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January
2004 -
You would have
thought that between SARS and the looming return of West Nile that Toronto’s
Medical Officer of Health would have a fairly full plate.
But the good
doctor appears to never let real health risks get in the way of the
important work of her unit- using junk science to stamp out phantom risks.
So last Monday while the numbers of SARS deaths continued to grow Dr. Basrur
and the Board of Health ran an eight hour meeting devoted to the hugely
important health risk of, yes, Designated Smoking Rooms (DSR’s are fully
enclosed and separately ventilated spaces where smoking in bars and
restaurants is permitted.)
Dr. Basrur’s
role in the phantom DSR health risk is an interesting one. In 1999 she
presented the Board of Health and City Council with a paper outlining the
“science” of secondhand smoke risks and a menu of policy options about what
to do about this allegedly major health problem. Unfortunately Basrur’s
understanding of the risks of secondhand smoke and the ways to deal with
those risks was deficient in at least three respects.
First, true to
the junk science tradition, she failed to provide any primary scientific
studies that supported her claim that secondhand smoke is a substantial
health risk for non-smokers, despite the fact there were more than 70 such
studies on secondhand smoke and lung cancer risks alone at the time. But it
wouldn’t do to have a Medical Officer of Health burdening her political
masters or the public with the science of an issue.
Second,
consistent with good junk science, Dr. Basrur ignored the most recent
evidence available about the risks of secondhand smoke in public places. The
evidence came from a very large study, conducted by the World Health
Organization, in seven European countries over ten years. The study was
particularly important since it specifically examined secondhand smoke risks
in public places like restaurants- which was one of Dr. Basrur’s main areas
of concern. The study found that there was no increased risk of lung cancer
to non-smokers in restaurants- despite the large amount of public smoking in
Europe. A very relevant finding for whether Toronto
needed to be smoke-free, but also a terribly inconvenient one for Dr. Basrur.
Third, despite
her training as a scientist, Basrur refused to accept the results of a
scientific experiment on the effectiveness of ventilation in dealing with
secondhand smoke, funded by the Ontario Restaurant Association. The
experiment at Toronto’s Black Dog Pub was designed and carried out by the US
Government’s Oak Ridge National Laboratory and the Center for Toxicology and
Environmental Health. Since Dr. Basrur had claimed that ventilation of
smoking areas could not protect non-smokers from secondhand smoke, the
experiment at the Black Dog was designed to determine whether ventilation
could indeed work.
The results
were dramatic, but again very inconvenient for Dr. Basrur. They found that
with properly designed ventilation the air quality in the non-smoking
portion of the Black Dog was comparable to the air quality in a completely
smoke-free establishment, even though the Black Dog permitted smoking next
to the non-smoking area. So despite the Medical Officer of Health’s claims
about ventilation failing to protect non-smokers, the real time experiment
of the Black Dog proved that ventilation did work. Equally important in
terms of health gains for both non-smokers and smokers, the study found that
ventilation systems like those used in the pub provided a “substantial
improvement in overall indoor air quality.
In a world
where public health policy was crafted with more than a passing nod to
rationality, the Black Dog experiment would have proved decisive. Here was
proof- not in some obscure, far-off place, but right in the home town, that
ventilation could be a win for everyone. Nonsmokers are protected from
secondhand smoke, and gain a bonus from cleaner air. Smokers are allowed to
smoke in properly ventilated areas. Restaurant and bar owners and employees
sensitive to the economic impact of smoking bans can still cater to their
smoking patrons. And public health achieves its goal of protecting
nonsmokers from secondhand smoke.
But the Toronto
of 1999 was not ready for rational public health policy when it came to
public smoking. Despite the Black Dog results, Dr. Basrur, the Board of
Health and City Council stubbornly clung to their junk science views that
secondhand smoke kills and that the only solution is to ban public smoking.
The reason for this attachment to junk science and phantom risk is to be
found in the nature of junk science itself, for at bottom junk science is
really not about science but about ideology, in this case the ideology that
people- even adult people- should be prevented by every conceivable means
from smoking.
Buried in Dr.
