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Inception – March 2007

The anti-tobacco movement and pharmaceutical companies

Many are complaining that those who influence tobacco policy are receiving big donations from the makers of smoking cessation products. I saw a Canadian newspaper article examining the potential conflict of interest, and I think it deserves a mention (under criticism). Thoughts?71.72.217.102 04:22, 28 June 2007 (UTC)

Yes, it would be a shame for a corporation to subvert public policy making to promote their product, despite its dangers... that would be reprehensible. Particularly if, say, there were reams of documentation of said corporations' nefarious machinations. Glad we're on the same page - though some might prefer the "anti-lung cancer movement" rather than the "anti-tobacco movement". Semantics. As to the contention that drug companies are behind "tobacco policy", I'd like to see this source. Regardless, though, it doesn't belong here. Maybe you could argue for a mention in the tobacco article or in an article on tobacco regulation, but I don't see how it applies to secondhand smoke in particular. After all, there's still no pharmaceutical that protects you from that. MastCell 05:47, 28 June 2007 (UTC)

Thanks for the input. That being said, I don't see a clear connection between the article and passive smoking. The link is here. Of course there is no pill that could protect us from second hand smoke. We all know that there is "no safe level of exposure". I am, though, glad that there are safe levels of lead, benzene, arsenic, asbestos, toulene and the like in our drinking water. Otherwise, we would all be dehydrated. Must be better to ingest it than to inhale it. I find that interesting...71.72.217.102 07:15, 28 June 2007 (UTC)

Interesting perhaps - but not altogether surprising. If you ingest something it goes through the stomach & digestive processes, and then has to find a way of getting absorbed into the bloodstream. If you inhale a gas, it enters the lungs which are designed to allow ready transfer of gaseous substances across the alveolar barrier into the lungs (per Fick's law) - so to use a slightly silly example, it's pretty clear why smoking cigarettes is more dangerous than eating them. Although they should form part of a balanced diet... Nmg20 08:56, 28 June 2007 (UTC)

You're not seriously comparing cigarettes to water, right? You agree that water is essential for life, and therefore the unavoidable consumption of trace amounts of metals or pollutants in drinking water is quite different from exposure to carcinogens from cigarettes? MastCell 17:21, 28 June 2007 (UTC)

Of course I'm not comparing the two; that would be ridiculous. Just pointing out the double standard. Without question, ETS is a source of indoor air pollution. On the other hand, making statements ("no safe level") that directly contradict the principles of toxicology is disingenuous to say the least.71.72.217.102 19:29, 28 June 2007 (UTC)

If you believe there's a double standard at work, then you are in fact comparing the two, and implying that they should be subject to the same standard. MastCell 20:42, 28 June 2007 (UTC)

No, I'm not. Perhaps I misunderstood you. What I'm saying is there are, no doubt, dangers in certain levels of exposure to almost anything (especially toxic chemicals, carcinogens and yes, even ETS). I specifically refer to the "no safe level" claim and the double standard that exists (not only in my imaginastion). To say that "X" is so dangerous that you cannot be exposed to a level small enough to not hurt you is not just absurd; it's pure fantasy.71.72.217.102 23:15, 28 June 2007 (UTC)

I don't want to be rude, User:71.72.217.102, but if you actually know people who believe that there are no dangers in exposure to carcinogens or toxic chemicals, could you let me know, as I have a bridge I urgently need to sell them? Thanks. Nmg20 00:14, 29 June 2007 (UTC)

Call me Chido. I've had this account for a few weeks, but rarely do I log in (I'll try to log in regularly from now on). There is nothing rude about the question. I won't take offense since I didn't say there are no dangers. I'll see if I can hunt someone down who thinks that, but I doubt I will. What I did say was (in a rare moment of agreement with the EPA) that there are "levels of contaminant(s)...below which there are no known or expected risks to health."Chido6d 02:06, 29 June 2007 (UTC)

Enstrom and Kabat

I did some digging into this controversial study and expanded the section a bit. Not surprisingly, a revert was done within hours -- even though I was meticulous to uphold the standards of this site (I'm learning). The reason given for the revert was "undue weight on a (small) minority view". My contribution consisted of the following: a two sentence summary of the study's conclusion(s), a one sentence summary (from a BMJ associate editor) of the responses received regarding the study, and one or two sentences from the BMJ editor defending their publication of the study. All statements were sourced and uncontroversial (I used the study itself and the BMJ only). As it stands, this section contains (approximately) 2 lines of information about the study itself (which is inadequate) and about 22 lines of criticism (some of which are not directly related to this study). The criticism was left intact. Assuming good faith, as difficult as that may be, I am writing here opening the forum for comments before undoing the disappearance of my contribution. Certainly the conclusion of the study, briefly stated, is not undue weight. Neither is documentation of the controversy it generated. It is also quite significant that the BMJ defended itself amid a firestorm of criticism and even calls for them to recant on publication of the study.71.72.217.102 18:27, 18 June 2007 (UTC)

Yes, the vandalism charge was inappropriate. I'm on the fence about the undue weight thing; the controversy was reasonably significant, though expanding at length on a couple of the dissenting studies while rapidly glossing over the much greater number and quality of studies supporting the link does give the appearance of undue weight. MastCell 18:37, 18 June 2007 (UTC)

As I pointed out, the length of the article, in large part, has to do with extensive criticism (which I am not particularly opposed to). The contribution is relevant because information on the study itself (and these aspects of it) is scant, and the controversy generated by its inclusion in the BMJ is not factually documented. The majority of studies were not considered controversial (at least by the health community), so this aspect would not be a factor in covering them. The vandalism charge was ridiculous. I was working on the edit, and I'm not sure how changes were saved before my edit was complete.71.72.217.102 19:20, 18 June 2007 (UTC)

I'm reverting the article to my version of this section in the absence of meaningful objection. The undue weight claim is subjective; in this case it has not been credibly established.71.72.217.102 23:39, 19 June 2007 (UTC)

I've put the Osteen and EK material in a section headed "Criticism", noting that this was promoted by TASSC and other front organisations. Together with the tobacco industry response, this makes up more than half the article. I think this is obviously undue weight. I'd suggest that the Osteen decision deserves three sentences - EPA reported risks, Osteen ruled against them, overturned on appeal, and Enstrom and Kabat about the same - findings, criticised for tobacco funding and methodological flaws, BMJ defended publication. Maybe the Osteen stuff could be cut off into a separate article, since it's a notable controversy in the US context.JQ 00:41, 20 June 2007 (UTC)

I'm for the briefer mention, and against spinning off another article as a POV fork. MastCell 01:52, 20 June 2007 (UTC)

I agree that it's "wordy", but much of that is due to contributions that stray from the facts of the case or study and babble on in efforts to discredit, debunk and preserve certain viewpoints (no offense intended). For example, regarding the Osteen decision, someone chose to discuss the testimony of Congressman Bliley. Though I still do not know how he testified, or what effect his testimony had, I do know that he received donations from "big tobacco". I also question the subtle jab at Judge Osteen's crediblilty; I'm not opposed to it, but why is it there? It didn't help me understand what the case and the surrounding controversy were all about. I had to find out elsewhere. For years, I had asked myself why the suit was brought, and on what basis was the decision overturned. Now, the information is there. I suppport a careful abridgement; what I would object to is deleting information relating directly to the Osteen case or the Enstrom/Kabat study.71.72.217.102 04:57, 20 June 2007 (UTC)

I've cut back to the basics on Osteen. Those who are really interested in a decade-old, effectively moot, court case, or a 15-year-old EPA report can follow the references. If this looks OK, I'll try the same with E&K. JQ 05:54, 20 June 2007 (UTC)

Thanks for your efforts, but it is not acceptable. It does not mention that the EPA had committed to a conclusion before research had begun, that they (EPA) relaxed the CI to achieve the desired result, etc. It also does not explain the basis for appeal. I don't have time to work on it now, but can try to do so this evening.71.72.217.102 12:10, 20 June 2007 (UTC)

I added the stuff about Bliley receiving money from the tobacco industry, but that came about because of a common problem on this and other tobacco-related articles: editors believe that public figures are automatically honest and beyond reproach. In Congressman Bliley's case, that manifestly wasn't true, and so I added details of the significant sums he'd received; I believe it made a valid point about the issues surrounding politicians' testimony in such cases, but have no real issue with it being cut from the article. As an aside, it did say in the text that he testified in favour of the tobacco industry. From memory, the Osteen stuff was actually added to make him appear more credible (by virtue of having found against the tobacco industry in the past), but it wasn't added by me.

I think the article reads far, far better in its shorter format - as John Quiggin has said, this information is outdated anyway and is not relevant to the article. As soon as we put back in part of it, we'll end up arguing over whether or not to put everything else back in too - for instance, if we're pointing out that the EPA were found to have committed to a conclusion in advance, I could suggest we should be pointing out that the testimony of some people at the hearing was potentially biased by financial contributions from the tobacco industry, and so say we need Bliley back in... Nmg20 12:38, 20 June 2007 (UTC)

The information is very relevant. The EPA was found to have behaved in a heinous fashion. Regardless of where you stand on this issue, committing to a conclusion before doing research is dishonest; it is bad science and it is reprehensible. If you feel that Bliley's testimony is important, I recommend pulling a quote from Judge Osteen's decision demonstrating that (I'm not sure it's in there). I think the CRS report on the study is less relevant. You also laid out a very weak case for general endorsement. A more accurate statement is that they endorsed certain (or several) aspects of the study, including its purpose -- but not its findings.71.72.217.102 22:49, 20 June 2007 (UTC)

As the Osteen decision has since been overturned, I'm not sure it holds any force of law, and going on as if it does is undue weight. I think the shorter version is more appropriate. MastCell 23:03, 20 June 2007 (UTC)

It does not have force of law. The court found that the EPA was advisory (not regulatory) and thereby was not subject to the lawsuit. The allegations and finding of misconduct were not overturned. I'm replacing the section with a brief overview and am open for discussion. Please no 3RR, vandalism or other allegations. By the way, I forgot to mention that I do not trust politicians. No matter where they get their money.71.72.217.102 23:21, 20 June 2007 (UTC)

If you can find a reliable legal source to say the decision still has legal force, that would be worth including. Unless you have a source for this, we should stick to the facts which are that the decision was made, then overturned on appeal. I'll restate my preference for the short version, but leave it up to editors other than me and 71.72.217.102 to say which is better. JQ 23:43, 20 June 2007 (UTC)

Hmm...I said the decision does not (repeat NOT) have legal force. Assuming good faith, I suppose you misread. Current version states nothing but the facts.71.72.217.102 00:23, 21 June 2007 (UTC)

Apologies, I did indeed misread. But if the decision has no legal force, it's just the opinion of one person in the US, stated a decade ago, about a report that's even older. Given the frequency with which it comes up in discussion, it deserves a mention, but not the lengthy exposition that you have supported.JQ 00:31, 21 June 2007 (UTC)

I noticed your (JQ) tweaking of my edit (Osteen decision); I had strongly considered removing that phrase as well and support the current version.71.72.217.102 11:28, 21 June 2007 (UTC)

My understanding of the Appeals Court decision (which may be faulty; I'm not a lawyer) is that they overturned the decision based on the EPA's lack of regulatory authority (as the IP stated above). As this was the EPA's first contention, the Appeals Court did not get so far as to rule on the EPA's other complaints about the Osteen decision (since it had already been overturned). Again, I'm leery about attaching a lot of weight to an overturned court decision from 1993, particuarly if this legal decision is being used as a counterweight to the reams of scientific evidence. MastCell 16:58, 21 June 2007 (UTC)

I've read (skimmed) the appeal and I think it was only based on the five arguments. At least that is all I could find...did the EPA plan to defend itself against misconduct as well? They did claim to follow certain protocols of the Radon Research Act, but to my knowledge they stopped claiming that they did not manipulate the data.

