Ireland's Smoking Ban

[debeest]

Boris, you're 100% wrong. Second-hand smoke effects have been studied probably hundreds of times, and the evidence is overwhelming that it causes heart disease and cancer and childhood asthma -- probably other harm as well, but off the top of my head I don't know for sure. That's what makes it different from farting or body odor or chewing gum.

[debeest]

Again, these laws are established to protect workers. Businesses have no more right to expose their workers to environmental tobacco smoke than to asbestos. The business's right to allow smoking falls before their employees' right to a healthy workplace. All laws involve balancing one person's rights against another person's rights. Generally, we give health and safety a higher priority than sensual indulgence. It's a miracle it's taken so long for the laws to catch up with the science.

[Boris Godunov]

Originally posted by debeest
Boris, you're 100% wrong. Second-hand smoke effects have been studied probably hundreds of times, and the evidence is overwhelming that it causes heart disease and cancer and childhood asthma -- probably other harm as well, but off the top of my head I don't know for sure. That's what makes it different from farting or body odor or chewing gum.

This simply is not true. First, the EPA report issues in 1993, where it sounds like you're drawing most of this from, has been roundly criticized and ruled against in issues by Federal Courts. The EPA dramatically overstated its case.

http://www.davehitt.com/facts/epa.html

Fact: After juggling the numbers, The EPA came up with an RR (Relative Risk) of ETS causing lung cancer 1.19. In layman's terms that means:

• Exposure to the ETS from a spouse increases the risk of getting lung cancer by 19%.
• Where you'd usually see 100 cases of cancer you'd see 119.

Fact: A RR of less than 2.0 is usually written off as and insignificant result, most likely to be due to error or bias. An RR of 3.0 or higher is considered desirable. (See Epidemiology 101 for more details.)

Heart disease? Not proven. The EPA study itself said there wasn't conclusive evidence of this, only limited, circumstantial evidence. Cancer? No, the levels of carcinogens to which people were exposed where well below levels normally considered dangerous (see above cite). Sure, it may irritate people's allergies and asthma--but so do flowers and other legal materials.

I'm not a smoker and I don't like being around it, but I don't believe in the hysteria surrounding it, either. It's fundamentally not a public health issue, it's a public nuisance issue. I certainly don't think there's enough evidence to warrant depriving business owners of their right to run their establishments as they see fit wrt legal activities.

[Imran Siddiqui]

If an establishment does not want to follow fire or hygiene regulations, should it be allowed to do so?

Is anyone except for the owner clamoring for this? Also cigarettes are legal, right?

[debeest]

Originally posted by Boris Godunov

This simply is not true. First, the EPA report issues in 1993, where it sounds like you're drawing most of this from, has been roundly criticized and ruled against in issues by Federal Courts. The EPA dramatically overstated its case.

http://www.davehitt.com/facts/epa.html

Fact: After juggling the numbers, The EPA came up with an RR (Relative Risk) of ETS causing lung cancer 1.19. In layman's terms that means:

• Exposure to the ETS from a spouse increases the risk of getting lung cancer by 19%.
• Where you'd usually see 100 cases of cancer you'd see 119.

Fact: A RR of less than 2.0 is usually written off as and insignificant result, most likely to be due to error or bias. An RR of 3.0 or higher is considered desirable. (See Epidemiology 101 for more details.)

Heart disease? Not proven. The EPA study itself said there wasn't conclusive evidence of this, only limited, circumstantial evidence. Cancer? No, the levels of carcinogens to which people were exposed where well below levels normally considered dangerous (see above cite). Sure, it may irritate people's allergies and asthma--but so do flowers and other legal materials.

I'm not a smoker and I don't like being around it, but I don't believe in the hysteria surrounding it, either. It's fundamentally not a public health issue, it's a public nuisance issue. I certainly don't think there's enough evidence to warrant depriving business owners of their right to run their establishments as they see fit wrt legal activities.

Boris, I hate to see a usually sensible person go wrong like that. I tried to view the link you cited, but got a 404 error, and on Hittman's rant site taboe of contents I couldn't find the article you tried to link to, so I don't know what wacko arguments he made.

