Is there anything a cigarette can’t do?

Today’s edition of alarmist health reporting comes from the BBC:

Women who are light smokers – including those who smoke just one cigarette a day – double their chance of sudden death, a large study suggests.

The link between heart disease and smoking is well established. The study that this article references is behind a paywall, but here is what it actually concludes:

Small to moderate amounts of cigarette consumption (1-14 per day) were associated with a significant 1.84-fold (95% CI, 1.16-2.92) increase in SCD [sudden cardiac death] risk and every 5 years of continued smoking was associated with an 8% increase in SCD risk (HR 1.08; 95% CI, 1.05-1.12, p<0.0001).

In other words, the elevated risk was found in a group of women that includes smokers who consume anywhere from one to fourteen cigarettes per day. That is a big difference! There may be (and likely are) very different levels of risk within this group. One can’t conclude from this study that smoking just one cigarette per day doubles one’s chance of dying from a heart attack. The press release for the study, reprinted at Forbes, doesn’t even make that claim. It appears to be an invention of the BBC. (Again, I haven’t seen the full study, but it’s very unlikely that there is anything in it to support the BBC’s interpretation.)

It should be obvious that smoking one cigarette a day carries a different health risk than smoking fourteen of them. In fact, the abstract for the study notes a linear relationship between quantity smoked and risk of sudden cardiac death. Yet the state of health journalism regarding tobacco products has become so degraded that reporters now ascribe near magical death-dealing qualities to the cigarette.

Why debunking junk tobacco science matters

In the past year alarmist studies about “thirdhand smoke,” the particles left behind from tobacco combustion, have proliferated. There’s no evidence such residuals are actually causing cancer but that hasn’t stopped anti-smoking activists and journalists from running with the story. Michael Siegel has recently spotted a couple ways this research has been abused to discriminate against smokers. First there’s the “sniff test” policy now in place at Kimball Physics, a technology company in New Hampshire:

No tobacco-residuals emitting person, article of clothing, or other object is allowed inside any Kimball Physics building. This restriction also applies to anyone or anything emitting characteristic tobacco odors. Anyone who has used a tobacco product within the previous two hours is automatically to be turned away, unless measures have been taken such that residuals-sensitive persons are not exposed. The determining factor, regarding allowable residuals levels and/or exposure durations, is whether anyone is either significantly bothered, or even worse, made ill.

This is an absurd policy and it should come as no surprise that the person who created it is a board member of the extremist anti-tobacco group Action on Smoking and Health. Nonetheless it creates a precedent that less fanatical employers might decide to follow.

Speaking of ASH, Siegel also catches them advocating bans on smokers adopting or fostering children. From ASH’s press release:

Midlothian Council in the U.K. is just the latest entity to prohibit smokers from adopting or providing foster care for children, a step Portsmouth, Hants, in England and other jurisdictions took several years ago, says public interest law professor John Banzhaf, Executive Director of Action on Smoking and Health (ASH). Anyone wanting to care for a child under the age of five will be required not to have smoked for at least six months, even if they only smoke outdoors. [...]

… thirdhand tobacco smoke, what the New York Times called “the invisible yet toxic brew of gases and particles clinging to smokers’ hair and clothing,” has just been reported by researchers at Lawrence Berkeley Laboratory to combine with a common indoor air pollutant to form very potent cancer causing substances. This, the researchers say, places children at serious risk, even if parents smoke only outside the home, because they carry the residues inside with them.

I criticized that Times article when it came out last year for taking such a credulous approach to the “thirdhand smoke” study it covered, buying into the researchers’ hype despite the fact that the study consisted of nothing but a phone survey. At the time the author couldn’t have known that her words and the reputation of the paper would be used to deny children foster care, but that’s how low the anti-smoking movement has sunk. Reporters need to realize that today’s anti-tobacco researchers should be treated with just as much skepticism as the Big Tobacco-funded scientists of the pre-Master Settlement days.

