| Siegel is speaking out against the movement he helped create.|
Outdoor smoking bans rile anti-tobacco leader
Jan. 15, 2007
By Suzanne Bohan, MEDIANEWS
In the early 1990s, Dr. Michael Siegel began leading pioneering efforts to ban smoking in workplaces to protect the health of nonsmokers.
Siegel, who got his start in the anti-smoking cause while earning his master's degree at UC Berkeley, has written dozens of scientific articles on the dangers of secondhand smoke. His testimony in court and at countless city council meetings also helped push public policy toward tighter restrictions on smoking.
But now Siegel is speaking out against the movement he helped create.
Why? Today's anti-smoking crusaders, he says, have lost their moorings in science by advocating smoking bans in the last refuge for smokers -- the great outdoors.
"I've been working in this field for 21 years," said Siegel, who earned an M.D. from Yale University and a master's degree in public health from UC Berkeley. "The goal was to get rid of smoking in the workplace. I never understood that the goal was to get rid of smoking so that no one even gets a whiff of smoke.
"It's a grass-roots social movement that's been so successful that it doesn't know where to stop," Siegel continued. "It's getting to the point where we're trying to protect people from something that's not a public health hazard."
At risk, he and other like-minded tobacco control advocates assert, is not only the credibility of public health officials but also the undermining of a freedom prized in democracies -- do as you wish as long as you don't harm others.
Most of the new or proposed laws restricting outdoor smoking emanate from city council chambers, although the state Legislature is also considering a proposal to ban smoking at state parks and beaches.
A number of California cities have enacted tough regulations against outdoor smoking.
The Southern California city of Calabasas broke new ground for the United States in spring 2006 when it banned smoking in all public areas, including sidewalks. As of March 1, Emeryville will have anti-smoking laws almost as tough as Calabasas, with new widespread smoking bans, including in parks and on footpaths.
San Francisco now bans smoking in city parks, golf courses and public squares, and Belmont made international news in November with its pending proposal to ban smoking citywide, except in detached, single-family homes.
Stanton Glantz, a UC San Francisco professor of medicine and an anti-smoking firebrand who has built a legendary reputation battling the tobacco industry, is among the many public health advocates lauding efforts to outlaw smoking outdoors.
Siegel was once a student of Glantz's, but the two men are now at loggerheads over the direction of the anti-smoking movement.
"He did some very good work, once upon a time," Glantz said of Siegel.
Glantz insists there is a health effect worth worrying about with exposure to cigarette smoke outdoors, particularly for those with chronic heart disease.
"It's going to be a very small number, but there is some risk," Glantz said. "But that's true of a lot of environmental toxics, like diesel exhaust."
Glantz noted, however, that studies can't state with certainty what level of outdoor exposure to tobacco smoke could cause harm.
"Nobody has ever done a study on people who are only exposed outdoors," he said. "You can't do such a study."
Siegel, however, has a fan in Audrey Silk, a retired New York City police officer and founder of Citizens Lobbying Against Smoker Harassment.
"Siegel had an attack of conscience 18 months ago that the arguments his colleagues were making were fallacious," said Silk, as she took a long draw on a cigarette during a phone interview. She was referring to the 2005 launch of Siegel's blog, http://www.tobaccoanalysis.blogspot.com/
She's outraged over the moralistic overtones and, in her view, lack of common-sense rationale for the latest generation of anti-smoking laws.
"Nobody is even trying to keep this in check," Silk said. The laws banning outdoor smoking, she believes, aren't about protecting public health, but strong-arming smokers to quit their habit.
Activists square off
Siegel, like virtually every other expert on the health risks of tobacco smoke, applauds the nationwide movement to ban smoking in indoor, publicly shared spaces such as offices, bars and restaurants. These bans are backed by large studies linking regular exposure to secondhand smoke indoors with heart disease and cancer.
Siegel's greatest concern with the tobacco control movement today is what he views as exaggerated assertions advanced by major public health organizations, including the U.S. surgeon general's office, that fleeting exposure to secondhand smoke poses a serious public health threat.
In June, the surgeon general released an updated report on the dangers of secondhand smoke. A news release accompanying the report warned that "even brief exposure to secondhand smoke has immediate adverse effects" by increasing the odds of developing heart disease and lung cancer.
"There is no risk-free level of exposure to secondhand smoke," the release said.
The surgeon general's report, however, only addressed indoor exposure, said Terry Pechacek, associate director for science with the Office on Smoking and Health in the Centers for Disease Control and Prevention, whose office helped prepare the report.