Yes, EPA risk assessment was heavily criticized. The tobacco companies buy people to do that. They have lots of money to buy people to do that.

Yes, there was a court ruling against EPA's risk assessment. Courts have also ruled almost invariably in favor of the tobacco companies on everything else. Courts have ruled that smoking doesn't cause cancer and heart disease, and courts have also ruled that since everyone knows smoking causes cancer and heart disease, the tobacco peddlers can't be blamed for failure to warn about the hazards of their products. Courts have also ruled that the EPA could not ban asbestos use because it's an infringement on NAFTA. That doesn't mean the EPA was wrong.

The US EPA still stands by its ETS risk assessments. The risk assessment was properly conducted and was based on hundreds of very consistent studies. Heart disease accounts for the great bulk of deaths attributed to ETS.

A relative risk of 1.19 is indeed small, and epidemiologists do indeed feel more confident when RR's are big. But when the confidence limits are extremely tight, as they are with ETS exposure and lung cancer, and where the numbers are generated through meta-analysis of hundreds of very consistent studies, and when there is little reason to suspect bias, then a significantly elevated RR of 1.19 is important. This is particularly true when, as with ETS and lung cancer, the health endpoint is fairly common and the outcome is severe.

About 7% of Americans (and roughly that for most developed countries) die of lung cancer. Almost all of that lung cancer is induced by smoking. About 0.5% of non-smokers die of lung cancer (maybe 0.3%, maybe 0.7%, it's hard to get good data on that). That's a non-smoker lifetime lung cancer fatality risk of 5000 in a million. With a relative risk of 1.19, that's an excess lung cancer death rate of 5000/1,000,000 * 0.19, or 950/1,000,000. It's not spectacular, but it's way more than EPA allows for most other kinds of carcinogen exposure. It's almost exactly the same as the 1/1000 lifetime cancer rate that US OSHA usually sets as a target for control of cancer risk from workplace exposures.

The RR of 1.19 is, I think, based primarily on spousal exposure. Workplaces such as bars and restaurants often have far higher levels of ETS than homes do, and thus workers exposed to ETS there are at much greater risk.

ETS doesn't just exacerbate asthma, it causes it. Children in homes with ETS have much higher rates not just of asthma attacks, but of asthma itself. Asthma is a very serious disease that not only debilitates people very seriously, but also is an important cause of death.

Smoking is the leading cause of death in the developed world. ETS only accounts for a small fraction of those deaths, but it's still a very large number. Cigarettes are legal, but they kill far more people than any other drug, legal or illegal. There's no reason to allow them to be inflicted on bystanders.

[Boris Godunov]

Not sure why you can't read the link, as it works fine for me, but here's the full text. Your response seems to be just more blanket assertions, however:

http://www.davehitt.com/facts/epa.html

The EPA Report

In December of 1992 the EPA released it's now famous report on second hand smoke. The report claimed that SHS causes 3,000 deaths a year, and classified it as a class A carcinogen.

This was, and remains, a powerful weapon in the anti-smokers arsenal. If a smoker is only hurting himself, he can argue that it's no one else's business. But if he is hurting everyone around him, all kinds of restrictive legislation can be justified.

Is SHS really deadly? Let's examine the facts carefully.

Fact: In 1993 the EPA issued a report which claimed that Environmental Tobacco Smoke (ETS) caused 3,000 deaths per year.

Fact: ETS is commonly referred to as Second Hand Smoke (SHS). The two terms are interchangeable.

After reading each of the following facts, ask yourself "Does this fact make the study more credible, or less credible?

Fact: The EPA announced the results of the study before it was finished.

Fact: The study was a Meta Analysis, an analysis of existing studies.

Meta Analysis is very difficult to do accurately, and is the easiest kind of study to fake and manipulate. With a disease as rare as lung cancer, leaving out just a few important studies can skew the results considerably.

The term "Meta Study" is often used to describe this type of report, but the word "study" is inaccurate. The EPA has never conducted nor financed a single ETS study. They have only analyzed the studies of others. It is more accurate to refer to it as an analysis, and to its publication as a report.

Fact: The first step in a meta analysis is identifying all of the relevant studies. The EPA located 33 studies that compared ETS exposure to lung cancer rates.

