Posted by Anne Landman on January 07, 2009

SmokingMany of the of the tobacco industry's underhanded strategies and tactics have been exposed, thanks to landmark legal cases and the hard work of public health advocates. But we are still uncovering the shocking lengths to which the industry has gone to protect itself from public health measures like smoking bans. Now we can thank the city of Pueblo, Colorado, for an opportunity to look a little bit deeper into how the industry managed the deadly deceptions around secondhand smoke.

A new study, now the ninth of its type and the most comprehensive one yet, has shown a major reduction in hospital admissions for heart attacks after a smoke-free law was put into effect.

On July 1, 2003, the relatively isolated city of Pueblo, Colorado enacted an ordinance that prohibited smoking in workplaces and indoor public areas, including bars and restaurants. For the study, researchers reviewed hospital admissions for heart attacks among area residents for one year prior to, and three years after the ban, and compared the data to two other nearby areas that didn't have bans (the part of Pueblo County outside city limits, and El Paso County, which includes Colorado Springs). Researchers found that during the three years after the ban, hospital admissions for heart attacks dropped 41 percent inside the city of Pueblo, but found no significant change in admissions for heart attacks in the other two control areas.

Eight studies done prior to this one in other locales used similar techniques and yielded similar results, but covered shorter periods of time -- usually about one year after the smoking ban went into effect. The results of this longer, more comprehensive study support the view that not only does secondhand smoke have a significant short-term impact on heart function, but that lives, and money, are probably being saved by new laws proliferating around the world in recent years that minimize public exposure to secondhand smoke.

Tobacco Smoke and the Heart

Heart structureWhen most people think "cigarette smoke," they immediately think "lung cancer," but far less public attention has been paid to how secondhand smoke effects heart function. In a memo dated 1980 that I first discovered in 1999, a Philip Morris scientist points out that nicotine lowers the heart's threshold to ventricular fibrillation -- an inefficient heart pumping pattern -- which increases people's susceptibility to heart attacks.

A 1991 report sponsored by the U.S. Environmental Protection Agency (EPA) estimated that secondhand smoke kills approximately 53,000 Americans year, mostly from heart disease. A public health study published in 2001 showed that exposure to secondhand smoke for even short periods of time, as little as 30 minutes, causes changes in platelets and cardiac epithelium. Lung cancer takes many years to develop, but heart function is impacted more rapidly upon exposure to secondhand smoke.

Tobacco Companies Have Long Been Aware of Secondhand Smoke Hazards

Tobacco companies knew much more about the health hazards of secondhand smoke, and knew it longer ago, than most people realize.

Recognizing the need to do more biological research on its own products, but also understanding the need to distance itself from this research for legal reasons, in 1971 Philip Morris purchased a biological lab in Germany called Institut Fur Biologische Forschung ("INBIFO"), or Institute for Biological Research. PM then created a complex routing system to ensure that work done at INBIFO could not be linked back to Philip Morris. INBIFO routed its study results through a PM research and development facility in Switzerland called Fabriques de Tabac Reunies, and documents created at INBIFO were often in French or German language.

Between 1981 and 1989, Philip Morris (PM) conducted at least 115 different inhalation studies on secondhand smoke at INBIFO in which they compared the toxicity of mainstream smoke (the smoke the smoker himself inhales) to that of secondhand smoke. PM discovered that secondhand smoke is 2-6 times more toxic and carcinogenic per gram than mainstream smoke. The company never published the results of these in-house studies or alerted public health authorities to their findings. Rather, they kept this information strictly to themselves -- even most Philip Morris employees were unaware of these studies.

Strategies to Deceive the Public

But Philip Morris did much worse than hide this crucial information from the public. Spurred by a 1993 EPA Risk Assessment that declared secondhand smoke a known human carcinogen, and recognizing the danger the secondhand smoke issue held for the cigarette industry, Philip Morris masterminded a massive global effort to confuse and deceive the public about the health hazards of secondhand smoke and to delay laws restricting smoking in indoor public places.
Smoke chemicals
A 1993 internal Philip Morris (PM) strategy paper titled "ETS (Environmental Tobacco Smoke) World Conference" shows PM organizing a wide range of strategies to shape public views on secondhand smoke and fight smoking restrictions worldwide. PM pursued tactics to "shift concern over ETS to slippery slope argumentation and/or tolerance"; liken secondhand smoke to perceived risks from other items of public concern, such as cellular phones and chlorinated water; "shift concern over ETS in the workplace from the health issue to one of annoyance;" "shift the concern over ETS in restaurants from bans to accommodation where bans are imminent;" "develop an 'ETS Task Force,' with global PM representation to develop strategies to combat smoking restrictions;" "... package comprehensive improvements in ventilation to forestall tobacco specific bans and ... shift the debate from ETS to IAQ [indoor air quality]." Another strategy was the "development of a global coalition against "junk science" to complement a similar coalition PM was already forming in the United States.