Reuters hypes thirdhand smoke fears

Reuters reporter Maggie Fox buys into the thirdhand smoke scare:

Old tobacco smoke does more than simply make a room smell stale — it can leave cancer-causing toxins behind, U.S. researchers reported on Monday.

They found cancer-causing agents called tobacco-specific nitrosamines stick to a variety of surfaces, where they can get into dust or be picked up on the fingers. Children and infants are the most likely to pick them up, the team at Lawrence Berkeley National Laboratory in California reported.

“These findings raise concerns about exposures to the tobacco smoke residue that has been recently dubbed ‘third-hand smoke’,” the researchers wrote in the Proceedings of the National Academy of Sciences, available here.

Of course there are policy implications:

James Pankow, who also worked on the study, said it may raise questions about the safety of electronic cigarettes, or “e-cigarettes.” which produce a nicotine vapor but not smoke.

The researchers said regulators who have cracked down on second-hand smoke with smoking bans may decide to consider policies on third-hand smoke.

That nicotine works on surfaces in this way is interesting from an abstract, scientific point of view. What the article fails to mention is that there is essentially no evidence that anyone, anywhere, has ever suffered from exposure to so-called “thirdhand smoke.” The reason these carcinogens are so deadly to cigarette smokers is that smokers inhale them deeply through their mouths directly into sensitive lung tissues dozens of times per day. Exposure from surfaces or from dust inhalation through the nose is going to be far less substantial.

Nonetheless, you probably shouldn’t wrap your infant in smoky blankets. Fair enough. But spreading paranoia about thirdhand smoke has significant negative consequences. We’ve already seen employers discriminate against smokers using these fears as justification. And if this research is used to back legislation against e-cigarettes — devices that are unequivocally safer to smoke than actual tobacco — that will be a blow to public health.

Unfortunately journalists tend to be extremely credulous of any research that condemns tobacco and its related products. Last year The New York Times gave significant coverage to a thirdhand smoke study that consisted entirely of conducting a telephone poll of random people. Soon after Scientific American published an uncritical interview with the study’s author, Jonathan Winickoff, who said in an unmeasured words, “Smokers themselves are also contaminated…smokers actually emit toxins.”

If reporters are going to cover these sorts of stories, they owe it to readers to put the actual risks in proper perspective.

[Via Lene Johansen's Twitter feed.]

Update: Since writing this some debate has gone back and forth on Twitter among science writer Lene Johansen, Jeff Stier at the American Counsel on Science and Health, and Reuters health editor Ivan Oransky. Since Twitter isn’t the most conducive format for extended comments I thought I’d clarify here why I object to the article.

The problem is not that this is junk science or that it shouldn’t be covered. The problem is that people reading the article aren’t interested in the abstract question of how nicotine reacts with other chemicals on a household surface. What they want to know is whether tobacco residue presents a real health hazard to them and whether there are policy implications stemming from the research.

A layman reading about all the carcinogens mentioned in the article would conclude that the health hazard is real. Given the dosages involved this belief is likely false and is certainly unproven. As science journalism, the article fails to give readers the context they need to make sense of the research.

As for policy, the article itself notes that the research is bound up with political goals. The findings may be used to justify such measures as employment discrimination, bans on e-cigarettes, and further restrictions on smokers. This makes providing the proper context doubly important. There are plenty of reputable skeptics of these measures and at the very least the article could have quoted one.

Update 2/9/10: Chris Snowdon’s lengthy debunking of thirdhand smoke fears from last year is worth rereading.

About that meta-analysis…

A few months ago newspapers eagerly picked up news of a meta-analysis of smoking ban studies finding that bans were associated with a 17% decline in heart attack rates in their first year. Will any of them report this whopper of a correction?

As it turns out, the study findings were due to a careless error. In the original study, the authors had inadvertently reported the Pueblo study has having reported a 70% reduction in heart attacks (a result that is completely implausible and clearly should have been noticed as having been in error). Instead, that study actually reported a 34% reduction in heart attacks. The meta-analysis authors published a correction in which they re-analyzed the correct data.

