Cancer Medicine Politics

The smoke thickens, along with something else that smells even worse

A couple of weeks ago, inspired by a somewhat drunken encounter two weeks prior, against my better judgment, I waded into the evidence supporting the contention that secondhand smoke is harmful to health, increasing the risk of heart disease and lung cancer in workers chronically exposed to it. In response to a list of quotes going around the Internet claiming that relative risks less than 2 are so unreliable that they may be ignored (conveniently enough, most relative risks reported for exposure to SHS are in the 1.2 to 1.3 range), I pointed out what a load of dishonest quotemining the list was, while Tim Lambert pointed out that it was an intentional and concerted campaign by the tobacco companies to cast doubt on the science showing SHS to be harmful. I thought I was done, but apparently I wasn’t. Or, as Michael Corleone said in The Godfather, Part III, “Just when I thought that I was out they pull me back in.”

So it was over the weekend, when the Libertarian comic who started it all tried to pull me back in. He managed to annoy me more than enough to lead me to oblige his apparent desire for some more Respectful Insolence™, except that it took a lot of effort not to drop the “respectful” part.

I probably didn’t succeed.

It started out in the comments, in which Tim Slagle stated:

I agree.

Nobody should be dragged into a bar against their will.

To which I responded:

Of course, the workers don’t necessarily have a choice but to be subjected to it for periods of time far longer than all but the most degenerate barflies. No doubt Tim will claim that no one has to work in a bar or restaurant with smoking, but that is, of course, a naively touching bit of Libertarian fantasy that has little relationship to the real world.

To which Tim made this breathtakingly bad analogy:

Coal mines exist in the “real world.” Even with modern OSHA regulations, 3% of all coal miners will still contract Black Lung Disease by the time they are 50. And I would suggest, there are far more employment opportunities in Chicago for a non-smoker, then there are in a coal mining town in West Virginia.

Should we stop mining coal? (Is it even a possibility?)

Tim seems to be arguing that exposure to SHS is an inherent risk of working in bars and restaurants that workers must simply accept or find work elsewhere. That is, of course, ridiculous. There’s nothing inherent in the work required in bars or restaurants that demands exposure to SHS, other than tradition. In contrast, exposure to coal dust is a risk inherent to working in coal mines that can’t be completely eliminated. You can’t change the properties or location of coal to prevent worker exposure to coal dust. Even so, guess what? We do try to decrease that risk as much as possible. In fact, assuming that Tim’s figures are correct, they are an excellent argument that OSHA should do more to decrease the unavoidable risks inherent in coal mining, not that we as a society should do less to minimize risks to workers not inherent to the job that can be fairly easily decreased in other industries.

This is where Tim decided to respond on his blog, and it was every bit what we’ve come to expect from him. In it, while calling me his “arch-nemesis” (egads, he must not have many people who are his nemesis if he considers me his “arch-nemesis”), he launches into more of the same. Before we get to the stuff that irritated the hell out of me, let’s give Tim credit for one positive admission:

But from what I had been told, any risk under 2.0, is negligible. Orac corrected those who suggested such a thing. Apparently there is no practice within epidemiology (the study of stuff like this) to discount such statistics. According to him, there has been a propaganda campaign (most probably orchestrated from inside the tobacco companies) to discredit SHS studies, and a list of suspicious quotes discrediting epidemiological studies under 2.0, has been circulating the Internet. I had to throw in the towel at this point. I’ve never studied Epidemiology, and I have to take his word for it. If he says a risk below 2.0 is significant, it is significant. I guess I was wrong…

So have I changed my mind? Yes and no. I can no longer defend the statement; “There is no science finding adverse health consequences from second hand smoke.”

Very good. There may be hope for Tim yet. Or there might have been if he hadn’t repeated a truly boneheaded analogy that he had used before in my comments:

I was going to write him a note telling him so, until I ran across this. Apparently, a recent study found there is an increased risk of developing cardiovascular disease for people who drink a can of pop every day. And look at that risk rate. Over 1.4…Apparently the risk of getting heart trouble from second hand smoke, is almost identical to drinking a can of pop every day. So working in a smoky bar, is as bad for you as a can of pop. In fact, since most people who work in bars have access to the soda gun, there is a good chance that every non-smoker in those SHS studies, drank a glass or two of pop every single day.

Can anyone spot the fallacy in that analogy? Sure, I knew you could. Drinking a can of pop every day harms no one but the person drinking the pop. (Yes, we’re both from the Midwest; so we say “pop” instead of “soda.”) Unless you’re forcing someone to drink a can or more of pop every day, it’s ridiculous to compare this to the effect of SHS. And, invoking Tim’s Libertarian principles, workers are perfectly free to ignore that soda gun and not drink pop. They are not free to stop breathing when there’s a lot of cigarette smoke in the air.