At the same time, PM implemented Project Brass, a secret action plan conceived by the Leo Burnett Company, to create a "controversy" over secondhand smoke where there really was none. Project Brass strove to "forestall further public smoking restrictions/bans," "create a decided change in public opinion," and "develop an atmosphere more conducive to smokers" in the general public.

Project Brass was just the tip of the iceberg. The tobacco industry implemented many projects over the decades to shape public perception about secondhand smoke and to delay laws regulating it. Many of these projects are listed under TobaccoWiki's "Projects and Operations" page: Project Mayfly, the INFOTAB ETS Project, PM and British American Tobacco's Latin American ETS Consultants Program, PM's ETS (Environmental tobacco smoke) Media Strategy, Philip Morris' Science Action Plan, and PM's ICD-9 Project to impede the creation of a medical billing code that would indicate illnesses that are attributable to secondhand tobacco smoke exposure.

These are just some of the projects we've learned of by combing through industry documents. Any one of these projects taken individually would be stunning in scope and ambition in its own right, but all of them taken together -- and the as-yet undiscovered efforts -- probably constitute the single most coordinated, widespread, expensive, under-the-radar PR campaign ever waged.

These extensive, expensive and hidden deceptions significantly undermined public understanding of the hazards of secondhand smoke and killed thousands and thousands of non-smokers and smokers alike.

The Final Chapter?

The Pueblo study was only made possible because the people of Pueblo courageously enacted a smoke-free law before the rest of the state did. Pueblo's law predated Colorado's statewide smoking law by three years. This is how it usually happens: a slew of cities and towns enact their own smoking bans until finally a measure is passed at the state level. Attaining smoke-free places has been a true grassroots activity. Once people experience air clean of cigarette smoke in bars, restaurants and other public places, they love it and don't want to go back to allowing smoking. There are many people alive today who could never conceive of encountering cigarette smoke on buses or airplanes, in hospitals, theaters or universities or other places where once smoking was the norm. Once upon a time, most people believed it was impossible to get bars to go smoke-free, but today this commonsense life-saving law that is the norm in many states and countries.

Time and society are marching on, and as more people are protected from secondhand smoke, we are only starting to learn the true scope of its health effects -- from studies like the one done in Pueblo.

Comments

I believe in the great danger of second hand smoke, but your article fails to say whether the data were normalized for certain factors, such as locations of hospitals, which might tend to skew the data either way, lifestyle, and the aging of the population in the inner city. Heart attacks are caused by too many factors for this study to be useful. The second hand smoke fight is best done based on epidemiological evidence, as it's nearly impossible to refute.

As with all studies, this one was not without some limitations, but nevertheless it builds on eight similar studies done prior to it that yielded strikingly similar results.

The U.S. Centers for Disease Control, Morbidity and Mortality Weekly Report, which published information on this study, had this to say regarding its limitations:

"The findings in this report are subject to at least four limitations. First, because no data were available on whether study subjects were nonsmokers or smokers, determining what portion of the observed decrease in hospitalizations was attributable to reduced SHS [secondhand smoke] exposure among nonsmokers and what portion was attributable to increased quitting among smokers was not possible. The prevalence of smoking decreased in Pueblo County as a whole, but the difference over time was not statistically significant. Second, the study did not directly document reductions in SHS exposure among nonsmokers after the city of Pueblo smoke-free law took effect, although studies elsewhere have reported such reductions (1,5,7,10). Third, individual residences were assigned based on postal codes, which might have resulted in a small amount of misclassification (3); however, misclassifying residents' exposure to the city of Pueblo smoke-free ordinance would result in underestimating the effect of this ordinance. In addition, residents of the area of Pueblo County outside the city of Pueblo limits might work in workplaces or patronize restaurants or bars in the city of Pueblo, or vice versa; again, this would bias findings toward the null. Finally, the ecologic nature of this study precludes definite conclusions about the extent to which the observed decline in AMI hospitalizations in the city of Pueblo was attributable to the smoke-free ordinance. To the extent that any unmeasured factors influenced rates, the findings described in this report might overestimate or underestimate the actual effect. AMI hospitalization rates initially were substantially higher in the city of Pueblo than in the two comparison areas, suggesting that these areas might not be fully comparable to the intervention site because of demographic and other differences. However, no significant changes in the manner in which AMI patients were diagnosed, treated, or transported occurred in the three study sites during the study period. Future studies could further expand the evidence base by including information on the smoking status of AMI patients and biomarkers (e.g., cotinine and troponin) for objective measurement of SHS exposure and case ascertainment, as was done in one recent study (7).

