The Senate Business and Jobs Committee, link here, (which I serve on) held hearings on the Statewide Smoking Ban bill. The chief author of the bill is Senator Kathy Sheran (DFL-Mankato). Here is a copy of the bill as it came to our Committee.On Feb. 19th, I voted against the bill, even though it was amended in committee to allow exemptions for bars and restaurants if they install ventilation. This blog entry will explain my position. It will be a long entry, but it’s easier to refer people to this website, than to explain a complicated subject to the many people who have contacted me.
MY BACKGROUND
I grew up in a home with 6 children, and parents who smoked. None of the children in our family smoke today, or have suffered any adverse health impact because our parents smoked. I have tried to discourage my own children and others from smoking. Perhaps in this partisan climate, anyone who opposes more government regulation of smoking, feels the need to make an “up-front” disclaimer. So, I just did. I am no apologist for tobacco. I am also a scientist. My degree is in Chemical Engineering. I worked at 3M Co. as an advanced research engineer for about 5 years before I moved to Northfield to practice law. I approach issues analytically. I try to challenge scientific claims before I make decisions.
GENERAL COMMENTS (MY OPINION)
About 20-25% of adults smoke today. This is a much lower percentage than 30 years ago. That’s a good thing, and no doubt helps to reduce cancer and cardiac problems. We all know of people who died of cancer or emphysema because of smoking. My law partner’s wife was one of them. But, if second hand smoke is such a public health hazard, then we should all know about more people who died or had heart attacks due to second hand smoke (sometimes called ETS or environmental tobacco smoke)? I don’t personally know of one person who died from exposure to second hand smoke, although I am sure there are some. Smoking Ban proposals have become too partisan (meaning “a fervent, sometimes militant supporter or proponent of a party, cause, faction, person, or idea”). The science has been compromised, and it is very difficult to make good policy decisions when the facts are so much in dispute. Smoking is clearly a disturbance or nuisance for many people who don’t smoke. I accept that second hand smoke is also a health risk for many people who have asthma or allergies. (Just like some people are allergic to cats, peanuts, or barbecue smoke). But, does secondhand smoke create a health hazard that endangers people if they go to bars and restaurants? Will the “free market” adequately allocate public places for both smokers and non-smokers without the government’s interference? These are the questions for legislators to decide. If I believed that Secondhand Smoke was a Public Health Risk, and that people could not avoid the danger, I would support a Smoking Ban. (Isn’t it odd that we continue to subsidize tobacco, and avoid bills that would ban smoking altogether. Prohibition hasn’t worked for marijuana, alcohol, or methamphetamine. It won’t work for tobacco either).
WHAT DO THE PROPONENTS SAY ABOUT SECOND HAND SMOKE?
The author of the bill, and other proponents of a Statewide Smoking Ban say, ” the research demonstrates that no one is safe from second hand smoke.” They allege that NO amount of second hand smoke is safe and that threshold levels for chemical compounds in second hand smoke aren’t needed. Even a brief amount of exposure to second hand smoke is dangerous. Proponents rely greatly on: The U.S. Surgeon General’s Report “The Health Consequences of Involuntary Exposure to Tobacco Smoke” . This report was first written in 1986 and updated in 2006. The Report is a “Meta-Analysis”, meaning that the authors of the report did not collect their own epidemiological data, but instead combined the results of previously published studies. The Minnesota Smoke-Free Coalition web site, linked here, also summarizes much of the testimony and arguments submitted to legislators. The Surgeon General’s Report relies upon and cites other studies, including: 1. U.S. Environmental Protection Agency (EPA) (Link here) done in 1992. If you want to read the entire EPA Report, you can find it here. Another report called “Setting the Record Straight: Second hand Smoke is a Preventable Health Risk”, is (Linked here). 2. International Agency for Research on Cancer (IARC), (Link here) done in 1998 and 2004 3. California EPA, (Link here) Office of Environmental Health Hazard Assessment ( Link here), done in 1997 and 2005. The Surgeon General’s report concludes, among other things: 1. “Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer”. 2. “The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke”. ( See page 9, Executive Summary of Report, “Major Conclusions”) See also, the National Cancer Society informational website on Second Hand Smoking linked Here.
