NYSA TI Single-Page 1
In fact, that's an area that has received a lot
Abstract
In fact, that's an area that has received a lot of attention from the NIH, and I think people are spending more effort on interracial and ethnic differences.
Fields
- Named Organization
- American Cancer Society
- American College of Cardiology
- American Heart Association (Voluntary health organization that focuses on cardiac health)Voluntary health organization that focuses on cardiac health and stroke. AHA occasionally teams with tobacco retailers to engage in promotions/fund-raisers (see http://www.smokefree.net/doc-alert/messages/247136.html and http://www.rawbw.com/~jpk/stand/Pictures.html).
- American Journal of Public Health (periodical)
- Americans for Nonsmokers' Rights (Anti tobacco organization)Concerned with clean indoor air.
- Beverly Hills Restaurant Association (Industry front group)Set up c. 1988 by the Tobacco Institute to clandestinely fight a local smoking restriction (TI00380927-0949, Pag. -0946).
- California Air Resources Board
- Californians for Nonsmokers' Rights (Americans for Nonsmokers rights precursor)Precursor organization to Americans for Nonsmokers Rights
- Center for Indoor Air Research (CIAR) (Industry formed/funded air research organization)Nonprofit organization funded by the tobacco industry. CIAR was formed in March 1988 by tobacco companies "to sponsor "high-quality research on indoor air issues and to facilitate communication of research findings to the broad scientific community."
- Congressional Research Service (Criticized 1993 EPA ETS report)Criticized EPA's January 1993 report designating passive smoke as a carcinogen
- Environmental Protection Agency (EPA)
- Federal Register (publication)
- McDonald's Corp.
- Ministry of Health and Welfare (Japan)
- National Institutes of Health (NIH)
- National Licensed Beverage Association
- National Research Council
- New England Journal of Medicine
- Nonsmokers Rights (California anti-smoking organization created by Stanton Glan)
- Occupational Safety and Health Administration (OSHA)
- Price Waterhouse (Accounting firm)
- R.J. Reynolds Corporation (second tier subsidiary of RJR Industries)
- Tobacco Institute (Industry Trade Association)The purpose of the Institute was to defeat legislation unfavorable to the industry, put a positive spin on the tobacco industry, bolster the industry's credibility with legislators and the public, and help maintain the controversy over "the primary issue" (the health issue).
- *University of California (use specific branch)
- University of California San Francisco
- Washington Technical Information Group, Inc.
- World Conference on Smoking and Health
- World Health Organization (Concerned with global public health)International organization concered with public health worldwide
- Named Person
- Alsop, L. Susan
- Barr, Glen
- Bero, Lisa A., Ph.D. (Epidemiologist, UC San Francisco)
- Feinstein, Diane
- Garfinkle, Larry
- Glantz, Stanton
- Grossman, Ted
- Lee, Peter N. (TAC Biostatistician)Frequently funded by the tobacco industry to criticize and discount published and epidemiological studies that linked between tobacco smoking and health damage.
- *LeVois, Maurice (use LeVois, Maurice Emile, Ph.D.) (industry consultant)1996 submitted comments to EPA, worked with PN Lee on IARC rebuttal.
- Lowe, Michael
- Mahler, Sara
- Mayor, Francisco
- Michaels, Robert
- Parmley, Bill
- Penn, Arthur
- Pfeffer, William, Jr.
- Rossi, Bob
- Rossi, Robert
- Samet, Jonathan
- Siegel, Michael B., M.D. (Epidemiologist, Boston U, School of Public Health, Anti-Toba)
- Toon, Michael
- Wald, Nicholas J., Ph.D. (Colleague of Sir Richard Doll, coauthor with Law of secondha)Professor of Preventive Medicine, Wolfson Institute of London, Colleague of Sir Richard Doll, coauthor with Law of secondhand smoke metaanalysis
- Warner, Kenneth E., Ph.D (Plaintiff's expert, health care costs)Plaintiff
- Woods, Rosemarie
- Wynder, Ernest
- Master ID
- TI10111465-1821
Related Documents:
Document Images
1
2
3
4
5
6
7
8
9
I0
Ii
12
13
14
15
16
17
18
19
20
21
22
23
24
25
457
is very ligtle independent cardiovascular epidemiologyon
those groups in general.
