Tobacco Documents Online

SUNDAY TELEGRAPH THE ,MARCH "tS, 1998 No'-" " " s. lgniflcant ns : m p.asslve smoking LEADING cancer experts I~ROB~TM~rH~l~$and I I ! I I I I I I ! have conceded that the World Health Organisation's study of the link between passive smoking and tung cancer failed to find any sta- tistically significant extra risk. as exclusively revealed by T~ Sund~ Telegraph last week. The experts include Prof Sir Richard Doll, the world's leading authority on the link between direct smoking and cancer, who said that the rejection was on the grounds that the results were simply yet more evidence of the kind produced by dozens of earlier studies, which have also usually failed to give conclusive results. He insisted, however, that taken together the studies point to a significant risk: "On its own. the WHO study is not defimtive, but it con- tributes to the weight of evidence." However, the rejection of the non.sigai.qcant f'mdings from the WHO study looks set to trigger accusations that "politically correct" sci. entists deliberately suppress data which fails to support their own beliefs. Despite repeated requests last week to the WHO team to put its own side of the stor~, and an undertaking from a senior team member to give a response to specific VICTORIA MACDONALD quesl~ons, none was given. However, The Sund~y Yele- ~'~ph this week ~v~is ~e ~ ~t of ~e flaws ~ ~e WHO ~, ~u~g ~e fa~ ~e sd~ ap~ to have ove~-inte~reted the fig~ lea~g ~ to ~ • e ~sk is ~at~ ~ it ~. ~e ~dy, condu~ by ~e ~0's ~t~fio~ ~ f~ R~ on ~, ~m- pared 6S0 lung-cancer ~m ~ 1,~2 h~y ~ple. It l~k~ at ~ple who w~ ~'to smok- ~, wo~ed ~ smoke~, ~ wo~ ~d w~ ~- ~ to ~ok~, ~d ~ose who ~w ~ ~ ~ok~. The ~0 sdenfis~ ~d Ash ~co~y ~a~ ~at the ~sults show ~ th~ was a 1~ ~ c~t ~k of a" spouse ~g ~ a smok~ dev~opmg l~g c~c~. Dr Rudolfo Saracci, a, se~or s~ on ~e ~0 t~m, y~te~ay d~ed .a' request to give furthe~ details of ~e ~e~ ~d~ ~gs ~nd~ pub~cafion ~ a~ medical jou~al. However, he ~isted ~t ~e "soun- dest mt~fion" of .~e results was thaF~here is ~deed ~ in~ase ~ Hsk relate~ to spousal ~os~". I

Robert Matthews investigate the truth about passive smoking ing", It did not argue for or ~' -I._ ._ ~IL~_ ~_9~'" "cancer. " . a.galnst smoking; nor ~d it ad. ~'~ ~~ ~', ~- In i~ repot, ~e s~dy t~ aress th~ debate on whether . • . .... ,:. '~ .... ," ?~'stated its ~gs ~ ~e,~r- ~c~al s~oking causes cancer, or ~ ~ .... ..-- " r( '.[ ~ ~nR~ge of s~tisticm an~y- ~hether smoking in fron(of ':~~- ~"~ ~ : s~. Th~se ~posed to en~n-, babies can lead to cot death, or ' ' men~l tobacco smoke ~m ~ even that other studies have ~ ~ll~? ~tm~(~) ' spouse, it cl~ed, have a "relat .shown a link ~een passive ~~0~~ ~ve~k"(~)ofl~g.cancero~ s~ ~ lung cancer, r~ ~ ~ " "" world" The message was un- equivocal, Tobacco, seemingly i responsible for so many ills, must be abolished from this planet, Yet last week the WHO found itself in an embarrassing position when The Sun~!/ Telegraph revealed I that it was behind a study -- the second largest ia the world and the largest in Europe -- which had found ao statistical evidence that passive smoking causes lung I cancer, The findings from the WHO's Internatlonal Agency for Research into Cancer had been I published in an internal report but not made public. The' WHO denied that ~t had kept the find- ings secret and said it was wait- ing for the study to be published I m a science iournal, Secret or not, it was a signal for a clash of the Titans: ,the anti. smoking lobby and the WHO I, against the tobacco industry. The anti.smoking lobby accused the tobacco industry of manipulating the media, The tobacco industry accused the anti.smoking lobby I of rmsrepresentmg statistics. Sir Ke~eth Caiman, the Gov. ernment's Chief Mecilcal Officer, s~id the ~ ~tudy msul~s ~¢ ....... . . . . Yet th~se were ~ arg~ents ~ea "misrepo~ed". The WHO ~~~~ used by our~csto"pmve" last ~pon on the study as "f~se and' ~U~~~ .~cle was based on one fa~ ~e . ham :"~ ~y. stat~fically sig~c~ risk de was not "false and ~slead- ~g~ gB~~ ' " >" that passive smoking causes

! I I I I I I I I I I I I I I I I I I I16, wlth a so-called 95 per cent confidence intem'al (more of this later) ranging from 0~93 to 1,44. On the face of it. the conclusion o is clear: thestudy had found a 16 per cent greater risk of cancer among those living with a smok. ing spouse, That, at least, was the message that the WHO and its . supporters wanted emphasised. But as ever with statistics, the devil is in the details. And it was these details that the critics of The Sun.day' Telegraph article chose to bveriook. The WHO study was based on results obtained by recruiting hundreds of people and taking into account all the obvious sources of lung cancer to which they were exposed, such as urban pollution. Then, by sifting out the effect of all these other potential causes, the research team was able to give an estimate of the risk of lung cancer due to inhaling someone else's smoke. Yet no matter bow careful the researchers are to rule out other explanations from such statistidal studies, one simple one remains: fluke. Statisticians have devel- oped ways of stating their confi- dence~ that they haven't been fooleck,by a fluke, and the WHO team