Tobacco Documents Online

27 SEP'i'EMBER 1989 NEW ZEALAND MEDICAL JOURNAL /v'2, ( SW '1 6)' r~ Passive smoking in Mew Zealand Mr Lee's letter )11 pretends to a scientific basis it does not have. Hirayama's first publication 12) i focused~ on cancer of the lung among nonsmoking J apanese wives and set off a flurry of criticism of the methodology-including the analysis. The analyses have been redone showing significance enhanced'by improved analysis. ,nly someone committed to nonsense would report a p-value for !he difference between the two results.. Mr Lee's criticism of the study by Helsing et al 1s)'makes no sense on the face of~ it. Controlling for 'a whole range:of possibly relevant confounding factors' has as much likelihood of heightening the significance as of lowering it'. The researchers found that adjusting the relative risks has in fact enhanced the significance of their findings. Mr Lee has a greater tolerance for assessing a study as •published' than most'scientists do,,as demonstrated by his tenth reference. Perhaps he gives more weight to studies of 9 subjects which unsurprisingly fail to yield significant results than most epidemiologists would. He may not, however, show so little tolerance for the epidemiological methods he exploits. Spousal smoking has, again and again„been shown to be associated with lung cancer risk 14.5s). The biomedical underpinning-proven studies in animals and dose-related responses ih hn*nAna_relating the constituents of both sidestream and mainstream tobacco smoke to production of cancers of: the lung is undisputed (7.81- Propinquity of the non•smoker to the smoker over time rather than the concentration of single toxic substances in the ambient air determines the degree of exposure. Given the large numbers of exposed nonsmokers even a very low degree of risk has substantial impact. Misclassification bias, a favourite theme of Mr Lee, is a two- edged criticism. As long as misreporting of exposure is as likely for cases as for controls misclassification depresses the relative risk. The risk will be overestimated only when cases whose husbands smoke denyy their own, actual smoking more readily than cases whose husbands do not smoke or when cases exaggeratee their husbands' smoking more than controls do. Where actual exposure has been measured and compared with reported exposure the agreement has been high and the misreported exposure has not been in only one direction. The validity of extrapolating exposure in the home to exposure at work raises other questions about indoor air. If the home setting is one where a nonsmoker can choose another room to be in than~ the one the smoker is in, then exposures at home would be lower than ~worksite exposures. In the workplace freedom to move away from the smoke source is generally denied. By extrapolating Kawachi et al )9) have probably underestimated the risk and the number of deaths attributable to passive smoking. Common sense does more than pseudo-science can to produce credibility. The weight of the evidence is against Mr Lee and others whom the tobacco interests sponsor )tol. J Reinken, FFMS Consultants, W ellington. 1. Lee PN. Deaths from lung cancer and iecheemic lieart'disease due to passive.amoking in Ne.° Zealand. NZMed J 1989'; 102: 448.. 2. Hiuayams T. Nonsmoking wivea of heavys smokers have a highernsh of,lung n.nae- a study fromJapan..Br Med J 1981; .282a 183-5'.. 3: HhJaing KJ. Sandler DP: Comstocjf GK'. Ch'eeE. Heartt disrise.fn, nonsmokers living .itM smokers. Am J Epidemiol 1988; 127: 915-22. 4. Abelin T. Curreno t.rends in the epidemiology of smoking:.p..sive smoic'utg and lung uncer. Sch,veie Rundach Med Prs: 1989; 76:: 87-92. 5.. Svendsen.KH. Kuller LH. Martin MJ. OcYene JK. Effects of passivesmohing:in the multiple risk factor intervention trial. AmJ EpidemioL 1987:.126: 783-95'. 6.. Svendsen.KH. Kuller LH.. Re: 'Effects of passive smoiung in rth'e multiple ruJc factor intervmtion trial'. AmJ Ep,idemiol19895 129. 226-7. 7:. US Departmmt of Health and Human Servioee:'rAe health oonsequeaaes of invohSntary •mdcing" a report of.the Surgeon-Cieneral. US DH1iS.~ Washmgwn..1:986. 8.Saraca R:.Paasivesmolcing and lungcancen. In: Zaridse DG: Peeo R. ads. Tobaoco:, a major international health hazard..lnternationd Agency, for Research on Cancer Scientific Publications No 74:.lARC..Lyon; 1986.. 9. K.vachi 1. Peartc NE. JarYsm.RT. I1vtls from lungcanm~ and iscti'emic heart diseasr due to passive smoking in Nev.Zealand'NZMed J 1989, 102. 337-40. 10. Martin P. Pa.sive smoking. NZ Med J 1987:,100: 69&7. Cancer registration working group We regret that Dr Hitchcock (NZ Med J 1989;,102: 419) regards. our letter on cancer registration )1] as incorrect. We can only repeat what'actually occurred. Dr Hitchcock mentions a submission from the Board of Healt'h., 515 After two letters from the group seeking details the board finally stated: 'In reply to your letter of 22 October 1987 we believe there is nothing to be gained from pursuing,the matters you raise in your letter. Our reference in our original letter referred to apparent breaches in the past and the need to provide effective controls.' That is as much information on, 'instances of breaches of confidentiality''as was ever received from the Board of Health despite the repeated requests from the group for information on actual instances. The board did not refer to any submission from private pathologists. We repeat `no individual, no doctor and no group provided the working group with information on breaches of~confidentiality'' Ill. The essential point' is that, despite all our efforts„ we could not find any substantiated evidence of an actual breach of confidentiality by the New Zealand Cancer Registry. It should not be necessary, but it may be helpful, to emphasise that had the group been given information on~ any instance apparently involving a material breach of confidentiality we would have regarded this as a serious matter and sought to ensure a thorough, , independent and' sensitive investigation. We would like to take this opportunity to thank the many organisations and ~ individuals who submitted comments on our report to the ReviewCommittee on Health Statistics. We appreciate the constructive criticisms and the general support for our proposals. K R Cooke,, Department of Preventive and Social Medicine, University of Otago Medical School; Dunedin; A J Gray, Cancer Society of New Zealand; W ellington; A F Burry, Department of Pathology; Christchurch Hospital, Christchurch; R Stewart, Department of Surgery, Wellington School of Medicine, Wellington. 1i Cooke KR. Gray AJ„Burry. AF. Sce.vart RJ.. NZ MedJ 1989; 102::197. Dietetic advice I was interested to ~ read the paper Children's diets:, what do parents ad&and avoid? by Dr R P'K Ford and colleague (NZ Med J 1989;, 102: 44'3h, with the analysis of advice on various food substances. It is quite staggering to find that none of the 103' children interviewed for this article had been given dietetic advice. Over and over again we are concerned to find that general practitioners give detailed advice when ~they are not trained to d'o so. The whole question of diet and nutrition is underestimatedand'undervalued in the undergraduate and postgraduate curriculum, Fortunately we have an efficient training programme for dietitians in New Zealand and, in my opinion, it is unethical and unprofessional ito attempt to give patients detailed advice on diet when we have well trained and qualified colleagues available to undertake this task. I was provoked to write such a letter because all too frequently we have people referred to hospital with complications of'diabetes who have never had the opportunity to have'a consultation withh a dietitian, who could certainly have influenced their eating patterns. D W Beaven, Department of Medicine,. Christchurch Medical School; Christchurch, Informed consent I recently received a copy of the New Zealand Medical Association's revamped~ informed consent/request for treatment form.. It is impossible for a patient to know that helshe has received an adequate explanation of risks etc when the patient is in no position to assess this. If any aspect of the operation is withheld or overlooked : the patient has no way of knowing.