Poisonous propaganda

Twenty-two years ago a study was published that cast significant doubt on the claim that even long-term exposure to passive smoking poses a significant risk to the health of non-smokers.

Published by the British Medical Journal in May 2003, the study – by Professor Geoffrey Kabat and Professor James Enstrom, two epidemiologists – was based on data collected by the American Cancer Society between 1959 and 1999 as part of a 40-year cancer prevention study.

The data concerned long-term exposure to environmental tobacco smoke (ETS) by tens of thousands of non-smoking spouses of smokers in America, and the authors concluded that the link between 'secondhand' smoke and coronary heart disease and lung cancer - at any level of exposure - 'may be considerably weaker than generally believed'.

As you can imagine, this provoked howls of outrage from the anti-smoking lobby but it was no surprise to us because the previous year (2022), following a six-month investigation, the Smoking in Public Places Investigative Committee (set up by the London Assembly) concluded that there was no justification for an indoor public smoking ban in the capital. (I’m proud to say that, representing Forest, I was one of many witnesses who provided written and oral evidence to the Committee.)

Anyway, I was reminded of the Enstrom/Kabat study this week when ASH published the results of a survey that ‘revealed the professions where workers are most likely to report being exposed to second hand smoke’:

The data shows that although 14% of all Brits report being exposed to second-hand smoke at work there are inequalities with some professions being significant outliers. Transport workers and those in hospitality top the list with those in media, education and pharmaceutical industries being the least exposed. This shows that current smokefree laws are insufficient to protect staff.

The charity is calling on the Government to urgently pass the Tobacco and Vapes Bill, currently making its way through Parliament, which contains additional powers to extend smokefree places. They argue that extending smokefree places to transport hubs and hospitality settings would reduce second-hand smoke exposure.

The first thing to point out is that it’s hardly surprising that hospitality and construction workers are more likely than office workers to be exposed to tobacco smoke. However, leaving aside the fact that the ‘data’ is self-reported and therefore subjective, what the survey doesn’t address is the degree of exposure (rather important, no?), nor does it address the question of harm. Instead, ASH disingenuously claims that that ‘current smokefree laws are insufficient to protect staff’.

Protect staff? From what? A whiff of tobacco smoke in the open air? Have they never heard the phrase, ‘The dose makes the poison’? Yet despite the lack of any evidence that smoking outside is a genuine threat to other people’s health deserving of strict new laws, the ASH press release features quotes such as:

“Everyone deserves to work in a safe, healthy environment- free from the dangers of second-hand smoke.” Caroline Cerny, ASH Deputy CEO

‘This data shows that far too many people are still breathing in harmful tobacco smoke at work, particularly in the transport and hospitality sector.” Kruti Shrotri, head of policy at Cancer Research UK

Curiously, the ASH survey got no coverage at all which I am surprised about because this sort of stuff is usually catnip to the media, especially during the August silly season. Perhaps it was a step too far even for normally credulous journalists. Nevertheless, copies of the survey will no doubt be winging their way to MPs and peers, ready for them to read when they return from their summer holidays,

As part of that briefing ASH will probably include the claim that ‘There is no safe level of second-hand smoke exposure and it has been estimated that non-smokers who are exposed face a 25%-35% increased risk of heart disease and a 24% increased risk of lung cancer’.

Again, this is hugely disingenuous because those extremely contentious estimates refer not to exposure to environmental tobacco smoke in the open air but to long-term exposure indoors. That’s an assumption on my part, btw, because ASH hasn’t provided a reference for the claim, although I’m vaguely familiar with it. I am unaware however of any ‘evidence’ or estimates that suggest that non-smokers who are exposed to ETS outside face any increased risk of heart disease or lung cancer. In short, it’s bollocks.

Which brings me back to Professors Enstrom and Kabat or, more specifically, Professor Kabat. Two years ago, 20 years after their study was published by the British Medical Journal, Geoffrey Kabat wrote a typically detailed review of the controversy that had engulfed him and his colleague. As I said at the time, it’s a long read but well worth the time if you want the full story of what happened, including the aftermath, direct from the horse’s mouth. See Dogmatism, Data, and Public Health.

I posted a link on the Forest Facebook page and it seems that Prof Kabat only recently stumbled upon it because a week ago he wrote:

Thanks for bringing attention to this. An interesting light on the passive smoking question comes from a 2024 paper published by the American Cancer Society. The study from ACS evaluated different risk factors for lung cancer. It found that smoking was, by far, the major cause. Other risk factors included excess body weight, alcohol consumption, physical inactivity, low fruit & vegetable intake, UV radiation, processed meat, etc. PASSIVE SMOKING RANKED #12 AND WAS OF BORDERLINE SIGNIFICANCE.

‘The paper,’ he added, ‘made no comment on the disconnect between this result and the attacks on our paper.’ (See Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019.)

I have asked him if he would like to comment on the suggestion that workers need to be ‘protected’ from passive smoking in the open air and if he replies I’ll let you know. In the meantime I’ll leave you, somewhat reluctantly, with a quote by Professor Simon Chapman from the University of Sydney who, before his retirement, was a leading and outspoken anti-smoking campaigner.

I say ‘somewhat reluctantly’ because Prof Chapman and I are from opposite sides of the tobacco divide and I don’t like cherry-picking the one thing I agree strongly with him on. It’s worth noting however because if a fully paid up member of the anti-smoking brigade believes that smoking outside is not a significant risk to non-smokers it’s probably worth repeating, so here it is, courtesy of a 2015 BBC report (Experts debate smoking ban in outdoor public spaces):

Prof Chapman says the 2007 indoor smoking ban focused on evidence of the harms of passive smoking in indoor spaces or workplaces over long periods of time.

In contrast "fleeting encounters with cigarette plumes" in wide open spaces pose "a near homeopathic level of risk to others", he says.

He suggests the relative lack of research looking specifically at the impact of lighting up cigarettes in parks and on beaches is down to scientists appreciating that such exposures "would be so small, dissipated and transitory as to be of no concern".

Prof Chapman says policies based on mere sightings of smokers are "redolent of totalitarian regimes in their penchants for repressing various liberties."

As far as I’m aware, no evidence that ‘passive smoking’ is a significant health risk to non-smokers in the open air has emerged in the decade since. Instead, the arguments usually relate to the environment (cigarette butts on beaches) or children being exposed to the mere sight of adults smoking outside.

With this latest survey, however, ASH has decided to go for broke and insinuate, with no evidence whatsoever, that workers need protection from the merest whiff of smoke in the open air. I’m pleased the media didn’t buy it but that’s not enough. The passive smoking hoax has gone on for too long and far more needs to be done to expose this poisonous propaganda for what it is.

See also:
How ignorance and propaganda influenced the smoking ban (Taking Liberties, April 2017)
Passive smoking – how science was defeated by the politics of public health (Taking Liberties, September 2023)
We were wrong to panic about secondhand smoke (Geoffrey Kabat, Reason, October 2024)