ETS studies and how to understand them
Children Mercy Hospital on Confidence Intervals.
A very poorly produced but highly informative video.
TABLE OF ENVIRONMENTAL TOBACCO SMOKE AND LUNG CANCER
STUDIES UP TO 2006
Pie Chart of the studies.
Articles Showing not to Trust Low Relative Risk
Award winning article in Science Epidemiology faces its limits.
Do We Really Know What Makes Us Healthy?
The case against the 1992 EPA Report
The Congressional Research Service published a report on the studies November 14, 1995
The fourth circuit Federal Court of Appeals later overruled the District court’s decision on jurisdictional grounds (Link here for the written decision) , but did not overrule the substantive findings of the Judge.
WHO 1998
On March 8, 1998, the British newspaper The Telegraph reported “The world’s leading health organization has withheld from publication a study which shows that not only might there be no link between passive smoking and lung cancer but that it could have even a protective effect.”
Meta-Analysis
Meta-analysis has been defined as “the process of aggregating the data and results of a set of studies, preferably as many as possible that have used the same or similar methods and procedures; reanalyzing the data from all these combined studies; and thereby generating larger numbers and more stable rates and proportions for statistical analysis and significance testing than can be achieved by any single study”. But this is almost never the case for meta-analyses of ETS, performed from cherry-picked and dissimilar studies to demonstrate a politically pre-conceived outcome: that the prohibition of smoking is legitimate because passive smoking hurts people. But the meta-analysis of studies that prove nothing cannot prove anything.
Beware of Meta-analyses Bearing False Gifts
EPIDEMIOLOGIC EVIDENCE IN PUBLIC AND LEGAL POLICY:REALITY OR METAPHOR?
Before we get into the Surgeon Generals Report here is a veil admission that it is not settled science even though they claim that it is. From Page 21 of the SG report.
Judge William
L. Osteen, Sr., in the North Carolina Federal District
Court criticized the approach EPA had used to select
studies for its meta-analysis and criticized the use of 90
percent rather than 95 percent confidence intervals for
the summary estimates (Flue-Cured Tobacco Cooperative
Stabilization Corp. v. United States Environmental Protection
Agency, 857 F. Supp. 1137 [M.D.N.C. 1993]). In
December 2002, the 4th U.S. Circuit Court of Appeals
threw out the lawsuit on the basis that tobacco companies
cannot sue the EPA over its secondhand smoke
report because the report was not a final agency action
and therefore not subject to court review (Flue-Cured
Tobacco Cooperative Stabilization Corp. v. The United
States Environmental Protection Agency, No. 98-2407
[4th Cir., December 11, 2002], cited in 17.7 TPLR 2.472
[2003]).
Recognizing that there is still an active discussion
around the use of meta-analysis to pool data
from observational studies (versus clinical trials),
the authors of this Surgeon General’s report used
this methodology to summarize the available data
when deemed appropriate and useful, even while
recognizing that the uncertainty around the metaanalytic
estimates may exceed the uncertainty indicated
by conventional statistical indices, because of
biases either within the observational studies or produced
by the manner of their selection.
Surgeon Generals Report (2006)
Where’s the Consensus on Secondhand Smoke?
Surgeon General Trades Integrity for Advocacy
Surgeon General’s Report Blows Smoke
The Missing Study
Did Carmona and coauthors cherry-pick the data? Absolutely. They ignore the largest and most credible study ever conducted on spouses of smokers, by Enstrom and Kabat, published in the May 12, 2003 issue of the British Medical Journal. The authors found:
“The results do not support a causal relationship between environmental tobacco smoke and tobacco-related mortality. The association between tobacco smoke and coronary heart disease and lung cancer may be considerably weaker than generally believed.”
Now there will be those that will say that Enstrom was paid off by Big Tobacco. The facts are that it was origionally a study funded by The American Cancer Society when they found that the numbers wouldn’t fit their agenda they abandoned the study.
In the interest of transparency and full disclosure, the paper included the following detailed statements about the funding history of the study and the competing interests of the authors: “Funding: The American Cancer Society initiated CPS I in 1959, conducted follow up until 1972, and has maintained the original database. Extended follow up until 1997 was conducted at the University of California at Los Angeles with initial support from the Tobacco-Related Disease Research Program, a University of California research organisation funded by the Proposition 99 cigarette surtax. After continuing support from the Tobacco-Related Disease Research Program was denied, follow up through 1999 and data analysis were conducted at University of California at Los Angeles with support from the Center for Indoor Air Research.
Defending legitimate epidemiologic research: combating Lysenko pseudoscience
Surgeon Generals Report 2010
Surgeon General Blows smoke up our
Veritas Vincit Pro Libertate 
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The excuse for excluding Enstrom/Kabat from the 2006 SG Report however is **NEVER** given as “because of the funding source” or “because of the quality of the study” or “because of bias or poor design.” Indeed, the only real criticism of that nature I’ve ever seen aimed at E/K was the fact that they used the same sort of weak data that the EPA *and* the SGR 2006 used to indict ETS. Apparently such weak data was fine as long as it gave the antismoking advocates the answers they wanted, but when it didn’t give the “right” answers it wasn’t good anymore.
However, as noted, the SGR did NOT exclude the E/K study on any such bases. Instead the formal claim seems to have been that the study was completed/published “too late” (in 2003) to be included. Well, people recognize that formal high level reports and such DO have “lead times” and have to have cutoff dates so the excuse seemed reasonable….
EXCEPT…. that if you look at the chapter of the SG Report dealing with lung cancer which WOULD have included the E/K Study, something surprising pops up in the footnotes: A full TWENTY of the footnote citations that came out “in time” to be included have publication dates in 2004 or 2005! And yet the 2003 E/K study came out “too late” to be included.
When something so clearly biased, so absolutely inexcusable, lies at the base of one of the most important conclusions of the overall Report….
HOW CAN *ANY* of the rest of it be trusted?
Congress should sue those responsible for producing the Report, including Carmona, for the full amount of tax money that was obviously wasted in producing a Report that clearly cannot be trusted to have any real scientific meaning. This seems clearly not just a case of misfeasance where someone sloppily made a mistake in their duties, but of MALfeasance where a number of “someones” deliberately sabotaged an important piece of government work that they were well paid for and which affected the lives of hundreds of millions of Americans.
Such malfeasance, if it exists to such an extent at such a clearly visible and non-technical level would indicate not just a strong likelyhood, but a virtual certainty that far less visible corruptions are hidden throughout the body of the Report. While there’s no practical means of doing so, not only should the perpetrators be exposed and punished for whatever crimes they may have commited, but the substance of the Report itself and its effects should be expunged from the record, mitigated, and corrected unless and until a proper Report is produced in its place.
Michael J. McFadden
Author of “Dissecting Antismokers’ Brains”
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