THE CONTEXT
The assumptions about the nature of persons and the legitimate role
of the State (of necessity unargued for) which structure our argument are those of an
unreconstructed liberal individualist, namely, that the individuals who make up democratic
society are the best judges of the shape they wish their lives to take, and consequently
they should be accorded the maximum liberty, compatible with similar liberty for everyone
else, to think, believe, and live as they choose. This means that the State's role is at
least fourfold: first, to prevent or minimize harms by one individual to another
individual; second, to minimize and where necessary adjudicate the inevitable conflicts
that occur between individuals and between individuals and the community; third, to defer,
wherever possible, from moral judgements about how its citizens choose to shape their
lives; and finally, to create the minimal institutional conditions which allow its
citizens' self-chosen lives the best chance of fulfilment.
What this means is that the State will resist the impulse, however
well-intentioned, to undermine and intrude upon its citizens' capacities and inclinations
for autonomy by defining one vast and unassailable conception of the good life to which
all must subscribe. What this means is that the state will see its citizens as persons of
intrinsic worth, fully equivalent in moral standing with itself, with lives not to be
managed or saved, but to be allowed to develop in ways of their own choosing.
In order to understand the ways in which science and public policy
intersect in the debate over smoking -- as indeed over many other "health"
issues -- it is necessary to place the smoking controversy in general and the
Environmental Tobacco Smoke controversy in particular within the larger context of both
governmental and nongovernmental efforts to discourage tobacco use.
For most of the twentieth century the campaign to delegitimize
smoking has employed two major weapons, science, particularly epidemiology, and morality,
within the general conceptual framework of what can be called health paternalism. Though
the mix has varied, the conjunction of the two has been not only consistent, but also
highly effective.
For example, once it was established that smoking increased the
risks of ill health in smokers, the groundwork was laid for a series of moral arguments
that purported to show that subjecting oneself to these risks was both so irrational and
immoral as to justify government efforts to prevent one from assuming the risks. The
health paternalism at work here rests on a series of assumptions about reason, autonomy,
and the nature of persons that include the following:
1. autonomy is not the foundational democratic
value inasmuch as considerations of happiness and welfare frequently take precedence over
it;;
2. individuals are frequently irrational in that
they
a. often do not understand their interests; and
b. even if they do understand their interests they do not know how best to realize those
interests;
3. individual's need the State's help in
a. discovering and realizing their "true" interests; and
b. avoiding irrational courses of action that result in unhappy consequences.
What unites these assumptions is the belief that the State is
justified in protecting competent adults from the allegedly harmful consequences of their
actions through restricting their autonomy.
Based on these assumptions, health paternalism advances the
following claims:
1. health is the preeminent value which outweighs,
in most instances, all other values such that a rational person would not normally place
his health at risk in the interests of some other value;
2. there is but one healthy/rational way to live one's life and such a
way does not include activities that carry with them significant risks to well-being or
longevity;
3. individuals have a moral obligation to order their lives in this
healthy/rational way; and
4. the State is justified, indeed the State has a moral obligation, to
ensure that its citizens conform to this health/rational paradigm, even if they wish not
to or are unable to through their own efforts.
Health paternalism is thus a subtle shift away from the generally
uncontroversial right of the State to ensure that consumers are fully informed about the
risks of certain products or activities to their health to the highly contentious claim
that the State is justified in attempting to manipulate and coerce. Despite its highly
problematic character, health paternalism has been to some degree immune from the sorts of
objections that are routinely brought against other forms of paternalism. Health
paternalism's immunity from such criticism does not derive from the cogency of its
arguments but from the fact that it rests not just on moral argument but on
"unquestionable" scientific fact. And in a world in which science is
increasingly the source of both truth and value the scientific character of health
paternalism is decisive.
But, however closely aligned to science, the ability of health
paternalism to secure all of the public-policy objectives of the anti-smoking movement was
always constrained by the fact that, at least within democratic societies, the
justifications for government intervention to protect adults from themselves -- to coerce
"healthy" lifestyles -- would continue to have a totalitarian flavour about them
that would ensure significant and widespread opposition. It is only by demonstrating that
the dangers from smoking transcend the smoker and extend to innocent bystanders that the
anti-smoking movement could move beyond obvious health paternalism and enlist unambiguous
support for public-policy measures designed to restrict, ban, and criminalize public
smoking. The movement away from the risks of smoking for smokers to the alleged dangers of
secondhand smoke for nonsmokers does not mean that the health-paternalist arguments have
suddenly disappeared from the public-policy agenda of the anti-smoking movement. Whether
one is considering the policy implications of tobacco advertising or the supposedly
addictive properties of nicotine, the paternalist justifications for government
interventions in the lives of smokers still constitute a significant strand of the
anti-smoking argument. What has changed is that arguments about harms to self have assumed
a secondary place to arguments about harms to others. What has remained the same is the
fact that the new arguments about harms to others, to innocent bystanders, strongly
resemble the old "paternalistic" (often religious) arguments. What is new is the
consideration of science and morality to justify public policy.
