The continuing effort to undermine SHS evidence

Lilian in cap and gown

Preface to the following:

I posted a blog here last November in memory of my late sister, Lilian Williams, née Pion. Although a nonsmoker, she died of lung cancer shortly before her 58th birthday, and I’ve remained convinced ever since that it was due to her involuntary (and sometimes voluntary) exposure to secondhand smoke. This blog further reflects on that view.

I’ve received quite a few comments from Virgil Kleinhelter who, despite the name, is evidently writing from the U.K.

[Update: A MoGASP supporter subsequently sleuthed this and located a Mr. Virgil Kleinhelter in Fairdale, Ky, so delete my supposition above.]

I generally allowed them, but when a recent e-mail from him focused more on epithets and offensive remarks, I wrote back to Mr. Kleinhelter that his comments would no longer be allowed on this blog. Several e-mails later I received the following from him which, while rather dismissive of smoke-sensitive individuals because they merely “don’t like the smell” of SHS, nonetheless provided an interesting link to a recently published study in PubMed, which I believe is a reliable on-line source for peer-reviewed articles.

I was sufficiently intrigued to go on-line and check out the summary of the study, originally conducted by a researcher in Oslo, Norway. The conclusion I came to is entirely contrary to Mr. Kleinhelter’s. Please read the following, which kicks off with Mr. Kleinhelter’s comment, and let me have your considered opinions (sans epithets!):

Virgil Kleinhelter
74.129.250.175
2010/02/15 at 9:32am

When will it sink in that SHS is not the threat it is made out to be. It always goes back to, I don’t like the smell or some other feeble reason to control others.

The latest research into passive smoking. It has been discovered that mechanism that triggers lung cancer in non-smokers is quite different to that in smokers.

Therefore breathing in other peoples smoke will not ever give you lung cancer. “INTERPRETATION: Lung cancer in never-smokers should probably be regarded as a different disease-entity than smoking-induced lung cancer. This could impact prognosis as well as treatment.” http://www.ncbi.nlm.nih.gov/pubmed/19844277

Mr. Kleinhelter’s conclusion that “breathing in other peoples smoke will not ever give you lung cancer” is completely contrary to what has become accepted on the subject since at least the first U.S. Surgeon General’s Report, “The Health Consequences of Involuntary Smoking,” released in 1986. [Click on the title for the full report or here for the summary and conclusions in Chapter 1.] A major conclusion of that report was that there was a causal link between lung cancer and secondhand smoke exposure in healthy nonsmokers. The best estimate, which is currently 3,000 lung cancer deaths (LCDs) a year in the U.S., is about 20% of all nonsmoker LCDs each year.

Following is the entire abstract I found on-line of the paper referenced by Mr. Kleinhelter:

Lung cancer in smokers and never-smokers
[Article in Norwegian]
Tidsskr Nor Laegeforen. 2009 Sep 24;129(18):1859-62.

Helland A, Brustugun OT.

Onkologisk avdeling, Radiumhospitalet, Oslo universitetssykehus, Rikshospitalet, 0310 Oslo, Norway. aslaug.helland@radiumhospitalet.no

BACKGROUND: Lung cancer is the most frequent cancer-related cause of death for both sexes. Smoking is the cause of most cases, but estimates show that 15-20 % of cases in the western world are not associated with tobacco. Recent evidence – based on molecular and clinical studies – indicate that lung cancer in patients who have never smoked has certain characteristics that are different from those in patients who smoke. In this article we describe some of these characteristics.

MATERIAL AND METHODS: The present paper is based on literature identified through non-systematic searches in PubMed.

RESULTS: Lung cancer in never-smokers is estimated to be the seventh most frequent cancer type on a global basis. A number of molecular and clinical characteristics differ between lung cancer related to tobacco use and those not related to tobacco use. 62 % of lung cancers among never-smokers are adenocarcinomas and 18 % are squamous cell carcinomas, while corresponding numbers among patients who smoke are 19 % and 53 %. The K-Ras-gene is often mutated in tumours from smokers, but seldom in tumours from non-smokers; whereas the EGFR-gene is mutated in tumours from non-smokers, and not in smokers. Also, age and sex distribution, therapy response and prognosis are shown to differ between the groups.

INTERPRETATION: Lung cancer in never-smokers should probably be regarded as a different disease-entity than smoking-induced lung cancer. This could impact prognosis as well as treatment.

I just checked on my sister’s British death certificate – she died from inoperable, incurable lung cancer on November 11, 1988, shortly before her 58th birthday – and it notes the cause of death as follows:

1a. Carcinomatosis
1b. Squamous cell carcinoma of lung

Certified by D.Elsdon Myers M.B.