chose one known as the con- fidence interval method. This gives the range of results ~hich the study might reasonably have- got if nothing more than chance were at work. And the bad news for tho~e . hailing the WHO results as proof- posltlve of a cancer link with pas- sive smoking is that the study's own confidence interval of 0.9;~ to 1-44 includes a relative risk of I ~ that is, no extra risk. In other words, the results are ~ as The Sund.ap T¢~e~'aph stated ~ consistent with there being no real cancer risk for non.smokers, and even with there being a reduced risk. The WHO last week accused The Sunday Tele~aph of concen- trating on the study's confidence intervals while ignoring the study's '°headline" relative risk figure of 1,16. But what the WHO declined to point out was that this headline figure alone is meaning- less m as, unlike a~confidence interval, it does not show how likely fluke is to give such a' result. The chances of getting this headline figure by fluke alone can be calculated. And once again, the bad news for the WHO and its followers is that those chances are so high that the headline fig- ure is not even close to being sta- tistically sigmficant. "They cer- tainly seem to have been guilty of some over-interpretation," said one expert on medical ~atistics at a major British university, who declined to be named. "The results are definitely not significant." Professor Sir Richard Doll, who first demonstrated the link . between direct smoking and lung cancer, also conceded that the WV'HO results were not statisti. cally significant: "On its own, the study, is not definitive, but it con- tributes to the weight of evi- dence." He added, however, that this was a trait common to many studies of passive smoking. ~ So why such a furore? The San- day Tele~'aph was saying that you may not like smoke in your face, but it doesn't look as if it will kill you. It appears that the violence ' of t.he reaction to The Sunday Tele- graph story was at least partly. because of the embarrassment the article caused the World Health 0rganisafion. But more than that is the emotion attached to the arguments over passive smoking. Each side has a vested interest in provin~ that it does or does not harm people. The anti-smoking Iobby, led by Action on Smoking and Health "(Ash), and backed by the British 'Medical Association and cance~ c.harifies, can scent victory. At last it has a Government that wants to crack down on smokin~ (even if it fudged the issue when it came to Fomnula One and t.obacco sponsorship). A White Paper on smoking redaction is being prepared for ~ pub'lication this autumn and already ministers have let it be known that they want a voluntary ban_.on.smoki_u_ g in public, places, including pubs ~nd restaurants. .Memories of the dgar.pth~ftng former health secretary Kenneth Clarke have not yet faded. But the~ must have been joy at the sight of Tessa Jowell, the health minister, speaking at the launch of last Wednesday's National No Smoki~ Day, promising action while taking a swipe at the tobaom industry. • The big blow ,was delivered on that same Wednesday (24 hours eariie~ than planned), in a repo~ fl'om the Scientific Committee on Tobacco and Health Which pub- lished a review of evidence col- lected over the past four years. It claimed that 120,0~ people a year die from smoking-related disease, that passive smoking increases the risk of lun~ cancer by ~6 per cent and that 80 cot deaths a year are attributable to smokin~ by mothers. Ttfe Government said ~ was definitive and cancelled out The ..qund~ Tel~graph claim~. Ia fact, the'SCOTH report was a collec- tion of previous studies, added together to reach a risk value. The WHO research was an origi- nal study. But it was the knowledge that the SCOTH report was due that led Ash and other anti-smoking groups to claim that the tobacco industry was attempting a counter-offensive. And this is without a doubt true. The tobacco industry is increasingly beleaguered. Danny Rogers, tobacco carte. spondent of Market, n# magazine, said: "The industry has found itself backed into a corner and, Like all cornered anLmals, it is fighting hack." Clive Bates, head of Ash, said: "Passive smoking and addiction destroy their civil liberties argu. merit. The industry has always maintained "that smoking is a habit that adults choose freely ~-u mat the Stat~ and Govern. ment should not intervene. That argument breaks down if otl~r people are harmed or there is addiction, because addiction means the smoke~ no longer chooses to smoke." But the industry does not only have ethical or moral concerns: it is facing multi-billion-pound law suits in A.meri~a and Britain fi'om people with lung cancer. In this country, too, there has been a - reduction in the number of adult :'cigarette smokers -- 52 ~r cent of men and 42 per cent of women in 19~2 to 29 per cent of men and 28 per cent of women in 1~6/97. John Carlisle, the former Tory MP who is no~" the executive director of industry affairs for the Tobacco Mannfacturers' Associa. tion, admitted that there was a counter-offensive against the sci- entific claims made by the anti- smoking lobby and the advertis. ing and sponsorship plan~ "We are hitting back because we fundamentally believe that the evidence it [the Government] ",has. does not warrant further restrictions in pnbLic places." That was not an argument that The Sunda~ Telegraph even attempted to enter. But what became clear as the week pro. gressed was how important it was to the anti- lobby that passive smoking should be seen to be harmful. • The WHO was keen to stress its . study was the largest ever carried ,out in Europe and was conducted in 12 centres from seven coun- tries, covering 650 cases of lung cancer and 1,542 controls. And yet despite its size and the' care with which it was carried out and even with all the l~u/fing and puffing, the simple fact reported last week by The $undm3 Tele- ~'~ph remains: the WHO study failed to make its case. t~im Fletcher- Page 34 I 719 J