I have edited the Enstrom/Kabat piece and it is brief, all the while noting how the entire section has been mysteriously sandwiched in criticism (both before and after). A couple of things I wanted to mention...I did not remove the reference to Milloy in malice. If you want to mention him, please do so elsewhere. The addition seemed to be an attempt to attribute everything that followed to a kook (Milloy). I also propose that those who believe in the purported dangers of ETS share the "scientific majority" view. The word mainstream is suggestive; majority is still powerful and should serve your purposes. One final note; if one wants to claim that Enstrom/Kabat proved an increase in COPD, I would respectfully suggest a better reference than the commentary of Davey Smith. I understand that he lumped different groups together and did some recalculations -- something that the study did not do. Such as that should at least be disclosed.71.72.217.102 05:38, 22 June 2007 (UTC)

Davey who? The reference wasn't a commentary by anyone called Smith, it was a communication to the BMJ from Hedley et al (PMID 12946981) - as the reference clearly stated. I put it back in the interests of fairness, in that their research might have a little more credibility if it didn't fly in the face of everyone else's data on every single ETS issue (they found a relative risk of 1.27 for COPD, although the 95% CI included 1) - but no problem seeing it cut if you don't feel it should be in there. Nmg20 10:26, 22 June 2007 (UTC)

Milloy and TASSC were among the most prominent critics of the EPA study. Milloy is certainly not a kook - until the recent past he was probably the most effective advocate of Big Tobacco (and Exxon, and lots more). Even now he still has a heap of influence with his gig at Fox News. Of course, he's on the payroll, but, as the article shows, so are Enstrom and Kabat, and most of the scientists who've published research purporting to show that smoking is safe. JQ 12:36, 22 June 2007 (UTC)

I support JQ's position here - it's leaning towards weasel words if we just say "there has been some dissent" without mentioning the most notable figures in propagating that dissent, IMHO. Mentioning Milloy and TASSC is directly comparable to mentioning the WHO and the IARC in the "Scientific basis for bans" section. Nmg20 12:40, 22 June 2007 (UTC)

That's fine...but I don't think the TASSC technically exists anymore. Doesn't he call it something else? I still don't like how it is worded, probably because it is one sentence. I will try to revise it and preserve all of the information; when this happens, if there is a problem, just revert and explain here.71.72.217.102 01:51, 23 June 2007 (UTC)

NPOV

I have put an NPOV banner on the article. I think that the 224 kilobytes of text above this testify that the neutrality of the article is disputed rather heavily. It doesn't do for some little clique of editors, with a strong anti-smoking bias, to declare that they own the article, that the consensus lies with them, and that they get the final say on what is included.--AcetylcholineAgonist 13:32, 13 March 2007 (UTC)

Erm, have you heard of something called "consensus"? If you dispute the article, discuss it here before slapping an NPOV tag on it. Note that the article is sourced throughout with a large number of scientific studies (i.e. not newspaper op-eds). It's certainly the case that evidence not singularly one-way in passive smoking studies, but most points against the direction you're arguing for. As for an "anti-smoking clique", at least feign assuming good faith. --Plumbago 13:50, 13 March 2007 (UTC)

You tell me to 'assume good faith', yet your entire post is patronising and dripping with insincerity. But I'll try. However, according to this policy: Misplaced Pages:NPOV_dispute, specifically the section on initiating POV discussions, one doesn't need to obtain 'consensus' to put an NPOV tag on an article. My concerns to do with NPOV are exactly the same as those being discussed above, so to lay them out here would be redundant and tedious. I'll assume (a la 'good faith') that Plumbago's little mistake about needing consensus to put a tag on an article was just that, a mistake, and not some way of trying to assert dominance here. I just registered an account, and have changed my IP messages here so they are signed with my account name.--AcetylcholineAgonist 14:01, 13 March 2007 (UTC)

A large portion of the 224kb of stuff above was the result of one person masquerading as several to provoke responses their poor understanding of the subject didn't merit. If you wish to tag the article POV, you'll need to explain here where the tone slips into POV - please quote exactly from the article and explain why you regard that as POV. This is exactly what the policy you linked to states that you should do - specifically:

"Then, under this new section, clearly and exactly explain which part of the article does not seem to have a NPOV and why. Make some suggestions as to how one can improve the article. Be active and bold in improving the article." You've done none of this as things stand, and until or unless you do, I believe that there's a consensus to remove any POV tags that get put on the article. Such tags should only stay up "until there is a consensus that it should be removed." Nmg20 15:53, 13 March 2007 (UTC)

The following are some snippets from editors or passers-by who think the article is biased, in the last few months (and I'm not wading through the entire tract above looking for every comment, pro or contra, made by every editor):

1. "This is a horrible article that's totally biased." (Anonymous, replied to by Nmg20 14 Dec 06)
2. I did not think Misplaced Pages could get any worse, but this is the most POV piece of shit article I have ever read. Did the anti-smoking lobby groups write the whole thing? (user:Pzg Ratzinger, circa Nov 06, accused by the owners apparent of having a 'hidden agenda')
3. I don't see any arguments toward the other side of this, so I'm putting put a notification. DO NOT remove it until there is a general consensus of both sides that the article is neutral (76.181.12.98 10:48, 12 December 2006 (UTC))

Recently, particularly to do with 'causes' versus 'statistically associated with' or some similar:

1. Accuracy is sacrificed to political agenda, scientific findings are misquoted and blown out of proportion, and words are chosen not for their semantic accuracy but rather because of the emotional and agenda-ridden baggage they carry (Rosenkreuz 20:29, 23 December 2006 (UTC))
2. BlowingSmoke & "friends"
3. But it is a stretch to say it causes death, because for most people exposed to second-hand smoke, it does not. (Guy (Help!) 12:25, 2 February 2007 (UTC))
4. I would have thought that it is pretty clear to most people that the claim "causes death, disease and disability" must be inaccurate for if it were an accurate statement then everyone exposed to passive smoking would die from passive smoking. (Munta 15:34, 7 February 2007 (UTC))
5. This effectively states that anyone who breathes in second-hand smoke will die or develop a disease SOLELY because of this. Can you not write an article about passive smoking without the anti-smoking brigade determining what the text is? (195.157.52.65 16:24, 16 February 2007 (UTC))
6. This article need to be more objective (70.130.138.210 15:10, 12 March 2007 (UTC))
7. Myself, and
8. A few arbitrary others

Those who seem to be comfortable with the article as it stands are:

1. Dessources
2. Plumbago
3. Nmg20
4. ONUnicorn
5. Smokeresearcher, and
6. A few arbitrary others

Thus, if we are to take all of these opinions into account, there may not be 'consensus' (i.e. unanimous approval) for putting an NPOV banner on the article, but there are certainly are sufficient dissenting voices to make it appropriate.

What is also disconcerting is the manner in which Dessources, Nmg20, et al, are constant, long term editors on this article, who, whenever a new editor comes along with a complaint, quickly shout them down with 'consensus' (i.e. each other) - if all the other editors listed above were to act simultaneously, as the people who are comfortable with the article do, things would be very different and disputes would operate differently as well. A single person working on their own is likely to be labeled a 'tendentious editor' or crank, but if they outnumber the regulars, it is the regulars who start looking tendentious.

So, I am putting up a tag again, to do with the very specific dispute, which is recurring, that there is not sufficient substantiation to use 'causes', and that the neutral, scientifically accurate term to use would be something like 'is statistically associated with an increased risk of'. There are a number of other points which I intend to raise once this first dispute is settled.

I would like to ask the 'regulars' here (whom I won't call a clique again) to please discuss this issue seriously, refraining from strawmen and other bully-boy tactics like I have seen above. It is important to remember that the issue is not whether any sources have used the word 'cause' - obviously some have. However, many other sources use some verbiage to do with statistical association. It is not acceptable to choose 'cause' simply based on one's own predilections, or because it is the stronger, more emotional word which is in line with one's own beliefs on smoking.

Let me put it like this. Suppose that out of 1 000 000 people, every year some 15 commit acts of terrorism, some 100 000 are Muslims, and 12 of the 15 terrorists are Muslims. Indeed, were we to conduct a census of the world, we may well find a similar statistical pattern (which also roughly mirrors the smoking situation, the exact numbers being unimportant, but rather their relative magnitudes). Would it be fair and neutral to include in the article on Islam the statement that 'Islam causes terrorism', even if we could point to scholarly sources (and there are many) which say this? Would it not be more accurate, more neutral, more sterile, more clinical, to say that 'statistically, most cases of terrorism are associated with Islam'? What makes this case different? And even assuming that some biochemical pathway has been discovered which firmly proves that chemicals in tobacco smoke can be linked to cancer and other diseases, this is no different to 'proving' (which is easy) that many cases of terrorism are 'caused' by attending speeches by radical Islamic leaders. The point is that the number of cases of exposure far outnumber the number of incidences of unpleasantness, thus making statistical association a more pertinent and accurate observation than a claim of causation.

It is neither scientifically nor semantically accurate to use the word 'cause' as it is used in this article. It's that simple. The case could be made equally strongly that the issue is not one of neutrality, but rather of factual accuracy. If people feel that this is the case, we can easily change the tag to reflect this. --AcetylcholineAgonist 16:35, 13 March 2007 (UTC)

Ok - I'm going to come straight out and say that I think you're User:BlowingSmoke come back to waste a bit more of everyone's time. For someone claiming to be a new editor at Misplaced Pages, you sure have a long and well-formed opinion of this article's edit history, your tone is just as confrontational as the aforementioned user's, and your timing would coincide with the end of his ban.

However, I'm assuming good faith for now - so if you want to tag the article as NPOV, follow Misplaced Pages guidelines on doing so. I've outlined them for you above - and I'm going to ignore all the accusations you make about my responses on this page, specifically that I and others "shout people down", use "bully-boy" tactics, and am motivated by my "own predilections" and a liking for "stronger, more emotional word".