WHAT DO OPPONENTS OF THE SMOKING BAN HAVE TO SAY
A group called Minnesotans against Smoking Bans ( Linked here) have created their own website. It includes information concerning health studies, the effect on Charitable Gambling receipt, and other arguments. Here is an interesting Article by a former Environmental Consultant named Edmund Contoski, which is critical of the EPA. I have read many other articles which are critical of the EPA, for its failure to follow proper scientific methods. Here is another Website, written by opponents of Smoking Bans, that lists virtually every study ever done concerning the risk of second hand smoke.
WHAT DO OTHER RESEARCHERS SAY ABOUT THE STUDIES?
1. Dr. Michael Siegel is a medical doctor and public health official who teaches at Boston University School of Public Health. He specializes in preventive medicine, and says: “The Surgeon General is publicly claiming that brief exposure to second hand smoke increases risk for heart disease and lung cancer. But, no evidence is presented in the Surgeon General’s report to support this claim.”
2. Dr. Melvin First, Professor Emeritus of Environmental Health at Harvard, and Dr. Alvin Feinstein, who taught at Yale School of Medicine and has been called “the Father of Clinical Epidemiology”, and Dr. Gary Becker (Linked here), a Nobel Prize winner have all reached different views from the surgeon general’s report.
Here is an article by Dr. First, in the Wall Street Journal in May,2003: In regard to your May 16 story “Passive Smoke Doesn’t Kill – Or Does It?”: James Enstroms’s finding that exposure to environmental smoke cannot be associated with increased risk of cancer and heart disease comes as no surprise to me as I authored, with a colleague, a study published in the New England Journal of Medicine (292:844-845, 1975) detailing the results of inconspicuous air samplings at restaurants, cocktail lounges, transportation terminals, etc. “to evaluate the health implications for non-smokers” and found that the concentrations of tobacco smoke were equivalent to smoking about .004 cigarettes per hour while in these facilities. It should be recalled that smoking in public places was normal and prevalent a quarter century ago. Nor am I surprised at the scurrilous responses of the concerned voluntary health associations.
Publication of the paper cited above resulted in many angry voices on the phone wanting to learn the funding source, although it was noted that it was funded “by the Massachusetts Lung Association and its local affiliates.” That is another interesting tale – the Lung Association put our report in a drawer and never released it. It is also curious that none of the surgeon general’s reports ever mentioned this study. Nor am I surprised that an attempt is being made to trash Dr. Enstrom’s conclusions because the study was funded in part by money from tobacco interests. Does this mean that all the researchers funded by anti-smoking agencies are biased in the opposite direction? I trust not. Such charges are deeply insulting to academics in good standing. For the record I am a non-smoker and as a responsible health professional I do not advocate smoking.”
Melvin W. First, Sc. D. Professor of Environmental Health and Engineering, Emeritus Harvard School of Public Health Cambridge, Massachusetts
3. Dr. Elizabeth Whelan, of The American Council on Science and Health (Linked here) states: “This ‘no threshold’ proposition cannot withstand scientific scrutiny.” (Referring to reports that there is no safe dose of second hand smoke. Even mainstream smoke, which is 100,000 times more concentrated than second hand smoke, has a threshold. All of the individual carcinogens known - or claimed- to be in second hand smoke all have thresholds.