In fact, that's an area that has received a lot
of attention from the NIH, and I think people are spending
more effort on interracial and ethnic differences.
As a general rule, though, when you look at the
major risk factors for heart disease, the importance of
those risk factors seem to be pretty much, to my
understanding, independent of ethnicity, although there are
some subgroups, for example, that are more prone to
hypertension, such as blacks, but the effect of the
hypertension on the heart, where it doesn't seem to be
different in blacks than whites.
So I wouldn't see the question that you're
raising as a particularly strong limitation on the studies.
It would be nice if we could do the perfect study
and have perfect stratification by everything imaginable,
but I don't think you'll ever find a study that you can't
find something to criticize.
MR. SIRRIDGE: You're familiar with the migrant
studies and how heart disease, risk and risk factors change
from Asian --
DR. GLANTZ: Which studies?
MR. SIRRIDGE: Migrant. It's a type of
BAYLEY REPORTING, INC.
(202) 234-7787 (800) 368-8993
T11011-1644
1
2
3
4
5
6
7
8
.9
i0
Ii
12
13
14
15
16
17
18
19
2O
21
22
23
24
25
epidemiologic study--
DR. GLANTZ :
MR. SIRRIDGE :
458
Yes. Yes.
-- where people move to different
places and then their rates are compared against those of
them who stayed in countries.
There have been a number of studies which have
measured Japan and places in the east with Hawaii and also
with California, of all places.
There has been a gradation of rates with a much
higher risk for people who have moved here, suggesting the
power and influence of traditional western risk factors. Is
that true?
DR. GLANTZ: I'm generally familiar with those
studies from talking to colleagues about them and reading
about them in the press. I wouldn't purport to be an expert
on them.
My understanding from this sort of general
scientific knowledge is that the main changes that seem to
account for those things are changes in diet, and again, no
one is saying that diet isn't one of the risk factors for
heart disease.
It's important, I think, though, when you look at
the ETS data, that they fact that we find reasonably
consistent risks around the world, that, to me, is evidence
that, again, the effects of ETS exist independent of those
BAYLEY REPORTING, INC.
(202) 234-7787 (800) 368-8993
T!1011-1645
1
2
3
4
5
6
7
8
9
i0
Ii
12
13
14
15~
16
17
18
19
2O
21
22
23
24
25
459
changes.
MR. SIRRIDGE: Doctor, isn't it also true the
there are problems comparing epidemiologic studies on heart
disease from different countries?
DR. GLANTZ: That's such a vague statement.
MR. SIRRIDGE: All right. Would you agree with
this statement: "The problem of comparability of
epidemiologic data across different countries where racial
ethnic groups is evident for cardiovascular diseases."
DR. GLANTZ: Who said that?
MR. SIRRIDGE: Anthony Padednick, Department of
Community and Preventive Medicines, University of New York
Stoneybrook. It's a chapter in a book he wrote in 1989,
called "Racial and Ethnic Differences in Disease".
DR. GLANTZ: Well, I mean, I'm not familiar with
that~book and can't comment on it. I think that, as a
general point, one needs to consider those differences when
thinking about the studies, and I have, in my analysis of
these studies.
Another thing that I think speaks directly to
this, and I'm sure Dr. Wells will address is, is when he did
an analysis of the studies and separated the U.S. studies
from the non-U.S, studies, you get quite comparable results,
and also when you look at studies -- better studies -- which
control for more of the potential confounding variables, you
BAYLEY REPORTING, INC.
(202) 234-7787 (800) 368-8993
TI1011-1646
1
2
3
4
5
6
7
8
9
I0
ll
12
13
14
15
16
17
18
19
2O
21
22
23
24
25
460
get highe~ risks than when you don't.
So the confounding, which we've heard so much
about in the cross examination so far, if anything, is
probably reducing the estimated risks.
I think, while as a general statement, that quote
you read perhaps is true. I think, in terms of ETS and
heart disease it's not a problem.
MR. SIRRIDGE: My point here, poctor, is that the
ETS studies are from all over the world. They control for
very few of the traditional major risk factors, and the
relative risks seem too high to be plausible according to
commentators of that evidence.
DR. GLANTZ: I don't agree with that statement.