You can access their entire report on the study [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5751a1.htm here].

I hope this helps answer your question.
Anne Landman

In my opinion this complaining about the tobacco industry lying about second hand smoke is an old, old story. Truthfully, I have known many people who died from lung disease but never smoked nor been around it... That may be because of second hand smoke - but maybe not, since their is so much pollution in the air - who needs second hand smoke to blame !!!

I have known bartenders and cocktail waitresses who never got lung disease, yet people who were never exposed - died of lung disease. Check the records.

Smoking is a nasty habit anyway (IMO) and it can only be a plus to your body to NOT partake in any manner......
But if people like to smell bad and go broke - go ahead and knock yourself out...... Because huge taxes are being planned for cigarretts, and will be implemented soon. Nationally and Statewide......

Another point. Whey do they never refer to taxes on all tobacco products? Like those awful cigars? Why do they always say cigarretts? Is it my immagination that they seem to discriminate?

I think the furor over second hand tobacco smoke and the so-called statistics are a bunch of made up numbers by people with nothing better to do. What about all the chemicals we breath everyday at home and work. Out-gassing from nylon carpet, which is petroleum based, all the chemicals and pollutants at work places, smog,etc,etc. By the way, if you go to the root cause of the issue you will find that the govt was not doing their job. No regulation of this industry, due to "trade secrets" of the industry.

Scientific Evidence Shows Secondhand Smoke Is No Danger
Written By: Jerome Arnett, Jr., M.D.
Published In: Environment & Climate News
Publication Date: July 1, 2008
Publisher: The Heartland Institute

Exposure to secondhand smoke (SHS) is an unpleasant experience for many nonsmokers, and for decades was considered a nuisance. But the idea that it might actually cause disease in nonsmokers has been around only since the 1970s.

Recent surveys show more than 80 percent of Americans now believe secondhand smoke is harmful to nonsmokers.

Federal Government Reports

A 1972 U.S. surgeon general's report first addressed passive smoking as a possible threat to nonsmokers and called for an anti-smoking movement. The issue was addressed again in surgeon generals' reports in 1979, 1982, and 1984.

A 1986 surgeon general's report concluded involuntary smoking caused lung cancer, but it offered only weak epidemiological evidence to support the claim. In 1989 the Environmental Protection Agency (EPA) was charged with further evaluating the evidence for health effects of SHS.

In 1992 EPA published its report, "Respiratory Health Effects of Passive Smoking," claiming SHS is a serious public health problem, that it kills approximately 3,000 nonsmoking Americans each year from lung cancer, and that it is a Group A carcinogen (like benzene, asbestos, and radon).

The report has been used by the tobacco-control movement and government agencies, including public health departments, to justify the imposition of thousands of indoor smoking bans in public places.

Flawed Assumptions

EPA's 1992 conclusions are not supported by reliable scientific evidence. The report has been largely discredited and, in 1998, was legally vacated by a federal judge.

Even so, the EPA report was cited in the surgeon general's 2006 report on SHS, where then-Surgeon General Richard Carmona made the absurd claim that there is no risk-free level of exposure to SHS.

For its 1992 report, EPA arbitrarily chose to equate SHS with mainstream (or firsthand) smoke. One of the agency's stated assumptions was that because there is an association between active smoking and lung cancer, there also must be a similar association between SHS and lung cancer.

But the problem posed by SHS is entirely different from that found with mainstream smoke. A well-recognized toxicological principle states, "The dose makes the poison."