We wish to argue that:
1. the "science" supporting the claims
about tobacco's risks to non-smokers is corrupted science, science that has been
politically laundered, science that because of its corrupted status actually ceases to be
science;
2. the use of such science by the government and the anti-smoking
movement reveals not only the illegitimacy of their public-policy agenda but the flawed
character of the advocacy as well; and
3. the existence and use of such corrupted science poses a significant
threat to legitimate democratic public policy.
CORRUPTED SCIENCE
If the government and the anti-smoking lobby are to justify their
claim that the debate in society about smoking in the last decade of the twentieth century
is really a debate about the dangers that smoking poses to nonsmokers then it is
imperative that those dangers be demonstrable, compelling, unequivocal, and significant.
And it is only science that can deliver dangers with the requisite pedigree. Should the
scientific evidence be less than decisive, the debates about smoking will return to a
debate about the legitimacy of health paternalism, which is a debate that neither the
government nor the anti-smoking movement can easily win. Everything, therefore, depends on
science. And with so much at stake, the pressure to adjust, shave, create, ignore,
reevaluate, even manipulate, is enormous. The pressure comes from at least four sources:
from the dispositions of scientists themselves, from the rational character of science
itself, from the structure of the scientific enterprise, and from society's expectations
of science.
- Scientists, like everyone else, have their own personal perspective,
values, and ideological agenda, whatever their commitment as scientists to the objective
nature of science. Indeed, a good many scientists, either apart from their scientific
training or because of it, believe that tobacco use is dangerous and immoral. Most
scientists and most health care professionals have come of age in a professional
atmosphere that for the last twenty-five years has been increasingly hostile to tobacco
use. It is not unreasonable to assume that many scientists have a strong professional
interest in establishing their personal beliefs and the beliefs of their milieu as
scientific fact. As William Broad and Nicholas Wade observe in `Betrayers of Truth: Fraud
and Deceit in Science,' "science is not a perfectly objective process. Dogma and
prejudice, when suitably garbed, creep into science just as easily as into any other human
enterprise, and maybe more easily since their entry is unexpected."
- The ideology of science, which focuses almost exclusively on the
objective and rational character of science, tends to blind both scientists and those who
rely on science to the fact that there are other elements involved in science besides
strict logic and rationality. "The presence of a strong rational element in science
has been taken to mean that is the only significant element of scientific thought. But
creativity, imagination, intuition, persistence, and many other nonrational elements are
also essential parts of the scientific process, and other less vital qualities such as
ambition, envy and the propensity to deception also play a role." (Broad and Wade, p.
218). These other aspects of the scientific process, which are common to other areas of
creative endeavour, tend to work against objectivity, particularly when they are not
acknowledged as part of the scientific paradigm.
- Scientific careers are advanced on the basis of published, peer-
reviewed findings -- findings that for the most part grow out of funded research. The
decisions about which research project to pursue and which research results to publish are
often determined by a subtle interplay between scientific orthodoxy, funding procedures,
quite genuine career considerations, and the search for scientific truth.
- Science exists within a society that has certain expectations about
what science ought to do, one of which is that science exists to make the case, as it
were, against whatever it is that society considers to be dangerous. The fact that much of
society believes tobacco to be dangerous creates a strong series of incentives to
establish and indeed enlarge the range of smoking-induced harms, while at the same time
ignoring or suppressing research that questions these received orthodoxies.
But what, it might be asked, is corrupted science? And more
importantly, what is the evidence that the official Environmental Tobacco Smoke (better
known as ETS or "passive smoke") story is indeed an instance of such a corrupted
science? Could it not be the story is indeed an instance of such science? Could it not be
the case, for instance, that the Environmental Protection Agency's conclusions about ETS
are in fact simply incompetent science, science that has failed to do its work properly
but not science that has deliberately decided to tell the wrong story?
It is certainly true that not every instance of weak or flawed
science is an instance of corrupted science. Corrupted science has at least three
characteristics that mark it off from simply incompetent science.
FIRST, corrupt science is science that moves not
from hypothesis and data to conclusion but from mandated or acceptable conclusion back to
selected data in order to reach the mandated or acceptable conclusion. That is to say, it
is science that uses selected data to reach the "right" conclusion, a conclusion
that by the very nature of the data necessarily misrepresents reality.
SECOND, corrupt science is science that
misrepresents not just reality, but its own process in arriving at its conclusions. Rather
than acknowledging the selectivity of its process and the official necessity of
demonstrating the right conclusion, and rather than admitting the complexity of the issue
and the limits of its evidence, it invests both process and its conclusions with a mantle
on indubitability.
