Would the anti-smoke folks lie?

Have the tobacco police gone too far?

I’VE been called a traitor,” says Michael Siegel, a public-health doctor at Boston University in Massachusetts. “It’s been a character assassination.” This treatment seems surprising as, reading Siegel’s CV, you’d think he was a poster boy for the anti-smoking movement. He regularly publishes research on the harmful effects of passive smoking and has testified in support of indoor smoking bans in more than 50 US cities.

Despite these credentials, Siegel has come under fire from colleagues in the field of smoking research. His offence was to post messages on the widely read mailing list Tobacco Policy Talk, in which he questioned one of the medical claims about passive smoking, as well as the wisdom of extreme measures such as outdoor smoking bans.

In front of his peers, funders and potential future employers, other contributors posted messages accusing Siegel of taking money from the tobacco industry. When Siegel stood his ground, the administrators kicked him off the list, cutting off a key source of news in his field. “It felt like I was excommunicated, says Siegel. “I was shocked: I’ve been a leader in the movement for 21 years.”

Siegel’s case is perhaps the most clear-cut example of a disturbing trend in the anti-smoking movement. There are genuine scientific questions over some of the more extreme claims made about the dangers of passive smoking and the best strategies to reduce smoking rates, but a few researchers who have voiced them have seen their reputations smeared and the debate stifled.

Putting aside the question of whether such tactics are ethical, they could ultimately backfire. About half of US states and many parts of Europe do not yet ban smoking even indoors in public places like bars and restaurants, so the anti-smoking movement cannot afford to lose credibility.

On the other hand, in some parts of the US, particularly California, the anti-smoking movement has grown so strong that smoking bans outdoors and in private apartments are in force in a few places, and being considered in more. These measures are at least partly based on disputed medical claims, so it is vital their accuracy be determined. But questioning the orthodoxy seems to be frowned on. “It’s censorship,” says Siegel. “We’re heading towards scientific McCarthyism.”

This is censorship. We are heading towards scientific McCarthyism
The irony is that the tobacco industry is notorious for its history of unethical research conduct. As evidence emerged in the 1950s linking smoking to lung cancer, several firms paid scientists to produce contrary findings. They held scientific conferences, and published journals to promote their results.

By the mid-70s, the dangers of first-hand smoke were indisputable, so the industry switched to questioning emerging evidence of the dangers of second-hand smoke. In spite of their efforts, a convincing case has now been made that long-term exposure increases the risk of heart disease, cancer, respiratory illness and cot death.

By the 1990s, California had banned smoking in all indoor public places, and in 2004 Ireland became the first country with a nationwide ban. The UK, Australia, some other European countries and about half of US states have since followed (see map).

Researchers like Siegel, and others under fire from the anti-smoking lobby, do not question that people regularly exposed to second-hand smoke suffer harm. “It’s difficult to imagine that there’s an easier argument to make than ‘smoke is bad for you’;,” says Carl Phillips, an epidemiologist from the University of Alberta in Edmonton, Canada, who has also been targeted.

But in the past few years some of the claims about passive smoking have gone further. Siegel first got into trouble when he questioned assertions that breathing in second-hand smoke for just 30 minutes raised people’s risk of a heart attack to that of an active smoker.

There is no doubt that passive smoke affects blood flow, even over the very short term. Research in the 1980s showed that 20 minutes’ exposure makes blood platelets slightly more sticky, which could theoretically raise the risk of blood clots and hence heart attacks and strokes. Realistically, though, this would only be a danger for those already at high risk.

In 2001, a study showed that 30 minutes of passive exposure to smoke reduces the blood vessels’ ability to dilate (Journal of the American Medical Association, vol 286, p 426). If this happened repeatedly over a long period, it could permanently harm blood vessels and harden arteries. In a few people who are on the verge of a heart attack, it is possible that 30 minutes’ exposure could tip them over the edge. But it would be no worse than eating a high-fat meal; most people would easily cope.

When anti-smoking lobby groups highlight this issue, however, they fail to mention that most people would be OK. Here is a typical claim, from the US group Action on Smoking and Health (ASH) in 2006: “Breathing drifting tobacco smoke for as little as 30 minutes (less than the time one might be exposed sitting on a park bench) can raise a non-smoker’s risk of a fatal heart attack to that of a smoker.”

Siegel has counted at least 65 organisations making such claims, and they are not fringe groups but anti-smoking stalwarts. They include the American Cancer Society and the UK National Health Service (NHS). “These claims are ridiculous,” says Siegel. “Just telling the truth would be enough to show that second-hand smoke is toxic.”

