Secondhand-Smoke Story Goes Up In Flames [Cmaj
May 5, 1998]

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CMAJ
CMAJ - May 5, 1998JAMC - le 5 mai

Secondhand-smoke story goes up in flames

Charlotte Gray

CMAJ 1998;158:1178-80

[ en bref ]Charlotte Gray is a CMAJ contributing editor.

© 1998 Charlotte GraySee also:

In brief

In March an Ottawa newspaper reported, on its front page, that a "secretly published study" had shown "not only that there might be no link between passive smoking and lung cancer, but that it could even have a protective effect." Charlotte Gray wonders how a single article could manage to get so many facts wrong and why supposedly reputable papers would publish it.En bref

En mars, un journal d'Ottawa annonçait en première qu'une «étude publiée secrètement» avait démontré «non seulement qu'il pouvait n'y avoir aucun lien entre le tabagisme passif et le cancer du poumon, mais qu'il pourrait même y avoir un effet protecteur». Charlotte Gray se demande comment on a pu, dans un seul article, réussir à publier tant de faits erronés et pourquoi des journaux supposément réputés publieraient un tel article.

Visions of prestigious newspaper awards must have danced in the young reporter's head when she got the call from "her source" in early March. The source assured her that the World Health Organization (WHO) was suppressing a research report, a "secret study" that suggested there was no link between secondhand smoke and lung cancer. The story had everything a young journalist lusts for — conspiracy, rejection of the conventional wisdom and an antigovernment spin her bosses would die for. This was better than Watergate! It might even knock the latest harassment charges against President Clinton off the front page of her newspaper, Britain's Daily Telegraph.

Unfortunately, the story that ran had more holes than Clinton has alleged girlfriends. The writer had no understanding of scientific practices and her "exclusive" had no sense of balance and offered no credible source. The reporter was Victoria MacDonald and the misinformation she presented appeared just before the UK's No-Tobacco Day and the scheduled publication of the report of the British Scientific Committee on Tobacco and Health. The story she filed about a small, run-of-the-mill study involving exposure to secondhand smoke consisted mostly of tobacco-lobby spin and a lot of egregious mistakes. But the tale fit all the parameters of a great newspaper scoop, and so it quickly took on a life of its own around the world.

MacDonald's editors loved her piece so much they published an editorial entitled "A setback for nanny" in the Daily Telegraph, which is owned by Canadian Conrad Black, a man well known for his distrust of government and dislike of taxes. One reason for WHO's attempt to keep the report "secret," suggested the editorial, was that the organization's "institutional raison d'etre is to interfere as widely as possible in the day-to-day life of as many people as possible. The more serious hazards to the health of humanity it can uncover, the more plausible its claims to lavish funding, larger staffs, higher pensions and better canteen facilities."

Before this antigovernment diatribe had even appeared, the story was on the Telegraph's international wire service. The editors who run Conrad Black's papers in Canada know a good story when they see one, and on Mar. 8 the Ottawa Citizen gave the marvellous scoop front-page coverage, and managed to compound mistakes contained in the original error-filled piece with the headline: "No harm from secondhand smoke." (The investigators never looked at secondhand smoke's impact on people with asthma or bronchitis.) The Daily Telegraph article also appeared in papers in Vancouver, Edmonton, Calgary and St. Catharines and sparked breathless editorial comment from those anxious to believe it, to dismiss all studies with a different conclusion and to attack antitobacco activists.

Globe and Mail business columnist Terence Corcoran was positively ecstatic, arguing that the "banned research" — it wasn't banned — showed that antismoking bylaws were simply an encroachment on individual rights, with no basis in science. In the same newspaper, Vancouver science fiction writer Spider Robinson asked: "What could be more satisfying than the sight of the forces of righteousness and rectitude scurrying about like doomed rats, fleeing a lethal flood of escaped facts""

Media misinformation

Dr. Andrew Pipe, an associate professor at the University of Ottawa and former chair of Physicians for a Smoke-Free Canada, read the Citizen article and winced. "A story like this has a most unfortunate public impact. Headline readers assume there has been a major breakthrough and never read on. And I'm afraid that many of those who are in a position to influence public policy only read headlines." The article confirmed Pipe's view that "there is just an appalling inability to assess and discuss scientific issues within the media."