Then, sadly, Tim couldn’t resist falling into some even worse reasoning. I should have expected it, given the Photoshopped image of Orac in a Maoist backdrop, which didn’t annoy me the first time I saw it but does now. (Someone comparing me to Maoists or Communists always annoys the hell out of me. I’m funny that way.) Then, not unexpectedly, Tim launched into an argumentum ad Nazi-ium so bad that I seriously thought of siccing the Hitler Zombie on him:

On the other side of the debate, is a motivation far more insidious. It is a desire for power. Many people who see the debate as manipulated solely by tobacco money, never look at that angle, nor recognize that for some, power is far more seductive than profit. There was a very power-hungry person, who once advocated smoke free workplaces. He is the one who cannot be named. (Not because there are dark powers associated with the name, it is because current protocol dictates that the first person to invoke his name, automatically loses the debate … spend a little time playing with you Googler, and I’m sure you’ll figure it out.) But I think it’s no coincidence that one of the worlds’ most infamous megalomaniacs, didn’t want people smoking around him.

The “one who cannot be named”? Who is Tim talking about? Lord Voldemort? It’s as if Tim thinks that by not actually writing the name he can pretend that his brain hasn’t actually been chomped on by the Undead Führer.

Actually, it would have been better if he were referring to You Know Who. In fact, what I suspect that Tim to be referring to is Robert Proctor’s book, The Nazi War on Cancer. It’s a fascinating read, and very instructive. Not surprisingly, its take-home message is far more complex than the facile “Hitler tried to ban smoking” ploy that smoking ban foes like Tim trot out all too frequently as an all-purpose means of invoking Godwin. Let’s put it this way: Just because the Nazis were the first to do studies that found the epidemiological link between cigarette smoking and lung cancer and tried to discourage smoking through public health measures, taxation, and advertising does not mean that efforts to ban indoor smoking must be a sign of incipient Nazi-ism or fascism or that the motivations of those who seek to decrease smoking or ban indoor smoking must derive from a lust for power. Let’s put it another way: The Nazis collected taxes on cigarettes; that doesn’t mean collecting taxes on cigarettes is a sign of incipient fascism. The Nazis had a rather interesting charitable program called the Winter Charity (Winterhilfswerk), where they collected money to distribute to the poor. (Its slogan was “None shall starve nor freeze” and the program was designed to provide food and fuel to indigent Germans.) That doesn’t mean that running a charity is a sign of incipient totalitarianism. The Nazis built the first superhighway, the Autobahn. That doesn’t make building superhighways a sign of incipient Nazi-ism. In other words, just because the Nazis did something that many governments might find legitimate reasons to do does not necessarily mean that our doing the same thing is a sign of Nazi-ism or fascism or that the motivation must be a lust for power. Unfortunately, what Tim said is only a slightly watered down version of the same analogy that one particularly loony commenter used. All that’s missing is the New World Order conspiracy-mongering and an explicit appeal to Hitler’s name.

As you can imagine, I don’t particularly like being compared to Hitler, regardless of how oh-so-coyly Tim couches his comparison. (By the way, you don’t have to mention Hitler’s name for Godwin’s law to apply, particularly when it is mind-numbingly clear to whom you are referring.) I like it even less when, after lamenting how many bars have supposedly closed as a result of smoking bans, Tim says:

But I wouldn’t expect Orac to understand. Some people just don’t care about the plight of the average Joe. To them it’s just about the numbers. It’s why I often find myself butting heads with Statists. I care more about the impact of Global Warming legislation on the economy today, than I worry about a projected 23 inches of ocean rise. I am more concerned about the real loss incurred by bar owners, than some mythological non-smoking waitress, who couldn’t find work anywhere else. But these people let their egos run out of control, and presuppose they know more than the individual business owners.

Quite frankly, it’s taking a lot of restraint on my part to refrain from violating my usual blog policy about not directing the f-word at Tim here. I highly resent Tim’s accusation. Even if his figures are correct (and, given the biased source from which they come, a blog run by a man who proclaims that his livelihood was destroyed by a smoking ban, I have my doubts that they tell the whole story but will have to investigate further to decide), I could retort that Tim apparently cares for the “little guy” even less than he thinks I do. After all, he apparently thinks nothing of expecting hospitality workers to expose themselves to potentially harmful smoke as a condition of employment and blithely says that they can just find another job doing something else if they don’t want to expose themselves to the elevated risk of heart disease and respiratory diseases due to prolonged exposure to SHS. He dismisses workers harmed by SHS and the concerns that they can’t find work in other industries as “mythical.” Unfortunately, these workers are not “mythical,” and fortunately there is emerging evidence that indoor smoking bans are already improving their health. Indeed, in New York, air quality in hospitality venues has improved markedly since the ban, and a recent study showed that the indoor smoking ban in New York has already resulted in lowered levels of biomarkers of SHS exposure. Such bans are also associated with improvements in symptoms, spirometry measurements, and systemic inflammation of bar workers. Tim also neglects to note that a 30% increase in heart disease due to SHS could be very significant, given how common heart disease is in the general population. Denying this evidence hardly shows “concern for the little guy” that Tim claims to value so highly, particularly since the economic impact in Minnesota may be neutral or not nearly as bad as the anti-ban advocates claim, results similar to New York City, where bar and restaurants do not seem to be hurting since the ban.