Even Stanton Glantz, a cardiologist at the University of California, San Francisco, who did a more recent study confirming the blood-vessel effect, acknowledges some of the claims about it are overblown. “A healthy 25-year-old won’t drop dead from a heart attack by breathing second-hand smoke,” says Glantz, who is one of the linchpins of the anti-smoking establishment.

Another disputed claim is whether the introduction of smoking bans in indoor public places brings about an immediate drop in heart attacks. A few studies of individual US cities have suggested this effect. According to Siegel, however, they covered small populations and were too short to account for yearly fluctuations, or indeed the fact that many western countries have seen a gradual long-term decline in heart-disease deaths.

Then last year, a large study was published that seemed to shore up the argument that bans cause a fall. The study covered most of the biggest hospitals in Scotland and compared the two 10-month periods before and after the introduction of the smoking ban in indoor public spaces in March 2006 (The New England Journal of Medicine, vol 359, p 482). It found a 17 per cent drop in people admitted to hospitals with acute coronary syndrome (ACS), which comprises heart attacks and angina.

Confusingly, however, the results of the study seem to be contradicted by the publicly available statistics on emergency admissions to hospitals due to heart attacks, released by the Scottish NHS in November 2007. These admittedly show fewer heart attacks in the year after the ban, but the fall was smaller, at only 7 per cent, which does not stand out from the background decline. In 2000 there was an 11 per cent drop, and between 2004 to 2006 the rate fell by roughly 5 per cent a year.

Sheila Bird is a statistician from the MRC Biostatistics Unit in Cambridge, UK, who is independent of either side in this debate. She points out that it is hard to compare the two sets of Scottish data because they measure different things: ACS diagnoses are made using blood tests while heart attack admissions are based on ECG measurements.

Bird also points out that because the NEJM study compared 10-month periods before and after the ban – not 12-month periods – it could have been distorted by seasonal fluctuations in heart-attack rates. The period before the ban spanned more colder months, when people generally have more heart attacks.

The picture in Scotland remains unclear, but last month saw a body blow to the side who say bans cause a fall. The first set of NHS data was published for England since the smoking ban came into effect there in July 2007. Between April 2007 and March 2008 there was a 3.7 per cent drop in heart attacks. That’s exactly the same as the year before the ban. Although the “post-ban” year includes three months before the ban, a crude analysis suggests that should only reduce the size of any fall by about one-quarter.

Third-hand smoke
Another issue that is currently raising eyebrows is the concept of “third-hand” smoke. This refers to the particles of smoke that linger on smokers’ clothes, hair and the carpets and furniture of a room for days, “outgassing” toxic vapours. Young children may be at particular risk, since they could ingest the residue while crawling around or mouthing their toys.

The first signs that third-hand smoke may be a danger emerged in 2004. A study showed that even if parents only smoke outside the home, detectable levels of cotinine – a metabolite of nicotine – were present in their children’s urine (Tobacco Control, vol 13, p 29).

Levels were much lower if the parents only smoked outside the house: 2.32 nanograms per millilitre compared with 15.57 from second-hand smoke. Still, some researchers think even this low level could be enough to cause harm, particularly to a child’s developing brain. “My sense is that these levels are high enough to be concerning,” says Kimberly Yolton, a psychologist at Cincinnati Children’s Hospital Medical Center in Ohio, who has previously shown that exposure to nicotine from second-hand smoke seems to slightly depress a child’s school results.

As yet there is no consensus on whether the cotinine levels are high enough to have any meaningful effect. “We’ll need a lot more evidence before we act on this,” says Martin Dockrell of Action on Smoking and Health in London.

In January, the issue of third-hand smoke gained new prominence after a paper on the subject in Pediatrics (DOI: 10.1542/peds.2008-2184). Many news outlets and even the US Department of Health and Human Services covered the “new-found risk”. Author Jonathan Winickoff, a paediatrician at Massachusetts General Hospital in Boston, said people should “hammer home” the risks of third-hand smoke, and urged smokers to wash their hands – and possibly clothes – before interacting with children.

The paper, however, sheds no new light on the degree of risk. It was just a telephone poll showing that people were more likely to have smoking bans in their house if they believed that third-hand smoke was harmful.

Does it matter if the dangers are exaggerated? Yes, says Siegel, because it risks alienating parents who might otherwise have heeded advice to avoid exposing their children to second-hand smoke. It could also leave people distrustful of health advice in general.

