smoking cessation strategy.

This is particularly unfortunate given the problems that the tobacco control movement seems to be having these days with its scientific integrity.

And it is at least slightly ironic, I think, given that one of the topics to be discussed at the conference is research sponsored by the tobacco industry and how the fox was apparently guarding the hen house. In some ways, having Pfizer and GlaxoSmithKline sponsor this conference is kind of like inviting the fox into the hen house.

One thing is for sure. A truly objective consideration of the appropriate role of nicotine replacement therapy in a national and global smoking cessation strategy is desperately needed. But such an objective review cannot and will not come out of the 2006 World Conference on Tobacco or Health, specifically because the chief sponsors of the conference are none other than the foxes themselves.

Challenge Issued to Anti-Smoking Groups to Retract Fallacious Scientific Claims

Today I am issuing a challenge to anti-smoking groups which have made fallacious scientific claims about the acute cardiovascular health effects of secondhand smoke: retract or correct these claims and apologize for misleading the public. I think that's the only appropriate thing to do, and I think it's necessary in order to preserve the credibility of the tobacco control movement.

I won't repeat all the specific claims here, but from what I can tell, there are at least 44 groups that have made such claims (and this is not a comprehensive list).

I have summarized the groups and their claims here and here.

I will be monitoring the status of these claims, and will report to my readers if any retractions or corrections are made.

16 More Anti-Smoking and Health Groups Found to Be Disseminating Fallacious Claims About Acute Cardiovascular Risks of Secondhand Smoke

Sixteen more anti-smoking and health groups appear to be disseminating inaccurate information about the acute cardiovascular health effects of secondhand smoke. This revelation comes on the heels of my earlier report that 28 anti-smoking groups were making these completely fallacious claims.

The Claims

Kendall County Health Department: "After only 30 minutes of SHS exposure, your coronary arteries show the same damage as a smoker."

Texas Department of State Health Services: "Just 30 minutes'’ exposure to secondhand smoke can constrict arteries and damage the body'’s ability to supply blood to the heart."

Smoke Free North West: "Short term exposure to tobacco smoke also has a measurable effect on the heart in non-smokers. Just 30 minutes exposure is enough to reduce coronary blood flow."

East Cambridgeshire and Fenland PCT: "Being exposed to 30 minutes cigarette smoke can significantly reduce the coronary blood flow in a fit healthy adult."

Smoke Free Hampshire & Isle of Wight: "Most importantly, just 30 minutes of breathing secondhand smoke affects blood and blood vessels nearly as much as being a pack a day smoker."

Smokefree Wyoming: "Within 30 minutes, your blood becomes stickier, damaging artery linings and restricting flow."

Oregon Department of Human Services: "Experts have found that just 30 minutes of secondhand smoke exposure can impair blood flow to and from the heart in non-smokers."

American Lung Association of Metropolitan Chicago: "People who spend just 30 minutes in a smoke-filled room have a measurable decrease in oxygen delivered to their heart."

New Jersey GASP: "Secondhand smoke hurts people in as little as 30 minutes. Healthy nonsmokers who enter a smoke-filled room show almost immediate changes in their blood, changes that can result in heart disease and stroke."

Hong Kong Medical Association: "Just 30 minutes exposure is enough to reduce coronary blood flow."

Northern Kentucky ACTION: "30 minutes of exposure is enough to increase your risk of heart attack and stroke."

Share Air: "Just 30 minutes' exposure to secondhand smoke can constrict arteries and damage the body's ability to supply blood to the heart."

Smokefree Anchorage Coalition: Secondhand smoke "increases risk of heart attack after just 30 minutes of exposure."

New York City Coalition for a Smoke Free City: "Just 30 minutes of exposure to secondhand smoke greatly increases non-smokers'’ risk of heart disease."

Illinois Coalition Against Tobacco: "Even as little as 30 minutes of exposure to secondhand smoke has a negative effect on arteries and oxygen's flow to the heart is decreased."