4. The National Cancer Institute published a 1998 report of the International Agency for Research on Cancer (IARC), linked here, and again here, commissioned by the World Health Organization. The study found that children were less likely to get lung cancer if both parents smoked than if neither smoked.(The RR was 0.78 for exposure to secondhand smoke during childhood). Apparently, during childhood, the body has some capacity to develop resistance to smoke, just like being vaccinated. The study also concluded: “ETS exposure during childhood was not associated with an increased risk of lung cancer. The OR (odds ratio) for exposure to spousal ETS was 1.16 (95% CI = 0.88 to 1.47). The OR for exposure to workplace ETS was 1.17, with possible evidence of increasing risk for increasing duration of exposure. Ever exposure to ETS from other sources was not associated with lung cancer risk. There was no detectable risk after cessation of exposure.” (underlining added)
5.The Enstrom-Kabat Study Kabat, G.I., et.al., American Journal of Epidemiology, Vo1.142, No.2, 1995, p.141-148; Link to article here. which was published in the British Medical Journal, concluded that: ” no significant associations were found for current or former exposure to environmental tobacco smoke and tobacco related mortality” This study was one of the largest study ever done, covering 100,000 people over 38 years and was reported and published in 2003.
Enstrom and Kabat published another Meta-Analysis and Critique which reviewed the relationship between exposure to second hand smoke and coronary heart mortality. The Link to the 2006 study is here. The study found that there is little relationship between ETS and coronary disease.
6. The Congressional Research Service also published a major review (Linked here) of all research studies. The CRS found no proof that second hand smoke increases cancer rates.
7. The Journal of the American Medical Association has published a 2006 report Linked here), by Dr. Saverio Stranges, which also suggests that exposure to Secondhand smoke is not as important a risk factor for heart attacks as previously thought.
8. This Web Site summarizes some of the most important second hand smoke studies, and provides links to those studies. Most of the studies and Articles conclude that there is NO public health risk associated with second hand smoke.
ANALYSIS OF THE STUDIES
In order to understand the issue of second hand smoke, you have to understand something about Statistics and Epidemiology. Understanding the Statistical analysis is vital to understanding the public health issue. Here is a Link to a Site, written by David Hitt, which helped me understand statistical analysis of health research studies, including the original 1992 EPA second hand smoke study.
Here are several Links to additional Websites which do a good job of explaining statistical analysis used in all health related studies:
1. This article is written by Steven Milloy.
2. This article explains How to Read a Study. Here are two articles describing what Epidemiology is, and the “Limits of Epidemiology”.
1. This article, written by Gary Taubes, is entitled “Epidemiology faces its Limits”.
2. The Forces International Site explains “What is Epidemiology”. From these articles, I learned that most of the second hand smoke studies, put the Relative Risk (RR) of second hand smoke at between 0.78 and 1.3. This means that there could be up to a 30% greater chance of getting cancer if you are exposed to secondhand smoke. ( If normal occurance of cancer is 100 cases, then a 30% increase in risk would yield 130 cancer cases). However, there is also a statistical chance that exposure to second hand smoke lowers the risk of cancer by 22% (in children), since the RR range includes 0.78. ( Again, the risk result in the study commissioned by the World Health Organization, is Linked here).
The Confidence Level (CI) is also important when determining statistical significance. If the CI includes a 1.00, then the Relative Risk (RR) is statistically insignificant regardless of the upper level of RR. This is because the confidence level (usually a 95% standard) puts the actual risk between the upper and lower bounds of the CI. There is just as likely a chance of being NO risk at all, if the Confidence Level range includes 1.0 or less. (See, Egger, et al, Meta-analysis Principles and Procedures).
Dr. Eugenia Calle, director of analytic epidemiology for the American Cancer Society, said in 1995, that Relative Risks below 1.3 cannot be reliably identified. When a study showed an RR of 1.5 (50% increase in probability) between abortion and breast cancer, Dr. Calle stated that an RR of 1.5 is too low to call abortion a risk factor for breast cancer. So how can RR’s below 1.5 be called significant for secondhand smoke, but not for the abortion link to breast cancer? Proponents of smoking bans don’t often discuss the risk ratios, preferring to simply claim that ETS is ” dangerous”, or that the scientific debate is “over”. Generally, the Relative Risk (RR) must be at least 3 to 4 before most researchers accept that there is a causal relationship established in health studies.