Establishing the truth relies upon researchers engaging in open debate about what the evidence really shows. This is less likely if criticism entails the risk of excommunication, as Siegel experienced. “It’s like an unwritten rule in this movement that you don’t question these claims,” he says.

At the time of going to press, the administrator who removed Siegel from the tobacco mailing list had not responded to New Scientist’s requests for a comment. However, one of the list’s current administrators, Bill Godshall, who is an executive director of SmokeFree Pennsylvania in Pittsburgh, defends the decision, claiming that some of Siegel’s posts had been “uncivil”. Siegel “staunchly opposed the very purpose of the listserve: advocating reasonable and responsible policies to reduce the leading cause of disease and death”, says Godshall.

But Siegel has his defenders. “It is sobering and scandalous to think, if Mike is correct, that our field now is guilty of the same junk science long perpetrated by the tobacco industry,” says Alan Blum, director of the Center for the Study of Tobacco and Society at the University of Alabama in Tuscaloosa.

It is scandalous if our field is now guilty of the same junk science as the tobacco industry
Ensuring the science is rigorous becomes paramount at a time when the anti-smoking clampdown is reaching new levels. Siegel fears that the growing concerns around third-hand smoke will trigger more firms to bring in non-smoking hiring policies, already in place at several US companies and the World Health Organization. Several independent researchers have voiced concerns that such measures will further exacerbate social inequalities between smokers and non-smokers (New Scientist, 31 January, p 5).

And even the most fanatical enemies of smoking have reason to be wary of the anti-smoking movement’s current direction. Making exaggerated claims will only reduce the movement’s impact in regions where smoking bans in indoor public spaces have not yet been introduced, Siegel believes. “It’s like the boy who cried wolf – the public won’t know the difference when the claims are true,” he says.

Siegel says his experience has not damaged his career, and has since set up a blog about the anti-smoking movement’s extremes. But Carl Phillips almost lost his job after he questioned the orthodoxy. Phillips is one of a few researchers who favour “harm reduction” strategies in tobacco control (New Scientist, 10 November 2001, p 28). This means promoting smokeless tobacco products – such as chewing tobacco, a form of “sucking” tobacco known as snus, and electronic cigarettes – to allow nicotine addicts to get their fix without many of the risks of smoking. Many anti-smoking researchers are vehemently opposed to such strategies.

Unlike Siegel, Phillips has accepted research grants from the US Smokeless Tobacco Company – a fact he declares on his research papers, and which was approved by his university as they came with no strings attached. This has allowed anti-harm-reductionists to paint him as a tobacco-company stooge, and he has experienced vandalism to a poster paper at a medical conference. After his adversaries threatened to block the school’s academic accreditation and cancel funding for other projects, the School of Public Health tried to terminate his contract. Phillips appealed to the university’s central administration, however, who overturned the school’s decision, and he remains in his post.

For many researchers like Phillips it’s a catch-22 situation. If their research challenges the orthodoxy, anti-smoking groups refuse to fund it, so they turn to tobacco firms instead. This provides ammunition to question the results. “It drives researchers from doing anything innovative,” says Phillips.

Given the tobacco industry’s reputation, this deep suspicion may be understandable. “The industry has sown the seeds of so much distrust that scientific debate can be difficult,” says Kelley Lee from the London School of Hygiene and Tropical Medicine, who has uncovered some of the industry’s dirty tricks.

On the other hand, many anti-smoking researchers accept grants from the drug firms that make nicotine-replacement therapies. When it comes to research ethics, the pharmaceutical industry’s reputation is not exactly whiter-than-white either.

So where can the anti-smoking movement go from here? “They must be intellectually mature enough to recapture the process of producing sound science,” says Lee. “There is no room for mud-slinging.”

Editorial: The dangers of inhaling dubious facts

David Robson is a junior editor at New Scientist

01 April 2009 by David Robson
Magazine issue 2702. Subscribe and get 4 free issues.
For similar stories, visit the Drugs and Alcohol Topic Guide
Editorial: The dangers of inhaling dubious facts

I find this to be a very interesting article written by David Robson. What are your thoughts? How can we get the “truth”? Do you agree with those quoted in the article? Were you aware that there are those within the anti-smoking movement that want the “truth” to be told? “Truth” that is not exaggerated or manipulated! Or do you think the facts as presented are the truth? Tell us your thoughts and what you think should be done? Let it fly!


#1 Bill Godshall on 05.10.09 at 12:20 PM

This posting is about as helpful (for encouraging discussion and consensus among folks within the tobacco industry and the public health community) as a posting on an public health website entitled “Would tobacco industry folks lie” that cites several totally unrelated situations involving different individuals in the tobacco industry as proof of an ongong conspiracy today of lies and malicious actions by everyone involved in the tobacco industry.