At Ottawa's Carleton University, Associate Professor Randal Marlin read the story and then shook his head in wonder. "I teach a course on truth and propaganda in the philosophy department here, and I can tell you that of all the organizations I watch the tobacco companies are the most mendacious. This story had their fingerprints all over it."

Marlin wrote a blistering letter to the editor, detailing the article's errors paragraph by paragraph. To its credit the Citizen printed his scathing response, even if it did spell his name wrong.

Passive smoke is good for you!

So what was this "lethal flood of escaped facts" that Spider Robinson mentioned" MacDonald's story revealed that WHO had commissioned a 12-centre, 7-country European study that was "one of the largest ever to look at the link between passive smoking — or environmental tobacco smoke — and lung cancer." The research compared 650 lung cancer patients with 1542 healthy people. The scientists had found there was "no statistical evidence that passive smoking causes lung cancer. . . . The results are consistent with there being no additional risk for a person living or working with a smoker." There was even a possibility, wrote MacDonald that passive smoke had "a protective effect against lung cancer." She wrote that nobody at WHO headquarters in Geneva would comment on the findings "despite repeated calls." She had then asked a spokesman for British America Tobacco Industries for a comment, and Dr. Chris Proctor obliged: "If this study cannot find any statistically valid risk you have to ask if there can be any risk at all."

The day after the story appeared in England and Canada, WHO fired back. "Passive smoking does cause lung cancer," its news release said. "Do not let them fool you." It said that WHO was not suppressing information and that the report itself did not fail to prove an association between passive smoking and lung cancer. The study had been "completely misrepresented" and its results were very much in line with those from similar studies: there was an estimated 16% increased risk of lung cancer among nonsmoking spouses of smokers, and 17% among people exposed to secondhand smoke at work. However, due to the small sample size, the increased risk was statistically insignificant.

Neil Collishaw, a Canadian who now heads WHO's Tobacco or Health Unit in Geneva, pointed out that "a major meta-analysis of 40 different studies of passive smoking and lung cancer was also published in the British Medical Journal in 1997. From these and other previous reviews of the scientific evidence emerges a clear global scientific consensus — passive smoking does cause lung cancer and other diseases." And the "secret" WHO report was not publicly available simply because it had been submitted to a medical journal for peer review.

Antismoking activists in Canada are particularly incensed because, in Ottawa and Vancouver at least, there were attempts to verify the story's accuracy and yet it still appeared. "I was called the day before it appeared," explains David Sweanor, senior legal counsel for the Non-Smokers' Rights Association. When the Citizen reporter told Sweanor what was in the Daily Telegraph article, he suggested that the Ottawa paper "had been duped" and that there is overwhelming evidence that secondhand smoke can cause lung cancer. Sweanor also explained that if a risk is described as "not statistically significant" this does not mean there is no risk and offered to provide the reporter with the BMJ's meta-analysis. He also gave him Neil Collishaw's home phone number in Geneva. (Nobody from the Daily Telegraph tried to contact Collishaw, despite MacDonald's claim of "repeated calls.") He also suggested that the reporter might call Dr. Don Wigle, a Health Canada epidemiologist and expert on secondhand smoke.

Sweanor, shocked that a story would actually suggest that secondhand smoke might be good for you, told the reporter "that the story was not just wrong, it was unethical. How many people are going to read that story and say, 'Great! I don't have to go out to the porch to smoke now, it won't hurt my kids' "" Sweanor asked the reporter if he would take such a cavalier attitude with other public-health issues. "Would the Citizen publish a story suggesting that alcohol improves driving or that there was no risk in having sex with someone with AIDS just because the Daily Telegraph had published it""

The Citizen called neither Wigle nor Collishaw, and none of Sweanor's reservations about the story appeared in the paper the following day, alongside the Daily Telegraph piece. "They ignored everything I said. They didn't want the information I gave them."