Health 24: "Only 30 minutes of exposure to second-hand smoke can damage a non-smoker's heart and increases the risk of heart disease by 30%."

The Rest of the Story

These claims are inaccurate because what the scientific evidence shows is that acute exposure to secondhand smoke can cause endothelial dysfunction - an early step in the atherosclerotic process - and platelet stickiness in healthy nonsmokers. That's it. There's no evidence that a single 30 minute exposure can actually cause atherosclerosis or clogged arteries - and therefore a heart attack - in an otherwise healthy nonsmoker.

In fact, it's completely implausible (and medically impossible) for 30 minutes of exposure to cause atherosclerosis, since it takes many years for this process to occur. And the platelet aggregating effects of a brief secondhand smoke exposure do not present any risk of precipitating a blood clot and causing a heart attack in someone who does not have severe existing coronary artery disease.

It's not even accurate to claim that a 30 minute exposure to secondhand smoke reduces the blood flow to the heart, because what the Otsuka study actually showed is that there was no reduction in coronary blood flow. In other words, 30 minutes of secondhand smoke exposure was documented not to reduce blood flow to the heart.

The truth is that the Otsuka study, which is being used to back up these claims that 30 minutes of exposure reduces blood flow to the heart, actually provides documentation that this brief exposure does not reduce coronary blood flow and therefore poses no acute risk of clogged coronary arteries and an acute myocardial infarction (heart attack).

Some of the claims being made are so fallacious that they completely defy medical science. For example, the claim that "only 30 minutes of exposure to second-hand smoke can damage a non-smoker's heart and increases the risk of heart disease by 30%" is false on its face. You don't need to review the scientific evidence to appreciate the fact that if you spend 30 minutes in a smoky room, you are not going to have a 30% increased risk of developing heart disease. You are not going to have the same risk of developing heart disease as someone who is exposed to secondhand smoke for many years.

Another particularly fallacious set of claims (although it seems to me that a claim is either fallacious or it's not but I don't know what else to call them) is the assertion that 30 minutes of secondhand smoke decreases oxygen delivery to the heart. I have no idea where that came from. I'm not even aware that the Otsuka study measured oxygen delivery to the heart muscle (it did not). So how can a group make such a claim? You practically have to be making it up.

The rest of the story is that the inaccurate and completely fallacious scientific claims being made by anti-smoking groups are so widespread and so blatantly false that they seriously threaten the credibility of the entire tobacco control movement.

Yet instead of responding swiftly and definitely to resolve the problem and end the crisis, anti-smoking groups and many advocates appear instead to be attacking the messenger. This is no time for ad hominem attacks. This is a time to act decisively in an attempt to preserve the credibility of the movement.

Anti-Smoking Groups Helping Philip Morris Execute Its Strategic Plan Without Having to Lift a Finger

In Philip Morris' anti-tobacco control industry strategic plan which I discussed yesterday in relation to the company's success in enticing the Campaign for Tobacco-Free Kids and other national anti-smoking groups to support FDA tobacco legislation, it outlines a strategy by which the credibility of anti-tobacco groups would be undermined by attempting to degrade their positive image among policy makers and the public.

The key to this plan was holding "the leadership of the ATI [anti-tobacco industry] accountable for their statements...". Specifically, "whenever an anti-tobacco advocate makes an 'erroneous statement' in public, we want a 'truth squad' to call them on it."

In other words, Philip Morris was apparently concerned about possibly erroneous scientific claims that anti-tobacco advocates were making publicly and wanted to institute a public communications strategy to call out these erroneous claims to the media's and the public's attention in order to weaken the credibility of the tobacco control movement.

The example used in the Philip Morris memo was the claim that 3,000 kids start smoking every day. But it is clear that the "truth squad" would be an ongoing tactic that would expose any example of a fallacious scientific claim by the "anti-tobacco industry."

The Rest of the Story

In light of this strategic plan to undermine the credibility of the tobacco control movement, all I can say is that a large number of anti-smoking groups are now handing Philip Morris a golden opportunity to effectively carry out this strategy on a silver platter.