THIRD, and perhaps most important, whereas normal
science deals with dissent on the basis of the quality of its evidence and argument and
considers ad hominem argument as inappropriate in science, corrupt science seeks to create
formidable institutional barriers to dissent through excluding dissenters from the process
of review and contriving to silence dissent not by challenging its quality but by
questioning its character and motivation. In effect then, corrupt science is science that
is flawed in both its substance and its process and that seeks to conceal these essential
flaws. It is essentially science that wishes to claim the policy advantages of genuine
science without doing the work of real science. The evidence that the EPA's science on ETS
is corrupt science falls into two categories: evidence about the substance of the science
and evidence about the process involved in creating and using the science.
THE SUBSTANTIVE ISSUE
The EPA's report `Respiratory Health Effects of Passive Smoking:
Lung Cancer and Other Disorders' claims that "based on the weight of the available
scientific evidence, the U.S. Environmental Protection Agency has concluded that the
widespread exposure to environmental tobacco smoke in the United States presents a serious
and substantial public health impact." The hedging is in the swerve from
"hazard" to "impact." Is this the case?
In order to answer this question one must first know something about
the data on which the EPA's decision is based. The EPA's report refers to the thirty
epidemiologic studies on spousal smoking and lung cancer that have been published between
1982 and 1990. It is important to note that in referring to the report then-EPA
administrator William Reilly spoke about ETS in the workplace and, though the Report has
been used as a basis for demanding smoking bans both in public places and in workplaces,
the EPA did not examine those studies that look at workplace ETS exposure. The
overwhelming majority of these do not find a statistically significant association between
exposure to ETS and lung cancer in nonsmokers: a fact that by itself destroys the
legitimacy of any harm-based demand for public or workplace smoking bans.
Thus, to begin with, the EPA's case is based not on workplace or
public- place ETS exposure, but on the risks of non-smoking spouses contracting lung
cancer from their smoking spouse. But what of the thirty studies? The thirty studies come
from different countries and vary substantially in size. Some studied fewer than twenty
subjects, others are based on larger populations, with the largest study involving 189
cancer cases. Of the thirty studies, twenty-four reported no statistically significant
association; only six reported a statistically significant association, that is, a
statistically significant increased risk for those nonsmoking spouses.
Relative risks are further classified into strong risks or weak
risks depending on the magnitude of the risk ratio. Within the thirty studies on ETS and
lung cancer none reported a strong relative risk. Moreover, whenever the assessment of
relative risk is weak, there is a substantial possibility that the finding, the
assessment, is artificial rather than real. That is to say, there is a strong likelihood
that even the weak relative risk is a reflection not of some real-world risk, but of
problems with confounding variables or interpretative bias. There are, for instance, at
least twenty confounding factors ranging from nutrition to socioeconomic status that have
been identified as associated with the development of lung cancer. Yet none of the thirty
studies attempts to control for all of these factors. So in assessing the global
scientific evidence about ETS and lung cancer, the crucial conclusion is that none of the
studies report a strong relative risk for nonsmokers married to smokers.
The EPA Report discusses all thirty studies but limits its
statistical analysis to only eleven U.S. studies of spouses of smokers. Of the eleven
studies, the EPA claims that ten reported no statistically significant association between
ETS exposure and lung cancer; and only one reported a statistically significant
association. But this claim about the one U.S. study is in fact true only by using the
EPA's unique 90 percent confidence level. Using the accepted 95 percent confidence level
none of the eleven studies reported a statistically significant risk.
The EPA analysis of these eleven studies claims that together they
show a statistically significant difference in the number of lung cancers occurring in the
nonsmoking spouses of smokers, such that they suffer 119 such cancers compared with 100
such cancers in nonsmoking spouses of nonsmokers. It is this finding of statistical
significance, a finding based on only eleven U.S. studies, none of which demonstrate a
statistically significant increased risk unless they are "reanalyzed" using the
EPA's 90 percent confidence interval (and even such "coaxing" of the figures
could produce only one study that purported to show statistically significant increased
risk), that provides the only basis for the EPA's decision to classify ETS as a
"Group A" carcinogen.
In order to arrive at its "conclusion," the EPA pooled the
data from the eleven studies into a combined data assessment called a meta-analysis. Meta-
analysis is governed by its own rules: not every study is a candidate for such combined
analysis. In general, meta-analysis is appropriate only when the studies being analyzed
together have the same structure. The difficulty with the EPA's use of meta-analysis of
the eleven ETS studies is that it has failed to provide the requisite information about
the structure of those studies, information crucial for an independent assessment of
whether the studies are indeed candidates for meta-analysis. Thus, the EPA conclusion is
based on a meta-analysis that is difficult, if not impossible, to verify.