I've already outlined my objections to changing "cause" to "is associated with" numerous times above; they boil down to the fact that every respected scientific journal and publication out there uses "cause" in association with passive smoking. That being the case, your opinion of the word and your politically-charged example are irrelevant - what matters here are the sources which Misplaced Pages allows us to use to support edits to articles. Nmg20 16:44, 13 March 2007 (UTC)

I am most certainly not BlowingSmoke. As my IP address will attest, I am South African. I'm not sure where he's from, but I really would be surprised if he were South African as well, and then I would concede that things look dubious. And I doubt that anyone would be insane enough to travel to a foreign country just to indulge in a bit of japery on Misplaced Pages.

The reason that I am familiar with this article's edit history is that I didn't just jump in to cause shit, but rather read through this page first, and I am disgusted by what I have seen here.

The 'sources which Misplaced Pages allows us to use to support edits to articles' could support either 'causes' or 'statistical association'. You know this. Not every source uses 'cause', even in respectable publications. Nothing short of a review of the entirety of the literature on ETS, counting how many use each turn of phrase, could establish a clear 'winner'. So we have to use common sense and rational thinking.

Thus, could you explain exactly why my example doesn't work? --AcetylcholineAgonist 17:01, 13 March 2007 (UTC)

My impression was based it on your having appeared exactly at the end of said user's ban, and posted pretty much the exact same stuff he was interested in - but I'll take you at your word.

You say that the sources Misplaced Pages allows us to use could support either wording. Three of the first four references, all of which are appropriate for inclusion, use "causes", and these are exactly the sort of multinational, easily accessible references which should be guiding the wording of an encyclopaedia article.

Please don't take this the wrong way - but I've outlined my objections to changing the wording repeatedly on this page since at least 23rd December 2006 when the topic first came up, and I haven't yet seen any attempts to discuss those - so, as I have limited time to devote to Misplaced Pages, I'm going to avoid adding to the discussion further by posting the same points in response to every new phrasing of the (same) question. Nmg20 17:43, 13 March 2007 (UTC)

Well, let's put it like this. One study you cite repeatedly, PMID: 15552776, does indeed toss the word 'cause' around. But, it states that 'a meta-analysis of over 50 studies on involuntary smoking among never smokers showed a consistent and statistically significant association between exposure to environmental tobacco smoke and lung cancer risk'. That it is the key research finding, not so? There are many other similar examples. The question becomes whether the statement I just quoted is semantically synonymous with 'causation'. There are a host of good semantic, statistical, scientific and philosophical reasons why this is not the case. Someone (I think Munta) above linked to an argument to do with this. I am forced to ask again: why is it that the article uses one possible turn of phrase (causation) but not the other (statistical association), when the two are often found in the same article, but it is not universally established that the two are synonymous? Can you provide a citation that explicitly proves that these two terms are synonymous? If so, I'll concede the point. If not, then I am afraid you have not yet settled the issue.

On a similar note, the article grossly oversimplifies the facts, and in so doing, it gives them a slant. For example, it states as a fact that 'the only factor determining whether or not a given study finds ETS to be unhealthy' (or similar wording, anyway) is 'whether or not its author is affiliated with the tobacco industry'. It cites this study PMID: 9605902 as support for that claim. First, the study does not lend support to that claim, unless it is statistically qualified as the authors did, with a confidence interval (which is pretty damned broad, as it happens). However, the conclusion of the study, from the abstract, is that 'The conclusions of review articles are strongly associated with the affiliations of their authors'. This would imply that just as it is possible (likely, perhaps) that if a researcher is affiliated with the tobacco industry, their research would be slanted, at the same time, if a researcher is affiliated with an anti-smoking campaign, public health authorities, etc., their research may be slanted in that direction. And it is not for Misplaced Pages or its editors to deem one particular slant better than any other, surely? This is just one example among many.

I haven't much time to devote to this morass either, so I simply cannot work through the article sentence by sentence. But there are many more examples of subtle slants and biases throughout the article.

Finally, you say that the first few references support 'cause'. You state that they are 'multinational'. They are not: 2 of the 3 which use the word 'cause' are publications of the U.S. Government or its agencies. All three publications are put out by governmental or quasi-governmental sources (the other being WHO), and not a single one is peer-reviewed. Now, it may be that you are of the opinion that the scholarship exhibited by those sources is of a high standard. But your opinion doesn't count (nor does any other, single person's). What counts is the opinion of the scientific community, as exemplified by the peer review process. Those references fail to meet that standard, and are thus completely inappropriate for establishing one of the 'main claims' of the article. Unless you can provide a citation stating that the U.S. Department of Health is recognised as being an authentic spokeperson for the scientific community, that is. --AcetylcholineAgonist 19:58, 13 March 2007 (UTC)

I accept that many of the scientific papers use "is associated with a significant increase in risk" just as many use "causes". The article here on wikipedia also uses both - at a rough count (leaving out references unrelated to causes of disease or death e.g. in the "industry responses" section):

"increases risk" or a near variant appears 30 times in the article.

"causes" appears 7 times, and I think it's worth reiterating where and why (emphases are mine):

In the introductory paragraph: "passive exposure to tobacco smoke causes death, disease and disability". This is backed up by references which use that specific wording.

"secondhand smoke causes the same problems as direct smoking" (Long-term effects, supported by reference 5)

"making it the 3rd leading cause of preventable death in the U.S." (Long-term effects, supported by reference 31, which I don't have to hand to check wording)

"estimating that 3,000 lung cancer related deaths in the U.S. were caused by passive smoking every year" (The Osteen Decision, supported by reference 9, which uses 'cause' repeatedly)

"The study finds that passive smoke also causes sudden infant death syndrome (SIDS) " (Risk Level of Passive Smoking, reference 51, which uses cause but is a newspaper article; I don't have the primary source to hand to check)

"involuntary smoking causes lung cancer in humans." (ditto, reference 49, direct quote from IARC report)

"In France passive smoking has been shown to cause between 3000 and 5000 premature deaths per year" (Epidemiological studies, reference 44, uses 'cause')

That means:

(1) the balance in the article is already tipped towards the wording you favour by a factor of 4:1.

(2) where "causes" does appear, it appears because that is what the relevant references say themselves.

(3) To change it would be to misrepresent what those studies said. Nmg20 20:56, 13 March 2007 (UTC)

It seems to me that the most accurate wording would be "can cause", as the causal link is clear but by no means universal. SonoftheMorning 01:21, 11 April 2007 (UTC)

"may cause" would be even better. — Preceding unsigned comment added by 69.141.30.12 (talk)

I can see User:SonoftheMorning's point - but stand by the current wording. Where the article uses simply "cause", it's because the articles it is citing do so, and to change that is altering what those articles said. Nmg20 18:56, 15 April 2007 (UTC)

Please, please, PLEASE -- just change the wording, especially in the opening section. It's quite clear from complaint after complaint (add my own to the list) that "cause" is far too strong a term in the contexts in which it has been used here, on such a controversial topic as this. Slightly more verbosity is required in this case to lessen the likelihood of misinterpretation which, as should be clear by now, is very real. I have no agenda to promote in either direction on this topic but a crystal clear (but not necessarily intended) bias towards anti-smoking sentiments presents itself in reading this article, which simply isn't appropriate for Misplaced Pages, irrespective of what more emotive turns of phrase some of its sources might themselves use. I second the call for an NPOV tag until all occurrences of "cause/causes" in this article (unless directly quoting those sources that use them) are replaced with less ambiguous alternatives, such as the suggested "are/is statistically associated with an increased risk of". Mixsynth 23:46, 23 April 2007 (UTC)

They won't change it, because they aren't interested in an accurate, unbiased article. Rather, they are pursuing some kind of twisted crusade toward a social agenda. Saying that secondhand smoke "causes" deadly disease is even more outrageous than saying "hard work causes great wealth" or "dining at buffets causes obesity". Of course either of the two preceding statements could be true; in certain cases they are true, but in most cases they are not. The same standard should apply here, but sadly it does not. It is irrelevant that the term is used by "authoritative" sources when those sources are corrupt and fraudulent, using such statements to advance social engineering and to create fear among the people. The proof is obvious and those who dispute it place their own credibility at peril. For example, (in the USA) OSHA has established clear and measurable standards for air quality in the workplace. Nearly half of the states have now banned smoking in most workplaces in order to "protect the workforce" from the "hazards" of passive smoke, even though objective air quality tests have not shown that smoking indoors raises air contaminants to levels above OSHA permissible exposure limits. In other words, the movement is not really concerned with air quality in the workplace (which would be understandable); rather, they are only concerned with whether or not there is any tobacco smoking going on. A place of business could have better air quality while allowing smoking than another that does not (based on ventilation, filtration and other factors). But this is irrelevant to their cause. As for this article, I would even like to see the source quoted in the opening paragraph itself (the W.H.O. SAYS/claims that passive smoke causes...). That would be fair enough, but I suppose there would be objections to that as well. Some here want it to read as if it is an undisputed fact (which it is not). 71.72.217.102 08:02, 26 May 2007 (UTC)

What can I say in the face of such rational, intelligent, well-thought out argument?

Misplaced Pages is not a soapbox. Really. It isn't.

You need to assume good faith in your dealings with others here. Accusing people you've never met of "pursuing some kind of twisted crusade blah blah blah" isn't really doing that.

Your "proof" is neither obvious nor credible - in fact, it's original research, in that it's just a synthesis of your own opinions. Guess what? That's also exactly the sort of rubbish wikipedia policy means doesn't go into its articles.