According to the research in this Norwegian paper, my sister died from the type of lung cancer that is more common among smokers, even though she never was a serious smoker herself. (When my sister was a young teacher I recall visiting her in her apartment and she would smoke after a meal without actively inhaling and never became addicted. But she was clearly not smoke-sensitive, because at least one of her good friends later in life, Harry Diamond, was a heavy smoker. I found that out when I met him at her funeral and he was puffing away at every opportunity.)

To me, rather than diminishing my belief that secondhand smoke was causally related to my sister’s premature death this study actually reinforces it.

Reminder: If you wish to submit a comment for publication please include your full name at the end of it. If you don’t wish it to be made public let me know and I’m willing to respect that but I won’t consider anything signed only using a first name or a pseudonym.

18 responses to “The continuing effort to undermine SHS evidence

  1. The Congressional Research Service concluded: “It is possible that very few or even no deaths can be attributed to ETS [environmental tobacco smoke].” Further, it stated that nonsmokers exposed to pack-a-day ETS every day for 40 years have “little or no risk of developing lung cancer”—much less dying from it.
    The CRS is part of the Library of Congress and has all the resources of that esteemed institution at its disposal. It is highly respected, nonpartisan, accepted by both Republicans and Democrats as fair and impartial, has no ties to tobacco companies, no regulatory or other agenda, and accepts no outside funding.

    Then there was the Congressional Investigation by the U.S. House of Representatives of EPA’s report on secondhand smoke. It found EPA guilty of “conscious misuse of science and the scientific process to achieve a political agenda that could not otherwise be justified.”

    The American Cancer Society has sponsored at least four studies over the years, all of which failed to find any statistically significant health risk from secondhand smoke, according to the standard cited by its own director of analytic epidemiology. But that hasn’t kept the ACS from claiming secondhand smoke is dangerous. The most powerful statistical study ever done on the subject was the Enstrom-Kabat study. It covered 100,000 people for 38 years. The ACS financed it, help set it up, and provided data for it until preliminary results indicated the opposite of what the ACS wanted. It then withdrew its financial support and denounced the study, which was eventually published in the British Medical Journal, one of the world’s foremost medical journals. The study concluded: “The results do not support a causal relation between environmental tobacco smoke and tobacco related mortality.”

    • First, “marbee,” thank you for providing your full name, which I’ve kept confidential at your request.

      Here’s a relevant quote by Harmon J. Eyre, MD, the American Cancer Society’s national chief medical officer, in a 2003 comment on the study you mentioned by Enstrom & Kabat. Please see below for a fuller excerpt:

      “Bad science can haunt us for generations,” added Dr. Eyre. “And regrettably, if questionable studies make it to publication, the damage is done.”

      Regarding your post, I’ve seen the three sources you quote referenced before to rebut the evidence concerning SHS and disease in nonsmokers. I believe all three have since been either debunked and/or seriously questioned as to their validity. I posted material doing just that on the Enstrom study on this blog on June 29, 2009 (link at http://tinyurl.com/kr2k7a) since it’s an oft-quoted study by those claiming SHS is harmless to exposed nonsmokers.

      This excerpt is from a 2003 ACS press release [on-line at http://www.no-smoke.org/pdf/BMJrelease.pdf] following the study’s publication which I posted previously:

      “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.]

  2. Martin Pion is a diligent researcher, who tracks sources with the zeal of a bloodhound. H.

  3. A common misunderstanding among smokers is that our focus is on preventing lung cancer in non-smokers, and if they can just prove that non-smokers don’t get lung cancer from SHS, that we will all go away.

    The truth of the matter is that the top 4 causes of death in Missouri, for example, are all related to tobacco smoke. Lung cancer is not number 1 on the list – heart disease is. Stroke and COPD are the other two. The relationship of SHS and other diseases, such as SIDS, other forms of cancer, and more, are just now becoming fully understood. Non-smokers don’t care to be exposed to the risk that smokers accept.

  4. I would add to this comment by Charley Gatton that “the risk that smokers accept” is due to the addictive power of nicotine. Many smokers try to quit every year but most fail …. which is what makes cigarettes such an attractive product for the tobacco cartel.

  5. What most ban proponents don’t understand is this issue is not about health. It is about Democracy in our Republic. While Smoking may not be a right, Tobacco is a Legal substance regulated of the FDA. The are Two Pillars of Democracy. Majority Rule and Minority Rights. Whether or not any one likes it Smokers are a minority. To prohibit or fail to provide for equal opportunity and access for a minority is illegal in America. To prohibit and infringe upon the right to peacebly assemble in Protest of the Government is against the Law in America.The List goes on and on.Minority Rights in America apply to Social and Cultural activities not just race, sexual orrietation, dissability etc. There is an extremely elavated risk of respiratory complications associated with every form of minning. No one is forced to participate in that employment field but neither is anyone denied the opportunity to work in the mines. Having come from a minning Family, I appreciate the regulatory improvments for safety, including respiratory protections. So rather than ban minning altogether protective action was taken to further minimize the risk to those exposed by choice.What is missing in America today is the appreciation of Freedom of Choice and the willingness of many to accept Personal Responsibility.The hands of labor and industry have been turned into begging bowls by those who believe freedoms just another word for nothing left to lose.