Adjusted confidence levels are not, however, the only problem with
the EPA analysis. Equally disturbing is the EPA's use of a one-tailed test as opposed to a
two-tailed test. Two-tailed tests (see sidebar) are generally used in statistical analysis
because it is rare for one to know a priori that a null hypothesis can be discredited in
only one direction. By using a one- tailed test the EPA assumes that ETS exposure can only
increase the lung cancer risk, despite the fact that a substantial number of studies show
a decreased risk. (One recent large study even showed a statistically significant
decreased risk.) While the EPA claims that a one-tailed analysis actually compensates for
a 90 percent confidence interval, what the use of such an analysis actually does is reduce
the confidence level even further.
The quality of the EPA's ETS science is the issue of
"confidence intervals." Even by limiting its analysis to only eleven studies,
and even by lumping these studies together through a meta-analysis, the EPA could not have
achieved the "right" result if it had not engaged in a creative use of what
epidemiologists call confidence intervals. Essentially, confidence intervals express the
likelihood that a reported association could have occurred by chance. The generally
accepted confidence interval is 95 percent, which means that there is a 95 percent
confidence that the association did not occur by chance. Inasmuch as most epidemiologists
use the 95 percent confidence interval, the EPA itself, until the ETS report, always used
this interval.
Curiously, the EPA decided that in this instance it would use a 90
percent confidence interval, something that effectively doubles the chance of being wrong.
Even more curious is the fact that when asked to justify this departure from accepted
scientific procedure, EPA administrator Reilly simply replied that the 90 percent
confidence interval "was recommended to us by the scientific community as appropriate
to this data." What Mr. Reilly really means by "appropriate to this data"
is that without using this 90 percent standard, the EPA could not have found that the
eleven U.S. studies were "statistically significant." Without employing a novel
standard, without in effect changing the accepted rules of epidemiological reporting, the
EPA result, already painfully coaxed into existence, would not have existed, and ETS could
not have been labelled a "Group A" carcinogen.
Thus, despite all of its careful selection of the right data, its
meta- analysis and finally its relaxed confidence intervals, the conclusive point remains,
as Huber, Brockie, and Mahajan note in `Consumers Research in the United States' (1991),
that "no matter how the data from all of the epidemiological studies are manipulated,
recalculated, `cooked,' or `massaged,' the risk from exposure to spousal smoking and lung
cancer remains weak....No matter how these data are analyzed, no one has reported a strong
risk relationship for exposure to spousal smoking and lung cancer."
THE PROCESS ISSUE
While a careful look at the substance of the EPA's ETS claims
clearly shows why this science can be called nothing less than corrupt science, an
examination of the process underlying this science demonstrates even more clearly its
wholly corrupted character. There are at least ten specific process issues worth noting,
each of which highlights a slightly different dimension of the corrupted character of the
EPA's ETS science.
1. First, EPA science issues from a perspective
that can be traced back to the Lalonde Doctrine propounded by former Canadian Minister of
National Health and Welfare, Marc Lalonde. Lalonde argued that health messages must be
vigorously promoted even if the scientific evidence was incomplete, ambiguous, and
divided. Health messages must be "loud, clear and unequivocal" even if the
evidence did not support such clarity and definition. What we have in the EPA is simply
the Lalonde Doctrine as an institutionalized process. Clearly the substance of the ETS
data does not support the "Group a" status, nor does it support public and
workplace smoking bans (desirable as some might find them on other grounds) on the grounds
that ETS threatens the health of nonsmokers.
But the substance of the ETS data is to be ignored because the
Lalonde Doctrine requires that the substance be portrayed as something that it is not in
order to further the health agenda.
What this does is to build into the heart of the scientific
enterprise an institutionalized motivation and justification for allowing ends extrinsic
to science to determine the findings of science, for allowing science to be subject to an
agenda not its own, for allowing science to lie with a clear conscience. Once one has come
to see science as something that of necessity happens within the context of health
promotion, then the process corruptions of the EPA follow quite "naturally."
This explains why at one level those involved with the EPA decision
are quite frank about the process. For instance, the EPA official responsible for the
revised ETS risk assessment was quoted in `Science' (July 31, 1992) as admitting that
"she and her colleagues engaged in some fancy statistical footwork" to come up
with an "indictment" of ETS. (The footwork to which she refers is the novel 90
percent confidence interval and the one-tailed test.) Or to take another process example,
the Science Advisory Board which reviewed the initial draft risk assessment on ETS, and
found the case against ETS based on its association with lung cancer unconvincing,
actually urged the EPA staff to attempt to "make the case" against ETS on the
basis of the similarities between ETS and mainstream smoke.