Fact: The EPA selected 31 of the 33 studies. Later they rejected one of their chosen studies, bringing the total to 30.

Fact: On page 3-46 of the report the EPA estimates, based on nicotine measurements in non-smokers blood, "this would translate to the equivalent of about one-fifth of a cigarette per day."

Fact: Studies that measured actual exposure by having non-smokers wear monitors indicate even this low estimate is exaggerated. Actual exposure (for people who live and/or work in smoky environments) is about six cigarettes per year. (See also the study by Oak Ridge National Laboratories.)

Fact: In 1995 The Congressional Research Service (CRS) released a review of the EPA report.

The CRS was highly critical of both the EPA's methods and conclusions.

Fact: According to the CRS "The studies relied primarily on questionnaires to the case and control members, or their surrogates, the determine EST exposure and other information pertinent to the studies.

Questionnaires can be notoriously inaccurate, as discussed in Epidemiology 102, but in this case some of them were not even filled out by the people being studied, but by "surrogates." In other words, some of the information was unverified hearsay.

Fact: The CRS pointed out that "from a group of 30 studies. . six found a statistically significant (but small) effect, 24 found no statistically significant effect and six of the 24 found a passive smoking effect opposite to the expected relationship."

Fact: Three other large US studies were in progress during the EPA's study. The EPA used data from one uncompleted study, the Fontham study, and ignored the other two, Brownson and Kabat.

Fact: The Fontham study showed a small increase in risk. The CRS report referred to it as "a positive risk that was barely statistically significant." (p. 25)

Fact: The CRS report said the Brownson study, which the EPA ignored, showed "no risk at all." (p.25)

Fact: The "scientists" who conducted the Fontham study refused to release their raw data for years. Philip Morris recently won a lawsuit to gain access to it.

Most researchers routinely make their raw data available after studies have been published. Does Fontham's refusal to make the data available make them more credible, or less credible?

Fact: The EPA based their numbers on a meta analysis of just 11 studies. The analysis showed no increase in risk at the 95% confidence level.

Fact: Even after excluding most of the studies, the EPA couldn't come up with 3,000 deaths, but they had already announced the results. So they doubled their margin of error. Let me repeat that, because it may seem hard to believe: After failing to achieve their pre-announced results by ignoring half of the data, they doubled their margin of error!

Would any legitimate epidemiologist keep their job if they were caught doubling their margin of error to support a pre-announced conclusion?

Fact: After juggling the numbers, The EPA came up with an RR (Relative Risk) of ETS causing lung cancer 1.19. In layman's terms that means:

• Exposure to the ETS from a spouse increases the risk of getting lung cancer by 19%.
• Where you'd usually see 100 cases of cancer you'd see 119.

Fact: A RR of less than 2.0 is usually written off as and insignificant result, most likely to be due to error or bias. An RR of 3.0 or higher is considered desirable. (See Epidemiology 101 for more details.)

This rule is routinely ignored when the subject is second hand smoke.

Facts: In review: The EPA ignored nearly two-thirds of the data. The EPA then doubled their margin of error to come up with their desired results. Even with all this manipulation, the numbers are still far too low to be considered statistically significant.

Fact: Although the EPA declared ETS was a Class A carcinogen with an RR of 1.19, in analysis of other agents they found relative risks of 2.6 and 3.0 insufficient to justify a Group A classification.

Fact: In 1998 Judge William Osteen vacated the study - declaring it null and void after extensively commentating on the shoddy way it was conducted. His decision was 92 pages long.

Fact: Osteen used the term "cherry-picking" to describe he way the EPA selected their data. "First, there is evidence in the record supporting the accusation that EPA "cherry picked" its data. Without criteria for pooling studies into a meta- analysis, the court cannot determine whether the exclusion of studies likely to disprove EPA's a priori hypothesis was coincidence or intentional. Second, EPA's excluding nearly half of the available studies directly conflicts with EPA's purported purpose for analyzing the epidemiological studies and conflicts with EPA's Risk Assessment Guidelines."