Yes - there's both silver and gold in it for Philip Morris in the recent actions of the tobacco control movement.

The silver is that the movement has handed Philip Morris an opportunity to execute its strategy by making the most outrageous and fallacious possible scientific claims: that 30 minutes of secondhand smoke exposure causes reduced coronary blood flow, hardening of the arteries, clogged coronary arteries, fatal arrhythmias, heart attacks, and death in otherwise healthy nonsmokers.

Let's face it: the 3,000 kids a day starting to smoke claim just didn't cut it in terms of convincing the media and policy makers that anti-smoking groups are full of crap. Because, at least from what I can tell, there are reasonable data to support this assertion. Of course it all depends on how exactly you define a smoker (whether you count someone who just tries a cigarette or someone who becomes a regular smoker, etc.). But the point is: there are reasonable scientific data upon which to base such a claim. Philip Morris was simply not going to win any major victories going to the media with this one.

In contrast, the 30 minutes of secondhand smoke is fatal claim is a gold mine. It is so utterly fallacious that it falls apart, even to a member of the media, on its face. You don't need to have a medical degree to appreciate the fact that it takes more than 30 minutes to develop hardening of the arteries and that there is no way that 30 minutes of secondhand smoke could present the same risk of a heart attack as a lifetime full of daily, repetitive active smoking.

Here, you are not talking about shades of interpretation. You are not talking about how you define a particular term. You are not even talking about an exaggeration or overstatement. Instead, you're talking about a complete misrepresentation of the scientific truth. It is not plausible, much less scientifically or medically possible, for the anti-smoking claims about the acute cardiovascular effects of secondhand smoke exposure to be true.

The gold is that it is not just one crazy advocate or group that is making these claims. In the original Philip Morris strategic plan, the idea was to try to discredit a small number of specific anti-smoking advocates, and to make the whole movement look like a scientific disgrace on account of the actions of a few overzealous individuals. But here, practically the entire movement is making these outrageous claims (or so it seems). I have already identified at least 28 anti-smoking groups that are publicly making these claims. And there apparently are quite a few more who I have yet to expose.

The overblown and inaccurate scientific claims that anti-smoking groups are presently making are a huge mistake not only because they are wrong and because it is irresponsible for public health groups to be disseminating complete misinformation, but also because it is a massive strategic blunder. Why hand Philip Morris a dream-come-true on a silver platter? Why make the most outrageous possible claims so that the tobacco companies can achieve their goal of diminishing the effectiveness of the tobacco control movement by weakening its credibility?

Why would you want to do this to yourself if your aim is to remain viable and effective as a movement? (I'll keep you in suspense - I'll be addressing this question in a subsequent post)

The rest of the story is that the tobacco control movement is on the verge of giving Philip Morris and the other tobacco companies a major hands-down victory. They have presented the tobacco companies with a gift - something that the companies could never have dreamed up in their wildest fantasies.

Can you imagine the tobacco executives sitting around the table discussing this?

"Let's go after them for the 3,000 kids a day claim."

"No, that's not outrageous enough. We need them to say something really outrageous so that we can nail them for it."

"Yeah - something really outrageous. What could that be?"

"How about something like secondhand smoke exposure causes heart attacks?"

"No, that's not outrageous enough. There's some evidence that chronic exposure may increase heart attack risk. We don't want to go there."

"Well what about acute exposure? What if they claimed that a very small amount of exposure - say 4-5 hours - caused fatal heart attacks in healthy nonsmokers?"

"Never. That's too absurd. Even the antis wouldn't make such a ridiculous claim. But maybe something like 4-5 years. Yea, that's it. In just 5 years of secondhand smoke exposure, a nonsmoker's risk of developing a heart attack is the same as that of a smoker."

When your opponent is aiming to undermine your effectiveness by destroying your credibility in the eyes of policy makers, the media, and the public, the last thing in the world that you want to do is to give them perfect ammunition to use against you by making completely outrageous scientific claims. But that's exactly what the tobacco control movement is now doing.

