| Why I Voted Against the
Statewide Smoking Ban
By Tom
Neuville
March, 1, 2007
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
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.
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:
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.
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.?
?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.
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