Basrur’s report is in fact an admission of this. She notes that “preventing
people from smoking in public can also help reduce smoking rates by reducing
the number of places where people can smoke.” So the truth is that this
isn’t about protecting non-smokers at all. It’s all about preventing smokers
from smoking. Whatever science says about secondhand smoker or ventilation
is not really important so long as we can make it tough for people in
Toronto to smoke.
But what about
the Toronto
of 2003? The 1999 by-law contained a compromise that allowed for DSR
indefinitely. In January of this year, Dr. Basrur, in a new report to the
Board of Health, urged the Board to “revisit”, read repeal, the City’s
policy on DSR. Which is what, in the midst of one of its most significant
health emergencies, the Board did last Monday.
Now Basrur’s
new report is curious in a number ways. First, Basrur is still worried about
the Black Dog. She continues to claim that its ventilation solution does not
protect people from secondhand smoke when in fact the non-smoking section of
the Black Dog has air that is equivalent to and in some instances better
than the air in completely non-smoking establishments.
But what she
fails to tell her Board and City Council is that not only has the Black
Study now been published in a peer-reviewed scientific journal, (2002) but
that in the year since its publication the journal has received no
criticisms of it nor studies refuting its claims. So even more
extraordinarily than in 1999 Dr. Basrur continues to make her junk science
claims in the face of published, scientific evidence that she is wrong.
But Basrur’s
report is curious in a second way. In 1999 she told her Board, Council and
the public that “Full protection [from secondhand smoke] is achieved only in
a smoke-free environment, or where there is a fully enclosed and separately
ventilated DSR.” Why then were these rooms able to provide “full
protection” in 1999 and not in 2003? What has changed? The supposed answer
is an easy one-liner “the risk to employee health could be substantial.”
There it is- junk science at its most blatant. Basrur feels no need to
explain, no need to provide evidence, let alone scientific evidence, about
the alleged risks of DSR, no need for anything more than an assertion. Has
Toronto, for instance seen an increase in health related problems for
employees working in DSR? Is there new, published scientific evidence about
worker risk in DSR? The evidence from the US OSHA directly contradicts
Basrur in that it suggests that work-related illnesses and fatalities for
service industry workers have actually fallen despite substantial increases
in employment.
Of course the
real answer has nothing to do with employee health: Dr. Basrur simply
doesn’t want people smoking anywhere in Toronto. DSR were simply a sham
compromise to make the ban on public smoking appear less draconian.
Equally odd is
the fact that Basrur neglects to tell her Board and City Council that last
year British Columbia
adopted a new regulatory regime to address exactly the problem that she
thinks is insoluble- ventilation. The most important difference in BC’s
approach as opposed to Toronto’s is that it is actually based on real
science.
After
examining the science behind ventilation and the likely secondhand smoke
exposures faced by employees in DSR, the BC government brought in
regulations which not only allow for DSR but also protect employee health by
specifying the amount of time that any employee can work in a DSR during a
24 hour period. One can understand Basrur not agreeing with this approach,
after all perhaps she knows something that the BC government and its
scientists don’t, but not telling her Board and City Council looks a lot
like a cover-up.
Finally, what
about the regulatory principle that regulations should be consistent and
certain without huge changes in direction? Since 1999 hospitality owners
have invested significant amounts of money in DSR on the basis of a policy
that permitted them indefinitely. They were told by the Medical Officer of
Health that they provided full protection from secondhand smoke. Now,
without a scrap of scientific support the same Medical Officer of Health is
proposing a complete regulatory about face.
At the end of
the day the most important issue here is not whether people can continue to
smoke in DSR in Toronto, but whether public health policy will continue to
be made based on a Medical Officer of Health’s junk science. Coupled with
Dr. Basrur’s scientifically illiterate assault on pesticides (See Terrence
Corcoran’s editorial from April 5, 2003), her recent policy work on DSR
points to a deeply flawed understanding not only of science but of the way
in which science should guide policy. For Dr. Basrur it looks increasingly
like first you decide the policy and then you “create” the science.
The wonderful
thing about science however, is that in the midst of all the subjective cut
and thrust that is part of the public policy process, it provides one of the
few reasonably objective measures of what is true. By allowing junk science
to pass as genuine science and provide the basis for social regulations on
smoking, pesticides or anything else, we not only devalue science but risk
losing our single most valuable resource in the public policy process. And
that is a sure prescription for ill health.
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