To be fair, the consequences of the Lalonde Doctrine are not
confined to the EPA's anti-smoking agenda. For instance, an article in the `Journal of the
American Medical Association' for July 29, 1989, reported a study that claimed to show a
link between ETS exposure and an increased risk of cervical cancer. In response to critics
who noted that such a link was biologically implausible and that the study had ignored
confounding factors, the authors replied that the study was justified simply on the ground
that it might reinforce the "dangers of smoking" message. "While we do not
know of a biologic mechanism for either active ... smoking or ETS to be related to
cervical cancer, we do know that cigarette smoking is harmful to health. The message to
the public, as a result of this study, is one that reinforces the message that smoking is
detrimental to health." It would be difficult to find a more succinct example of the
Lalonde Doctrine at work. There is no compelling evidence to support our claim, the
authors all but admit, but it is important, in the interests of health promotion, that the
public be made to think that there is scientific evidence of harm.
2. But second, while those involved in the EPA
process are at one level open about the process, at another level they are profoundly
dissembling. For instance, the EPA fails to mention that the "Group A" status
for ETS was arrived at using a process that violates its own Guidelines for Carcinogenic
Risk Assessment. Rather than acknowledging that this suggested that both the substance of
its findings and the process were corrupt, the Science Advisory Board reviewing the ETS
issue argued that this suggested a need: not that ETS posed no threat to the health of
nonsmokers, but rather that the Guidelines for Carcinogenic Risk Assessment be changed.
Given that the right conclusion must be reached and the data do not support that
conclusion, one must manipulate the data and revise the guidelines governing the process
and the conclusion.
3. Third, the ETS risk assessment process has been
corrupted from theoutset by the fact that it has repeatedly violated the standards of
objectivity that prevail in legitimate science by utilizing individuals with anti-smoking
biases. One member of the group working on the ETS issue at the EPA is an active member of
U.S. anti-smoking organizations, while the Science Advisory Board that examined the EPA's
ETS work included not only a leading anti-smoking activist, but several others strongly
opposed to tobacco use.Finally, the EPA contracted some of the work on certain documents
related to the ETS risk assessment to one of the founders of a leading anti-smoking group.
4. Fourth, the EPA changed the accepted scientific
standard with respect to confidence intervals, without offering any compelling
justification, in order to make its substantive findings statistically significant.
5. Fifth, the EPA's Workplace Policy Guide which as
a policy document would, in the course of normal scientific process, be developed only
after the scientific evidence was in, was actually written before the scientific risk
assessment was even completed, let alone reviewed and finalized. Quite obviously, science
was made to fit with policy, rather than policy with science.
6. Sixth, the EPA fails to note that, if the two
most recent U.S. ETS studies were to be included along with its eleven other studies, it
would have resulted in a risk assessment that was not statistically significant, even
using the 90 percent confidence interval. With its entire "conclusion" at risk,
there are exceedingly compelling process reasons for the EPA to have excluded these later
two studies from its analysis.
7. Seventh, exclusion, however, was apparently
insufficient, for the EPA does more than simply not use the studies, it actually refers to
them in an appendix and actually misrepresents one of them by claiming that it supports
the EPA's ETS conclusions. The study, by Brownson, et al., which appeared in the November,
1992 `American Journal of Public Health,' reported no statistically significant increase
in risk between lung cancer and ETS exposure. In order to get around this politically
unacceptable conclusion, the EPA quotes Brownson as concluding: "Ours and other
recent studies suggest a small but consistent increased risk of lung cancer from passive
smoking." But this is not the issue, as the EPA well knows. The question is not
whether there is a small increased risk, but whether there is a statistically significant
risk, which Brownson concludes there is not. In effect, the EPA misrepresents a scientific
finding by changing the terms of reference from statistical significance to just plain
risk.
This penchant for misrepresentation is not, however, confined to
recent studies. For instance, the EPA analysis consistently makes reference to the
Garfinkel, et al., study. At Chapter 5.48 the EPA claims that the Garfinkel study presents
"at least suggestive evidence of an association between ETS and lung cancer...."
But a careful reading of Garfinkel does not confirm this at all. Garfinkel actually says
that "we found an elevated risk of lung cancer, ranging from 13-31 percent, in women
exposed to smoke of others, although the increase was not statistically significant."
(L. Garfinkel et al., "Involuntary Smoking and Lung Cancer: A Case-Control
Study," Journal of the National Cancer Institute, 75, 1985.) The entire question of
suggestive evidence is bogus: the relevant question is whether Garfinkel found a risk that
was statistically significant. He did not, and the EPA misrepresents his findings.
8. Eighth, the EPA represents its process as a
comprehensive and objective analysis of the ETS data. In the usual course of things this
would imply a careful examination of the criticisms that have been levelled at the studies
used to reach its conclusions. However, a careful examination of the bibliography
accompanying the report suggests that this is not the case. Although the note with the
bibliography indicates that it is not a "comprehensive list of all references
available on the topic," it is still a list of all references cited and reviewed for
the report. Yet, to take but one example, one would never know from the report or its
bibliography that the work of Trichopoulos had been subjected to significant criticism by
both Burch and Heller, since neither is mentioned in the bibliography. Nor would one know
that Trichopoulos acknowledged such criticism and even criticized his study himself. (See Trichopoulos
et al., "lung Cancer and Passive Smoking" Int J Cancer,
27:1-4.)
