The anti-smoking ‘truth regime’ that cannot be questioned

Two new books expose how epidemiology has been used as a tool of propaganda in the war on tobacco – and woe betide anyone who tries to inject some real facts into the debate.

Dr Michael Fitzpatrick


‘In retrospect, it is striking’, writes epidemiologist Geoffrey Kabat in Hyping Health Risks ,‘how disposed the public [in the USA] was to believe that some form of environmental pollution – whether chemicals in the soil and water, radionuclides from nuclear reactors, or magnetic fields from power lines, or something else – must be involved in the development of breast cancer’.

However, to the disappointment of environmental activists, intensive local investigations (notably in Long Island, New York) of exposures to organochlorine compounds (including DDT) and combustion products – the major focus of suspicion – showed no evidence of a link with breast cancer. While in relation to breast cancer such negative findings have largely been accepted, in other areas – such as the alleged links between electromagnetic fields and childhood cancer – the strength of popular conviction has led to the distortion and misrepresentation of scientific studies.

What Kabat characterises as a ‘deliberate willingness to be careless with data’ is most apparent in the controversy over passive smoking, where he identifies ‘a political strategy of hyping an unrealistic risk in order to gain public support for tobacco control policies’. Kabat was co-author, with James Enstrom, of a paper published in the British Medical Journal (BMJ) in 2003 under the provocative headline ‘Passive Smoking May Not Kill’. This paper reported the results of a large, 40-year-long, rigorously conducted study of the effects of ‘environmental tobacco smoke’. It revealed a marginally increased risk of coronary heart disease (and an even smaller effect on lung cancer). The increase in relative risk was slightly smaller than in numerous similar studies, but within the same range – the sort of increase that, given the margins of error of such studies, would generally be deemed too small to be considered of significance.

Yet, as Kabat observes, anti-smoking campaigners and public health authorities have routinely manipulated the results of such studies to justify increasingly coercive policies. He details their methods of selecting positive and neglecting negative studies, overstating the significance of results and ignoring weaknesses and inconsistencies. Their key calculation is based on multiplying marginal increases in relative risk by vast population numbers to construct an estimate of the annual mortality attributable to passive smoking. Headlines proclaiming that ‘passive smoking kills’ thousands every year then provide the banners for the anti-smoking crusade.

The Kabat and Enstrom paper, published at a moment when the campaign for bans on smoking in public places had reached a critical stage in the UK, provoked a torrent of condemnation and abuse, with – (unsubstantiated) allegations of corruption and fraud. A subsequent commentary on ‘the BMJ affair’ by two sociologists, entitled ‘Silencing Science’, was based on a study of the 144 ‘rapid responses’ received by the BMJ:

‘Silencing is based on intimidation, as partisans employ a strident tone full of sarcasm and moral indignation. There are elements of an authoritarian cult involved here: uphold the truth that secondhand smoke kills or else!’

Their conclusion was that ‘public consensus about the negative effects of passive smoke is so strong that it has become part of a truth regime that cannot be intelligibly questioned’. The result of what Kabat dubs ‘the new McCarthyism in science’ is that epidemiology is reduced to propaganda.

In his fascinating history of anti-smoking, Velvet Glove, Iron Fist, Christopher Snowdon (who was previously interviewed for the spiked review of books here) provides the wider context for the witch-hunt against Kabat and Enstrom. He shows how the campaign against passive smoking took off in the 1970s, long before the first studies that claimed to show its ill-effects. An early campaigner’s statement that ‘we were just waiting for science to tell us what we already knew’ accurately reveals the subordinate role of science in the anti-tobacco cause. Snowdon also shows that the campaign against passive smoking has grown more strident and more influential in inverse proportion to the scientific evidence. Though large studies in the 1990s had shown all ‘those who had eyes to see that the passive smoking theory had unravelled’, the anti-smoking bandwagon rolled on regardless.

Snowdon provides entertaining examples of the preposterous claims of anti-smoking campaigners – some suggesting that passive smoking causes diseases (such as breast cancer) that have never been linked to active smoking. From Helena, Montana to Glasgow, Scotland, campaigners have claimed dramatic falls in mortality following the introduction of smoking bans – claims that disintegrate under the slightest scrutiny (which they rarely receive from a cravenly ‘on-message’ media). More objective reports suggest increases in levels of smoking, particularly among young people, since the introduction of bans.

Snowdon quotes a recent editorial in the New Scientist, which suggests that the anti-smoking campaign may have reached some sort of limit. Commenting on the promotion of the concept of ‘third-hand smoke’ – the notion that toxic residues in the form of particulates can be transmitted from a victim of passive smoking to a third party (and hence justifying bans on smoking in the home as well as in the workplace) – campaigners were accused of ‘distorting the facts to make their case’. The editorial concluded that ‘using bad science can never be justified, even in the pursuit of a noble cause’. Yet, as Snowdon observes, the ‘real message’ that emerges from his study is that ‘government health agencies could no longer be trusted to provide accurate medical advice and were now wilfully misleading the public in an effort to manipulate behaviour’. This is the real damage done to public health by its embrace of the cynical moralism of the anti-smoking crusaders.

Dr Michael Fitzpatrick is the author most recently of Defeating Autism: A Damaging Delusion, published by Routledge. (Buy this book from Amazon(UK).) He is speaking in the debate Is the NHS institutionally ageist? at the Battle of Ideas festival on Sunday 1 November 2009.

Hyping Health Risks: Environmental Hazards in Daily Life and the Science of Epidemiology, by Geoffrey Kabat, is published by Columbia University Press. (Buy this book from Amazon(UK).) Velvet Glove, Iron Fist: A History of Anti-Smoking, by Christopher Snowdon, is published by Little Dice. (Buy this book from Amazon(UK).)