It turns out that the 11 studies did not find a 17% reduction in heart attacks, but only found an 8% reduction in heart attacks.

This level of decline in admissions for heart attacks is obviously not significantly different from the levels of decline in heart attacks that are being observed in the absence of smoking bans, which have varied between 5% and 10% per year in many communities.

That’s from Michael Siegel, of course, one of the few anti-smoking researchers defending scientific accuracy.

The shoddiness of the science behind the claims of rapid drops in AMI rates following smoking bans never ceases to amaze, nor does journalists’ willingness to report on it uncritically.

For more on the extremely flawed Pueblo study, see here.

A warning about Wales

The Daily Post reports that new figures soon to be released by Wales’ Chief Medical Officer will show that heart rates have dropped in the region during the second year of its smoking ban. I look forward to seeing those figures, but the close of the article is particularly striking:

There was a 12.5% fall in the number of patients admitted to hospital with a heart attack between October and December last year, compared to the same period in 2006, before the ban on smoking in enclosed public spaces was introduced in Wales: some NHS trusts have seen the number of heart attacks fall by up to 40% in the same period.

See anything suspicious there? To my knowledge there isn’t anyone promoting the theory that smoking bans only reduce heart attacks in the final three months of the year. So why focus on just that time period?

The answer is that cherry-picking those 3 months supports ban proponents’ predetermined conclusion. As Christopher Snowdon has shown with the government’s own data, the rate of AMI actually rose slightly during the year the ban took effect and there were more heart attacks in the 5 months immediately following the ban than there were in those same months the year before. Overall there was practically no difference in the AMI rate between the two years, which is surprising since Wales’ rate of heart attacks had been on a downward trend. A fair reading of all the data is that the ban had no discernible effect, yet the story told by activists and mindlessly repeated by reporters is that the ban caused a reduction in heart attacks.

Such a weird statistic should have immediately raised flags for a journalist. A quick search on Google for the words “Wales,” “smoking ban,” and “heart attacks” would have revealed why the figure was selected. Unfortunately Post reporter Tom Bodden took it at face value, so readers don’t get the full story and the misleading statistic is propagated even more widely.

As Snowdon notes, the Welsh rate of AMI has been falling in recent years by as much as 10% per year. The fact that it didn’t fall in the year smoking was banned is an anomaly. My guess is that in the report about to be issued the rate will have resumed its previous decline and, in a classic case of conflating correlation with causation, researchers will credit the drop solely to the smoking ban.

It will be up the to journalists covering the report to treat it with skepticism, ask tough questions, and at the very least seek out a critical source before phoning in their stories. I’m not optimistic that they will.

Update 12/7/09: My prediction seems to be too optimistic. Chris decided to check the data again today and it turns out that the heart attack rate in Wales actually increased last year. So how will the upcoming report show that it declined? Well, that will be interesting to find out!

Update 12/9/09: Here’s the story and here’s Snowdon on why it’s just another example of junk science.

Previously:
More lazy tobacco reporting

No Peace Prize for Moon bombers

The Oregonian is comedy gold this week. Though honestly, if I edited its letters page I would have printed this too.

Balanced tobacco reporting at NYT

The New York Times’ coverage of the new Institute of Medicine report on smoking bans and heart attacks includes these passages:

Dr. Michael Siegel, professor of community health sciences at Boston University, said that such limitations were significant flaws and that the panel was being “sensationalistic” about the impact of smoking bans.

“Anybody could have told you without any kind of review that smoking bans don’t raise heart attacks,” Dr. Siegel said, but “it could be that they have an exceedingly small effect” and that reductions were “just occurring anyway” because of improvements in treatment of heart disease. [...]

Dr. Siegel said that connection was “unequivocal,” but that a significant risk applied only in people who have severe heart disease. “An otherwise healthy person is not going to walk into a bar for 20 minutes and have a heart attack,” he said.