Now the possible explanations for such selectivity are that:
1. The authors of the study are not
familiar with such criticisms, which would suggest incompetence, or
2. they are familiar with the criticisms but have misunderstood,
ignored, or discounted them.
But even if one were to discount or ignore them, it is still odd, if
one is committed to objectivity and openness, not to cite them. Not to cite them suggests
that one wishes to act as if they didn't exist, and to do this is to give rise to more
than the suspicion that the EPA's ETS work is really an instance of a closed-loop process
abuse. In a closed loop the circle is never opened up to divergent, dissenting views that
challenge the orthodox conclusion. It is not simply that such divergent views are
discounted, it is rather that, as the EPA discussion and bibliography indicate, they
simply are never heard -- indeed judging from the bibliography they don't exist. When one
considers this closed loop process in the context not merely of what the EPA excluded in
terms of dissenting voices, but in the context of what it sought to include in terms of
determining voices -- the anti-smoking movement -- then it is hard to assign any degree of
objectivity to the process.
9. Ninth, there is significant evidence that the
EPA ignored the misgivings of its own scientists about its ETS assessment process and
conclusion. Two internal EPA documents (April 27, 1990, and March 23, 1992), both by the
EPA's Environmental Criteria and Assessment Office and both recently released by
Congressman Tim Valentine, suggest that the EPA and report was badly conceived and argued,
that the alleged "causal" connection between lung cancer and ETS was overstated,
and that the evidence does not support a Group A carcinogen assessment for ETS.
10. Tenth, despite the significant difficulties
that have been raised about the quality of EPA science, the EPA process is incapable of
correcting itself. This was made particularly clear by the Expert Panel in its report
`Safeguarding the Future: Credible Science, Credible Decisions,' which noted that:
1. EPA "science is of uneven
quality";
2. the "EPA has not clearly conveyed to those outside
or even inside the Agency its desire and commitment to make high-quality science a
priority";
3. "the science advice function -- that it the process
of ensuring that policy decisions are informed by clear understanding of relevant science
-- is not well defined or coherently organized within EPA";
4. the "Agency does not have a uniform process to
ensure a minimum level of quality assurance and peer review for all the science developed
in support of Agency decision making";
5. the "Agency lacks the critical mass of externally
recognized scientists needed to make EPA science generally credible to the wider
scientific community"
6. "science should never be adjusted to fit policy."
This is perhaps the most significant process corruption of all,
namely a process that is quite conscious of its problems but is unwilling and unable to
address them. Of course even this characterization is perhaps too kind given that what the
Expert Panel describes as problems are really, for the anti- smoking movement, just the
normal way that science must proceed if it is to make the anti-smoking case. If this is
the case, then there is no conscious sense of process problems. What the Expert Panel's
Report actually provides, of course, is another description of corrupted science --
science corrupted in its substance and its process, science driven by a predetermined
policy agenda; science based on inadequate data; science of uneven quality and
inadequately peer-reviewed; science lacking critical validation by outside scientists
representative of "wider scientific community;" and science, finally, fully
aware of its corruption, but unable to heal itself.
THE USES OF CORRUPTED SCIENCE
It is clear from the way in which the EPA has handled the ETS issue
that the anti-smoking movement is aware of, if not directly involved in, using corrupted
science in the pursuit of its public-policy agenda. Indeed, as Alvan Feinstein, a Yale
University epidemiologist writing in `Toxicological Pathology' noted, a prominent
epidemiologist commenting on the EPA's work on ETS admitted that, "Yes, it's rotten
science, but it's in a worthy cause. It will help us to get rid of cigarettes and to
become a smoke-free society." But what sorts of moral questions are raised by the
anti-smoking movement, a movement that has always claimed the moral high ground for itself
alone, using and pressuring governments to use corrupted science as a basis for public
policy.
One moral question is obviously the question of the legitimacy of
misrepresentation, for corrupted science is at bottom science that misrepresents the state
of reality. And what a careful analysis of the scientific claims of the EPA and the
anti-smoking movement reveal is a profound and systematic disregard for the truth about
the dangers from ETS. Not only are data manipulated to produce the desired results and
suppressed or dismissed when they do not fit the standards of political correctness, but
accepted standards about confidence intervals are changed without justification. In
effect, one has an ethic that legitimizes misrepresentation in the service of a good cause
-- "a smoke-free society."