It’s too bad. There could have been a reasonable discussion about whether the hazards posed by SHS, which are moderate, merit indoor smoking bans, once Tim had reluctantly admitted that science supports the contention that SHS is harmful. I’ve said from the beginning that these issues are not necessarily black and white or easy to sort out and have even pointed out that extrapolating the data on SHS to try to support outdoor smoking bans, for example, is utterly ridiculous. Everything in politics–yes, even Libertarian politics–and law is a balance between competing interests, more than one of which are usually valid, in this case, avoiding unnecessary harm to workers versus the potential economic impact. Instead of basing an argument on why his favored interests (decreased regulation, personal freedom regardless of whether it might pose a risk to others) trump the scientifically demonstrated harmfulness of SHS, Tim seems to feel the need to label those who come down on the side of indoor smoking bans as, in essence, Nazis who don’t care about the little guy. And, no, that’s not a straw man. Read his entire post if you don’t believe me.

But, in fact, it’s even worse than that, because Tim finishes by returning to a theme that irritated the hell out of me enough in the first place to post about it originally. Yep, we nasty, fascistic scientists who want power and will supposedly abuse science to attain it, are once again portrayed as childhood geeks who are now getting even with the cool kids, who, apparently, besides being rich enough to afford Hummers and big houses that contribute to global warming, also smoked:

This whole argument started over a bit I did, about how scientists probably got beat up on the dodgeball court when they were kids. I was trying to illustrate how some nerdy kids will grow up bitter with a disregard for humanity, and they disguise this disregard as logic. Orac started this thread disputing my allegation.

He might think that a bar should be able to survive, just by providing a place to drink, but statistics prove otherwise. At least a hundred families in Minnesota have lost their life investment, and at least a thousand more people are now out looking for work. Meanwhile there has been a recession in the various industries surrounding food and beverage in the Twin Cities. How could anyone think that is, an acceptable sacrifice? Or maybe nobody really does. Maybe they are just getting even for Dodgeball.

Actually, this whole argument started about several bad arguments and misrepresentations of science that Tim used in his act, only one of which was his idiotic routine about geeks who got beat up and excluded from the cool kids’ parties, some of whom, according to Tim, grew up to become scientists who would later wreak horrible vengeance upon their former tormentors by exaggerating the dangers of global warming, the better to separate them from their CO2-belching SUVs and large houses. Now, apparently, we’re at it again, exercising our Maoist and Nazi tendencies (what, no mention of Stalin?–I’m disappointed), this time to use the dangers of SHS as a cudgel to beat the hospitality industry over the head with and bring about its demise and-cackle, cackle–get thousands of bartenders and wait staff fired. Why? Because, he seems to really think that we want power and don’t care about the little guy, hence our nefarious plan for vengeance on those drinking, smoking cool kids who are now adults.

I think the most revealing part of Tim’s post, though, is here:

The reason why I am suspicious of things like Second Hand Smoke, and Global Warming is not because I am anti-science. I actually enjoy science. I spent some time in college studying it, (and if I hadn’t decided I like beer and girls better, I might be studying it still.) Actually, I am antiregulation, and anytime somebody tells me that science has proven a need to regulate my life, I get really suspicious.

I retort that Tim appears to like science when it provides him useful and cool things like iPods, plasma TVs, the treatments of modern scientific medicine, computers, pictures of galaxies and supernovas, and all the wonders of technology and knowledge. Then science is neat. But when science tells Tim something that he doesn’t want to hear, something that he doesn’t like, something whose consequences suggest that some sort of government action or regulation might be advisable or that some sort of change in human behavior should be encouraged, for example, that human activity is contributing to global warming or that SHS exposes hospitality workers to an increased risk of respiratory ailments, lung cancer, and heart disease, suddenly Tim doesn’t like science so much anymore. Suddenly, in his eyes and his comedy routine, scientists become power-hungry geeks seeking to impose their will on the rich and/or cool kids who excluded them or beat them up. He can’t refute the science; so he attacks the messengers, the scientists whose work supports these findings, using his comedy as a weapon during his act.

That sort of thing may work in comedy, but it’s a sad excuse for an argument.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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