Please spare us any further posts like the above, and go read Misplaced Pages's pillars, eh? Nmg20 09:22, 26 May 2007 (UTC)

What you can say is nothing. I understand that it is my right to question the neutrality of this article; that is exactly what I am doing, and I believe I am doing it in the proper place (this discussion). To quote as indisputable fact "authoritative" sources whose conclusions defy common sense (and use "evidence" so far outside of scientific norms) is the height of deception. It is difficult to assume good faith when some ignore the very good ideas previously given (by others) to make this article more balanced, no matter how reasonable the argument. There is a reason why the anti-tobacco movement uses questionnaires and cooked numbers rather than objective air quality tests in their intrusive campaign. Wonder why? I don't. 71.72.217.102 02:57, 27 May 2007 (UTC)

No, really - you need to read WP:SOAP, WP:NOR, and WP:PILLARS. Honestly. They will help you understand the nature of this project: it is nothing like what you want it to be. In addition, your characterisation of the wealth of scientific evidence referenced in the article suggests your grasp of "scientific norms" and indeed "common sense" is exceedingly tenuous. Nmg20 11:45, 27 May 2007 (UTC)

I acquiesce that this is not the forum to attack the research. What I strongly object to, once again, is how this research is presented as factual, beyond reproach and not in dispute. That is exactly how this article reads. I think it is quite significant that health and medical authorities cannot find air samples with contaminant levels above OSHA PEL's - even in bars and night clubs, where smoking is/was usually the most prevalent. Using relative risk estimates, the former Surgeon General in his report disclosed a pooled estimate of 1.22 for workplace exposure (chapter 7, page 439). Many people might think this is significant without the following information: The National Cancer Institute states, “Relative risks of less than 2 are considered small and are usually difficult to interpret. Such increases may be due to chance, statistical bias, or the effect of confounding factors that are sometimes not evident." Robert Temple, director of drug evaluation at the Food and Drug Administration said, “My basic rule is if the relative risk isn't at least 3 or 4, forget it." And an editor for the New England Journal of Medicine said, "As a general rule of thumb, we are looking for a relative risk of 3 or more before accepting a paper for publication." In spite of this, the former Surgeon General concluded, “The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults.” It may be worth including the apparent hypocrisy in the article. Why such a different standard here? Nmg20, I understand that you and I are on opposite sides of this issue. But the article is not neutral by any means. It does not sufficiently acknowledge the controversy that exists, even though Dr. Carmona declared "the debate is over". That is wishful thinking on his part...the debate is far from over. 71.72.217.102 01:44, 28 May 2007 (UTC)

Yes, but Misplaced Pages is not the forum for you to continue the debate. If you think it's worth "including the apparent hypocrisy", find a reliable source and quote it in a way that does not violate WP:WEIGHT. Right now, scientific consensus is that passive smoking is harmful. Misplaced Pages needs to report that consensus accurately, not provide a forum to debate or change it. That's what others are trying to get across to you. MastCell 21:36, 28 May 2007 (UTC)

Just FYI, the statement "As a general rule of thumb, we are looking for a relative risk of 3 or more before accepting a paper for publication" was blatantly taken out of context and is very prevalent among anti tobacco ban groups. The exact full sentence is "As a general rule of thumb, we are looking for a relative risk of three or more before accepting a paper for publication, particularly if it is biologically implausible or if it’s a brand-new finding." Also, the tone of the article they are sourcing from is portrayed very differently by them. if we really need to cite the quotation, we need be sure to cite the whole sentence from the original article --priyadi 05:31, 3 June 2007 (UTC)

The real problem with this entry is that 'passive smoking' is a term with a recent history, co-opted by many in the scientific and medical communities to describe something they study - this should be made clear in the entry. If wikipedia is supposed to be an encyclopedia, it cannot read like a 'good health' brochure. The focus must be on where the term orginated (this is entirely absent, unfortunately), who or what group employs it (this is rather vaguely delineated), and what they mean by it. It's really not that complicated. Encyclopedic entries should not be moral tracts. For those of you riled by accusations of 'anti-somking bias,' read an entry such as, say, 'expressionism' - you will read about a concept, the major players involved in the concept, the historical trajectory of the concept, and its contemporary influence. The fact that 'passive smoking' gives no sense of history at all (in an enclyclopedia!) - other than the notion that it is now recognised as bad - tells us we are already in deep trouble here.

Gee, I have been reading through the discussion page here, and I feel I have to add this. The purpose of the entry is not to decide whether 'passive smoking' is 'really' what some say it is or it isn't. The purpose of the entry is to describe the concept and illustrate its significance - an encyclopedia is a cultural record, not an edition of the Lancet. Or a government health pamphlet. — Preceding unsigned comment added by 211.29.0.163 (talk • contribs)

No, it doesn't read like a "good health brochure". It's an encyclopedia article and it contains scientifically agreed-upon facts. Passive smoking causes health problems. That's a fact - it has no moral dimension to it, other than the one that contrarians want to assign it having lost the scientific argument. The article does "define passive smoking and illustrate its significance". This is a health-related issue. This is not expressionism, which is an aesthetic movement whose origins and historical significance are paramount. It's fine to mention that some contrarian opinion still exists, provided it's not assigned undue weight - and since essentially every major health organization agrees that passive smoking is harmful, the amount of space given fringe opinion should be minimal. MastCell 19:24, 29 May 2007 (UTC)

I'd like to add to what MastCell has said that 'passive smoking' isn't some sort of marketing term - it's not a term which was plucked from the air to give researchers something to do. The term originated as a way of describing an effect which had been observed since smoking began - you can see the smoke coming out the cigarettes, for heavens sakes! As to all the stuff about "what group employs it" - anyone who wants to describe the fairly simple mechanics of smoke leaving the end of a cigarette "employs" it...

The idea that Misplaced Pages should restrict itself to your concept of a "cultural record" is at odds with its stated aims and with the concomitant number of projects dedicated to medical articles (WP:MED, WP:CLINMED, WP:PHARM, for instance) and with guidelines on the inclusion of research (WP:V, WP:MEDMOS, WP:RELY), etc. Nmg20 23:52, 29 May 2007 (UTC)

I think what the contributor was saying is that while passive smoke is not new, the concept is - particularly the concept that it is dangerous to one's health. That being said, the article is so hopelessly riddled with propaganda and gobbledygook that I don't know where to begin. For example, please examine the following statements, the first from the article, and the second from the US Congress (cited in the article, number 64 I believe): (Misplaced Pages) "The effect of passive smoking on lung cancer has been extensively studied. Studies...have consistently shown a significant increase in relative risk among those exposed to passive smoke." (Congressional Research Service) "For a variety of reasons, EPA's conclusions have been controversial. While many in the scientific community have accepted the EPA conclusions, other have criticized them. First, the findings in the studies were mixed, and of the 30 studies examined by EPA...24 found an increased risk, though only five were statistically significant at the 95 percent level, and six actually found a negative risk (with one statistically significant). Of the eleven U.S. studies, eight found a positive risk and three found a negative risk, though none was statistically significant." Folks, this is the reason for the controversy. Some of you may think I am simple minded, but I don't think that is "consistent" nor "significant". THE STATEMENT IN THE ARTICLE IS POV. 71.72.217.102 03:23, 3 June 2007 (UTC)

That's the whole point of Meta-analysis. You combine samples from several studies and make statistical analysis from them, regardless of what the original studies say. If it's like what you say that 24 found increased risk and 6 found negative risk, so it is really not surprising the conclusion yields increased risk. Also, the EPA study was done in 1992, 15 years ago. There are other studies that are far newer and this article already sources quite a few of them. --priyadi 05:52, 3 June 2007 (UTC)

Not propaganda nor gobbledegook, nor POV. A scientific consensus exists. The article attempts to reflect it. Misplaced Pages works as intended. MastCell 06:54, 3 June 2007 (UTC)

Yes, there are more studies that show increased risk than decreased risk, BUT 1) The reults are all over the place 2) Only 5 out of the 30 (1 in 6) studies show statistically increased risk, and 3) one shows statistically significant decreased risk. Obviously, one can draw any conclusions that he or she likes from something like this. But to say that the studies are consistent, or consistently significant, is simply false...hence my point (which seems to have been overlooked).

If one combines results from recent studies, the results are remarkably similar: 24 in 149 found statistically significant increased risk (about 1 of every 6.2 studies). I'm not trying to include 'original research' here; just mentioning to Priyadi that things haven't changed much since '92. So the article makes a statement which is not sourced and is false. Just wondering if anyone even cares. 71.72.217.102 17:49, 3 June 2007 (UTC)

"All over the place" is your interpretation of them; the scientists who did the analyses concluded differently. You would *expect* some studies to find no or even negative risk by statistical chance - that's the whole reason for doing meta-analyses. The point of them, as the article says, is to weight the larger studies appropriately and draw a conclusion based on the whole body of research data out there. Beyond that, all of what you've posted above is your interpretation of different figures and so is original research; and if it were in fact the case any budding epidemiologist or statistician could have made their name by pointing it out in the scientific press. With respect, the fact that they haven't suggests to me that you aren't interpreting the data properly. Nmg20 21:21, 3 June 2007 (UTC)

Maybe I should have used the words of the U.S. Congress: the results were "mixed" and have "generated considerable controversy". Your parsing of words may be a disservice to this medium. I would not expect some studies to find no risk or negative risk for something rising to the level of a national health hazard. I would expect to find consistent, statistically significanct increase in risk (some higher than others, of course). Therefore, your patronizing is unnecessary as my method of interpreting data is most reasonable.71.72.217.102 04:43, 6 June 2007 (UTC)

If you wanted to include them in the article, then yes you should have used the words of the U.S. Congress - which, given that you accuse me of "parsing words", I feel obliged to point out were emphatically not "all over the place". As I said above, those are your words and so don't belong in the article - if you take my pointing that out and explaining why it is so as patronising, that's too bad. My intention was to explain something which some readers of the talk page might not understand, not to patronise you; WP:Assume good faith should have been your first port of call here.

Do you have a reference for that U.S. Congress report, please? Nmg20 13:58, 6 June 2007 (UTC)

I'm assuming he's referring to the Congressional Research Project's gloss on the EPA report (referenced in the article). Which was 14 years ago. There have been quite a few developments since then, and those conclusions (which were generally in favor of the EPA's conclusion, anyway) are outdated. Passive smoking's harmful effects are no longer "considerably controversial"; essentially all tobacco companies have admitted them. Misplaced Pages is not a venue for advocacy or original research; the scientific/medical community's conclusions are clear and have been accepted even by the tobacco industry. If you disagree with them, that's your right, but this is not the venue to try and advance your position. MastCell 16:25, 6 June 2007 (UTC)

Nmg20, the link to the Congressional Report is number 64 in the footnotes at the time of this comment. You should be able to locate it there, though the format is hard to read (it doesn't fit well on the screen). I ask that you and/or your friend give evidence that the Congress "generally endorsed" the EPA study, or that assessment of it will be deleted as well. I have read the report a couple of times and have (honestly) come to a different conclusion. Take a look, and see what I mean. MastCell (who chose to report me without warning), the only tobacco companies that have accepted such conclusions are those who took part in the Master Settlement Agreement (by coercion or to avoid being put out of business). As far as I know, non-US based companies have not rubber stamped the WHO, the SG and the EPA. On another note, what significant developments have there been since '92-'93? The more recent research I've looked at is remarkably consistent (as far as I can tell, and as noted above). 71.72.217.102 05:52, 7 June 2007 (UTC)

Thank you - I looked for it first in your post here from 3rd June, where it's tagged .

It is interesting that you assume that User:MastCell, who I've never met, is my "friend" merely because he shares my opinions. Does the fact that no one's supporting your views mean you don't have any friends? I would suggest not, so please don't assume that the reason multiple people are disagreeing with you is because we're all great mates - the simpler and more accurate explanation is that, quite independently, lots of people disagree with you.

In terms of why the Congressional Report "generally endorsed" the EPA study - it acknowledges:

(1) That many of the EPA's conclusions were correct, e.g. "The results presented by these studies indicate that if there is any risk of developing lung cancer from exposure to ETS, it increases as the exposure level increases."

(2) That the problems with the data come from the nature of ETS epidemiology studies and not from the EPA use of them (sections on bias)

(3) They acknowledge that the EPA's use of meta-analysis was the best technique to use in coming to a conclusion, and criticise those bodies who haven't performed meta-analyses (e.g. in lung cancer discussion)

(4) Essentially, the only criticism seems to be that they didn't clarify the risk as far as they could have done: "Although this approach is valid, and is superior to just counting up the studies, it still does not entirely clarify the risk."