But is a smoke-free society a sufficient justification for a public
health movement founded on unreliable science and blatant misrepresentation? We would
suggest that it isn't. First, structuring a public health campaign on deceit is to place
it upon terrain that is both notoriously slippery and crevice-laden. The frightening thing
about institutionalized deceit, even in the allegedly righteous cause of eliminating
smoking, is that like any moral corrosive it is both so easy to justify and so difficult
to restrict its use to the ends that originally justified its employment. Second, the
entire project of corrupted science, like all projects of deception, is designed to
manipulate individuals and society to do things that they would not normally do, and to do
so based on a false picture of reality. The liar's game is, after all, morally deviant
precisely because it subverts our autonomy by misinforming us. The liar distorts the truth
in order to obtain our consent not through argument but through coercion. And the great
enemy of freedom is not so much overt coercion but the coercion brought about by biased
information. The corruption of a science that misrepresents is moral corruption of the
most foundational sense, for it corrupts a centrepiece of both morality and democracy,
namely our ability to act freely.
But there is a second moral question here that goes beyond the
morality of misrepresentation into what might be called the morality of suppressing
dissent. Both the process of producing corrupted science and of utilizing it as the basis
for public policy demand a fundamental intolerance of dissent, both scientific and
otherwise. The imperatives of health promotion are such that both the ambiguities and
uncertainties that form a legitimate part of science and more importantly, serious
questions about the quality of the evidence and whether it justifies the proposed
public-policy measures, cannot be tolerated. This means that scientific and public-policy
dissent must be suppressed by portraying dissenters as in the pay of the tobacco industry
or marginal to the scientific establishment. This strategy raises a host of subsidiary
moral questions. Whatever the cost, "science" must be seen to provide a
conclusive and united answer to the question of tobacco and its harms to the innocent.
Thus, despite the vital role of questions, argument, and dissent in science as well as in
democratic life, the anti-smoking movement seeks to silence dissent in the interests of
protecting not the truth but its misrepresentation of the truth.
The third moral question centres on what the manufacture and use of
such science does both to science and to legitimate democratic public policy. Corrupted
science is rather like an intellectual acid that eats away at everything that it touches.
For instance, it gnaws away at the distinguishing feature of science -- its objectivity --
and threatens to render science essentially worthless for public-policy purposes. Though
science is never completely objective, if indeed complete objectivity is possible, it at
least, in distinction from much of the political process, professes a fundamental interest
in reason, evidence, and bias-free judgement. In fact, much of science's standing in
contemporary society derives from its objective character, as does much of its usefulness
in the public-policy process.
In effect, we have a high degree of confidence in the scientific
process as providing a careful, evidenced, and to some degree, value-free, assessment of
certain questions relating to public policy, and it is precisely this utility that the use
of corrupted science threatens. If science ceases to work outside of the political and
policy process, if it ceases to be a tool available to both sides of an issue, if it
becomes politicized and ideologically sensitive, then it ceases to be valuable in the
policy process. Rather than acting on the voice of reason, it becomes nothing more than
another special pleading.
In this sense, to use corrupted science, for however allegedly
worthy an end, is inevitably and irretrievably to corrupt science itself. No one who
genuinely cares about good public policy, policy crafted on the basis of careful argument,
cogent reasoning, and compelling data, policy that can stand the test of careful probing
and consistent dissent, can countenance the corruption of science.
But the use of bogus ETS science to manipulate the public policy
debate on smoking threatens not just science, but also the standards of rationality that
distinguish legitimate public policy. Adherence to the norms of rationality require that
the identification of problems, causes, and solutions be based on empirical evidence of
the most rigorous sort, evidence that is specific, strong, consistent, or coherent and
demonstrates the appropriate causal connections, that rests on rational arguments that are
clear and logically compelling. Problems and solutions that cannot meet this standard of
argument are not allowed a place in the public-policy process since to do so is to abandon
the commitment to reason that is a fundamental democratic value.
Yet the use of corrupted ETS science as a basis of public policy is
nothing less than an abandonment of rationality as a measure of legitimate public policy.
As we noted above, the EPA and the anti-smoking movement's ETS science cannot meet any of
the tests of rationality that determine legitimate public policy problems and solutions.
The ETS "evidence" is not specific, strong, consistent, coherent, nor does it
demonstrate the appropriate causal connections. If it fails these tests, it cannot provide
compelling rational reasons -- as opposed to rhetorical and emotional reasons -- for its
public-policy recommendations.
The use of corrupted ETS science is, however, more than simply an
abandonment of reason in the public policy process; it is also frightening, an attempt to
institutionalize a particular irrational view of the world as the only legitimate
perspective: to replace rationality with dogma as the legitimate basis of public policy.
If the use of corrupted ETS science by the EPA and the anti-smoking movement represented
simply the abandonment of reason, then such actions would be simply nonrational. But the
EPA's efforts go beyond the nonrational to the irrational, to an assault on reason itself.