I’ve blasted the paper repeatedly for uncritically passing on unsubstantiated claims of tobacco researchers, so good for reporter Pam Belluck for writing a balanced piece.

Congrats also to Michael Siegel for getting his views included. If you missed his detailed rebuttal to the report, be sure to read it here.

The culture that is Portland?

I don’t want to make light of domestic violence, but I will make light of how this news story was written:

Portland man gets probation after stabbing ex-girlfriend’s pet fish

A 27-year-old Southeast Portland man who beat his ex-girlfriend and then stabbed her pet fish and left it impaled in her apartment has been sentenced to two years of probation and a psychological evaluation.

An attorney for Donald Earl Fite III said he didn’t want to talk about the details of the assault, but that stabbing the fish was “a very low point” in his client’s life.

“He is absolutely mortified and ashamed about what he did to the fish,” said attorney Tom MacNair today in Multnomah County Circuit Court. [...]

According to an affidavit filed with the court, [his ex-girlfriend] had broken up with Fite, but returned to her East Burnside Street apartment in Portland last July 25 to find Fite lying on her bed. Fite wanted to get back together, but [she] didn’t.

When she told him she had plans that evening, [she] refused to let her leave the room she was in, the bathroom, according to the affidavit. She tried to push past him. He threw her against a wall. She again tried to leave, punching him in the nose to get by. He grabbed her by the hair and threw her against the bathtub – ripping out her hair extensions and causing her to hit her head.

My emphasis is in italics. The paper’s emphasis — and perhaps the perpetrator’s too — is all about the fish, whose family will hopefully be comforted by the outpouring of remorse over its untimely demise. What the hell, Oregonian?

Fortunately the court appears to have had better priorities, restraining the man from being around his ex-girlfriend but allowing him continued access to pet shops. No, I am not making that up.

[Thanks to Jonathan Blanks, who's as confused about this as I am!]

We are journalists, not marketers

The FTC has issued new guidelines cautioning bloggers to disclose ties to products they endorse or risk an $11,000 fine:

The revised Guides also add new examples to illustrate the long standing principle that “material connections” (sometimes payments or free products) between advertisers and endorsers – connections that consumers would not expect – must be disclosed. These examples address what constitutes an endorsement when the message is conveyed by bloggers or other “word-of-mouth” marketers. The revised Guides specify that while decisions will be reached on a case-by-case basis, the post of a blogger who receives cash or in-kind payment to review a product is considered an endorsement. Thus, bloggers who make an endorsement must disclose the material connections they share with the seller of the product or service. Likewise, if a company refers in an advertisement to the findings of a research organization that conducted research sponsored by the company, the advertisement must disclose the connection between the advertiser and the research organization. And a paid endorsement – like any other advertisement – is deceptive if it makes false or misleading claims.

Yes, it’s true: Sometimes marketers send me stuff hoping that I will write about it. Shocking, right?

Speaking only of the booze blogging world, I don’t see how this rule is either necessary or workable. It’s not necessary because we all know that our credibility will take a hit if we endorse bad products. I’m more likely to mention a product that I’ve received for free than one that I have to pay for simply because I don’t have an infinite budget for liquor, but I’m not going to sell out by giving a review to every crappy product that hits my door; I have the barely touched bottles of flavored spirits to prove it. (Actually I don’t, because I give those away for friends to use at house parties when people are too drunk to care.)

If there’s a demand for disclosure policies bloggers will provide them. Doug’s doing this now at his Pegu Blog by appending every post using a free product with a note saying that “the Liquor Fairy was here.” It’s a good idea and seems to work for him. In my case though I’d have a hard time deciding when to include a disclaimer, in part because I’m courted by marketers not just as a blogger but as a bartender as well.

A clear case of when I could (and generally do) include a disclaimer is when I get a package in the mail with a sample bottle and a note saying the sender hopes I will write about the product. Some less clear and entirely realistic cases include:

A liquor company holds a contest for bartenders offering real or potential rewards to those who participate by creating a drink with their product. I like the drink I come up with and feature it here; I mention that it was for a contest but don’t specify the rewards of participation.