As one who has been closely involved with all of the unrelated situations cited in this article, I was dissappointed that Robson had already chosen to write sensationalism and divisiveness before he contacted me for comments (as he chose to ignore the substantative points I made).

Just because there are some bad actors in the tobacco industry and the anti tobacco movement is not justification for the perpetuation of finger pointing by the everyone else in the tobacco industry and the public health community.

#2 Jack on 05.12.09 at 2:55 AM

I actually think that it’s good that this blog is open to all points of view. Must we assume that BG is right about everything. So I am for freedom of speech here on this blog. I think that BG needs to read some of what he writes here on this blog and realize some may deem his rantings as bordering on sensationalism. So the article points out thebad actors. Whats wrong with that! I actually think its ridiculous that one would defend the thought that can not express their opinion. And BG it looks like you must still have a gripe with Michael Siegel who I actually find pretty persuasive in his writings rather than just being on some type of high horse of an agenda. I still question why I lived in a household with two parents that smoked where I experienced second hand and third hand smoke and I’m sure when someone decides there is a 4th hand smoke but not one of us have ever experienced a smoking related illness. OH but they sure did have health related issues related to eating. Anyway if someone is using numbers to prove a point they should be able to stand the heat! Is it not fair that one points out the fact that not all that the anti’s say is true? Hey I just realized BG you actually point out the fact that they are not being truthful when it comes to the varying harm of different products.

#3 OTP Kid on 05.12.09 at 9:10 AM

The arrogance of Bill Godshall is unveiled to the fullest extent here for the first time as he states “I was dissappointed that Robson had already chosen to write sensationalism and divisiveness before he contacted me for comments (as he chose to ignore the substantative points I made).”

Can’t we ban this clown?

#4 Carl V Phillips on 05.12.09 at 3:57 PM

Bill et al.,

Just so you know, I talked to Robson at length also, and he chose to use relatively little of what I told him. Had he used more, the piece would probably have tended toward condemning the anti-tobacco extremists even more. Frankly, I think it undersells the point about some of that they *systematically* do.

But you bring up an interesting point: We should not overgeneralize. But are we overgeneralizing? Can you identify who among the powerful mainstream anti-tobacco actors should be cited as exceptions to the unethical behavior? I am very interested in the answer. And keep in mind that I am talking about the anti-tobacco people, not the public health community — the anti-tobacco extremists have long since ceased to be part of that.

#5 Bill Godshall on 05.13.09 at 12:40 PM

There are tens of thousands of people who are commonly referred to as tobacco control advocates (including myself), but only a small fraction of those folks have claimed that:
– brief exposures to secondhand smoke increase heart attack risks,
– smokefree workplace laws significantly reduce heart attacks, or that
– universities should not be allowed to receive tobacco industry funding.

Same goes for many other contraversies involving nicotine, tobacco and smoke (that weren’t mentioned in Robson’s article).

As one who has been repeatedly defamed by abstinence-only tobacco prohibitionists as a “tobacco industry stooge”, and by right-to-smoke extremists as a “Nazi”, its obvious to me that the “us versus them” and “you’re either with us or against us” attitudes of extremists on both sides of the tobacco/smoking battles is counterproductive for science, public health and the tobacco industry.

Also, a careful review of Mike Siegel’s blog (from 2005 to 2008) will reveal comments by Mike (and many right-to-smoke advocates) in response to my harm reduction postings that criticize me for downplaying the health risks of smokeless tobacco products and suggesting that I’m a stooge for spit tobacco companies.

But persistance pays off, and I’m pleased that Mike has changed his views on tobacco harm reduction over the past few years, as have many others who consider themselves in the tobacco control movement.

Now I’ve got to go to an anti tobacco website to respond to several slanderous postings implying that I’m being secretly paid off by tobacco companies to advocate harm reduction products and policies.

#6 Citizen on 05.19.09 at 11:27 PM

I would have no problem with any real scientific debate on medical claims about passive smoking, but Michael Siegel’s actions go way beyond that. I won’t go into it here, but I note that the article on him at Sourcewatch at least takes a look at his often repeated assertion that tobacco control is motivated by hatred towards smokers (ie, Incite smoker rebellion…Stimulate smokers to scream bloody murder).