I'm trying to put a halt to it before it's too late. But so far I'm coming up completely empty. And it's a shame, because credibility is something that can not be regained easily, if ever.

ASH Director Threatens Personal Lawsuit Against George Washington University Staff Member if Outdoor Smoking is Not Banned

In what appears to be the first move of its kind ever, the head of Action on Smoking and Health (ASH) has threatened George Washington University's (GWU) director of Risk Management and Insurance with a personal lawsuit filed against him individually for his failure to ban smoking outside all University buildings, according to an article in the GW Hatchet, a student newspaper.

The point of contention is not over indoor smoking, which is already banned in GWU buildings, but over smoking outside of these buildings, within a 25-foot distance.

According to the article, ASH's executive director said in his letter "that Smith [the director of Risk Management] is personally liable for the University's ruling and would be charged individually for his 'failing to act on this important health issue.'"

The article noted that "Banzhaf said last week that the letter also included citations of a study of tobacco smoke outside doorways on the University of Maryland campus. The study showed that it caused air pollution in the U.S. Environmental Protection Agency's 'Code Red' category, meaning that it could pose an acute and chronic threat. The suit, Banzhaf said, would call for Smith to settle the case in front of a special D.C. Office of Human Rights jury - not in a regular court. Smith, as well as GW's General Counsel's Office, directed all questions to GW's Media Relations department. 'The University will support Mr. Smith,' assistant director of Media Relations Matt Lindsay said last week. 'In this case, we do not think that the letter sets out anything which would support a lawsuit.'"

The Rest of the Story

This is going way too far. To promote the adoption of an outdoor smoking ban at a university is one thing. To try to hold an individual university staff member liable for failure to adopt an outdoor smoking ban is quite another.

In addition to being frivolous because there are simply no legal grounds upon which to hold this individual personally liable for a decision that was made in a rational manner and based on a legitimate legal and practical concern (the enforceability of such a ban), this action really gives anti-smoking advocates and organizations a bad name by making us all look like fanatics who will sue anyone and anything in our way to pursue an overzealous agenda of trying to cleanse our world of smokers.

I want to make it clear that I don't buy the science argument for a minute. Sure - the levels of secondhand smoke outside a building entrance can be quite high. But nobody works outside the entrance to a building and stays there all day. You just move right through it and that's the end of it.

Now it may be true that there are a small number of people who are extremely sensitive to secondhand smoke: severe asthmatics for example. For such individuals, I think appropriate and reasonable accommodations can be made. But a legislated approach, where smoking is banned outside every building in a large area of a big city, is overkill.

Remember that because of the location of GWU in the urban center of Washington, D.C., a 25-foot no-smoking zone around every university building would essentially represent a complete ban on smoking in most outdoor areas of the section of the city where the university is located - including streets, sidewalks, and parking lots.

Even if secondhand smoke were a significant public health problem in outdoor public places where nonsmokers could easily avoid the smoke, I don't think you sue an individual employee for failure to adopt such a policy. Sue the university if you like, but it's not fair or appropriate to hold an individual responsible for an institutional policy like this. And I'm very glad that the university is going to defend this individual, even though I am an anti-smoking advocate myself.

It is becoming increasingly difficult for me to successfully argue that the anti-smoking movement is not turning into a completely fanatical movement. And an action such as this one makes it infinitely more difficult.

We have become absolutely crazy - meshuginah, for those of you who speak a little Yiddish.

Challenge Issued to Anti-Smoking Groups: Identify Study that Demonstrates 30 Minutes of Secondhand Smoke Causes Heart Attacks or Retract these Claims

Today I am issuing a challenge to the large number of anti-smoking groups which have made fallacious claims about the acute cardiovascular effects of secondhand smoke: either identify a scientific study which documents that 30 minutes of exposure to secondhand smoke causes heart attacks in healthy nonsmokers or retract these fallacious claims.

