Wednesday, October 25, 2006

Anti-Smoking Advocates Told to Ignore the Science and Continue Making Absurd Health Claims; Rest of the Story Author Implored to Stop Speaking Out

In a message sent to thousands of anti-smoking advocates on a major list-serve, a prominent leader of the anti-smoking movement implored these tobacco control advocates to simply ignore the scientific arguments that I'm making about why a number of claims about the acute cardiovascular effects of secondhand smoke are misleading or fallacious.

The message, entitled "Please ignore Michael Siegel" stated: "Mike Siegel's statements below -- which he claims intimidated SmokeFree Ohio into changing their ads -- are just wrong. The increase in platelet aggregation after 20 minutes makes the platelets as 'sticky' as in a smoker. This DOES put [non]smokers at increased risk of a heart attack."

The message then included the text of the note I sent to a large list of anti-smoking groups, which is the same as my post from earlier today about the failure to respond to my concerns about the fallacious and misleading claims that are being made, such as the claim that 30 seconds of secondhand smoke exposure can cause coronary artery disease.

In further response to my post, anti-smoking advocates are imploring me to stop expressing my opinions. One advocate and researcher wrote: "I do not understand your position. All the anti-smoking information is medically correct. All information qualifiers cannot be added to every 30 second commercial. Your letters and blogging will only help big tobacco kill more folks. Please stop."

The Rest of the Story

I certainly understand the anger that many anti-smoking advocates and groups seem to have to my pointing out the misleading claims that are being made. We have all dedicated much of our lives and our careers to this cause, and it is not easy to be told that what anti-smoking groups are communicating is misleading. I also acknowledge the right of advocates to urge their fellow advocates to ignore my arguments. I don't criticize them for these actions. It would certainly be a lot easier for everyone if this problem simply went away and they are, in their own mind, trying to protect the movement from what they see as a threat. It is admirable to try to confront threats to the movement.

However, what I don't agree with is the scientific arguments that these advocates are relying upon.

1. First, in order to credibly argue that advocates should simply ignore my arguments, one would have to contend that it is indeed accurate to state that 30 seconds of secondhand smoke can cause severe coronary artery dysfunction as bad as that seen in a chronic, active smoker.

After all, that's one of the main points I make in my post. I point out, as an example of the misleading and inaccurate claims that are being made, the following statement from an anti-smoking group's press release: "Research studies have shown that even just thirty seconds of exposure to secondhand smoke can make coronary artery function of non-smokers indistinguishable from smokers."

I don't see any reason why anti-smoking advocates should ignore my concerns about this statement. The statement is not only misleading, it is downright wrong and it is downright ridiculous. There is not a shred of evidence that 30 seconds of secondhand smoke exposure causes damage to the coronary arteries that is the same as that from chronic active smoking.

In fact, anti-smoking advocates should be concerned about this statement not only because it is wrong, but because it undermines the public's appreciation of the dangers of active smoking. The statement implies that active smoking is no worse in terms of coronary artery dysfunction than merely breathing in drifting tobacco smoke for 30 seconds.

2. Second, in order to credibly argue that advocates should simply ignore my arguments, one would have to contend that it is indeed accurate to state that a brief exposure to secondhand smoke puts nonsmokers at the same risk of a fatal heart attack as chronic, active smokers.

After all, that's one of the main points I make in my post. I point out, as an example of the misleading and inaccurate claims that are being made, the following statement from an anti-smoking group's fact sheet: "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."

I don't see any reason why anti-smoking advocates should ignore my concerns about this statement. The statement is not only misleading, it is downright wrong and it is downright ridiculous. There is not a shred of evidence that 30 minutes of secondhand smoke exposure causes the same risk of a fatal heart attack as that of someone who has smoked actively for 30-40 years.

In fact, anti-smoking advocates should be concerned about this statement not only because it is wrong, but because it undermines the public's appreciation of the dangers of active smoking. The statement implies that active smoking is no worse in terms of fatal heart attack risk than merely breathing in drifting tobacco smoke for 30 minutes.

3. Third, in order to credibly argue that advocates should simply ignore my arguments, one would have to contend that it is indeed accurate to state that eating in a smoky restaurant increases the risk of a fatal or non-fatal heart attack by 30%, which is the same amount by which a lifetime of secondhand smoke exposure increases heart attack risk.