An early April Fool's Day joke"

Similarly, a reporter from the Province in British Columbia called Robert Broughton, president of Airspace Action on Smoking and Health, and was told that the story looked like an early April Fool's Day joke. Broughten explained why the study was not as important as the Daily Telegraph article suggested. None of his comments, or comments from other experts, appeared in the Province alongside the original Telegraph story. Broughton has already filed a complaint with the BC Press Council.

The day after the Telegraph piece appeared, the Citizen published a follow-up article outlining Sweanor's and Collishaw's objections, and in subsequent editions it printed several letters of protest. Randal Marlin described the article as a "tissue of falsehoods." Dr. Raymond Dawes of Barry's Bay, Ont., said the article was "both irresponsible and dangerous." But the Citizen never carried a retraction or an acknowledgment that its headline was completely inaccurate, or any mention of WHO's stinging response. The Province has not carried any letters, let alone a retraction or a full account of the WHO response.

To understand why so many newspapers were prepared to distort the science in this story and publicize a dangerously complacent message about passive smoking, one must look at this as a media and not as a public-health issue.

Neil Reynolds, editor of the Citizen, told me this was a fairly straightforward story. When Reynolds, a smoker, saw the story arrive that weekend, "the issue wasn't about science, it was about a UN agency hushing up a report it didn't like." He did not consider the scientific findings controversial because "previous studies have shown that the link between secondhand smoke and lung cancer is very, very slim, if it exists at all." (It is true that several studies have failed to find a "statistically significant" relationship, but none has shown that there is no link and several have demonstrated a significant causal relationship.)

Reynolds says his paper went with the story because it was about WHO being embarrassed, and he did not publish its response because he considered it a predictable defensive reaction. And he still doesn't accept the argument that the full study was not available because it had been submitted to a scientific journal. "This is a UN-sponsored piece of research, so peer review is less important. These UN organizations are not usually so strict about releasing results." (This is true of some UN bodies, but most scientists insist on peer-reviewed publication for credibility's sake.)

The criticism from academics, physicians and antismoking activists did not prompt a reassessment of how the story was handled, says Reynolds, because "incendiary issues" like abortion or the health risks posed by tobacco always produce a lot of mail. "You expect strongly worded responses from organizations committed to one side of a story."

There is not just a 1990s' distrust of government and expert opinion at play here, but also a particular distrust of WHO itself. There have been rumours in Geneva that WHO is bowing to political pressures to suppress unpalatable research findings on several fronts, with one WHO scientist suggesting that the US government has tried to suppress his work on the high incidence of thyroid cancer following the 1986 nuclear accident at Chernobyl. The Economist says his results could make the US government liable for lawsuits for everything from the Nevada bomb tests in the '50s to the Three Mile Island nuclear accident in 1979.

WHO has also been accused of caving in to pressure when it failed to include data suggesting that cannabis is less harmful than alcohol and tobacco when it published a report on the effects of the drug. It has denied these accusations, but nonetheless they have alerted journalists that something may be amiss at WHO, and the reporter who can uncover that something will have the Next Big Story. The scientific integrity of the studies is not even a consideration.

None of this is any comfort to antitobacco activists, who regard the Southam newspapers' callous disregard for facts as both "reckless and irresponsible," as Andrew Pipe put it. Conrad Black's papers have done exactly what the tobacco lobbyists wanted: they suggested that there is still a debate on the dangers of passive smoke and, says Sweanor, they have "muddied the waters and suggested doubts."

Sweanor thinks the Citizen's hunger for sensationalism distorted its coverage. "The week after the secondhand smoke headline appeared, there was another one suggesting that we were all going to get wiped out by an asteroid. But at least it retracted that claim."

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