According to the widespread propaganda being spread by the anti-smoking movement, 30 minutes of secondhand smoke exposure causes hardening of the arteries, clogged coronary arteries, reduced coronary blood flow, catastrophic or fatal cardiac arrhythmias, heart damage, reduced ability of the heart to pump, heart attacks, and death in nonsmokers, even in those who don't have severe existing coronary disease.

These claims are presently being made by a large number of national anti-smoking groups, including Action on Smoking and Health, Americans for Nonsmokers' Rights, and the Campaign for Tobacco-Free Kids, and by a large number of state and local groups as well, including SmokeFreeOhio, TobaccoScam, and many other state and local anti-tobacco coalitions.

Given the profound implications of such scientific claims for the public safety, I think it is only appropriate that these groups be asked to provide at least one scientific study that documents their claims. I am therefore challenging these anti-smoking groups to provide even a single study that documents that among healthy nonsmokers (without pre-existing severe coronary artery disease), 30 minutes of secondhand smoke causes any of the following:

• hardening of the arteries ;
• clogged coronary arteries;
• reduced basal coronary blood flow;
• catastrophic or fatal cardiac arrhythmias;
• heart damage;
• reduced ability of the heart to pump;
• heart attacks; or
• death.

The Rest of the Story

I can tell you now that no anti-smoking group will be able to win this challenge.

The reason is quite simple: there is simply no scientific evidence that 30 minutes of secondhand smoke exposure causes any of the serious health effects listed above.

In fact, it is completely implausible (actually, impossible) for a 30 minute exposure to secondhand smoke to cause most of the above effects. Hardening of the arteries, for example, is a process that takes years (probably a minimum of 20 years). It simply cannot happen in 30 minutes. So there can't be any scientific evidence that 30 minutes of secondhand smoke exposure causes hardening of the arteries, even though a large number of anti-smoking groups are making precisely such a claim.

If it were possible, then one would see very young individuals suffering heart attacks. But the truth is that it is extremely rare to see anyone under age 40 suffer a heart attack simply because they smoked. Since many people start smoking in their teens, this means that it takes a minimum of 20-30 years, not 20-30 minutes, for tobacco smoke exposure to cause atherosclerosis (hardening of the arteries).

If the anti-smoking groups changed the word "minutes" to "years," then I think they might be able to provide scientific studies to support their assertions. But this means that they are off by a factor of about 525,600, or half a million. That's five orders of magnitude.

To call these claims exaggerations is therefore an injustice to the word "exaggerate." They are not merely exaggerations - they are completely fallacious.

I think the tobacco control movement should have a little more scientific integrity then to present scientific information that is off by a factor of half a million. I think we should be able to do a little better than that. And more importantly, we should care about doing a little better than that.

What am I supposed to tell the media when they question me about my opinions about whether the scientific claims of anti-smoking groups can be trusted: "Yes, absolutely...well, kind of...they are definitely within five orders of magnitude."

And how are we to retain any credibility on any scientific issue - including the issue of the chronic health effects of secondhand smoke - when we are off by a factor of half a million on the acute effects of secondhand smoke?

I'll shortly be calling for a retraction of these public claims, but first, let's see if any of the groups making them can provide documentation to back them up. Good luck to all the groups!

Heart Attack on a Plate: Top 10 List of Foods that Can Cause an Immediate, Fatal Heart Attack

According to the reasoning of at least 28 anti-smoking groups, transient changes in endothelial dysfunction imply an increased risk of an immediate, fatal heart attack. These groups have claimed that because a study by Otsuka et al., published in JAMA, showed that 30 minutes of exposure to secondhand smoke causes endothelial dysfunction in nonsmokers, those individuals who are exposed transiently to secondhand smoke are therefore at risk of developing atherosclerosis and suffering a heart attack.

Another article published in JAMA demonstrated that eating a single high-fat meal also causes endothelial dysfunction in healthy individuals. In this study, endothelial dysfunction was measured as flow-mediated artery dilation (identical to the way that endothelial dysfunction was measured in the Otsuka study).