Fact: Osteen found other deep flaws in the the EPA's methodology. In his judgment he stated: "The record and EPA's explanations to the court make it clear that using standard methodology, EPA could not produce statistically significant results with its selected studies. Analysis conducted with a .05 significance level and 95% confidence level included relative risks of 1. Accordingly, these results did not confirm EPA's controversial a priori hypothesis. In order to confirm its hypothesis, EPA maintained its standard significance level but lowered the confidence interval to 90%. This allowed EPA to confirm its hypothesis by finding a relative risk of 1.19, albeit a very weak association. EPA's conduct raises several concerns besides whether a relative risk of 1.19 is credible evidence supporting a Group A classification. First, with such a weak showing, if even a fraction of Plaintiffs' allegations regarding study selection or methodology is true, EPA cannot show a statistically significant association between ETS and lung cancer."

Fact: The following is another direct quote from Judge Osteen's decision: "In this case, EPA publicly committed to a conclusion before research had begun; excluded industry by violating the Act's procedural requirements; adjusted established procedure and scientific norms to validate the Agency's public conclusion, and aggressively utilized the Act's authority to disseminate findings to establish a de facto regulatory scheme intended to restrict Plaintiffs, products and to influence public opinion. In conducting the ETS Risk Assessment, disregarded information and made findings on selective information; did not disseminate significant epidemiologic information; deviated from its Risk Assessment Guidelines; failed to disclose important findings and reasoning; and left significant questions without answers. EPA's conduct left substantial holes in the administrative record. While so doing, produced limited evidence, then claimed the weight of the Agency's research evidence demonstrated ETS causes cancer. Gathering all relevant information, researching, and disseminating findings were subordinate to EPA's demonstrating ETS a Group A carcinogen."

Most of the media ignored the judge's decision.

When confronted with this decision, many anti-tobacco activists and organizations harp on the fact that Judge Osteen lives in South Carolina. The obvious implication is that he's influenced by the tobacco industry in his state. It may also be an appeal to the "stupid southerner" stereotype.

Fact: Judge Osteen has a history of siding with the government on tobacco cases.

Fact: In 1997 Judge Osteen ruled the FDA had the authority to regulate tobacco.

So much for his alleged bias.

Fact: Although this study has been thoroughly debunked by science and legally vacated by a federal judge, it is still regularly quoted by government agencies, charity organizations and the anti-smoking movement as if it were legitimate.

Fact: Anyone referring to EPA classifying ETS as a Class A carcinogen is referring to this study.

Opinion: You should seriously question the credibility of anyone who refers to this study, or any of the conclusions that it reached, as if they were facts. That includes everyone who refers to the EPA's ruling that ETS is a Class A Carcinogen. Once they do, every subsequent statement they make should be considered highly suspicious until it is thoroughly verified.

Fact: Most of the information on this page was gleaned from Judge Osteen's 92 page decision, the CRS report, and the EPAs study.

You are strongly encouraged to read these documents yourself. You can find the judge's entire decision here. The CRS report is available here. The EPA's report is not available on-line because it's about 600 pages long. It is, however, available to US citizens at no charge. Call (800) 438-4318 if you'd like a copy. Ask for document EPA/600/6-90/006F. The title of the report is "Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders."

Fact: Carol Browner, the former head of the EPA, still insists that this study is valid!

I certainly don't see any evidence the author is some sort of paid shill of the tobacco industry. I'm more interested in a refuation of his arguments.

Here's the analysis of the interpretaion of the WHO study I was referring to, which is regarded as the most comprehensive to date:

http://www.davehitt.com/facts/who.html

The Who Study

The World Health Organization's study is a textbook example of the right way to conduct an epidemiological study. Unfortunately for them, it yielded unexpected results.

Fact: The World Health Organization conducted a study of Environmental Tobacco Smoke (ETS) and lung cancer in Europe.

Fact: ETS is commonly referred to as Second Hand Smoke (SHS). The two terms are interchangeable.

Fact: This was a case control study using a large sample size.

Fact: The purpose of the study was to provide a more precise estimate of risk, to discover any differences between different sources of ETS, and the effect of ETS exposure on different types of lung cancer.

Fact: The study was conducted from twelve centers in seven European countries over a period of seven years.