In summary, yes they do say that the results of the studies used in the meta-analyses were "mixed" - but they whole-heartedly endorse meta-analysis as the tool of choice here. They do acknowledge "considerable controversy" - but only in the handling of dose-response data (which they acknowledge was only present in some of the studies used in the meta-analysis). In the overall assessment of their conclusions, this is toned down considerably: "EPA's findings have received much support from the scientific community, but have been criticized by other scientists, statisticians and the tobacco industry."

In terms of what important work there has been since 92-93, I'd refer you to references 7, 11-13, 15-17, 19, 26-30, 32-35, 38-42, etc. All these have been published in the interim. Nmg20 09:08, 7 June 2007 (UTC)

By "friend", I mean your acquaintance from Misplaced Pages who shares your views and agenda. I'm sorry to have neglected the parsing issue once again by my use of the term. It's also quite obvious that on this page there are a number of people who disagree with you and your acquaintance. If you like, you may call those people my friends; no offense will be taken from that (I promise). With regard to the EPA report and the CRS, you have laid out a weak case for "general endorsement". I'm not saying that to be critical; what I'm saying is that it is obviously nothing more (and nothing less) than a thorough discussion of the report and the results therein. They mention the good and the bad. For whatever reason, they are even deign to factually state (agree) that ETS poses significant risk. Regarding the more recent studies, I have noticed them and I thank you for the information. The point is that the results are indeed very consistent to those from the 80's and early 90's. Does anyone know of specific events or developments that caused a consensus (among medical and health authorities) to form around what these results mean?71.72.217.102 04:26, 8 June 2007 (UTC)

That's a very curious definition of "friend" - but there we go. Regardless, I don't see many people arguing the same position as you on this issue, so I don't really see where you're claiming the support for your views and agenda from?

You're misrepresenting the more recent data. Taylor et al 2001 (PMID 11494987) note "since 1992 the RR has been greater than 1.25", and the studies of subgroups (children etc) are all compelling (e.g. Janson 2004 PMID 15137524, Kallio et al 2007 PMID 17548727, as posted by User:MastCell). It simply isn't true to characterise the last 15 years of research as inconsistent - it's not. Nmg20 09:02, 8 June 2007 (UTC)

What my close friend Nmg20 said. If you want more hot-off-the-presses studies, there's PMID 17548727 (which we should probably add to the article). Since 1992-1993, a number of major medical organizations have concluded that passive smoking is harmful, a conclusion which has been accepted by major tobacco companies and the public (in the form of smoking bans). The tobacco companies may have been compelled to publicly admit the link by litigation, but the declassified Philip Morris and other internal documents show they were aware of and accepted the existence of the link long before, and sought to sow doubt or downplay it. As far as your violation of WP:3RR, you've been around long enough to know better, but now you've been officially warned not to edit-war. MastCell 17:25, 7 June 2007 (UTC)

MastCell, I've not only been warned, I was reported. Apparently, you failed to first read my apology and disclosure that I did not know of such a rule. Perhaps you can learn something as well...in the future, why not just educate someone first? You seem to do so well at educating people on a number of issues. It's really very impressive

By the way, do you have more information about the tobacco industry accusation? It seems pretty important.71.72.217.102 04:26, 8 June 2007 (UTC)

"Current scientific evidence shows that exposure to secondhand tobacco smoke causes death, disease and disability"

At the risk of repeating arguments which have been covered already at length on this talk page, I am restating the case for the current formulation in the summary section of the article.

The causal link between exposure to tobacco smoke and diseases, disability and death has been the subject of intensive and extensive research, and long and in-depth discussions by the scientific community for at least two decades. It appears that today, the worldwide scientific and public health communities agree overwhelmingly that passive smoking is indeed the cause of disease, disability and death. In reporting this fact, we, Misplaced Pages editors, must adopt a neutral point of view, and the best way at our disposal to guarantee such a NPOV approach is by citing verifiable and authoritative sources.

This is what is being done in the summary section, which bases its finely crafted wording on four references. These four references are currently the four most authoritative sources of information on passive smoking. Each one arrives at the conclusion that there is a causal relation between exposure to passive smoking and diseases, leading either to death or disability.

• WHO Framework Convention on Tobacco Control - This is the first international treaty on public health, adopted in May 2003 by 192 countries and signed by 168. Its text has been the subject of intense negotiations, which have lasted several years and has involved the contributions of some of the best public health experts of the world. Its Article 8.1 states "Parties recognize that scientific evidence has unequivocally established that exposure to tobacco causes death, disease and disability." (emphasis added) This formulation has been elaborated with great care, not by "anti-tobacco zealots", but by ministers of health and their representatives of virtually all countries of the world. It would be hard to find a more authoritative and consensual formulation.

• U.S. Department of Health and Human Services. "The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General", 2006 - One of the major conclusions of the Surgeon General Report is: "Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke." (emphasis added)

• California Environmental Protection Agency: Air Resources Board, "Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant" (June 24, 2005) - The CalEPA reports states its finding in its executive summary as follows "ETS exposure is causally associated with a number of health effects, including effects on infants and children.". It provides a list of 26 "developmental, respiratory, carcinogenic and cardiovascular effects for which there is sufficient evidence of a causal relationship." (emphasis added)

• WHO International Agency for Research on Cancer "Tobacco Smoke and Involuntary Smoking" IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83, 2002 - The evaluation of the Monograph is: "There is sufficient evidence that involuntary smoking (exposure to secondhand or 'environmental' tobacco smoke) causes lung cancer in humans." (emphasis added) This assessment is made by a group comprising 25 of the world's top experts in cancer research, epidemiology and tobacco control.

The importance and significance of these references is emphasized in a recent communication by the World Health Organization ():

There is no doubt: breathing second-hand tobacco smoke (SHS) is very dangerous to your health. It causes cancer, as well as many serious respiratory and cardiovascular diseases in children and adults, often leading to death. There is no safe level of human exposure to second-hand tobacco smoke.

These are the indisputable conclusions reached by international and national health authorities, backed up by extensive rigorously reviewed and published research results, over many years. Three recent major publications remind us of these facts:

• The 2004 IARC Monograph 83: Tobacco Smoke and Involuntary Smoking
• The 2005 California Environmental Protection Agency (CalEPA) Environmental Health Hazard Assessment of Environmental Tobacco Smoke
• The 2006 U.S. Surgeon General's Report on The Health Consequences of Involuntary Exposure to Tobacco Smoke

In the same communication (), the World Health summarizes the result of current research by stating the following facts:

Fact 1
SHS contains thousands of identified chemicals, at least 250 of which are known to be carcinogenic or otherwise toxic. Among those chemicals and toxins are the deadly, odourless, colourless gas carbon monoxide (CO), increased levels of acetaldehyde, acrolein, formaldehyde and many other substances. When inhaled, these poisons are concentrated and quickly spread throughout the body, leading to a range of serious diseases.
Fact 2
People are most exposed to tobacco smoke in the following enclosed spaces:

• WORK PLACES
• PUBLIC PLACES
• HOMES

Fact 3
Second-hand tobacco smoke (SHS) has officially been classified as carcinogenic – cancer causing – in humans. It also causes severe acute and chronic heart disease. Other adult conditions linked to SHS are bronchitis, pneumonia, asthma, and in children: lower respiratory infections, asthma, middle ear infection, sudden infant death syndrome and low birthweight for babies of women exposed to SHS during pregnancy.

Judge Gladys Kessler, in her Final Opinion in the case United States of America vs. Philip Morris U.S.A. Inc. produced a very detailed study on how the scientific community has reached a consensus concerning the health effects of exposure to secondhand smoke. (pages 11215-1230). Her conclusion is as follows:

Using the five criteria adopted by the Surgeon General as a framework for evaluating causality , scientists in the public health community view the accumulation of data to determine if a causal relationship exists. In this case, the overwhelming accumulation of data demonstrates that ETS causes disease. Passive exposure also causes a reduction in the rate of lung function growth during childhood, and is linked to Sudden Infant Death Syndrome (SIDS). In adults, exposure to secondhand smoke causes lung cancer. Passive exposure causes two to three percent of all lung cancer cases in the United States. Exposure to secondhand smoke can also cause coronary heart disease in adults." (page 1230-31 - emphasis added)

Judge Kessler summarizes the state of scientific knowledge about the health effects of passive smoking as follows:

Since the 1986 Surgeon General's Report, every major scientific review and assessment of the science on passive smoking and its health effects has independently and consistently concluded that passive smoking causes disease and other adverse health effects in adults and children. (page 1229 - emphasis added)

If other Misplaced Pages editors want to change the formulation presently used in the summary section ("Current scientific evidence shows that exposure to secondhand tobacco smoke causes death, disease and disability"), this is always possible, but they would have to back up their proposal with references at least as authoritative and verifiable as the references indicated above.

--Dessources 01:07, 25 April 2007 (UTC)

Studies concerning passive smoking

MastCell removed the link which gave an extract of the risk levels of the studies with the comment link which "misleads the reader by use of factually inaccurate material". Therefore I inserted again a link, where the actual studies could be viewed to give factually accurate information. Maybe MastCell did not notice, that it was a different link, because it was removed again. I think it is important, that the results of of the studies can be looked up. Why should this page about passive smoking try to suppress information leading to the real studies on passive smoking. If MastCell has a better page, where the studies can be seen, than MastCell should put this link on the page if he is so concerned about the information about passive smoking. I think the real studies are more important than some abstracts or articles from some newspapers, which only give an extract from the studies. Catlover77

I'm not opposed to linking to or citing the actual studies. However, the link added was to a pro-secondhand-smoke (?) site with a large banner indicating that there was no danger from passive smoking. It seemed that, rather than encouraging people to look at the primary data and draw their own conclusions, the site was framing the data and telling people what to think. If we want to cite the primary studies, let's cite them - but linking an advocacy site with an agenda that flies in the face of the scientific consensus is not the best way to accomplish that. I'd welcome other opinions. MastCell 01:09, 25 April 2007 (UTC)

But that's exactly what this article doesn't do (seemingly by design). It quotes a lot of "authoritative sources" and their conclusions, but it discloses little or not at all the actual evidence or how these sources arrived at these conclusions (other than to say 'a study was done'). There is a reason for this. 71.72.217.102 06:20, 5 June 2007 (UTC)

Yup - because for an editor to criticise their methodology in the article would be original research. If the methodology is flawed, you need to find another published article subject to the same peer-review criteria as the original which says so. This policy exists for a reason, and that reason is because the scientific press, for all its flaws, is a hell of a lot more impartial and a hell of a lot more competent and judging the validity of research than the alternatives. Nmg20 09:59, 5 June 2007 (UTC)

That's not what I'm saying. You are either not reading carefully, or there is some other issue at work. What I was saying is that the article should lay out more (or at least some) primary data and information on methodology (without commentary), "encouraging people to look at the raw data and arrive at their own conclusions" (as MastCell said). This is not the same as criticism from an editor. 71.72.217.102 16:54, 5 June 2007 (UTC)

What is not what you're saying? Are you not saying the methodology is flawed? What did you mean by your final sentence, "There is a reason for this" - what reason were you driving at for the "seemingly by design" lack of "actual evidence" in the article?