I mean, I can speak to -- I mean, that's not an accurate
statement.
MR. SIRRIDGE: Are you familiar with the report
by the Congressional Research Service with respect to that?
DR. GLANTZ: Yes.
MR. SIRRIDGE: I'm sure Mr. Repace gave you a
copy of it, didn't he?
DR. GLANTZ: No. I have a copy of it, but I got
it from -- I don't even know who gave it to me --
MR. SIRRIDGE: But you've discussed this --
DR. GLANTZ: -- who it was --
MR. SIRRIDGE: -- you've discussed it with
BAYLEY REPORTING, INC.
(202) 234-7787 (800) 368-8993
Tl1011-1647
1
2
3
4
5
6
7
8
9
I0
ll
12
13
14
15
'16
17
18
19
2O
21
22
23
24
25
461
Mr. Repac%?
DR. GLANTZ: I don't think so, actually. I don't
recall. I've discussed it with several people. I don't
think I've talked to him about it. I'll be happy to -- I
mean, it's a piece of trash.
First of all, if I could quote from it --
JUDGE VITTONE: Dr. Glantz.
DR. GLANTZ: Oh, okay. I'm sorry.
MR. SIRRIDGE: You would like a question?
JUDGE VITTONE: Yes. Ask it.
DR. GLANTZ: Well, he's been making statements
rather than asking questions.
JUDGE VITTONE: Well, let me worry about that.
DR. GLANTZ: Okay.
JUDGE VITTONE: Okay. Now, do you have a
question, Mr. Sirridge?
MR. SIRRIDGE: I do, indeed.
I'd like to read you a statement from the
Congressional Research Service.
DR. GLANTZ: Yes.
MR. SIRRIDGE: You probably have it in front of
your too.
DR. GLANTZ: Yes, I've just gotten it.
MR. SIRRIDGE: "The most likely explanation of
these large risks" --
BAYLEY REPORTING, INC.
(202) 234-7787 (800) 368-8993
T!1011-1648
1
2
3
4
5
6
7
8
9
i0
ii
12
13
14
15
16
17
18
19
20
21
22
23
24
25
462
. DR. GLANTZ: Where -- where --
MR. SIRRIDGE: I'm sorry. From page 6 of the
CRS, dated March 23rd, 1984. Your paper is cited, in fact,
in the footnotes there.
"The most likely explanation of these large risks
from passive smoking, epidemiological studies for heart
disease, is the absence of control for other factors. There
are many important causes of heart disease (for example,
diet, lack of exercise, lack of preventive health care) that
may be engaged in by smokers. That is, there is much
evidence that smokers tend to be less concerned about health
risks in general. In general, studies do not and perhaps
cannot control for many of these factors. If smokers' wives
share in these behaviors, the relationships found in the
epidemiologic studies are spurious."
Did you consider that statement in reaching your
conclusions for the 0SHApanel?
DR. GLANTZ: Actually, I just realized that I
don't have that document here. Do you have a copy I could
read, before commenting on it? There were two reports, and
I brought the one on economics rather than the one you're
quoting from.
MR. SIRRIDGE:
DR. GLANTZ:
MR. SIRRIDGE:
I have one copy, is all I have.
If I could just --
There's another one from September
BAYLEY REPORTING, INC.
(202) 234-7787 (800) 368-8993
TI 1011-1649
1
2
3
4
5
6
7
8
9
I0
Ii
12
13
14
15
16
17
18
19
2O
21
22
23
24
25
13th.
DR. GLANTZ:
MR. SIRRIDGE:
DR. GLANTZ:
but I want to be accurate.
MR. SIRRIDGE: Okay.
DR. GLANTZ: I'm sorry.
thing.
question.
it.
463
But I'll --
Certainly, I'll let you read that.
Yes. I'm not trying to be difficult
I brought the wrong
JUDGE VITTONE:
[Pause.]
JUDGE VITTONE:
That's okay.
Let's hear the question first.
DR. GLANTZ: Yes. I've forgotten.
MR. SIRRIDGE: I've forgotten the precise
JUDGE VITTONE: Yes. That's why I'd like to have
MR. SIRRIDGE: Okay.
JUDGE VITTONE: Okay.