A liquor company gives me a bottle or taste of their product unaware that I am a blogger. I like the product and write about it.

A liquor company takes me to dinner and offers samples of their products. A few months later the same company comes out with a new product that I independently purchase and enjoy. I write about it here.

A liquor company holds an open tasting event geared toward bartenders, bloggers, and enthusiasts. I attend and blog about the product.

A liquor company sends me a bottle for review. I don’t review it here, but I mention liking it on Twitter.

You get the idea: Spend enough time in this business and a lot of free stuff is going to come your way. And given the massive consolidation in the liquor industry there’s not going to be any brand owned by one of the big companies that I won’t have some plausible connection to. Trying to disclose all of this would get rapidly out of hand; not disclosing it leaves me liable to thousands of dollars in fines under an untested rule. (It’s unlikely the FTC would come after me, but all it takes is one vindictive person to file a complaint.)

I’ve been considering adding an explicit review policy to this site and may do so soon, but I don’t know how I could fully comply with the FTC guidelines even if I wanted to. The same ends are accomplished by bloggers’ need to maintain credibility without the potentially chilling effect this rule would have if it’s enforced too liberally.

What strikes me as the biggest flaw in these guidelines is that they treat bloggers as equivalent to celebrity endorsers or “word-of-mouth marketers” rather than as journalists. With possible exception for sites designed specifically as disguised ads, it seems better to leave disclosure to journalistic discretion rather than codifying it into law.

[Via @BrookeOB1.]

More smoking ban miracles, more bad reporting

Reports are once again lighting up with a new study about smoking bans triggering a sudden drop in heart attack rates. Here’s Sunday Times reporter Jonathan Leake:

The ban on public smoking has caused a fall in heart attack rates of about 10%, a study has found.

Researchers commissioned by the Department of Health have found a far sharper fall than they had expected in the number of heart attacks in England in the year after the ban was imposed in July 2007.

In Scotland, where the ban was introduced a year earlier, heart attack rates have fallen by about 14% because of the ban, separate research has shown. Similar results are expected in Wales where a third study is still under way. [...]

“We always knew a public smoking ban would bring rapid health benefits, but we have been amazed by just how big and how rapid they are,” said John Britton, director of the UK Centre for Tobacco Control Studies at Nottingham University.

I’d love to dig into this study and find out how they got these numbers. The problem? As Michael Siegel explains, there is no study:

It turns out that there is no “study” to behold. The “study” appears to merely be a work in progress that has not yet been published or even submitted for publication, yet its results and conclusion were widely disseminated through the media. In other words, this is yet another example of what I call “science by press release.”

It appears that the conclusions of the study have been released to the media, but that the actual research itself is not being made publicly available. The study itself is not available, from what I can tell, on the University of Bath web site or the web site of the UK Centre for Tobacco Control Studies.

Therefore, it is impossible to judge whether the conclusions of the study are valid or not. And if the conclusions turn out to be unwarranted, then it will be too late to reverse them. The media have already disseminated the conclusion widely. Any correction given down the road would have little effect.

How these figures were calculated is therefore anybody’s guess. Christopher Snowdon suggests a few options based on previous manipulations in smoking ban studies and notes that the publicly available data from the NHS don’t support the conclusion:

We know that the heart attack rate fell by between 2 and 4% before the ban and by between 2 and 4% after the ban (see the HES website). To date, we only have the data for the first 9 months following the smoking ban, but that it is enough to go on. After all, if smoking bans immediately save lives, the first 9 months is where we would see the biggest drop.