The study concluded that "A single high-fat meal transiently reduces endothelial dysfunction for up to 4 hours in healthy, normocholesterolemic subjects, probably through the accumulation of triglyceride-rich lipoproteins." (see Plotnick GD, Corretti MC, Vogel RA. Effect of antioxidant vitamins on the transient impairment of endothelium-dependent brachial artery vasoactivity following a single high-fat meal. JAMA 1997; 278:1682-1686).

The endothelial dysfunction in this study was caused by a meal containing 50 grams of fat.

Thus, anti-smoking groups should be cautioning the public not to eat any of the following foods that can apparently trigger a heart attack, as they contain 50 or more grams of fat and will therefore cause endothelial dysfunction:

10. Two servings of Sonic cheese tater tots

9. Five ounces of sour cream and onion-flavored potato chips

8. Eleven Hostess twinkies

7. Five Kellogg's brown-sugar cinnamon pop tarts

6. One serving of Chicken McNuggets (20 piece)

5. Two Quarter Pounders with cheese

4. One Burger King bacon double cheeseburger deluxe

3. Two classic Cinnabon rolls

2. One Chick-fil-A chicken deluxe sandwich with 3 packages of Polynesian dipping sauce and small cole slaw

1. One Taco Bell beef and potato burrito with 3 tablespoons guacamole and 3 cinnamon twists

If you are at risk of heart disease or even if you are completely healthy, do not eat the above foods. You will be at risk of keeling over and dropping dead from a heart attack.

Note, however, that you can safely have 8 servings of the highly-recommended tater tot casserole.

Campaign for Tobacco-Free Kids' Support for FDA Legislation Part of Philip Morris Plan

A 1996 Philip Morris internal document reveals that enticing an anti-smoking group to support the company's call for federal regulation of tobacco products in order to divide the tobacco control community was part of a considered strategy to undermine the effectiveness of the anti-tobacco groups.

According to the document, one of four strategies to undermine the effectiveness of the tobacco control movement was to "Put the ATI [anti-tobacco industry] on the defensive to enhance internal conflicts and cause divisions among its leadership regarding strategies and tactics."

To carry out this plan, Philip Morris wanted "to challenge members of the Anti Tobacco Industry to join us in achieving real solutions on issues of common concern. We will invite them to ... support our efforts to pass federal legislation."

The Rest of the Story

As it turns out, Philip Morris was successful in enticing the largest (at least in terms of funding) of the anti-smoking groups - the Campaign for Tobacco-Free Kids and the American Heart Association, American Lung Association, and American Cancer Society - to support its efforts to pass federal legislation to place regulatory authority over tobacco products in the hands of a politicized Food and Drug Administration, but at the same time, tying the hands of the agency in ways that Philip Morris considered essential to preserving its profitability.

Indeed, these four anti-smoking groups are now leading the charge for the enactment of weak federal legislation that would give FDA the authority to regulate tobacco products but would tie its hands in terms of actually taking any major action that might result in substantially safer products. The legislation that these groups are pushing contains precisely the political compromises that Philip Morris insisted upon in order to ensure that the chances of FDA taking any meaningful action that would threaten tobacco company profits would be minimal.

The success of Philip Morris' enticement of these heavily-funded groups also resulted, as planned by the company, of the development of a rift in the tobacco control community, in which the less well-funded groups, mostly at the local level, opposed the national groups in their efforts to help the largest tobacco company protect and preserve its market share and profits.

Why is it that Philip Morris was apparently successful in enticing the Campaign for Tobacco-Free Kids into joining it in pushing for weak FDA legislation? And why was it the most heavily funded groups that were enticed, rather than the groups with very little funding?

I can only speculate. My best guess is that groups like the Campaign for Tobacco-Free Kids and the three major voluntary health groups are unduly motivated by a concern for their own prestige, as well as their continued funding. To achieve federal regulation of tobacco products, for the first time, would be a huge feather in their caps. It would present tremendous public relations (and therefore increased funding) opportunities for these groups.