Accordingly, we physicians record direct exposure to cigarette smoke by smokers in the medical record as "pack-years smoked" (packs smoked per day times the number of years smoked). A smoking history of around 10 pack-years alerts the physician to search for cigarette-caused illness. But even those nonsmokers with the greatest exposure to SHS probably inhale the equivalent of only a small fraction (around 0.03) of one cigarette per day, which is equivalent to smoking around 10 cigarettes per year.

Low Statistical Association

Another major problem is that the epidemiological studies on which the EPA report is based are statistical studies that can show only correlation and cannot prove causation.

One statistical method used to compare the rates of a disease in two populations is relative risk (RR). It is the rate of disease found in the exposed population divided by the rate found in the unexposed population. An RR of 1.0 represents zero increased risk. Because confounding and other factors can obscure a weak association, in order even to suggest causation a very strong association must be found, on the order of at least 300 percent to 400 percent, which is an RR of 3.0 to 4.0.

For example, the studies linking direct cigarette smoking with lung cancer found an incidence in smokers of 20 to around 40 times that in nonsmokers, an association of 2000 percent to 4000 percent, or an RR of 20.0 to 40.0.

Scientific Principles Ignored

An even greater problem is the agency's lowering of the confidence interval (CI) used in its report. Epidemiologists calculate confidence intervals to express the likelihood a result could happen just by chance. A CI of 95 percent allows a 5 percent possibility that the results occurred only by chance.

Before its 1992 report, EPA had always used epidemiology's gold standard CI of 95 percent to measure statistical significance. But because the U.S. studies chosen for the report were not statistically significant within a 95 percent CI, for the first time in its history EPA changed the rules and used a 90 percent CI, which doubled the chance of being wrong.

This allowed it to report a statistically significant 19 percent increase of lung cancer cases in the nonsmoking spouses of smokers over those cases found in nonsmoking spouses of nonsmokers. Even though the RR was only 1.19--an amount far short of what is normally required to demonstrate correlation or causality--the agency concluded this was proof SHS increased the risk of U.S. nonsmokers developing lung cancer by 19 percent.

EPA Study Soundly Rejected

In November 1995 after a 20-month study, the Congressional Research Service released a detailed analysis of the EPA report that was highly critical of EPA's methods and conclusions. In 1998, in a devastating 92-page opinion, Federal Judge William Osteen vacated the EPA study, declaring it null and void. He found a culture of arrogance, deception, and cover-up at the agency.

Osteen noted, "First, there is evidence in the record supporting the accusation that EPA 'cherry picked' its data. ... In order to confirm its hypothesis, EPA maintained its standard significance level but lowered the confidence interval to 90 percent. This allowed EPA to confirm its hypothesis by finding a relative risk of 1.19, albeit a very weak association. ... EPA cannot show a statistically significant association between [SHS] and lung cancer."

In 2003 a definitive paper on SHS and lung cancer mortality was published in the British Medical Journal. It is the largest and most detailed study ever reported. The authors studied more than 35,000 California never-smokers over a 39-year period and found no statistically significant association between exposure to SHS and lung cancer mortality.

Propaganda Trumps Science

The 1992 EPA report is an example of the use of epidemiology to promote belief in an epidemic instead of to investigate one. It has damaged the credibility of EPA and has tainted the fields of epidemiology and public health.

In addition, influential anti-tobacco activists, including prominent academics, have unethically attacked the research of eminent scientists in order to further their ideological and political agendas.

The abuse of scientific integrity and the generation of faulty "scientific" outcomes (through the use of pseudoscience) have led to the deception of the American public on a grand scale and to draconian government overregulation and the squandering of public money.

Millions of dollars have been spent promoting belief in SHS as a killer, and more millions of dollars have been spent by businesses in order to comply with thousands of highly restrictive bans, while personal choice and freedom have been denied to millions of smokers. Finally, and perhaps most tragically, all this has diverted resources away from discovering the true cause(s) of lung cancer in nonsmokers.

Dr. Jerome Arnett Jr. (jerry.arnett@gmail.com) is a pulmonologist who lives in Helvetia, West Virginia.

Arnett has presented no evidence that secondhand smoke is not harmful; he has done no more than challenge evidence presented for the claim that it is harmful.

Even the 2003 "definitive paper on SHS and lung cancer mortality...published in the British Medical Journal" that "found no statistically significant association between exposure to SHS and lung cancer mortality" didn't "show secondhand smoke is no danger"; that is not the same thing as not finding an association.