NewScientist states: “other contributors posted messages accusing Siegel of taking money from the tobacco industry.” Did that really happen, or is this just Michael Siegel’s version of events? Siegel himself documented some of the reactions to him posted at the mailing list from which he was eventually excluded. From Siegel’s blog: “Here is a sampling of what my colleagues had to say about me.” (http://tobaccoanalysis.blogspot.com/2006/06/personal-insults-and-attac_114965365049823423.html)

“I can tolerate no more claptrap from Dr. Siegel’s tobacco-industry soundbytes that appear with predictable regularity in all the posts from that source.”

“These attacks and rantings have had a detrimental impact on the freedom to interact, and smack too much of the tobacco industry’s efforts to create a ‘doubt’ campaign, and to create momentum for the press to talk about a ‘division’ in the health activist movement.”

“It is one thing to point out problems one may see in any line of research or policies, etc., but it is quite another thing to continually attack the advances people are making, attack the people in the movement, to try to stop the increase of smoke-free areas, and to end up (intentionally or accidentally) continually assisting the tobacco industry in their fight to return to smoky areas and a ‘doubt campaign.'”

“I join those who are weary of having our years of work trashed by Siegel’s constant tobacco industry style attacks…”

Clearly a lot of people were frustrated by what they saw as a constant barrage of tobacco industry-style rhetoric and attacks coming from Michael Siegel, but I don’t see any accusation that he took money from the tobacco industry. I fully expect that any such accusation would have been promptly published on Siegel’s blog as evidence of his persecution, but there is none to be found.

I find that this article could have been written by Michael Siegel himself; the author has done little more than reiterate Siegel’s anti-tobacco control schtick.

I would also add in response to comments left here that I find the idea of building a consensus between public health advocates and the tobacco industry completely ridiculous. We’re talking about an industry in the business of addicting and killing people.

#7 Joe on 05.21.09 at 3:07 AM

Citizen – If it was possible to reduce harm in the cigarette would you honestly accept that possibility. Just curious!

#8 Fredrik Eich on 05.21.09 at 8:15 AM

I don’t think it’s possible to prove to the public that a “reduced harm” cigarette works. We know that smoke exposed animals live longer than non smoke exposed animals, formulating a cigarette that increased the already increased survival expected in smoke exposed animals would be ignored as it is now. Decreasing the life expectancy of smoke exposed animals to that of non smoke exposed animals would be pointless.
Human intervention trials would be said to be unethical by professional anti smoking groups even if the animal data strongly suggested that it would be unethical not to.
In order to demonstrate reduced harm, one first has to demonstrate the harm.

#9 Bill Godshall on 05.21.09 at 5:44 PM

I agree with everything posted above by Citizen (regarding certain claims by Mike Siegel) except the last paragraph by Citizen, which I vehemently disagree with because it is inaccurate and misleading.

If all 45 million cigarette smokers switched to smokefree tobacco/nicotine products (most of which are also marketed by tobacco companies), it would be the single most successful public health improvement
in the history of America (as tobacco attributable mortality would decline from about 450,000 per year to no more than several thousand per year).

#10 Michael J. McFadden on 05.30.09 at 11:06 PM

Would the anti-smoke folks lie? Heh… ya gotta be kidding! Remember, even in general scientific/medical research we’ve recently seen a very disquieting amount of “fraud” of various types just for motivations of money and prestige. Imagine how much greater the fraud must be with the additional motivation of “knowing” that what you do in your fraud is “for the greater good,” in an end-justifying-the-means mentality.

Want to see a truly amazing story of some recent antics by the anti-smoke folks? Check out how the authors of the Klein study on restaurant and bar job losses manipulated the data and promised their antismoking funders that they’d produce work that would specifically bolster smoking bans… even before they’d done the research… and then walked with a cool half million dollars for their “well-intentioned” efforts.

Go to http://www.jacobgrier.com and read Jacob’s columns of May 22nd, 27th, and 29th and the comments after them. Go ahead… it’s better than the National Enquirer! And just wait’ll you see the half-million dollar grant proposal to Philip Morris by Michael J. Kumquat!

And THEN ask yourself, “Would the anti-smoke folks lie?”

Michael J. McFadden
Author of “Dissecting Antismokers’ Brains”

#11 Amused on 06.09.09 at 12:03 AM

Just out of curiosity, do you have any idea how crazy “Dissecting Antismokers’ Brains” makes you look?

#12 Michael J. McFadden on 06.09.09 at 12:17 AM

Only until they read it Amused. And then they offer substantive criticisms of it… just look around the web and I’m sure you can find a few.

Or not.

Michael J. McFadden
Author of “Dissecting Antismokers’ Brains”

Leave a Comment