On the other hand, smaller groups without much funding were perhaps more likely to be motivated by their principles, such as not protecting the profits of the nation's largest tobacco company and not helping to preserve and perhaps increase market share for a particular tobacco company.

Ultimately, then, I think money (and power) is the primary reason why Philip Morris was successful in enticing Tobacco-Free Kids into supporting its plan. It was by dangling that potential feather in the cap (and its resulting meaning in terms of prestige and money) in front of these groups that a tobacco company was, I believe, successful in executing a brilliant plan to undermine the tobacco control movement.

This might ring a bell, as it is nearly an identical enticement (although much more specific in terms of political power and monetary gain) that I think led the Attorneys General to agree to the disastrous Master Settlement Agreement, whose negative effects on the public's health would be dwarfed if the FDA tobacco legislation were actually enacted by Congress.

Philip Morris can now sit back and enjoy watching this scenario unfold. It can practically sit back and let the Campaign for Tobacco-Free Kids, the American Heart Association, American Cancer Society, and American Lung Association do all the dirty work for it in lobbying Congress to promote legislation that is actually the company's chief legislative priority.

I don't think it has any serious chance of passage right now, but if it were to be enacted into law, what I have called the Marlboro Monopoly Act would be a gift to Philip Morris from its well-funded anti-tobacco friends. Friends who have apparently followed the company's public relations plan to a T.

IN MY VIEW: Anti-Smoking Movement Heading Down the Tubes; It's Time to Turn Back

If we were a basketball team, I'd say it's time to look for a new coach: someone who could take the program in another direction. Someone who could take a program that is in a mess and find a way to straighten things out. A Roy Williams kind of guy. Someone with character and integrity. Someone who cared about getting results, but also cared about the way that one gets results. Someone who understood the importance of credibility, character, and reputation.

The anti-smoking movement, I believe, is in a real mess. The highlight of that mess of course is the completely fallacious claims that are being made nationally by many anti-smoking groups. Thirty minutes of secondhand smoke exposure, according to us, causes hardening of the arteries, clogged coronary arteries, heart attacks, and death. Not only that, but it presents a risk for those adverse outcomes that is no different than that of actively smoking for 20-30 years.

We're also in a mess because we continue to make undocumented accusations and claims, attacking individuals and groups of being allied with or fronting for Big Tobacco without having evidence to back up our assertions.

We're in a mess because we are completely misusuing kids to promote our agenda. We are tricking and deceiving kids in order to get them to take an action which is quite possibly not in line with the values that the kids themselves would support. We are using kids to promote our own pet policies without providing adequate information and without informed consent being achieved.

We're in a mess because we're supporting absurd and over-reaching public policies that are neither supported by scientific data or by any reasonable policy analysis.

We're in a mess because instead of trying to help smokers, we have become committed to punishing them, trying to find as many ways as we can to discriminate against them and turn them into second class citizens. And we're rubbing their faces in the dirt by attacking them as being child abusers.

We've become obsessed with our own merit and are going to great pains (including being dishonest) to make our merit known.

We're scheming with Big Tobacco and promoting Philip Morris' legislative agenda.

We've become dominated by bigotry, and laden with hypocrisy.

And this is all in the past two months alone.

Worst of all, we're doing nothing to fix the problem. No one seems to care. No one seems to even acknowledge that there is a problem in the first place. We are simply unable of looking inwards. We are only capable of looking outside and attacking and criticizing others. For ourselves, we can have nothing but self-congratulations, even when it is completely unwarranted. We defend ourselves by attacking others. Or attacking those who are levying the criticism.

Yet the ugly truth is that we are willing to make scientific claims that are so fallacious on their face that even the tobacco companies are unwilling to make similar claims in a situation where they could profit immensely by doing so.