Arnett says,

"Millions of dollars have been spent promoting belief in SHS as a killer, and more millions of dollars have been spent by businesses in order to comply with thousands of highly restrictive bans, while personal choice and freedom have been denied to millions of smokers."

He doesn't mention that the Heartland Institute, on whose website this article appears, gets funding from the tobacco industry, as does the Competitive Enterprise Institute, with which he is affiliated.

Arnett deserves a booby prize for sticking that title on that article, and you, Mr./Ms. Anonymous, deserve one for uncritical cutting and pasting. Are you by any chance trying to convince yourself that your own secondhand smoke isn't hurting anyone?

So Mutternich, just because something that says 2nd hand smoking is not so bad is linked to a website that takes money from the tobacco industry, it can't be right?

How flawed is that logic? If that's true, then, none of the supposed science listed on the ANTI smokers websites can be believed in either, because they obviously only want to promote one goal, and that is total control over human lives and what we can and cannot do...

The evidence of the BMJ study indicates that 2nd hand smoke CANNOT be shown to have a causal effect on illness.

On the other hand, the EPA study and the WHO study have also been shown to have been "crafted to arrive at a pre-determined conclusion". The EPA study was invalidated and thrown out by a high court, yet it's still the standard by which you ANTI's rally....

So, WoodstockLibertarian, not just linked to a website that takes money from the tobacco industry, but published on it. What's the matter, couldn't Dr. Arnett find anyplace to publish that doesn't take money from the industry?

But of course, the fact that the site in question takes tobacco money doesn't by itself prove that secondhand smoke is harmful, and I never said it did. I didn't offer it as a syllogism, did I? It is, however, a big "trust but verify" flag. I hope too that Dr. Arnett would understand my seeking out some other pulmonologist should I ever find myself needing one.

A quick Google search on Dr. Arnett revealed two things: 1) There won't be any commies or pinkoes involved in making health care policy if he can help it; 2) His referencing of works by Ayn Rand, Ludwig van Mises et al. in at least one review he wrote suggests he may have a bit of a "fire tamed at man's fingertips" perspective in matters concerning tobacco.

As for "total control over human lives," feel free to breath in as much secondhand and/or firsthand smoke as you like as far as I'm concerned, and Happy Libertarianing.

"The evidence of the BMJ study indicates that 2nd hand smoke CANNOT be shown to have a causal effect on illness."

Are you sure you wouldn't like to soften that to "has not yet been shown"? Otherwise you've claimed to have proven a negative, as has Dr. Arnett in the title, "Evidence Shows that Secondhand Smoke Is No Danger." That was my point.

I'd say that 39 years is long enough of a study, especially in a pool of 118K people, to say "CANNOT".
And remember, all your ANTI smoking stuff shows "increased risk factors". Yet you focus people on the % number, and don't explain it.

If 1 in 100000 people will die of lung cancer, thats a ONE THOUSANDTH of a percent chance.
If you increase the RISK FACTOR by 20%, that does not mean (as the anti's would like you to believe!!) that 20% of people will get lung cancer if they're exposed to 2nd hand smoke.

The likelihood of a non-smoker of getting lung cancer is something on the order of 1.3%. An increase of 1% in the risk factor would not make this number 2.3%, rather it would make it 1.313%......

Glad you want the government to have the power to dictate to you like that. Just wait until they come after something that's important to you!

"And remember, all your ANTI smoking stuff shows 'increased risk factors'. Yet you focus people on the % number, and don't explain it.

If the "% number" is there, prudence would strongly suggest avoiding the circumstance in question whether or not the precise mechanisms are spelled out. It's not like anyone is claiming an increased risk of something good happening, is it?

"The likelihood of a non-smoker of getting lung cancer is something on the order of 1.3%. An increase of 1% in the risk factor would not make this number 2.3%, rather it would make it 1.313%......"

...Which in your population of 100,000 would still come to 13 more. So which matters more to you, those 13 people or your liberty to spew secondhand smoke? Or for that matter, can you say the original 1.3 percent were never exposed to secondhand smoke? I don't think so.

Another point you haven't mentioned was that the focus of the original post was heart disease, not cancer. (Whoops, sorry, I guess I wasn't supposed to remember that.)

"Just wait until they come after something that's important to you!"

Oh, they already have. For one thing, I can no longer say I'm a citizen of a country that does not torture. What seems important to you, though, is your own liberty to subject others to your secondhand smoke. At least, nothing you've said so far seems to contradict that.

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