American Heart Association and KEEP ST. LOUIS FREE! team up(?!)

Mr. Bill Hannegan of KEEP ST. LOUIS FREE! writes that he “joins” with Ms. Bonnie Linhardt, Missouri State Advocacy Director, American Heart Association, after her letter appeared in the June 28, 2009, St. Louis Post-Dispatch. What prompted this unholy alliance is that both are opposing the St. Louis City smoke-free air bill introduced by Ald. Lyda Krewson and due to have public hearings on Tuesday, June 30, and Wednesday, July 1, starting at 12 noon. The reason is the trigger language which requires St. Louis County to enact similar legislation before the City’s law will go into effect.

Agreed, if we can get that proviso removed it is preferable, but if not this bill still offers us a way forward towards the goal of a regional comprehensive smoke-free air ordinance that is long overdue.

Ms. Linhardt’s opposition to this effort takes me back to August 2005 on the day of a critical vote on a comprehensive smoke-free air bill then being considered by St. Louis County Council. It had some exemptions, such as the gaming floor of Harrah’s Casino, in order to have a chance of passage. During the public portion before the vote Ms. Linhardt, speaking on behalf of the three local voluntary health agencies – American Heart Association, American Lung Association, and American Cancer Society – argued that because the bill had some flaws it should be rejected. She was evidently persuasive because the bill, which was expected to garner a majority vote, was killed by a vote of 4:3. The councilwoman who switched her vote, Hazel Erby, gave as part of the reason Ms. Linhardt’s testimony against the bill.

I believe that Ms. Linhardt’s arguments are once again flawed and she is letting the perfect be the enemy of the good.

I’m pleased to note that Steve Patterson, in his Urban Review STL blog of June 26, appears to agree.

Mr. Hannegan cannot be allowed to perpetuate his myth about Enstrom and Kabat, whom he describes glowingly in a posted comment on the STL website following Ms. Linhardt’s on-line letter as “Two of the most qualified secondhand smoke epidemiologists.” Yes, they published a paper in the British Medical Journal in 2003, “Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98,” purporting to show “no causal relation between environmental tobacco smoke and tobacco related mortality,” contrary to numerous other studies.

Their paper had been soundly rejected several years before after submission and review by the Journal of the American Medical Association.

The American Cancer Society, which supplied the data on which the study was based, also roundly condemned it, as is clear from this excerpt from a press release, available on-line at and worth reading in its entirety:

“ATLANTA — May 15, 2003 — The American Cancer Society today strongly criticized a misleading tobacco industry-funded study that compromises Society data by using flawed methodology to falsely conclude environmental tobacco smoke (ETS) may not affect lung cancer risk. Dr. James Enstrom, the author of the study published in the British Medical Journal, received funding from a tobacco industry group linked to coordinated attempts to confuse the public about the dangers of secondhand smoke.”

The press release noted that the ACS had done a much larger study using more appropriate and reliable data, called the Cancer Prevention Study II, which “Clearly shows an increased risk of lung cancer and heart disease.”

The press release concluded:

“Bad science can haunt us for generations,” added Dr. Eyre. “And regrettably, if questionable studies make it to publication, the damage is done.”
[Harmon J. Eyre, MD, the Society’s national chief medical officer.]

The study was also heavily criticized at the time by many scientists in the field for being based on flawed methodology such as the following, published on the BMJ website by Jayant S Vaidya, University College London, Dept of Surgery.

Like Eyre of the ACS, Vaidya includes a prescient comment, pointing out that the study will be used to promote vigorous opposition to secondhand smoke laws. Both were so right!

Jayant S Vaidya,
University College London, Dept of Surgery, W1W 7EJ

“There is a major flaw in the study and the Editors may wish to consider a public retraction.
This study assumes that there is a considerable difference in the exposure to ETS of never smokers’ spouse compared to ever smoker’s spouse. This is obviously not true.
Most never smoker’s spouses would have been exposed to considerable ETS before the late 1990s, when the general exposure to ETS in California started reducing. It would be only in the last 3-4 years of the 39-year study when the ETS exposure to workplace might have been so reduced that there might be a difference in the two groups.
So for most of the data, assuming the spouses meet in their non- working hours, they would be exposed to each other- for typically 2-4 hours a day (assuming a 11 hour work+travel and a 9 hour sleep+eat+bath etc.), whereas they would be exposed to ETS at work for up to 8-10 hours.
Thus the study is comparing a 8-10 hour exposure to ETS among spouses of ‘never’ smokers to a 12 hour exposure to tobacco smoke among spouses of ‘ever’ smokers. Assuming a 30% increased mortality for passive smoking and assuming never smokers are exposed to ETS for about 10 hours when they are not with their spouse, compared to 12 hours by spouses of ever smokers, the difference in mortality between the groups should be about ((12- 10)/12) x 30= 5%. In addition, there would be many quitters among the ever smokers – thus reducing the ETS to the spouse and many occasional smokers (mainly at the time when they met their spouse) among the never smokers – increasing the ETS exposure to spouse. Despite the large size of the study, it is well known that a 5% difference in RR is extremely difficult to demonstrate in epidemiological studies, and especially in this study, inability to find a difference especially when only a tiny difference was expected cannot be taken as absence of a difference.
There is no doubt that however flawed this study, unless it is retracted by the BMJ, tobacco industry will use it extensively to promote their vigorous opposition to anti-smoking legislation in general, and anti-ETS laws in specific. Of course they have an urgent need to replace their loss of customer base of about 10,000 to 20,000 per day with new recruits of young smokers.”

One response to “American Heart Association and KEEP ST. LOUIS FREE! team up(?!)

  1. You are right, 1/2 a pie is better than 100% of nothing. I think the county will be encouraged to follow suit rather than look foolishly tied to the past.

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