MR. SIRRIDGE: The question is, Doctor, this
appears to be a statement by some analysts who have reviewed
the evidence and have an understanding of the mechanisms and
the risk factors associated with heart disease. True?
DR. GLANTZ: No. And the reason for that, and
the reason for -- apparently, there is yet a third
Congressional Service document because I have seen the one
BAYLEYREPORTING, INC.
(202) 234-7787 (800) 368-8993
TI1011-1650
5
6
7
8
9
I0
II
12
13
14
15
16
17
18
19
20
21
22
23
24
25
464
that you had, in which the authors point out that they are
economists, not biomedical scientists, and really aren't
competent to comment on the biological evidence.
I found that report a remarkably irresponsible
document. I mean, I would never write a paper for
publication that said I'm not competent to make these
statements, which, if I could have found the correct
document, and I will provide to the record if need be.
THe other thing, and the very, very fundamental
flaw that exists in the CRS study is, it presumes a
threshold for both lung cancer and heart disease, and there
is no evidence accepted by the general scientific community
that the threshold effect exists.
! think, first of all, the authors of that
report, by their own admission, were not competent to write
it..
Secondly, the assumptions they made are at great
variance with established scientific view.
Third, I checked about this and asked what kind
of peer review did these documents get before they were
released, and the answer was none.
So I think that document is an appalling
document. It's an embarrassing document. I had previously
thought the Congressional Research Service did good work,
and I hope that that's an exception to the rule.
BAYLEYREPORTING, INC.
(202) 234-7787 (800) 368-8993
T!1011-1651
1
2
3
4
5
6
7
8
9
I0
Ii
12
13
15
16
17
18
19
2O
21
22
23
24
25
465
MR. SIRRIDGE: We' ll let others decide whether
it's an exception, whether it's accurate.
opinion.
DR. GLANTZ :
MR. SIRRIDGE :
DR. GLANTZ :
That's true. I'm entitled to my
Absolutely.
Dr. Glantz, you mentioned this
morning that -- in fact, I was interested in your view that
the relative risk for environmental tobacco smoke and heart
disease could be i0.
DR. GLANTZ: The data are -- if you look at, I
think it was the Garland study done and not a terribly big
one, from a statistical point of view, the relative risk
could be anywhere in that 95 percent confidence interval
with equal probability.
I was not saying that I thought it was 10. I was
just making a statistical statement based on that one study.
If you look at the pooled estimate, the 95
percent confidence intervals are, in fact, quite narrow.
They're about plus or minus .l, or probably even a little
less than that, so I do not think the relative risk is
MR. SIRRIDGE: Was the Garland ~tudy the one
where they made the huge mathematical error?
DR. GLANTZ: No. The Garland study, there was a
typographical error in the paper, which Garlan subsequently
published an erratumm on. There was not a mathematical
BAYLEY REPORTING, INC.
(202) 234-7787 (800) 368-8993
Tl1011-18~-52
1
2
3
4
5
6
7
8
.9
i0
II
12
13
14
15
16
17
18
19
2O
21
22
23
24
25
466
error in their work.
I actually, when people started claiming that,
called Garland and asked him about it, and he sent me a copy
of the erratum which had already been published.
I believe they interpolated two numbers or
printed the log instead of the actual numbers, but the
analysis was correct.
MR. SIRRIDGE: And the risk went from 14.7 down
to 2.7? Is that your memory?
DR. GLANTZ: The correct result -- the result in
Garland's paper, as published with the erratum, had the
correct number. Me did not change what he said the risk
was. What they did was corrected a typo.
The analysis that was done in that paper was done
correctly.
MR. SIRRIDGE: What do you think the risk is, if
it's ~ot I0 -- you said you didn't think it was 10?
DR. GLANTZ: I think it's around 1.3 -- 1.2 to
1.4, somewhere in there.
MR. SIRRIDGE: Well, Doctor, haven't there been
comments made by qualified analysts and scientists in the
ETS area that even that risk is too high compared to the
cardiovascular risk that's been reported for active smokers?
DR. GLANTZ: Well, most of the criticism I'm
aware of has come from the tobacco industry's consultants.
BAYLEY REPORTING, INC.
(202) 234-7787 (800) 368-8993
TI1011-1653