After all, that's one of the main points I make in my post. I point out, as an example of the misleading and inaccurate claims that are being made, the following statement from an anti-smoking group's smoking ban manual: "Current scientific data suggest that eating in a smoky restaurant can precipitate myocardial infarctions in nonsmokers and increase the risk of fatal and non-fatal cardiac events in nonsmokers by about 30 percent."

I don't see any reason why anti-smoking advocates should ignore my concerns about this statement. The statement is not only misleading, it is downright wrong and it is downright ridiculous. There is not a shred of evidence that eating in a smoky restaurant, which would provide about 30-60 minutes of secondhand smoke exposure, increases the risk of a heart attack by the same amount as a lifetime of exposure to secondhand smoke.

In fact, anti-smoking advocates should be concerned about this statement not only because it is wrong, but because it undermines the public's appreciation of the dangers of secondhand smoke itself. The statement implies that the risks of lifetime exposure to secondhand smoke are no worse than those of merely eating in a smoky restaurant for an hour or so."

4. Fourth, in order to credibly argue that advocates should simply ignore my arguments, one would have to contend that it is indeed accurate to state that coronary blood flow is reduced in healthy young adults exposed to secondhand smoke.

After all, that's one of the main points I make in my post. I point out, as an example of the misleading and inaccurate claims that are being made, the following statement from an anti-smoking group's smoking ban manual: "Blood flow in the coronary arteries is decreased in healthy young adults exposed to secondhand smoke."

I don't see any reason why anti-smoking advocates should ignore my concerns about this statement. The statement is not only misleading, it can certainly be construed to be wrong. There is not only a lack of evidence that basal coronary artery blood flow is reduced in healthy young adults exposed to secondhand smoke, there is documentation that there is no impairment of basal coronary blood flow in these subjects.

In fact, the Otsuka et al. study which is being relied upon to support this statement actually found that 30 minutes of secondhand smoke did not impair basal coronary blood flow in healthy adults. What was impaired was the coronary flow velocity reserve, a measure of the coronary arteries' ability to dilate in response to artificially imposed stressors. This finding does not mean that someone exposed to secondhand smoke suffers decreased coronary blood flow.

Anti-smoking advocates should be concerned about this statement not only because it is wrong, but because it undermines the public's appreciation of the dangers of active smoking. If a brief exposure to secondhand smoke impairs coronary blood flow, then secondhand smoke is worse than active smoking. Because active smoking doesn't impair basal coronary blood flow until a person develops narrowing of the coronary arteries, which may take no less than 15-20 years to occur.

5. Fifth, in order to credibly argue that advocates should simply ignore my arguments, one would have to contend that it is indeed accurate to state that the heart damage suffered by active smokers is no worse than that suffered by nonsmokers exposed to secondhand smoke for a mere 30 minutes. Obviously, this is a preposterous assertion. How could the damage to the heart caused by active smoking for years be only as bad as that caused by breathing in drifting tobacco smoke for a half hour?

After all, that's one of the main points I make in my post. I point out, as an example of the misleading and inaccurate claims that are being made, the following statement from an anti-smoking group's fact sheet: "Even a half hour of secondhand smoke exposure causes heart damage similar to that of habitual smokers. Nonsmokers’ heart arteries showed a reduced ability to dilate, diminishing the ability of the heart to get life-giving blood."

I don't see any reason why anti-smoking advocates should ignore my concerns about this statement. The statement is not only misleading, it could reasonably be construed as being wrong. If you look at a bunch of long-time active smokers and a bunch of nonsmokers who just ate at a smoky restaurant for a half hour, you will most definitely find that the smokers have a much higher likelihood of, and severity of, damage to the heart than nonsmokers.

Many of the smokers will in fact have had heart attacks from smoking-induced coronary artery disease. These smokers may have severe heart damage. Some may have ejection fractions of only 30-40%, or even less. In contrast, unless the nonsmokers had coronary artery disease from some other cause, none of them will show evidence of heart damage.

Moreover, a decrease in coronary artery flow velocity reserve does not mean that the heart is unable to get life-giving blood. What it demonstrates is endothelial dysfunction, which is significant if the exposure continues or recurs. However, it has no clinical consequences for a mere 30 minute, one-time exposure. The person exposed does not have any problem with their heart not getting life-giving blood. This aspect of the statement is grossly misleading.

In fact, anti-smoking advocates should be concerned about this statement not only because it is wrong, but because it undermines the public's appreciation of active smoking. It implies that the damage to the heart caused by a lifetime of active smoking is no worse than that caused by a mere 30 minute exposure to secondhand smoke. Why should a smoker quit smoking if they are suffering no more damage to his heart than someone who breathes in drifting tobacco smoke for 30 minutes?

