Smoke and MirrorsButts, Lies and Public Health

THE days of deception on the health risks of ciga rettes aren't over after all - although now the distortion's coming from the "good guys." 

For decades, the industry-funded Tobacco Institute denied the harmful consequences of smoking and did a great disservice to public health.  Today, however, it's anti-smoking advocates spreading the disinformation - overstating certain risks.  But - because such deception undermines the credibility of all public-health work - they're being called on it by one of their own. 

A startling study by Dr. Michael Siegel of Boston University's School of Public Health is pointing the finger at the well-intentioned likes of Action on Smoking and Health, the politically powerful Campaign for Tobacco-Free Kids and New York City's Department of Health. 

In a study published this week in the journal Epidemiologic Perspectives & Innovations, Siegel warns that these groups are wildly inflating the health risks of exposure to second-hand smoke.  In doing so, they tarnish the very credibility that the public-health community must have in order to save lives. 

Siegel is no friend of Big Tobacco - he's a vocal opponent of smoking and a supporter of smoke-free workplace rules.  Indeed, it was his place as a leading member of the tobacco-control community that compelled him to publish his findings that some groups are harming the movement's credibility by overstating the dangers of short-term exposure to environmental tobacco smoke (ETS). 

There is evidence that long-term, high-dose ETS exposure increases the risk of heart disease and heart attack.  And there is speculation that even short-term exposure may be unsafe to those with severe coronary artery disease.  But the evidence does not support the claim that more than 100 groups are wantonly making - which is that acute, transient exposure to ETS increases heart-attack risk in healthy individuals. 

The lack of evidence hasn't stopped Commissioner Thomas Frieden at the city Health Department, which is buying ads in The New York Times claiming that "just 30 minutes of exposure to second-hand smoke produces some of the same physical reactions that would occur from long-term smoking, and increases the risk of heart disease in non-smokers." 

The "evidence" behind that assertion is so flimsy that it would be laughed at if it supported the finding that smoking is less dangerous than we once thought.  The clear implication is that some anti-smoking activists have adopted an "ends justifies the means" approach in pursuit of their noble cause. 

This is what makes Siegel's report so troubling.  No longer can we rely on the public-health establishment for scientifically accurate information.  They'll fudge the numbers if they have to, so long as it promotes their overall agenda - in this case, the drive to outlaw smoking in all public places. 

Even more disturbing is that some in the tobacco-control community are attacking those raising questions.  Siegel was banned from the primary tobacco listserv for simply sharing his dissenting views.  And he's not the only one.  UCLA epidemiologist Dr. James Enstrom has been personally vilified for, in his words, "questioning the lethality of ETS, such as a claim in the 2006 Surgeon General's Report," which alleges that ETS kills about 50,000 Americans per year. 

Science eventually catches up with those who hyperbolize about risks, and the public learns to disregard them.  It would be tragic to see some public-health advocates lose the mantle of sound science and end up going the way of the old Tobacco Institute. 

Cigarette smoking is the leading cause of preventable death in the United States and needs our urgent attention.  Overstating the case may help the advocates win this political battle but at significant cost to the overall public-health war.