Fact: The participants consisted of 650 patients with lung cancer and 1542 control subjects. Patients with smoking related diseases were excluded from the control group. None of the subjects in either group had smoked more than 400 cigarettes in their lifetime.

Fact: Three of the study centers interviewed family members of the participants to confirm the subjects were not smokers.

Fact: The study found no statistically significant risk existed for non-smokers who either lived or worked with smokers.

Fact: The only statistically significant number was a decrease in the risk of lung cancer among the children of smokers.

Fact: The study found a Relative Risk (RR) for spousal exposure of 1.16, with a Confidence Interval (CI) of .93 - 1.44. In layman's terms, that means

• Exposure to the ETS from a spouse increases the risk of getting lung cancer by 16%.
• Where you'd normally find 100 cases of lung cancer, you'd find 116.


• The 1.16 number is not statistically significant.



Fact: The real RR can be any number within the CI. The CI includes 1.0, meaning that the real number could be no increase at all. It also includes numbers below 1.0, which would indicate a protective effect. This means that the number 1.16 is not statistically significant.

Fact: A RR of less than 2.0 is usually written off as an insignificant result, most likely to be due to error or bias. An RR of 3.0 or higher is considered desirable. (See Epidemiology 101 for more details.)

Fact: The study found no Dose/Response relationship for spousal ETS exposure. See Epidemiology 102 for more information.

Fact: The RR for workplace ETS was 1.17 with a CI of .94 - 1.45, well below the preferred 2.0 - 3.0, and with another CI that straddled 1.0.

Fact: The RR for exposure from both a smoking spouse and a smoky workplace was 1.14, with a CI of .88 - 1.47.

Fact: The RR for exposure during childhood was 0.78, with a CI of .64 - .96. This indicates a protective effect! Children exposed to ETS in the home during childhood are 22% less likely to get lung cancer, according to this study. Note that this was the only result in the study that did not include 1.0 in the CI.

The WHO quickly buried the report. The British press got wind of it and hounded them for weeks.

Fact: 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."

Finally, the WHO issued a press release. Although their study showed no statistically significant risk from ETS, their press release had the misleading headline "Passive Smoking Does Cause Lung Cancer - Do Not Let Them Fool You." (I say "misleading" because it would be impolite to call it an outright lie.)

Fact: In paragraph four they admitted the facts: "The study found that there was an estimated 16% increased risk of lung cancer among nonsmoking spouses of smokers. For workplace exposure the estimated increase in risk was 17%. However, due to small sample size, neither increased risk was statistically significant." (Emphasis added.)

Fact: The press release doesn't mention the one statistically significant result from the study, that children raised by smokers were 22% less likely to get lung cancer.

Fact: The WHO tried to blame the results on a small sample size. However, the in the Journal of the National Cancer Institute, where the results were published, the researchers clearly state: "An important aspect of our study in relation to previous studies is its size, which allowed us to obtain risk estimates with good statistical precision..." It should also be noted that a larger sample size wouldn't have changed the numbers significantly, just narrowed the CI a bit.

[Provost Harrison]

Originally posted by Kucinich


Sig material!

Or cig material!

I would like to see this catch on a bit more. Whenever you want to go somewhere for a drink you end up stinking of smoke and it makes the atmosphere very bad.

[chequita guevara]

Originally posted by Sikander
But for some strange reason the measurable demand for such places lags far behind people's willingness to boss one another around via the government.

Actually it's quite nice to be able to go out again without having to suffer the tyraany of smokers. I rather dislike the choices of staying home or exposing myself to cigarette smoke.

[chequita guevara]

Originally posted by Imran Siddiqui

If an establishment does not want to follow fire or hygiene regulations, should it be allowed to do so?

Is anyone except for the owner clamoring for this? Also cigarettes are legal, right?

Yup, just like alcohol, which is also controled.

[debeest]

I'm not relying on the EPA meta-analysis. In the course of my work as a toxicologist and an epidemiologist doing mostly occupational health work over the past 20 years, I've read dozens of studies of ETS, particularly in the workplace.

Hitt claims that EPA ignored 2/3 of the data. Anyone who knows anything about meta-analysis knows that it's essential to first lay out criteria for study exclusion in order to ensure that only sound, valid studies are included and to ensure that only studies using comparable methods are included. Most meta-analyses select only a fraction of the relevant studies. They're supposed to. That's how meta-analysis is properly done.

