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MARTHA PERSKE
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Asthma: The Politics of
Blaming Tobacco Smoke
Date of original release: 8/7/00 |
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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.
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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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