The reason the article doesn't lay out raw data is that it's an encyclopaedia, not a statistical discussion forum. Per WP:NOT, "...articles should contain sufficient explanatory text to put statistics within the article in their proper context for a general reader. Articles which are primarily comprised of statistical data may be better suited for inclusion in Wikisource as freely available reference material for the construction of related encyclopedic articles on that topic". To me, that suggests that top-line statistics are fine in context - but that a detailed discussion of stats and methodology is not something we should be including.

That said, I'm not opposed to an increase in detail if it's done responsibly. What exactly do you have in mind? Nmg20 13:54, 6 June 2007 (UTC)

My gosh, calm down. I didn't mean to ruffle your feathers. It just seems clear that the editors/writers of the article would rather lay out ready-made conclusions and interpretations rather than laying out information. And, yes, there is a reason for it. And I believe you know what it is.

I realize that the details of every study cannot be spelled out in an article like this. But as an example, I've noted that the term "relative risk" is only mentioned once in the article (in a factual sort of way), and there is no reference whatsoever to odds ratio. Nowhere to be found is the fact that the relative risk for secondhand smoke is somewhere in the range of 1.2. I realize that it would be my responsibility, if so inclined, to add this information in accordance to the standards of this site. What I was not saying is that I would never suggest that an editors criticism be included as a part of the article. That would be absurd. While this discussion page relates to the article, not all statements made on this page are intended to be included in the article! 71.72.217.102 06:26, 7 June 2007 (UTC)

Relax - my feathers are unruffled. A word of advice: when what you want is to see something specific added to an article, you will do a lot better by coming straight out and saying what it is than by coming onto the discussion page, editorialising, and muttering darkly about "some other issue at work" and accusing your fellow editors of "not reading carefully".

I support including the most recent estimates of relative risk and/or odds ratio in the article, preferably with an explanation of what they mean in the context of passive smoking quoted or paraphrased from a reliable source. Nmg20 09:15, 7 June 2007 (UTC)

It is good, that you do see, that the actual studies should be cited. So do you have a link or links, which provide access to these studies? I think it is irrelevant, whether it is a pro or anti second hand smoking page, as long as the information is correct, it does not matter. And what better source can be provided than the original studies. As the page of passive smoking should be neither pro nor anti but give verifyable information. But when I look at the ASH pages, the original studies are mostly not provided only a summary and and a lot of links to the full text studies or articles are dead or do not show anymore the information which concerns the summary. So if they do not provide anymore the actual studies this information has to come from other sources. Allthough if you do not like Forces as source for this information, then provide a source of your choice with this information. As it seems that you are into this topic you may have a source available, which I do not know.

The argument the page tells people what to think is very weak, otherwise links to anti-smoking pages should rise the same concern from you, which it seems this it not the case.

So if you know a link which leads to the full text studies concerning passive smoking please provide it. Catlover77 08:34, 25 April 2007 (UTC)

I support MastCell's position as expressed above. In addition, there is another very serious reason for not including the proposed link (). The site makes available electronic copies of all the cited articles, free of charge, while most of these are protected by copyright. This is a serious breach of the authors' and editors' copyright privilege, which could be assimilated to theft of intellectual property. Clearly, Misplaced Pages cannot give its caution to such a practice by linking to such a site.

--Dessources 14:29, 25 April 2007 (UTC)

Good point - thanks for pointing that out. MastCell 16:02, 25 April 2007 (UTC)

Boffetta study

124.168.82.43 (talk · contribs · WHOIS) has now twice inserted a false claim about the Bofetta study. Please see the JNCI editorial - the study is accurately represented, and found a modest increase in risk with home or workplace exposure in adults, and no increase in kids. Please don't insert false information or misinterpretations of sources. MastCell 16:27, 28 April 2007 (UTC)

Sigh. This has a sort of hopeless feel to it. I've reported it at the 3RR noticeboard. MastCell 16:32, 29 April 2007 (UTC)

When an odds ratio is ).78 with 95% confidence interval 0.64-0.96 then it is orthodox usage to regard it as significantly different.(0.64 and 0.96 are both less than 1). Ask any statistician (without giving the context). When the 95%CI includes 1.0 it is regarded as nonsignificant and likely due to chance. A paper which includes both significant and nonsignificant normally and naturally pays far more attention to the significant results. A paper which reported the effects of 3 drugs in disease treatment and dismissed the only one to show a significant effect would be regarded as absurd. I removed nothing from the article and added:

Correction: Reference 14, Boffetta et al, is claimed as evidence that passive smoking (PS) causes lung cancer. It is not. The results of Boffetta et al show that spousal and workplace PS have no significant effect on lung cancer rates but childhood exposure significantly reduces lung cancer rate by 22%, the reverse of what this article claims. See: http://jnci.oxfordjournals.org/ cgi/content/abstract/90/ 19/1440?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=boffetta& searchid=1&FIRSTINDEX=10&resourcetype=HWCIT This confirms a similar observation by Brownson et al (1992): http://members.iinet.com.au/~ray/b.html J.R.Johnstone ray@iinet.com.au http://members.iinet.com.au/~ray/ —The preceding unsigned comment was added by RayJohnstone (talk • contribs).

The study's interpretation is quoted above, from the accompanying JNCI editorial. However, if you're uncomfortable with the study being cited as showing an increase in relative risk with increased exposure to passive smoke, I suppose that could be understood as the findings were slightly more complex than are alluded to in the current text. Therefore, I've removed it and replaced it with a larger international cohort from the same authors, affirming the dose-response relationship between passive smoking and lung cancer (PMID 14735478). Hopefully that will remove the focus of controversy. MastCell 21:04, 30 April 2007 (UTC)

No it won't. Instead of removing it why don't you say what Boffetta et al found - and Brownson et al. Do not rely on authorities, whether JNCI or anyone else. Nullius in verba. ray@iinet.com.au www.iinet.com.au/~ray Re the JNCI editorial, notice what they have to say about childhood exposure: "...there was no increase in risk associated with exposures to ETS in childhood." Quite true: there was a significant decrease. Doesn't their wording tell you something? ray@iinet.com.au www.iinet.com.au/~ray RayJohnstone 03:58, 1 May 2007 (UTC)

Concerning the relative risk for lung cancer in nonsmokers exposed to passive smoking during childhood, the IARC Monograph, which was produced in 2004, lists 24 studies, some of which exhibiting an apparent protective effect (including the Boffetta study) and other an apparent deleterious effect. Meta analyses do not suggest an association. This question has been amply debated among experts, and we have solid references on which we can base the information presented in this article, including the IARC Monograph, which has been produced by 25 of the world's top experts in cancer research, epidemiology and tobacco control. RayJohnstone may disagree with the way the Boffetta study has been interpreted by these experts, and may wish to re-open a debate which the scientific community at large considers settled. However, this would be considered as original research, which has no place in Misplaced Pages according to its no original research policy. Furthermore, the policy is that Misplaced Pages is not the place to insert personal opinions, experiences, or arguments, and therefore does not provide the appropriate forum for re-interpreting the IARC/Boffetta study. On the other hand, the JNCI editorial qualifies as a verifiable and authoritative sources, as specified in the Misplaced Pages's official policies and guidelines. Finally, RayJohnstone should observe that, contrary to the point he advocates, that it is a requirement of Misplaced Pages that editors rely on authorities.

--Dessources 12:33, 1 May 2007 (UTC)

I can't find any mention of 24 studies in the reference you quote, but I may have missed something. Please check and/or give more information.RayJohnstone 16:44, 1 May 2007 (UTC)

The 24 studies are listed in Table 2.6, on pages 1260-61, of the referenced monograph. The meta-analyses are listed in Table 2.9, on page 1267. Both appear in the part entitled Involuntary smoking, pages 1189-1407. The link above () gives access to Chapter 5 of the monograph, entitled "Summary of data reported and evaluation," which is the last chapter of the monograph (pages 1409-13), and the only one which is available online. The monograph may be ordered with WHO Press.

--Dessources 17:48, 1 May 2007 (UTC)

Fair point. I am new to Misplaced Pages and should have checked their policies first. I do think there is an important place for non-authoritative views. Yes, I am aware this would open the door to all kinds of strange and wacky ideas. But without some of them science would never have progressed.RayJohnstone 16:23, 2 May 2007 (UTC) Re your replacement for the Boffetta trial. It includes their results with one exception. The childhood exposure results are absent. Why?RayJohnstone 16:36, 2 May 2007 (UTC)

Misleading

The percentage of increase (20% more likely) seems inherently misleading.

if 10 out of a million non-smokers die of lung cancer

and 12 out of a million of those exposed to second hand smoke die of lung cancer, there is a 20% increase, but statistcally, that is insignificant...

could the percentages be clarified some? just seems misleading the way it is worded. 72.174.2.252 17:33, 30 April 2007 (UTC)

It's misleading for a reason. It sounds much more frightening to say "20-30% increase" than to say that the incidences increased from 10 to 12 or 13. 71.72.217.102 08:03, 26 May 2007 (UTC)

Section on "studies in humans"

I tagged the new section on "Studies in humans". There are a couple of issues - first, it violates Misplaced Pages's policy against original research or synthesis. It's basically an unsourced critique of study methodology by an editor. Secondly, it clearly presents the studies in a negative light, as if they suffer from crippling methodologic flaws, when in fact the evidence has been strong enough for quite a few regulatory bodies to take action - and even the tobacco companies, for the most part, acknowledge its validity. Thus, presenting the data in this light also violates Misplaced Pages's policy on neutral point of view and undue weight. MastCell 17:31, 3 May 2007 (UTC)

Agree with all of the above - it should be removed. Nmg20 09:44, 4 May 2007 (UTC)

I've been bold and removed it. I moved it here (see immediately below) so that, if there's interest, it can be improved to the point where it could be re-integrated into the article. MastCell 15:55, 4 May 2007 (UTC)

The possible risk of ETS for lung cancer or cardiovascular disease could be determined if the frequency of lung cancer or cardiovascular disease is greater in non-smokers exposed to ETS. Because it is impossible to find persons never exposed to ETS, the only real possibility is to observe if the frequency of lung cancer is higher or lower in non-smokers that are more or less exposed. A study would then require a reliable measurement of both the extent of individual exposure and of the frequency of lung cancers in different groups of non-smokers. Because there are many other proven risks for lung cancer, a study also must find whether individual lung cancers in non-smokers might be linked to other risks and not to ETS.