The WHO study is cited as further evidence that ETS doesn't cause cancer. In fact, it should be considered further evidence that it DOES cause cancer. The RR in the WHO study is not significant, because the elevation of risk really is not huge, but it is elevated to virtually the same extent as the summary RR from the meta-analysis. Add the study into the meta-analysis, and you would get slightly narrower confidence limits that might give significance where it had not existed before.

The WHO finding of a reduced incidence of cancer among offspring is interesting. I don't know the details of the study, but I wonder whether it was adequate to evaluate cancer in offspring. Most cancer develops late in life. How many aged non-smoker offspring of smoker parents were included in the study? Given the number of cases and controls, I am sure that the numbers were inadequate for an evaluation. If the non-smoker offspring were selectively young compared to the broad population or the cancer cases, that would constitute a huge bias toward reduced risk.

I don't know about the EPA's alleged "doubling of the margin of error." That sounds to me as if they had switched from using a two-tailed significance test to a one-tailed test. Either might be appropriate; in some ways it's arbitrary, like all significance testing. In any case, the whole idea of significance testing is considered dubious today -- confidence limits provide the same information along with a great deal more information, and the idea that "significant v. non-significant" provides a clear line of distinction is recognized as wrong. If EPA changed for the purpose of achieving statistical significance, that would obviously be wrong -- but it would have no effect on the numbers, which indicate a modest, probably not statistically significant, but nevertheless highly important, elevation of risk.

The insistence on statistical significance is one of the great shibboleths fostered by corporations that don't want action taken. Even though the evidence points to a need for action, they cry out "There's no significant evidence! There's no proof!"

Please note what had just happened to the US Congress in 1995 when they Congressional Research Service released their "highly critical" attack on the EPA report. As I recall, Newt and Company were pretty much insisting that the earth is flat.

May I suggest that you, as a reasonable person, take a look at a variety of sources, instead of relying solely on the cherry-picked assertions of an Internet rant-master who doesn't even know that the term "ETS" is NOT interchangeable with "second-hand smoke?" Second-hand smoke is smoke exhaled by the smoker, and it's very different from sidestream smoke, the smoke that drifts off the burning tip of the cigarette. ETS comprises both sidestream and secon-hand smoke. It's a small point, but it's indicative of his ignorance on the issue.

[Imran Siddiqui]

Yup, just like alcohol, which is also controled.

By licensing. No one is banning alcohol from all public places.

[rah]

I'm concerned about those California studies. If you live in LA, your options are limited. You're not going to leave the state to eat dinner out frequently. I'd be more interested in those where there is a city ban (a smaller city) where the option to drive 5 miles to get outside of the ban radius is possible. That would be a truer test of whether it has an impact.
Or even in a town near the border of California where it's easy to go into Nevada to avoid the ban.

[debeest]

I take the California studies as clear evidence that a broad, comprehensive ban on smoking in bars and restaurants would not reduce profits. Do we really need to worry about whether localized bans would drive local profits down? Just promulgate broad, comprehensive bans and profits will not suffer.

[Solly]

Ming

Most bar owners I know have talked about how they will lose business if they didn't allow smoking.

You ain't looking at this as a whole. I'm sure individual pub/bar owners may lose custom if they, on their own, banned smoking. If the industry as a whole bans it, they can benefit.

Their are parellels to the banning of cigarette advertising in certain places. All firms advertised because other firms did - when it was banned, they could reduce advertising expenditure and hence make more profit.

[Ming]

Originally posted by Park Avenue
Ming
You ain't looking at this as a whole. I'm sure individual pub/bar owners may lose custom if they, on their own, banned smoking. If the industry as a whole bans it, they can benefit.

Their are parellels to the banning of cigarette advertising in certain places. All firms advertised because other firms did - when it was banned, they could reduce advertising expenditure and hence make more profit.

First point.. The bar owners seem to think that people won't stay as long or drink as much if they can't smoke...

And to the second point... just because many forms of advertising were no longer allowed, you have made a bad assumption that ad budgets were reduced... they weren't. The money was just reallocated to different media