6. Sixth, in order to credibly argue that advocates should simply ignore my arguments, one would have to contend that it is indeed accurate and well-documented that secondhand smoke exposure causes debilitating pulmonary emphysema. It would have to be accurate to draw a conclusion that is not found in the Surgeon General's report or in the California EPA report. It would have to be accurate to draw a conclusion that in fact runs counter to what the Surgeon General concluded.

Remember, the Surgeon General concluded that there is not sufficient evidence to conclude that secondhand smoke causes emphysema: "The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and risk for chronic obstructive pulmonary disease."

After all, the fact that many anti-smoking groups are claiming that secondhand smoke causes emphysema is one of the main points I make in my post. I point out, as an example of the misleading and inaccurate claims that are being made, the following statement from an anti-smoking group's fact sheet: "Secondhand smoke can cause the debilitating disease pulmonary emphysema, causing severe damage to the walls of the air sacs, with the lungs eventually losing their capacity to expand and contract."

I don't see any reason why anti-smoking advocates should ignore my concerns about this statement. The statement is not only unsupported by both the Surgeon General's report and the California EPA report, but by relying on cherry-picking the evidence to document this claim, and by ignoring the conclusions of two major reports, anti-smoking groups are undermining the scientific value of the careful consideration of the scientific evidence that the Surgeon General and California EPA provided. If we are going to conclude that secondhand smoke causes a particular disease just based on a few studies, but before the evidence is really solid, then why bother with the Surgeon General's report in the first place?

The idea that secondhand smoke could cause pulmonary emphysema is certainly scary, and definitely worthy of vigorous research. However, it's simply premature to be drawing such a definitive conclusion and disseminating it to the public. It hurts our credibility to be doing so. Anti-smoking advocates should be concerned about this.

All of these arguments are reasons why anti-smoking advocates should not, if they care about our scientific integrity, ignore the concerns that I have expressed. And we haven't even gotten to the issue of whether or not it is misleading to claim that 20 or 30 minutes of secondhand smoke exposure increases your risk of suffering a heart attack.

I'll deal with that issue in more detail in a subsequent post, but for now, let's just stipulate, for the sake of argument, that it is indeed accurate and well-documented that a 20 or 30 minute exposure to secondhand smoke does cause heart attacks in nonsmokers with severe existing coronary artery disease. It is plausible that this is the case, although I personally don't believe there is enough evidence to make such a claim. But forget that - let's just assume that there is plentiful evidence.

My argument, then, is that it is still misleading to make an unqualified claim that brief secondhand smoke exposure increases heart attack risk. To avoid misleading the public, one would have to qualify the claim by making it clear that you are referring to people who already have severe coronary artery stenosis. After all, they are the only ones at risk. A brief secondhand smoke exposure is not going to cause you to develop heart disease if you don't have it already, and it's not going to turn moderate heart disease into severe disease.

So I maintain that I am on solid ground suggesting that many members of the public will be misled by telling them that brief secondhand smoke exposure may cause them to keel over from a heart attack. I contend that people will assume this puts them at risk, even if they don't have severe existing coronary artery disease.

What possible damage could there be from simply stating clearly that: "For people with severe existing heart disease, even a brief secondhand smoke exposure could be the trigger that causes them to have a heart attack."

It is troubling to me that the way the tobacco control movement is responding to these concerns is by trying to simply ignore them. And even worse, by imploring me to keep quiet about the science.

The appearance is that we cannot discuss the science. We must accept as truth everything that is being stated by our anti-smoking groups. If they say it, it must be true. It is not subject to discussion, and any meaningful scientific discussion of the issues must be quelled. We simply cannot allow the science to even possibly get in the way of the statements that we want to make in support of our position.

The advocate who complained that we cannot add qualifiers to every 30-second commercial seems to be agreeing that qualifiers are appropriate and that if we only had the space and time, we should add them. Yet I'm not talking about 30-second commercials. I'm talking about web sites, fact sheets, and manuals, where there is plenty of room to add qualifiers and to present the science accurately and completely, so as not to deceive people.

Of course, the ad hominem approach (telling me that I'm helping Big Tobacco to kill people) is merely a technique (it has been used repeatedly on me) to try to quell dissent from within our troops.

But the bottom line truth is that I'm trying to save the credibility of the movement, because I'm afraid that if we continue to make misleading, inaccurate, and absurd claims, we're going to destroy our scientific reputation. That will "help Big Tobacco to kill people."

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