1. Measurements - Because lung cancer is a disease that develops slowly and manifests itself for the most part at an advanced age, the exposure to ETS needs to be measured over the lifetime of non-smokers. ETS exposure has not been measured as it would be to expensive. Instead 60-to-70-year-old non-smokers have been asked to recall what their personal exposure to ETS might have been during their lifetimes. People or their next of kin were asked via questionnaires to recall how many cigarettes, cigars or pipes had been smoked in their presence since early childhood. These persons recalls were recorded by the studies as precise numbers devoid of error and uncertainty.

2. Confounders - According to summaries conducted by groups that have found elevated risks for ETS, the average of all studies on lung cancer and passive smoke published up to May 2006 (about 75) claims a risk elevation of some 20 per cent. Such a relatively low risk is insignificant because the studies have not accounted for a whole series of other known risks of lung cancer, and biases that are inevitably present.

3. The Methodology - The overwhelming majority of ETS studies does not define risk on the necessary basis of higher or lower frequency of cancer in function of higher or lower exposures to ETS. Self-declared non-smokers all with lung cancer and exposed to ETS have been compared to self-declared non-smokers without lung cancer, the latter also exposed to ETS because it is impossible to find never exposed people. Such presumption also implies the reasoning that remembering a 20 per cent excess exposure had been responsible for all the lung cancers of the non-smokers with the disease, while non-smokers who remember only a little less exposure remain totally immune from lung cancer.

Nmg20, you might care to look at my page for an alternative view re smoking.RayJohnstone 16:41, 4 May 2007 (UTC)

Um - your page is a whole heap of articles on your website, and it's a little hard to tell which if any have been peer-reviewed and published in the scientific press? The articles you have up there from the Australian board of national statistics might be interesting to include if you have links to them on the appropriate site? Nmg20 17:35, 4 May 2007 (UTC)

The process of "peer-review" now means little if anything. It once did. But with the proliferation of journals, just pick one at the bottom of the heap. You'll get published. It will be "peer-reviewed". You will do better to read what people have to say and judge for yourself.RayJohnstone 16:16, 5 May 2007 (UTC)

I agree with Nmg20 that RayJohnstone's articles listed on his website do not seem to meet Misplaced Pages's requirement for reliable and authoritative sources. In some of them, the author even denies any link between active smoking and increased mortality (e.g. "The Myth of Immortality" in the Australian Surgeon). No matter how his writings must have pleased the tobacco industry, even they had low consideration for his work on smoking related matters, as transpires from an internal Philip Morris report (, page 5).

--Dessources 00:15, 6 May 2007 (UTC)

Thanks for your tips on how I should collect and assess information, Ray, and good luck getting some of the stuff on your site published by a journal. Any journal. Nmg20 22:57, 7 May 2007 (UTC)

It took me a while to find the best link which describes the methology for the studies and which is not copyright protected.

Below you will find part of the paragraph regarding ETS Questionnaire from the EPA Report http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=2835 You have to download the link on this page to see the whole report (more than 500 pages)

I assume that this paragraph is more or less valid for all the studies used in the EPA Report otherwise they would not have put it in.

3. 3. 3. Questionnaires for Assessing ETS Exposures

Questionnaires are the most commonly used method to assess exposure to ETS in both retrospective and prospective studies of acute and chronic effects. They are the least expensive method to obtain ETS exposure information for large populations. They can be used to provide a simple categorization of ETS exposure, to determine time-activity patterns of individuals (e. g. , how much time is spent in environments where smoking occurs) , and to acquire information on the factors or properties of the environment affecting ETS concentrations (e. g. , number of cigarettes smoked, size of indoor environments, subjective evaluation of level of smokiness) . The time-activity pattern information is combined with measured or estimated concentrations of ETS in each environment to provide an estimate of total exposure. Information on the factors affecting ETS concentrations is used to model or predict ETS levels in those environments.

Questionnaires are used most extensively to provide a simple categorization of potential ETS exposure (e. g. , do you live with a smoker?, are you exposed to ETS at your place of work?, how many hours a week are you exposed to ETS?) and to obtain information on possible confounders (e. g. , occupational history, socioeconomic status) . When used simply to determine a dichotomous exposure (ETS-exposed vs. unexposed) , any misclassification tends to bias measures of association toward the null. Thus, any effect that may be present will be underestimated or even may not be detectable. If there are more than two exposure categories (e. g, light, medium, or heavy exposure) , the intermediate categories of exposure may be biased either away from or toward the null. Misclassification errors may arise from respondents'(1) lack of knowledge, (2) biased recall, (3) memory failure, and (4) intentional alteration of information. Additionally, there are investigator-based sources of misclassification. Errors may arise if semiquantitative levels are incorrectly imputed to answers;e. g. , even if house exposures are higher than occupational exposures on average, for any given individual the ranking may well be reversed from that of the average. In using questionnaires to assess exposure categories to ETS, to determine time-activity patterns, and to acquire information on the factors affecting concentrations, it is important to minimize the uncertainty associated with the estimate and to characterize the direction and magnitude of the error. Unlike for active smoking assessment, standardized questionnaires for assessing ETS exposures in prospective or retrospective studies of acute or chronic health or nuisance effects do not exist. Lebowitz et al. (1989) reported on an effort to develop a standardized questionnaire to assess ETS exposure in various indoor environments. This questionnaire, however, has not yet been validated. Questionnaires used to assess ETS exposure typically have been developed for specific studies and have not been validated for general use. There is no "gold standard" with which to validate the questionnaires. Various strategies, however, have been used to assess the validity of diverse types of questionnaires used to assess ETS exposure. Efforts to validate questionnaires have used survey data, air monitoring of nicotine in various microenvironments, and nicotine or cotinine in body fluid samples. A recent study (Leaderer and Hammond, 1991) of 96 homes using a questionnaire to assess residential smoking and a passive nicotine air monitor found that 13% of the residences reporting no smoking had measurable levels of nicotine while 28% of the residences reporting smoking had nondetectable levels of nicotine. A good level of agreement between questionnaire-reported number of cigarettes smoked and residential levels of ETS-related RSP and nicotine was observed in this study (Figures 3-12a and 3-12b) . Studies (Marbury et al. , 1990;Coghlin et al. , 1989;Coultas et al. , 1987, 1990a, 1990b;Riboli et al. , 1990;Cummings et al. , 1990) comparing various measures of ETS exposure (location of exposure, intensity of exposure, duration of exposure, number of cigarettes smoked, etc. ) with cotinine levels measured in physiological fluids generally meet with only moderate success (explained variations on the order of 40% or less) . The largest such study (Riboli et al. , 1990) was a collaborative effort conducted in 10 countries;correlations in the range of 0. 3 to 0. 51 (p <0. 01) were found between urinary cotinine levels and various measures of exposure derived from questionnaire data. Using cotinine as a biomarker of exposure, studies indicated that a substantial percentage of those reporting no ETS exposure by questionnaire do have measurable exposure. Differences in the uptake, metabolism, and excretion of nicotine among individuals make it difficult to use this measure as a "gold standard"in validating questionnaires.....

I hope you agree, that people are more interested how studies are done in humans than in animals. If you have differnt information how studies were done, then please provide it and post it with the valid sources. If you want we can put as a reference also the EPA Report in the section.

Catlover77 16:58, 7 May 2007 (UTC)

You seem to have gone through a 525-page report and pulled out one page, then placed your own emphasis on words that are meant to imply that the EPA's methodology was suspect. I have to say I regard this as undue weight and possibly original research, especially since the EPA's own conclusions (based on the entirety of its research, not just the page in question) are stated unequivocally on the summary page you've linked to above: "...widespread exposure to ETS in the United States presents a serious and substantial public health impact. More specifically, EPA concluded that ETS is a human lung carcinogen, responsible for approximately 3,000 lung cancer deaths annually in U.S. nonsmokers."

Selectively citing a few words in a 525-page document to imply that its methodology and conclusions are faulty, and citing the EPA report to support a conclusion distinctly different from the one it actually reached (forgive me if I'm misreading things here) would be a clear instance of undue weight and a misuse of a primary source. MastCell 18:45, 7 May 2007 (UTC)

In addition to MastCell's comments, it should be noted that the EPA report dates back from 15 years ago and that there are now considerably better and more comprehensive scientific reviews of the subject, which incorporate the results that have accumulated at a rapid pace over the intervening years. The most comprehensive of such reviews was undertaken by the California Environment Protection Agency (CalEPA) and was completed in 2005 (all relevant documents can be accessed from ). This review served as the foundation for the decision of the State of California to designate environmental tobacco smoke (ETS) as a toxic air contaminant. The regulation has become effective on February 8, 2007.

Part A of the CalEPA review covers exposure assessment (250 pages, ), and Part B deals with health effects of ETS (528 pages, ). The draft of the CalEPA review was made available, on a worldwide basis, for public review and comments. These comments and the responses are contained in Part C (571 pages, ). Some of the comments, especially those emanating from tobacco companies and their representatives, contain arguments similar to those raised by Catlover77 (see for example comments by Maurice E. LeVois, made on behalf of Lorillard Tobacco Company on pages 27-121, and see the responses from the board of experts which conducted the review). Catlover77 should have sent his/her comments to CalEPA at the time of the public review, or should wait for the next opportunity to do so when it presents itself. Misplaced Pages is not the proper forum for re-activating old arguments which have been shown to be unfounded in authoritative and reliable sources such as the CalEPA report and others (e.g. the 1997 CalEPA ETS report and the Surgeon General 2006 report).

--Dessources 23:02, 7 May 2007 (UTC)

The CalEPA report says of Boffetta's work: "In summary, the majority of individual studies reported null or slightly elevated, but nonsignificant, risk estimates for “ever” exposure to ETS during childhood, including the large pooled European study (Boffetta et al., 1998)." and of Brownson's work: "The previous OEHHA report reviewed in detail three large U.S. population-based case-control studies designed specifically to investigate the association between ETS exposure and lung cancer published since 1991 (Cal/EPA, 1997). These studies were conducted in Florida (Stockwell et al., 1992), Missouri (Brownson et al., 1992), and a multicenter study in five geographic areas of the U.S. (New Orleans, Louisiana; Atlanta, Georgia; Houston, Texas; Los Angeles County, California; and San Francisco Bay Area, California) (Fontham et al., 1991; Fontham et al., 1994). A smaller, hospital-based study (Kabat et al., 1995), as well as several other smaller studies were also summarized (Liu et al., 1993; Schwartz et al., 1996; Ko et al., 1997). The results of one U.S. cohort study were also discussed (Cardenas et al., 1997). OEHHA determined that these three population-based studies successfully addressed many of the weaknesses (i.e., small sample size, possible selection bias, possible misclassification biases, inadequate adjustment for potential confounders) found in previous studies on ETS and lung cancer. All three case-control studies identified a statistically significant association between increased risk of lung cancer and long-term ETS exposures." Both statements regarding the work of Boffetta et al and Brownson et al are untrue. So much for authorities.RayJohnstone 04:12, 8 May 2007 (UTC)

RayJohnstone declares in a peremptory way that statements made in the CalEPA report concerning the work of Boffetta et al. and of Browson are untrue, without any further explanation. I fail to see why we should consider him a more reliable authority on this subject (in particular given his track record in the tobacco field) than the body of experts who produced the CalEPA review. Furthermore, I repeat that Misplaced Pages is not intended as a forum for conducting such kinds of debates, which could be considered as original research.