n n m m m mm m m m m m m m m m m LI l MARCH 15, 19'98 S k ng th • Th" d Way 1TIO : ere 1s a lr IONCE worked for a man who prided himself o,n the purity of his liherta,r- inn instincts. He dido t smoke himself but believed most publicly in the freedom of others to do so, to the point where his staff thought it pro- dent to he seen lighting up. The workforce would crowd in for meetings, his small office would fill with tobacco smoke and he would sit there determinedly content, ignor- ing his watering eyes and dry, racking cough. There was method in this, for had he even begup to acknowledge that cigarette ~moke irritated, he would ave found it difficult to sus- • rain the libertarian argument on smoking -- that the min- ority should he free to enjoy an activity that has no effect on the majority. You can see why he wan.ted~ to believe, for smokers are so much more fun. They're the ones who are up for a drink, ready for aiaugh, looking for action; the ones who sit gos- siping happily in the smoking rooms to which we've sen- tenced them, impervious: :to the disapproving gaze of pass- ers-by; the ones who carry off that insouciant air at parties (though ! have yet to meet a smoker who looks forward to the day he can give his son a first taste of Silk Cut Ultra). ! never got the hang of it myself, for all my childhood attempts with Embassy Reg- als. But I do rememher think- ing that the smoking football- ers Nobby Stiles and Billy Bremner were more than a match for Johnny Hollins, who tried so hard to keep young readers of Charles Bu- chan's Football Monthly from their Players No 6. And it was to become clear that the Health Educalion Authority copywriter who warned us that kissing a smoker was like kissing .an ashtray had never kissed a girl with gin and tobacco on her lips. As for the notion that it is actually unhealthl~ to be around smokers, can't we just agree that we are not going to find out? Victoria Macdonald and Reheat Matthews explain on page 23 how those who are opposed to smoking have not necessarily discovered the Kim .Fletcher Holy Grail they have sought so long: the proof that passive smoking leads to cancer. So the smokers have it, don't they? Especially when you take into account the irri- tating Thank-You-for-N0t- Smoking prissiness, the nau- seating' nanny tendency of those who oppose them. Yet as I sit across a restau- rant table from a smoker and watch, in my libertarian way, the curl of smoke rise, catch on the air and float delicately across'lthe qext table, I begin to worry. 1 see our neighbours making little coughing noises and wafting their napkins in the air. I see them looking meaningfully at each other and across to us. Now i desperately'~,ant to support my lunch guest's right to smoke, but I can't help thinking that it may not he very nice sitting on the next table in the middle of all that smoke. And once the covert war has broken out and the neighbours are muttering about being poisoned and my friend is telling me it is unpleasant to sit near ugly people or listen to stupid voices or smell cheap scent, I begin to realise that the anti- smokers and the anti-anti- smokers just about deserve each other in their fanaticism. Before long,, of course, it will all become irrelevant, at least in the West. The British smoking population falls year by year, from 52 per cent of ' men and 42 per cent of women in 1972 to about 29 per cent of both last year. True, the latest Social Trends reports an increase in smoking among under 1~ 6s in tl}e last few years. (from 10 to 15 per cent claim- lug at least one cigarette a week). But if the priggish reaction of my own children to the mere sight o| a cigarette is anything to go by, the statistic is a blip. So no Little Smoker's Kit, with its licorice pipe, choco- late cigars and candy ciga- rettes, for nay six-year-old son. Last week lie wrinkled his nose in disgnst as he boarded a Tube carriage just vacated by a couple of dere- licts with lins of Special Brew and burning cigarettes. "Ughm. Somebody's been smoking on this train." What would lie have made of the top deck of a corpora- tion bus on a wet November evening, that warm tug of damp wool and thick smoke? Of that stale stench across his clothes all the following morn- ing? To his generation it would seem as remote as the public bar spittoon seems to mine. And who in Victorian • England thought we wonld ever see the end of those? Dominie Lawson's. column returns in tl~o weeks.