  6. Reverend Joe Sinnett

    No one has the right to endanger the Health of others while putting their own health at risk? There’s an uninformed blanket statement not well thought out. Therfore we should eliminate all individual choice and nullify the concept of personal responsibility. You have just opened the door to the Devil made me do it defense. It is this midevil thinking that preceded the burning of the witches and coincides with Hugo Chavez of Venezuelas Ruling Athority.

    • You’re invoking the Devil on the side of the tobacco industry? Very appropriate!
      Where’s your logic here? This is very clearly a public health issue but so many seem to have been brainwashed by the tobacco industry, who at one time or another have challenged all the evidence against smoking, i.e. at one time they claimed it wasn’t proven to cause disease or death in smokers, and that nicotine was not addictive. When later secondhand smoke was implicated as well, they adopted similar arguments against SHS, i.e. that it didn’t cause any disease or ill-effects in exposed nonsmokers. Their arguments have all been scientifically debunked but you still seem to be buying them.
      When a workplace is smoke-free then everyone has access to it, smokers and nonsmokers alike, without being subject to harm from a known human carcinogen.

  7. Reverend Joe Sinnett

    The invocation of the Devil was introduced from the efforts to Legislate Morality by Ban proponents. The most extensive reseach project regarding the impact of shs was done over 38 years by a Liberal Education research facility and was funded by anti- tobacco money. It has been proven that arsenic kills. But alas it is in our drinking water. The comparison reflects the same results. Parts per billion. Footbal Stadiums are for Football fans, Nascar is for race fans. No one is compelled to be a fan of either. If there are 20 smokers gathered for social activities and there are no non smokers present then there goes the shs argument as they are all responsible for their own health risks in the same environment. There are many restrictions involving the age appropriate arenas in Life. Example you are prohibited from being President if you are not 38 years old. The apparent reasons for these limits involves a level of presumed life experience and maturity. Incorporated in that is the freedom of personal choice and individual responsibility. My personal experience that ban proponents tend to cringe at that concept. For whatever reason they appear to be constitutionally incapable of making a decision not to go someplace where there is something going on they don’t like and consequently they feel more secure if the Government can supposedly intervene and remove all temptation. Smoking Ban proponents are much like Potter in it’s a Wonderful Life, same language same contempt for anyone who might look at life differently and the same greed and power driven motivation to stamp them all out and will stoop to using any means necessary including exploiting children. If there are those who are a contradiction to this personal experience I have yet to meet them or read anything that would lead me to come to a different conclusion. hate me if you want to,Love me if you can.

  8. Reverend Joe Sinnett

    The entire Smoking Ban argument and defense rests solely on one comment made by a Surgeon General who’s credentials are considered less than stellar based on a Federal Court Ruling. In addition when factual science principles are applied the effects of second hand smoke are virtually non-existant Primarily because it is scientifically to reach conlusions absent the capacity to or availability of comparitives. However when epidemiology is applied no scientific criteria is required for theories which get represented as scientific avidence. Therefore without science, epidemeology is the theorectical equivelent of a defense of the Devil made me do it. No substantive science to support the claims which consequently is the equivelent of saying there is a Santa Claus simply because a Child Finds wrapped presents under a tree Dec.25th

    • As a scientist I have to say that your entire argument makes no sense. There are three major U.S. Surgeon General’s Reports devoted either exclusively or partially to reviewing the evidence on the ill-effects of secondhand smoke (SHS). They were published in 1986, 1989, and 2006 and drew major conclusions: in 1986, that it causes lung cancer in healthy exposed non-smokers, as well as other serious ill effects, and that merely separating smokers from nonsmokers in the same space does not prevent these ill effects. You will find them on-line at http://www.surgeongeneral.gov/library/reports/index.html. Have you reviewed any of this documentation?

  9. RJS (Reverend Joe Sinnett)

    The Surgeon General Report is not the same as science. Being a Scientist you should know that. This report was a conclusion based on epidemiology. This is just one more case of follow the money and see what gets reported as fact.

  10. Unfounded message board opinionations are not the same as science either.

    RJS’ mischaracterization of the SGR as “a conclusion based on epidemiology” shows he’s been copy/pasting off too many pro-smoking websites.