By refusing to include evidence of scientific dissent from the
officially determined "truth" about ETS, as evidenced in the omission from key
bibliographies of any references to criticisms of key findings and studies, by
manipulating and mis-reporting data, and by portraying those who disagree as being
"mouthpieces" for the tobacco industry, the proponents of the anti- smoking
policy agenda reveal themselves as enemies of the open and self- correcting process of
reason. In a very real sense the "truth" about ETS ceases to be open to rational
assessment and assumes instead the status of revealed dogma. And only those who ultimately
fear, if not loathe, reason are comfortable with dogma as the basis of public policy.
By far the most morally objectionable aspect of the anti-smoking
movement's use of the ETS issue is its readiness to use corrupted science to deprive
smokers not only of their right to pursue their pleasure in public, but quite possibly to
gain or retain their employment, or advance their prospects. Put more bluntly, it is the
question of whether it is morally justifiable to use bad science to hurt people? What
should never be lost sight of in this debate is that without the alleged scientific
justification of harm to innocent parties, there is no compelling public-policy rationale
for banning or restricting smoking in public places or workplaces. Once the corrupted
science is stripped away, there simply are no harms, and without those harms, smoking
becomes a self-regarding behaviour, interventions against which can only be advanced on
patently paternalistic grounds. The anti- smoking movement might still argue that public
and workplace smoking should be banned in order to discourage smokers from smoking, but
this argument loses its compelling harm-to-others character and becomes instead nothing
more than an argument about the state intervening in the private lives of competent
adults.
What is so morally offensive here is that truly morally blameless
people -- not the alleged victims of smokers -- but smokers themselves, are to be harmed
in significant ways on the basis of bogus science and for no good reason. What makes the
morality of the anti-smoking movement as corrupt as its science is that it is prepared to
exploit for its own ends our readiness to deprive individuals of certain rights if the
exercise of those rights appears to harm others by explicitly manufacturing harms to
others. In doing so, the anti-smoking movement simultaneously violates perhaps the two
most fundamental moral principles, first by treating persons, in this case smokers and
their alleged harms to others, as merely means to the end of a smoke-free society and not
as ends in their own right, and second by inflicting substantial pain on an entire class
of people without their consent and for no compelling reason.
But the question of the moral justifiability of using corrupted
science to hurt people goes beyond the question of depriving individuals of their right to
a significant pleasure, or even of a job, to something far more crucial, namely the
justifiability of depriving individuals of their moral standing through stigmatizing them
as moral outcasts. In the end, this is, of course, the logical outcome of ETS science, to
make smokers a class of moral miscreants who see themselves and are seen by others as so
ruthlessly intent on pursuing their own interests that they are blind to the harm they
inflict on others. It is indeed but a short way from the claim, "Smoking kills"
to the conclusion that "Smokers kill." But then, such a conclusion is the public
policy justification for bans on public smoking.
The debate about Environmental Tobacco Smoke, though ostensibly a
debate about smoking, is really a debate about much more than smoking. It is a debate at
bottom about the legitimacy of perverting science and public policy founded on science in
the interests of a particular health ideology. It is a debate at bottom about the worth of
a health paternalism that guarantees to leave all of us substantially less free but no
less ill.
| TWO-TAILED
TESTS A null hypothesis is a precisely stated
assertion associated with a statistical test; results of that test are intended to
determine whether the null hypothesis should be accepted (regarded as true) or rejected
(regarded as untrue).
Because we are more comfortable accepting demonstrations that
statements are false than otherwise, statisticians usually arrange their experiments so
that the null hypothesis is contrary to the underlying thesis. Thus, rejection of the null
hypothesis corresponds to confirmation of the thesis.
Suppose that like the EPA we want to demonstrate that exposure to
ETS increases the risk of lung cancer. Since we cannot examine everyone exposed to ETS we
design a statistical experiment to determine whether our thesis seems to be true. Our null
hypothesis is: Exposure to ETS does not increase the risk of lung cancer. Next we select
random samples of individuals exposed to ETS and random samples of individuals not exposed
to ETS. If equality holds between the two samples, that is if the rates of lung cancer are
not different, we have failed to demonstrate our thesis. If, on the other hand,
individuals exposed to ETS have significantly higher rates of lung cancer we can reject
the null hypothesis.
In posing a null hypothesis for statistical testing one always
states an alternative hypothesis which is to be accepted if the null hypothesis is
rejected. The alternative hypothesis must encompass the entire range of alternatives to
the null hypothesis. In this case the correct alternative hypothesis is that the risk of
lung cancer in populations exposed to ETS and populations not exposed to ETS are
different, that is populations exposed to ETS might have increased risks of lung cancer or
they might have reduced risks of lung cancer.
This is an example of a two-tailed analysis since exposure to ETS
can either increase or decrease the risk of lung cancer. In using a one-tailed test, the
EPA failed to state the correct alternative to its null hypothesis. The EPA in effect
assumed that ETS exposure could only increase the risk (one tail) of lung cancer. Since a
substantial number of studies have shown a decreased risk with ETS exposure -- including a
large recent one which was statistically significant -- two-tailed tests are required. |
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