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Asthma

The Politics Of Blaming Tobacco Smoke
Martha Perske

Date of original release: 8/7/00

Fewer people smoke now than ever before, and smoking restrictions and bans have resulted in even less exposure to secondhand smoke.  Yet, adult and childhood asthma cases have increased from approximately 6.7 million in 1980 to 17.3 million in 1998, according to the Centers for Disease Control and Prevention. [1]  

The dramatic increase in asthma clearly flies in the face of the U.S. Environmental Protection Agency's stated claim in 1994 that restricting exposure to secondhand smoke would result in the reduction of thousands of new cases of  childhood asthma annually and save billions of dollars a year. [2]

Contrary to what the EPA would have us believe, medical researchers are increasingly putting the blame for asthma on our modern day obsession with cleanliness, not on tobacco smoke. For further discussion on this, see"Smoke and the Asthma Epidemic: A Reality Check," by Wanda Hamilton.

Blaming tobacco smoke was "politically correct"

Dr. Fernando Martinez, director of respiratory sciences at the University of Arizona, is among those specialists who believe that improved hygiene and overuse of antibiotics are at the heart of the problem. "Like most people," he says, "I assumed tobacco smoke and pollution were the problem -- this was the politically correct way to think.  But these factors turned out not to play a major role." [3]

Dr. Martinez's change of mind is especially noteworthy considering that he co-authored Chapter 8 of the 1992 EPA report [4] which continues to be the basis of claims that secondhand smoke causes asthma.

The EPA Report

So, what exactly does Chapter 8 of the EPA report say?  Well, that's hard to determine since first it says one thing, then concludes another.

It says, for example, that the evidence is "suggestive" but not "conclusive" that secondhand smoke causes asthma in kids:

       It was further concluded that ETS [environmental
       tobacco smoke] is a risk factor for new cases
       among previously asymptomatic children, since
       the evidence is suggestive, but not conclusive, of
       a causal association...  (EPA report, p. 8-10)

Then without explanation, EPA jumps from "suggestive" to "conclusive":

       This report concludes that, in addition to inducing
         new cases of asthma,
ETS exposure increases
       the number and severity of episodes...  (emphasis
       added)  (EPA report, p. 8-15)

Next, even though there is insufficient evidence that ETS causes new cases of asthma, EPA says that between 8,000 and 26,000 new cases of asthma per year are attributable to ETS:

       For new cases of asthma in previously asymptomatic
       children under 18 years of age, we estimate that 8,000
       to 26,000 is a probable range of new cases per year
       that are attributable to ETS exposure from mothers who
       smoke at least 10 cigarettes per day.  The confidence
       in this range is medium and is dependent on the
       conclusion that ETS is a risk factor forasthma induction.  
       (EPA report, p. 8-15)

The EPA's 8,000-26,000 estimate has been and continues to be disseminated to the public as fact, with no ifs, ands, or buts.  

For example, the American Heart Association jumped on the politically correct bandwagon by claiming that "Mothers who smoke 10 or more cigarettes a day can cause as many as 26,000 new cases of asthma among their children each year." [5]

On July 31, 2000, a full-page anti-smoking ad ran in the New York Times, claiming among other things that secondhand smoke causes 26,000 new asthma cases each year in the U.S. [6]  

In a published letter to Ann Landers, EPA Administrator Carol Browner warns readers "not to smoke in front of children" because among other things secondhand smoke "causes children to develop asthma." [7]  Likewise, in her formal statement in support of Representative Waxman's Smoke-Free Environment Act of 1993 (H.R. 3434), Browner unequivocally states that "...second-hand smoke causes children to develop asthma in the first place." [8]

Two different stories

Apparently, EPA's right hand doesn't know what its left hand is doing.  At about the time that Carol Browner was unduly alarming the public with her claim that secondhand smoke causes asthma, the chairman of EPA's Science Advisory Board Committee, Dr. Morton Lippmann, was saying otherwise.  In testimony before a Congressional panel, Lippmann said that his Committee "agreed with EPA" that the data were "insufficient" to claim that secondhand smoke causes asthma, and that "further research is needed to determine if a causal link...can be established." [9]

Oddly enough (or maybe not), on the very day that Morton Lippmann presented his testimony, Alfred Munzer, M.D., testified before another Congressional panel and sang a different song, more in tune with Carol Browner.  Munzer, testifying on behalf of the Coalition on Smoking or Health (American Lung Association, American Cancer Society, and American Heart Association), talked about the EPA's "exhaustive review of the health effects of environmental tobacco smoke on children."  He began by saying: "Let me restate these effects of environmental tobacco smoke for the record:  8,000 to 26,000 cases of childhood asthma per year..." [10]

No mention was made of the EPA's contradictory positions.

Science versus advocacy

More recently, Dr. David Stempel of the Virginia Mason Medical Center in Seattle, Washington, said, "Passive cigarette smoke often has been thought to increase the risk of active asthma, but studies to date have not demonstrated this association convincingly."  He said that at a 1999 conference co-sponsored by the American Lung Association, so the anti-smoking groups cannot claim ignorance of the current state of scientific thought. [11]

Drs. Martinez and Stempel seem to represent principled scientists who will not adhere to the advocacy line when the scientific data cannot substantiate the advocacy.  But their scientific understanding and their principled statements beg several important questions:  In light of their scientific analysis, are the anti-smoking groups bound by any standards as they continue to further the asthma myth, along with other pronouncements that have only tenuous scientific moorings?  What is the moral difference between their misrepresentations and those of which the tobacco industry is accused?

Scientific understanding is a building process.  What we know will lead us to what we can know.  But if science is undermined -- by any side to further any cause -- so are we, all of us.

___________________________
ENDNOTES

[1]  "Poor People Are Fighting Baffling Surge in Asthma," New York Times, 10-18-99, A1.

[2]  The Costs and Benefits of Smoking Restrictions:  An Assessment of the Smoke-Free Environment Act of 1993 (H.R.3434).  U.S. Environmental Protection Agency, April 1994, p. 27.  Prepared at the request of Congressman Henry Waxman, sponsor of H.R.3434.

[3]  "Does Civilization Cause Asthma?" by Ellen Ruppel Shell, Atlantic Monthly, May 2000.

[4]  Respiratory Health Effects of Passive Smoking:  Lung Cancer and Other Disorders.  U.S. Environmental Protection Agency, EPA/600/6-90/006F, December 1992.  Dr. Fernando Martinez and EPA Project Manager Steven Bayard authored Chapter 8, "Assessment of Increased Risk for Respiratory Illnesses in Children from Environmental Tobacco Smoke."

[5]  Heart and Stroke Facts:  1994 Statistical Supplement, American Heart Association.

[6]  New York Times ad:  "The #1 Killer in the Workplace Is . . . Secondhand Smoke."  July 31, 2000.  Funded by the Coalition for a Smoke-Free City.

[7]  Daily News, Los Angeles, CA, 1-25-94.

[8]  Statement of Carol Browner, Administrator, U.S. Environmental Protection Agency.  Costs and Benefits of Smoking Restrictions, April 21, 1994.

[9]  Hearing before the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, House of Representatives.  Environmental Tobacco Smoke.  July 21, 1993. Transcript p. 136.

[10]  Hearing before the Subcommittee on Specialty Crops and Natural Resources of the Committee on Agriculture, House of Representatives.  Review of the U.S. Environmental Protection Agency's Tobacco and Smoke Study.  July 21, 1993.  Transcript p. 81.

[11]  "Risk Factors for Acute Exacerbations of Symptoms," by David Stempel, MD.  American Lung Association/American Thoracic Society International Conference, April 25, 1999


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