Unfortunately, we don't have a general manager or an athletic director overseeing the situation. Someone who could pull the plug, bring in a new coach, and turn the program around by moving it in a different direction. Nor do we have voting shareholders who could themselves demand a change in the organization and the way it is being run.

There's simply no way to change things that I can see. And so, for now, I have to sit back and watch sadly as the movement goes down the tubes. But not for lack of trying. I have written a total of 427 posts in the 12 months that this blog has been in existence.

My one-year anniversary should be a time to celebrate accomplishments. But instead, it seems more of a time to mourn the near death of what once was a real, grassroots, social movement, rooted in the principles of public health, committed to scientific integrity, honesty, compassion for smokers, and service of the public's trust.

I'm not suggesting that the movement has been perfect. But its flaws were ones that I could live with. For the most part, I could be proud of what we accomplished and the way in which we did it. But not any longer.

Ohio Tobacco Use Prevention and Control Foundation Accuses Ohio Licensed Beverage Association of Working Directly with Big Tobacco

According to an article in The Toledo Blade, the Ohio Tobacco Use Prevention and Control Foundation has apparently accused the Ohio Licensed Beverage Association of working directly with Big Tobacco. Presumably, this is part of an effort by the anti-smoking group to discredit the Beverage Association by tying it directly to tobacco companies and thus undermining its attempts to persuade legislators to oppose a proposed statewide smoking ban.

The article quotes a Foundation official as stating: "I don'’t have memos. I don'’t have canceled checks, but there'’s no doubt in my mind that the tobacco industry is supportive of the licensed beverage organization or the hospitality industry people. I'’m certain there are discussions in which the tobacco industry'’s expertise is being shared with the beverage association."”

The Rest of the Story

This is yet another example of an unsubstantiated attack being made by an anti-smoking group. Here, the group readily admits that it has no evidence to support its attack. It readily admits that it is pure speculation. Nevertheless, the lack of documentation to support its claims apparently fails to stop the anti-smoking group from making this public attack.

If the Foundation does not have memos, if the Foundation does not have canceled checks, and if the Foundation has no other similar documentation to support its contention that the Ohio Licensed Beverage Association is funded by, or working close with Big Tobacco, then it simply shouldn't be making such an accusation. If you're going to make an accusation like that publicly, you ought to have appropriate documentation to support it.

I view anything short of that as being not only inappropriate, but unethical for a public health organization.

I don't exactly know why, but it seems to me that the anti-smoking groups in Ohio are getting a bit desperate in their attempts to promote smoke-free legislation. They are resorting to questionable, irresponsible, and unethical tactics. First, SmokeFreeOhio puts out completely erroneous scientific claims to support the push for a statewide smoking ban. Now, the Ohio Tobacco Use Prevention and Control Foundation makes an undocumented attack on a business group to try to discredit it.

Can't anti-smoking groups behave ethically anymore? Back "in my day," we made our share of attacks against business groups that were fronting for Big Tobacco. But we made those attacks only when we had appropriate documentation of their relationship with the tobacco companies. We didn't just throw these accusations out there knowing that the public would assume that we were correct. We viewed that as not acting responsibly.

And we also made our fair share of scientific claims about the hazards of secondhand smoke. But at least we had some scientific documentation to back up our claims. We didn't spread completely erroneous and scientifically implausible information in order to support our agenda.

Why this desperation? Especially when efforts to protect nonsmokers from secondhand smoke are going so well. It's not like there aren't any smoking bans being enacted. Two major cities and several states have enacted bar and restaurant smoking bans in just the past few months. There's no need for desperate measures.

Of course, I would oppose these desperate and irresponsible measures no matter how poorly advocates were doing in promoting smoking bans. I think they're simply inappropriate tactics. But what gets me is why the groups are using these tactics at a time when there is no desperation in the first place.

As I've said before, if you want to talk the talk, you have to walk the walk. If you have the evidence to support your claims, fine. But if not, then don't make public scientific claims and accusations. Keep it to yourself. Or take it somewhere else. I've had enough of this.