Snowdon also notes his surprise at seeing the Scottish statistics reported in the Times since the paper previously considered the study one of the “worst junk stats of 2007:”

“Smoking ban cut heart attacks in Scotland by 17 per cent”, researchers and politicians trumpeted to the world in September through press releases, a conference and interviews, all faithfully reported. It was the ban what done it, they said… until six weeks later when official data halved the drop — to 8 per cent — against a trend immediately before the ban of a 5 or 6 per cent drop, and a fall a few years ago of 11. All of which makes it hard to be sure what, if any, effect the ban really had. The researchers went strangely silent.

Leake quotes numerous experts who favor the unpublished study and not a single critic despite the thrashing that so many similar studies have taken. This is the sort of lazy journalism we’ve seen repeatedly in the field of tobacco regulation, where researchers can make any outlandish claim against smoking without fear of skepticism from gullible reporters. I don’t expect intellectual integrity from anti-tobacco activists, but we should demand better from the press.

Update 9/15/09: Now even ASH has backed away from this claim, saying “We have heard that the figures reported in the Sunday Times yesterday (and now circulating elsewhere) are not based on any research conducted to date.”

Previously:
More lazy tobacco reporting
Lazy reporting and the Pueblo ban study

Lazy reporting and the Pueblo ban study

The Centers for Disease Control have issued a new report about the impact of the smoking ban in Pueblo, Colorado. The study has the media breathlessly repeating claims that the ban dramatically saves lives. “A smoking ban caused heart attacks to drop by more than 40 percent in one U.S. city and the decrease lasted three years, federal health experts reported Wednesday,” writes Reuters reporter Maggie Fox, who doesn’t bother quoting any dissenting sources. Mary Engle at the LA Times health blog says uncritically that whatever the mechanism behind the fall in heart attacks, “Pueblo’s smoking ban can take the credit.” Bill Scanlon at the Rocky Mountain News throws science to the wind and extrapolates that Colorado will see a statewide “sharp decline” in heart attacks in 2009 — more than two years after its ban went into effect.

I realize times are tough in newsrooms, but there’s no excuse for such biased, lazy reporting. Journalists should treat the claims of ideologically driven anti-smoking groups with just as much skepticism as they would junk science coming from big tobacco companies.

Since the CDC’s report is going to be cited constantly by smoking ban advocates it’s worth taking a look at its methodology and limitations. Fortunately it’s straightforward enough that any moderately intelligent person can understand it. The following is my layman’s reading of the results, with the caveat that I’m approaching this without formal training. Nonetheless, it’s clear that one shouldn’t take this study’s conclusions at face value. Its use by anti-smoking groups, researchers, and the press to promote smoking bans is a case study in the abuse of science for political ends.
[Read more...]

Speakeasy shutdown

“If you are a member of the press/blogger/other media type person you are not permitted to write about our location or our operation in any way shape or form.” That was the first rule people who scored a reservation at DC speakeasy Hummingbird to Mars were required to abide by. Washington Post spirits writer Jason Wilson, whose job is to help Washingtonians drink better, publicized it anyway. Now the project is shutting down and DC drinkers have one fewer place to go for an outstanding cocktail. Bravo, Mr. Wilson.

(Serious ethics question: Is this not akin to reporting something a source explicitly asked to be off the record?)

The Best Bites Blog has the story here. Check out the video for an intriguing cocktail technique: using sous vide to infuse a liquor with spices, the airtight seal preventing any damage to the alcohol. That’s something I’d like to try.

Update: Jason Wilson clarifies in the comments that the real reason the speakeasy is shutting down has to do with the organizers’ busy schedules, not his column. So I apologize to him for getting that wrong (and for assuming the Washingtonian blog knew what it was talking about). He also says:

No, it’s actually nothing like a source asking for a conversation to be off the record. The rules clearly stated that if I chose the break those rules, I might be “unwelcome” in the future. The same as if I chose to show up 45 minutes for a restaurant reservation, my table might be given away. Hummingbird to Mars is free to make me “unwelcome” at future events.

I’m not sure I buy that just attaching consequences to breaking an informal NDA makes it acceptable to do so. Unethical? Perhaps not. A dick move? Absent the permission or tacit approval of the bar, certainly.