Here is a Link, which includes quotes from several prominent scientists: “As a general rule of thumb, we are looking for a relative risk of 3 or more before accepting a paper for publication.” - Marcia Angell, editor of the New England Journal of Medicine” “My basic rule is if the relative risk isn’t at least 3 or 4, forget it.” - Robert Temple, director of drug evaluation at the Food and Drug Administration.
In contrast, mainstream smoking has an RR of 40. This means that your chance of getting cancer is 40 times greater than average if you smoke. That’s quite a difference from 0.3 times greater if you breathe second hand smoke.
The reliability and credibility of the 1992 EPA study was litigated in a North Carolina Federal District court in 1998. The decision can be reviewed at this link: Flue Cured Tobacco Coop vs. US Environmental Protection Agency . (Note the court’s conclusion beginning on page 87).
In this case, a Federal Judge found:
1. EPA publicly committed to a conclusion before research had begun; excluded the industry by violating the Act’s procedural requirements; adjusted established procedure and established scientific norms to validate the Agency’s public conclusion; and aggressively utilized the Act’s authority to disseminate findings to establish a de facto regulatory scheme intended to restrict Plaintiff’s products and to influence public opinion,”
2. EPA’s findings were based on insufficiently rigorous statistical tests and were therefore invalid. EPA, he noted, “disregarded information and made findings based on selective information . . . ; deviated from its risk assessment guidelines; failed to disclose important [opposition] findings and reasoning; and left significant questions without answers.”
Another article about the Court decision can be found here. (Heartland Institute) and here (Frasier Institute in Canada).
The fourth circuit Federal Court of Appeals later overruled the District court’s decision on jurisdictional grounds (Link here for the written decision) , but did not overrule the substantive findings of the Judge.
This case is important because the Surgeon General’s report is largely based upon this 1992 EPA study.
OTHER INTERESTING ARTICLES AND STUDIES
1. An environmental consultant named Ed Contoski has studied the issue of Secondhand Smoke. He has written to me this year, and I assume, other legislators. Attached is an article by columnist Craig Westover which includes the entire letter from Mr. Edmund Contoski to State Representative Doug Meslow in Nov. 2004. I have reviewed the arguments and citations of Mr. Contoski, and they seem persuasive.
2. Here is an article summarizing studies involving OSHA (Occupational Safety and Health Agency) . As for second hand smoke in the air, OSHA has stated that: “Field studies of environmental tobacco smoke indicate that under normal conditions, the components in tobacco smoke are diluted below existing Permissible Exposure Levels (PELS.) as referenced in the Air Contaminant Standard (29 CFR 1910.1000)…It would be very rare to find a workplace with so much smoking that any individual PEL would be exceeded.” -Letter From Greg Watchman, Acting Ass’t Sec’y, OSHA, To Leroy J Pletten, PHD, July 8, 1997.
In February 2003 OSHA went one step further beyond merely withdrawing regulations that included a nationwide smoking ban and clearly restated its position regarding Environmental Tobacco Smoke. Current federal OSHA policy, as stated in its February 24, 2003 “Reiteration Of Existing OSHA Policy In Indoor Air Quality,” is:
“Although OSHA has no regulation that addresses tobacco smoke as a whole, 29 CFR 1910.1000 Air contaminants, limits employee exposure to several of the main chemical components found in tobacco smoke. In normal situations, exposures would not exceed these permissible exposure limits (PELs), and, as a matter of prosecutorial discretion, OSHA will not apply the General Duty Clause to ETS.”
3. Here is an interesting study done by the National Cancer Institute which shows: A recent meta-analysis based on 4626 cases concluded that the relative risk of lung cancer in lifelong nonsmokers who lived with a smoker was 1.24 (95% confidence interval [CI] = 1.13-1.36) Subsequently, we reported in the Journal the results from a large case-control study of environmental tobacco smoke (ETS) and lung cancer based in 12 European centers. This study provided an odds ratio (OR) for lung cancer of 1.14 (95% CI = 0.88-1.47) for spousal and workplace exposure to ETS; In other words, if a lifetime nonsmoker lived with a smoker, their risk of getting cancer from the second hand smoke is between a “12% decrease and a 14% increase”. Therefore, there is no statistically significant risk. (see the discussion above)
4. Here is an article, by Dr. Michael Siegel, summarizing studies which show that heart attacks actually had smaller declines in States with Smoking Bans than in the rest of the country. A similar article at Townhall.com is linked here.