    The fact is, as written [on page 64] in the intro to Ch. 2 of the 2006 SGR, “The Toxicology of Secondhand Smoke”:

    [“Evidence Synthesis”]

    “This chapter reviews the substantial amount of data from cellular, animal, and human studies supporting the overall conclusion that exposure to secondhand smoke causes a broad range of adverse effects in both children and adult nonsmokers. These data provide a strong foundation for the biologic plausibility of causal conclusions related to specific diseases and other adverse health effects that are reviewed in Chapters 5 through 9. This chapter provides substantial additional evidence on the underlying pathogenic mechanisms for major adverse health outcomes associated with exposure to secondhand smoke.”

  11. >>The Congressional Research Service concluded: “It is possible that very few or even no deaths can be attributed to ETS [environmental tobacco smoke].”

    More swill from the professional spammers.

    Thanks for posting all the impeccable health info you copy/pasted from bloggers’ websites, “marbee.” Very scientifical! And you know, I ALWAYS believe whatever I read on anyone’s blogsite. It’s unfortunate you had to trip over thousands upon thousands of normal, easy-to-find regular science articles on reputable sites to come up with this aberrant post by some obscure blogger.

    “Edmund Contoski,” the blogger with no apparent references or education, is utterly wrong about the CRS report. While this quotation is _in_ the report, it is in no way what the report “concluded.” In context, that “possible” is a counterpoint to an immediately preceding discussion of studies that did find such deaths. It’s merely an acknowledgment that very little is definitive in science; that’s how science works.

    [MoGASP: Edmund Contoski’s article, quoted by “marbee” and the subject of rebuttal by “Gene” above, can be found here: http://www.amlibpub.com/liberty_blog/2009/05/new-study-big-blow-to-smoking-ban.html]

    Unless you’re a blogger-believer, of course. Then every little cherry-picked phrase is the Gold Standard, and prime fodder for your PR campaign– fodder you can spam message boards around the world with (readers should Google “marbee”).

    The CRS report also said:

    “It is possible that ETS exposures are too small to be the cause of lung cancer in any meaningful sense; it is possible that some exposures are large enough to have an effect and others are not; and, it is possible that even a very limited exposure could cause some disease.”

    The CRS report talked about all sorts of possibilities, and made NO conclusion about the health effects of ETS.

    Oh, except in one area: children:

    “In the case of acute respiratory illness, the EPA estimated that 300,000 cases are due to ETS, with 7,500 to 15,000 hospitalizations. These estimates were confined to effects for children under 18 months.

    “As noted earlier, it is likely that much of the exposure to ETS, especially among young children, may be due to exposures in the home by parents where regulation cannot have an effect, and any government role would probably concentrate on education. While ETS may pose a serious risk to young children in the home, such education programs would probably be most effective by emphasizing all of the risks resulting from parent’s behavior that these children face in that environment.”

  12. Note: Biologic plausibility, Plausibility is a word used when there is absence of proof. Nice choice of words. My info came from working in IAQ industry and reading reports to address indoor air quality issues. Not promote Pharmaceutical interests nor the Tobacco industries. Plausible is, you can drown if your under water for 15 minutes. Seems logical untill you aply it to taking a shower and decide you’re at risk or drowning after 14 minutes. This whole smoking issue started with Nicotine is an addictive drug to second hand smoke . However the very agencies that raise the most caine are the very ones that promote nicotine delivery devices. They complained about E-Cigarettes untill they managed to figure out how to copy it and now are in favor of it. I am not saying that Smoking is a Healthy Life Choice. I am saying that No Safe Level is an exagerated lie. If No Safe level were true, I am smoking while writting this, therefore you should be coughing. No Safe level would make that plausible.

  13. I don’t know how much filing and photocopying you had to do at whatever “IAQ” place you worked at, but ASHRAE begs to differ with you:

    http://www.ashrae.org

    American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE)

    New Position Document (2005) On Secondhand Smoke (SHS) / Environmental Tobacco Smoke (ETS) in the Workplace, Public Places.

    Among the findings by ASHRAE in the 2005 document are:

    • It is the consensus of the medical community and its cognizant authorities that SHS is a health risk, causing lung cancer and heart disease in adults, and exacerbation of asthma, lower respiratory illnesses, and other adverse effects on the respiratory health of children.

    • Currently, the only way to effectively eliminate health risk associated with indoor exposure is to completely ban smoking activity.

    • An increasing number of local and national governments, as well as many private building owners, are implementing bans on indoor smoking.

    • Because of ASHRAE’s mission to act for the benefit of the public, it encourages absolute elimination of smoking in the indoor environment as the optimal way to minimize SHS exposure.”

  14. >>Plausible is, you can drown if your under water for 15 minutes. Seems logical

    Seems logical?? Who are you, Rev. David Blaine?

    “untill you aply it to taking a shower and decide you’re at risk or drowning after 14 minutes.

    Oh my goodness. OK, we’re officially off into Wacky-ville now. If you can’t see that from the above, you really should seek help, please.

    Whatever you do, quit posting semi-coherent missives on message boards. You’re not doing yourself any favors.

    I’m out —

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