--Dessources 15:09, 8 May 2007 (UTC)

If you want further explanation see: http://members.iinet.net.au/~ray/b.html http://members.iinet.net.au/~ray/b.html Better still, read the whole papers. The CalEPA reverses the results of these authors.RayJohnstone 17:49, 8 May 2007 (UTC)

OK. We're getting into a general debate on passive smoking, which is outside the talk page guidelines. It's intended to be used to coordinate specific changes to the article. For the purposes of Misplaced Pages, review articles from highly reputable journals and EPA monographs are considered reliable secondary sources; personal webpages or other self-published sources are not. MastCell 18:21, 8 May 2007 (UTC)

Checked the section about collection Data in the CalEPA report. It seems not much has changed, regarding data collection except of maybe 1 or 2 samples of exposure concerning only the last 2 days of exposure.

Regarding the EPA Report the C.I. was 90 % and the usual 95 %. If they would have applied the usual C.I. the results would have been very different.

1.5. Important Considerations in Evaluating the ETS Literature

1.5.1. Measures of ETS Exposure in Epidemiological Studies Characterization of ETS exposure in most epidemiological studies is limited to broad categories (e.g., yes/no, number of hours per week). Accurate categorization is difficult, given the large variation in individuals’ exposures. Exposure has generally been determined in three ways: ascertainment of spousal smoking status; estimation of the number of hours a person is exposed (at home, at work, or elsewhere); or measurement of exposure levels or biomarkers. Some studies also ascertained childhood exposure from parental smoking. Interviews or questionnaires are often used to collect the first two types of information. Some of the limitations of assessing ETS exposure are briefly discussed below, while Part A (update of Chapter 2 in the 1997 report) provides more detail on exposure measurement. A study’s measurement precision and potential for misclassification are important considerations when reviewing epidemiologic studies, particularly environmental epidemiology studies (Hertz-Picciotto, 1998). These are discussed in the following two subsections.

1.5.1.1. Precision of ETS Exposure Measures Precision in epidemiological measurements is related to the reduction of random error, and may be increased by increasing the size of the study and/or improving the efficiency with which information is obtained from study participants. For example, many studies assess ETS exposure in the home with a single question regarding spousal smoking, which in most cases is an imprecise measure of exposure to ETS, since there are substantial exposures to ETS at work or in other social situations. The measurement precision of these studies could be improved with additional questions regarding other smokers in the home, frequency and duration of smoke exposure, and exposures at work or in other settings. In addition, the amount smoked by the spouse outside and inside the home, as well as the time spent in the home by the nonsmoking spouse, varies from couple to couple. Other considerations include size and ventilation of the subjects’ residences. Measurement imprecision and resulting misclassification can also be an issue when exposure is determined by asking subjects about the number of hours they are exposed, for example, at home or work. While questions on number of hours exposed provide more information about multiple exposure sources, respondents may vary in their awareness of and ability to quantify their exposure (Coultas et al., 1989). The tendency is toward underestimation of hours exposed (Emmons et al., 1992). Few studies of this type attempt to verify self-reported exposures. Studies that have more detailed exposure assessments generally have higher precision and are considered of higher quality. Imprecision in measurement blurs the distinctions among exposure groupings and biases the effect estimate towards the null.

1.5.1.2. Exposure Misclassification Misclassification of exposure status occurs when individuals are categorized as being more or less exposed than they actually were. If the likelihood of exposure misclassification does not depend on whether the study subjects are diseased or not (that is, misclassification is “nondifferential”), then an association between exposure and the disease will be more difficult to detect (i.e., the results will be biased towards the null). Misclassification is a concern in studies that rely on the ascertainment of spousal smoking status, because ETS exposures also occur outside the home, e.g. at work. Friedman et al. (1983) found that using spousal smoking to classify persons as ETS-exposed resulted in considerable misclassification in both directions. Forty to fifty percent of persons with non-smoking spouses reported passive smoke exposure and as many as thirty five percent of those married to smokers reported no exposure. Misclassification can also occur when exposures observed at one point in time are assumed to apply to other time periods. This is a particular problem when there are windows of susceptibility at a particular lifestage, but exposure information is missing for that important window. For example, when adults are not asked about childhood exposures from parental smoking, important susceptibility windows are likely missed for some health endpoints. Studies utilizing a limited evaluation of exposure, such as a single question about spousal smoking at baseline, have been shown to underestimate risk of lung cancer (Johnson et al., 2001) and cardiovascular disease (Whincup et al., 2004). In addition, Whincup et al., (2004) evaluated cotinine levels at baseline in their prospective studies and demonstrated that the magnitude of the risk of heart disease was larger at given cotinine levels in the earlier years than the later-years of follow-up , as the exposure measure was further removed in time. This is an important exposure assessment problem in cohort studies that evaluate exposure only at baseline. Misclassification of exposure to passive smoking by limited exposure ascertainment results in referent groups that contain people who have been or are exposed to ETS. This is an important problem in studies of health effects of ETS exposure and biases the results towards the null. Virtually all nonsmokers have been exposed at some point to ETS, particularly in the past when smoking was more prevalent and there were no restrictions on smoking in the workplace, at schools, or in public places. Thus, practically speaking, while a referent group may have a stray light smoker, almost 100% of the people in the referent group of all studies with poor ascertainment of exposure have had at least some exposure to ETS, and in many cases significant long-term exposures. Fontham et al. (1994) found that 64% of never-smoking women in the U.S. reported passive exposure in childhood, 14% non-spousal adult household exposure, 24% social exposure and 60% reported exposure at work. The majority of these exposures occurred over many years. The implication is that the referent categories of non-exposed people can in fact be highly contaminated with exposed individuals if the study only assesses spousal smoking status. Even studies that do a more thorough assessment of all sources of ETS exposure are likely to have some individuals in the referent category with at least some ETS exposure. The result of such misclassification is to bias the results towards the null, which could lead to loss of significance of results, particularly for relative risks between 1 and 2 as in the case for ETS and lung cancer. Examples of exposure misclassification reducing risk estimates for ETS-associated cancers are found in Chapter 7, Sections 7.2. and 7.4. To increase precision and minimize misclassification errors, the occurrence and duration of exposure to all sources of ETS should be ascertained as completely as possible. More recent studies have used measurement of biomarkers of exposure to improve assessment of ETS exposure. The biomarker cotinine, a metabolite of nicotine with relatively short half-life (20-30 hours in blood plasma), is useful in categorizing and verifying recent exposure. However, because it only reflects exposures of the past day or two, it is less useful in evaluating chronic exposure. Measurement of cotinine can also be useful for identifying active smokers, as levels generally differ between smokers and nonsmokers exposed to ETS by one to two orders of magnitude. Assessment of current ETS exposure of children is somewhat less problematic. Although concerns similar to those discussed above regarding measurement imprecision and exposure misclassification remain, children, especially infants and young children, are likely to be exposed to tobacco smoke in fewer circumstances than adults, and are much less likely to smoke themselves (though this is considered important to exclude). Cotinine concentrations in children are well correlated with smoking by the mother (Greenberg et al., 1989); thus, information on cigarette consumption by the mother is likely to provide a reasonable proxy for a young child's ETS exposure. This may not be the case if the mother is not the primary caregiver. The use of paternal smoking alone as a proxy for ETS exposure of infants and children can be problematic, as fathers are generally less likely to be the primary caregiver.

1.5.1.3. Smoker Misclassification In studies of the health effects of ETS exposure, misclassification of smokers as nonsmokers (smoker misclassification) is a potential problem, and smoker misclassification has been a criticism of ETS studies, particularly studies of lung cancer because the relative risk for lung cancer in smokers is so large. Misclassification of smokers as nonsmokers can inflate a risk estimate if such individuals, who have a higher risk of lung cancer, are in the passive-smoke-exposed nonsmokers group in a study. However, the misclassification of ever-smokers as never-smokers affects a very small percent of the nonsmoking referent group in the majority of studies (Nyberg et al., 1997, 1998b; U.S.EPA, 1992d). For example, smoking misclassification was evaluated extensively in a validation study conducted at three of the 12 centers from the IARC study of ETS and lung cancer (Nyberg et al., 1998b). Comparing the results of questionnaire data from index subjects and next of kin (spouses or children), they found that 1.7% of the subjects who said they had never smoked regularly were actually former regular smokers. Furthermore, the misclassification was non-differential with respect to disease status, which tends to bias results towards the null. Nyberg et al. (1997) found less than 5% of ever-smokers were classified as never-smokers. These investigators also note that the misclassified ever-smokers have much lower risks of lung cancer than either current active smokers or former regular smokers because they tend to be either long-time ex-smokers or light smokers, who have only moderately elevated risks for lung cancer. This makes it even less likely that misclassified smokers significantly impact the lung cancer risk estimates from ETS exposure. Finally, in diseases where the relative risk for smokers is small, the impact of smoking misclassification is even less important.

As most people are interested how the studies are done in humans it is an important section. So it should go back in the page. Any suggestions?

Catlover77 15:53, 14 May 2007 (UTC)

Yes, the same one I made above: going through a 545-page report and selectively emphasizing a few phrases to play up your point of view that the report is flawed is original research and a misuse of a secondary source. The report should be cited in relation to its actual conclusions, which are quite clear. If you'd like to include a reliable source criticizing the report, then we can discuss that. However, this looks like essentially the same proposal made above, and my objections are the same as those I described above. MastCell 16:12, 14 May 2007 (UTC)

Original research

This edit consists of original research and is not suitable for Misplaced Pages. Please see the guidelines on original research and synthesis of published material. Briefly, Misplaced Pages is not a publisher of original analyses or syntheses of published data. Cobbling together statistics from disparate sources and synthesizing them to further a claim is impermissible under the original research policy. Further, it bothers me that we're again seeing a robust secondary source (in this case, the "Lifting the Smoke Screen" report) used to try and make a point which is opposite of the conclusion drawn by the authors. Please review the relevant policies above; Misplaced Pages is not the appropriate venue for that sort of thing. MastCell 18:07, 14 May 2007 (UTC)

To follow up the repeated posting of this link, please see the earlier discussion of this site in the archive. It is manifestly unsuitable as a link on Misplaced Pages per the policies MastCell has already posted a number of times, and indeed as a reference in any encyclopaedia worth its salt.Nmg20 08:58, 15 June 2007 (UTC)

1. "=IARC - Questionnaire – European Multicentre Case Control Study of Lung Cancer in Non-Smokers" (PDF).