5. Is there a bias in even getting your study published, if you conclude that second hand smoke is not a health risk. Here is an article , published in the Journal of the American Medical Assn., which says that bias does exist.
6. Townhall.com has this Article commenting on the politics of the Surgeon General’s 2006 report on Second hand smoke. (See Link to article here).
7. An article by the Oak Ridge National Laboratory, linked here, managed by the Dept. of Energy, summarized:
” The study, which involved 173 people employed at restaurants or taverns of varying sizes in the Knoxville area, concluded that exposures to respirable suspended particulate matter (RSP), for example, were considerably below limits established by the Occupational Safety and Health Administration (OSHA) for the workplace.”
8. A interesting article published in by the Cato Institute is (Linked here) . The Article concludes:
“With its document on passive smoking, the EPA disregarded the suggestions of its own review. Scientific integrity was compromised, if not outright abused, by the manner in which this risk assessment was generated. Abusing scientific integrity and generating faulty “scientific” outcomes through manipulations, assumptions, and extrapolations leads to the development of mistaken programs at enormous cost to our government and to taxpayers. Indeed, the cost to the scientific process itself is even greater. Science should dictate what policies need to be established; predetermined policies should not dictate how science is conducted.”
9. Some people claim that any scientist or researcher who has ever been funded by a tobacco company or affiliate, is automatically not credible. Nobody asks if the foundations, government agencies or corporations which fund the advocacy and reaserch in favor of Smoking Bans, have any bias.
Here is an interesting article by Dr. Elizabeth Whelan, on the question of whether corporate “connections” should disqualify research from consideration.
I wrote to Dr. Whelan to ask how she responds to such charges of bias. She replied to me, by email, as follows:
Dear Senator Neuville,
I have been one of the nation’s leading pro-health/anti-smoking advocates since the late l970’s.
I am the author of a book on the history of the cigarette in America—”A Smoking Gun: How the Tobacco Industry Gets Away With Murder”,— and also the author or coauthor hundreds of articles on the deleterious health effects of smoking–and editor of a classic book entitled “Cigarettes: What the Warning Label Does Not Tell You”. I have testified in dozens of legal cases against cigarette companies brought by the families of those who have died prematurely from smoking ( I testified on the side of the plaintiffs!)…
The charge that I have ties with the cigarette industry is completely ludicrous.
Please see our website for more details on our anti-smoking work.
Apparently the fact that I have stated the truth (that the dangers of second hand smoke have frequently been overstated) has led those who do not know how to debate me on the science to bring these charges against me—since they have no other arguments.
Thank you for writing.
Dr. Elizabeth M. Whelan
President
American Council on Science and Health
1995 Broadway 2nd Floor
New York 10023
CONCLUSION
It is hard for legislators to make good decisions when the information we get is conflicting, exaggerated, or manipulated. That has happened with the Smoking Ban proposals. Unfortunately, the misrepresentation of scientific data by proponents has damaged the credibility of the anti-smoking movement. I am also concerned that the Statewide smoking ban can’t be enforced at Indian Casinos. This would create an unfair advantage for casinos, and cause private bars and restaurants within 50 miles of a casino to lose business. Allied Charities and several bar owners also testified that profits from charitable gambling declined significantly (up to 2/3 reduction) in Minneapolis and St. Paul, when those cities established a smoking ban . Finally, private business owners have a property right that government should not take away lightly. I still oppose smoking. But, the statewide Smoking Ban is an over-reaction to a problem which is more of a nuisance, than public health issue. Adults can choose to enter or avoid a bar or restaurant that allows smoking. Citizens also have a right to know the truth about the scientific studies. In my view, those studies show very weak relationships between cancer or heart attacks and second hand smoke.
