Monday, July 31, 2006

Ohio's Debunkify Campaign Should Feature Myths Being Spread by SmokeFreeOhio

An article published this week in Brandweek highlights the Debunkify campaign being run by the Ohio Tobacco Use Prevention and Control Foundation to try to correct misperceptions about smoking and the health effects of secondhand smoke.

According to the article: "The Ohio Tobacco Use Prevention and Control Foundation and its 'stand' marketing campaign will roll out by September the mobile version of its 'Debunkify' effort. ... In keeping Debunkify 's tagline 'Kill the myths, before they kill you' the van crew will try to correct misperceptions like Ohioans' overestimation about the number of smokers and the underestimation about the deadliness of second-hand smoke. Those two notions were discovered from foundation focus groups and case study findings."

The Debunkify website introduces itself as follows: "The load of garbage you've been made to swallow over the years has put you and everyone you know at risk, and it's time we all did something about it. Most of what you think you know about tobacco use is just plain wrong. Myths, pure and simple. Bunk. So toss off your blinders, yank out your ear plugs, strip off your denial and prepare to be DEBUNKIFIED."

The Rest of the Story

I think it's a wonderful idea to debunk myths that have been spread among the public about the health risks of smoking and secondhand smoke, especially those that have been propagated by various groups like tobacco companies through their public communications.

There's just one problem here though.

If the Ohio Tobacco Use Prevention and Control Foundation truly wants to debunk the myths that are being spread around Ohio by various organizations about the health effects of secondhand smoke, then in addition to any myths R.J. Reynolds might be spreading, the Foundation should also debunk the myths that an Ohio anti-smoking group - SmokeFreeOhio - is spreading as well.

Myths about secondhand smoke appear to be an equal opportunity phenomenon in Ohio. Apparently, they can be spread just as easily by anti-smoking groups as by Big Tobacco.

Case in point is SmokeFreeOhio, which continues to spread myths about the acute cardiovascular health effects of secondhand smoke even though they were notified months ago that these claims were scientifically unsupported.

Rather than respond to my concerns in a scientific manner and defend its statements by citing the scientific evidence that 30 minutes of secondhand smoke exposure can cause hardening of the arteries, one member of the organization recently resorted to an ad hominem attack, publicly calling my scientific analysis of this issue to be nothing but "blather."

By the way, I'm not bothered by having my commentary termed blather. My son suggests that all the time. What is bothersome is the fact that absolutely no scientific evidence is produced to support the contention that I am speaking nonsense (my son does a far better job). Thus, it becomes simply a baseless personal attack and lends further support to the growing perception that SmokeFreeOhio is not willing to back up its public statements, perhaps because they are unable to do so.

First, SmokeFreeOhio claims that 5 minutes of secondhand smoke exposure makes the heart work harder to pump blood because of narrowing of the aorta. There is no evidence, however, that acute exposure increases blood pressure. On the other hand, acute exposure is documented to increase cardiac output, meaning that the heart is able to pump more blood out to the body.

This fact debunks SmokeFreeOhio's second fallacious claim, that 20 minutes of secondhand smoke exposure reduces the ability of the heart to pump. There is simply no evidence that acute exposure decreases heart contractility or increases blood pressure, making it more difficult to pump blood. Again, what the evidence shows is that cardiac output increases, indicating that the heart is, if anything, "better able" to supply blood to the body.

The third fallacious claim is that 20 minutes of secondhand smoke puts a nonsmoker at elevated risk of a heart attack. There is no evidence that this is the case, and it is completely implausible that a 20-minute exposure could increase heart attack risk for anyone other than someone who already has severe existing coronary disease and is basically a "heart attack waiting to happen."

SmokeFreeOhio's fourth myth is that 30 minutes of secondhand smoke contributes to hardening of the arteries by narrowing arteries and restricting blood flow. This claim is simply implausible. It is not possible for a 30 minute exposure to cause atherosclerosis, because hardening of the arteries is a process that takes many years to develop. Thus, there is no risk of a nonsmoker developing hardening of the arteries from being exposed to secondhand smoke for just 30 minutes. Moreover, the scientific evidence shows that a 30 minute exposure does not reduce basal coronary blood flow; thus, arteries are not narrowed and blood flow is not restricted. It is simply the reserve flow that is restricted, but that is of no acute clinical significance (although it certainly is significant if a person were to be exposed day in and day out for many years).

The fifth big myth is that the changes in fat metabolism induced by 30 minutes of secondhand smoke could lead to heart attacks and strokes. This is preposterous. It takes years and years of exposure and years and years of changes in this fat metabolism before a person is at increased risk of heart attacks and strokes. Once again, if these changes occurred day in and day out for many years, then they would be very significant clinically. But a simple 30 minute exposure does not increase heart attack or stroke risk due to induced changes in lipid metabolism.

The sixth, and perhaps most egregious myth, is that a 2 hour exposure to secondhand smoke can cause fatal or catastrophic arrhythmias. This is simply false. There is no evidence that such an exposure poses any risk of a fatal or catastrophic arrhythmia. A 2 hour exposure has been found to reduce heart rate variability, but this is basically a measure of cardiac autonomic function, and it does not indicate that the individual is somehow at risk of dropping dead from an arrhythmia. If it were, then the researchers who conducted this study would be in jail now for knowingly and unduly putting the lives of their research subjects at risk.

I would hasten to add that if SmokeFreeOhio's myths were not myths, but were true, then there would be no excuse for not banning smoking completely and immediately. If exposed individuals' ability to pump blood was reduced by a brief secondhand smoke exposure and this exposure put them at significantly increased risk of hardening of the arteries, heart attack, stroke, and a catastrophic or fatal arrhythmia, then we would simply have to ban smoking. There's no risk of that magnitude that I'm aware of that society tolerates. If SmokeFreeOhio actually believes what it is claiming, then there is no excuse for SmokeFreeOhio not to be calling for a complete ban on smoking. It would be irresponsible of me as a public health practitioner if I did not call for a ban on a voluntary activity that people do that could kill other people in just 20 minutes of exposure to it.

This is not a pretty situation, because if SmokeFreeOhio does not believe what they are claiming, then they are lying to the public. And if they do believe what they are saying, then they have lost all scientific credibility and they are irresponsible for allowing people to remain exposed to this incredible hazard.

Based on the response I have received from the organization (mainly, a failure to correct its so-called "fact sheet" after months and months), it is difficult for me to come to any conclusion other than that the organization is making an intentional decision to exaggerate and distort the science in order to increase the emotional appeal of their communication. Perhaps with the threat of a competing ballot initiative and millions of dollars of R.J. Reynolds funding, they are worried that they need to be more dramatic in order to win.

However, in my view, by risking the scientific credibility of the entire anti-smoking movement , harming our scientific reputation, betraying the public's trust, and misleading the public, the battle is already being lost. And it's not only the public that's losing. It's all of us in tobacco control and it's the character, values, credibility, and reputation of the movement which are all harmed by our joining Big Tobacco in spreading myths.

We, like the tobacco companies, now need to have our own myths "debunkified."

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