The word "brief" is also left up to interpretation. "We can't quantify what is 'brief,'" said Pechacek, who declined to state how long an interval qualifies as "brief."
Overall, tobacco smoke is such a minuscule fraction of air pollutants that it's usually disregarded in air contaminant inventories, said C. Arden Pope, an air pollution expert at Brigham Young University in Utah, whose study on secondhand smoke exposure indoors was cited in the state report.
"Most of the time, it's so small we don't even bother trying to measure it," Pope said. Furthermore, he added, smoke from other sources, such as wood fires, barbecues and burning leaf litter, waft for waft is as hazardous to health as secondhand smoke.
Advocates of outdoor smoking bans insist that evidence suggests -- although it doesn't confirm -- that people with heart disease are indeed at risk if they routinely encounter wisps of secondhand smoke while outdoors.
Glantz, for example, said even five minutes of breathing tobacco smoke changes blood chemistry and blood vessel function enough to increase the risk of a heart attack in people with severe heart disease.
The CDC's Pechacek also explained the reason for the surgeon general's warning that even brief exposure could trigger cancer. "There is some risk that even a very small amount can damage a cell," he said, setting off a chain reaction that causes cancer.
But several doctors, Siegel among them, prominently took aim at the surgeon general's conclusions about the dangers of fleeting exposure to tobacco smoke in a 2006 article in the Journal of the American Medical Association.
"It takes many years for these chronic diseases to develop," Siegel said in the article. "We're really risking our credibility (as public health professionals) by putting out rather absurd claims that you can be exposed briefly to secondhand smoke and come down with heart disease or cancer."
Siegel doesn't buy that five minutes of exposure to secondhand smoke poses a hazard, but he agrees that 30 minutes in a smoky room could potentially endanger a person with advanced heart disease.
But those conditions wouldn't be met outside, he said. "In most outdoor places where people can move about, they can simply avoid the exposure."
Nonetheless, even small odds justify legislative action against outdoor smoking, Glantz said. "If you can't be assured the risk is zero, you should act," he said.
'Pushing the envelope'
Other tobacco control advocates share Siegel's concerns that the movement has gone too far.
Columbia University researchers Ronald Bayer and James Colgrove co-authored a 2002 article in the American Journal of Public Health critiquing anti-smoking campaigns.
"Starting in the 1970s, anti-tobacco activists drew on suggestive and incomplete data to push for far-reaching prohibitions on smoking in a variety of public settings," they wrote.
Simon Chapman, editor of Tobacco Control, the influential journal of the anti-smoking movement, wrote a scathing opinion piece in the journal titled "Banning Smoking Outside Is Seldom Ethically Justifiable."
Prohibitions on outdoor smoking "push the envelope of tobacco control into areas where questions need to be asked to ensure tobacco control policies are firmly anchored to scientific evidence," Chapman wrote, "and especially concern those who value the freedom of individuals to do what they please to the extent that this does not harm others."
Laws banning smoking on public health grounds that lack evidence, Chapman added, could create backlashes by skeptical citizens that "undermine support for other tobacco policies which, if implemented, may bring profound public health benefits to communities."
Cities take heed
Each time city lawmakers in California proposed bans on outdoor smoking in 2006, they cited findings from both the surgeon general report and a California Air Resources Board report on the health risks of even fleeting exposure to secondhand smoke, although neither report addressed health hazards of smoke encountered outdoors.
The surgeon general's declaration that there's no safe level of tobacco smoke in particular alarmed Belmont Mayor Coralin Feierbach.
On the basis of that and other assertions about the dangers of tobacco smoke, she and other council members in November voted to ban smoking citywide, except in single-family, detached homes.
"That was pivotal," Feierbach said. "No secondhand smoke is essentially safe. It's pretty scary."
The city attorney is reviewing the council's proposed law and expects to send it back to the council for a final vote in March.
"What we're trying to do," Feierbach said, "is make people aware that smoking is not something that should be done when there are other people around."
Fork in the road
Glantz believes that Siegel and his like-minded colleagues are maintaining an older viewpoint in the anti-smoking movement, which accepts that there's a level of smoking society should tolerate.
But a new way of thinking is taking hold, Glantz said, which envisions a society free from any form of tobacco smoking.
"There's another model that if smoking drops below a certain threshold, then the whole social support structure (for smoking) will collapse," Glantz explained.
"And I think we're getting pretty close to that in California," he continued. "It will be out of sight, and it won't be something people will do in polite social circles."
To Silk, founder of Citizens Lobbying Against Smoker Harassment, that comment smacks of an alarming form of intolerance taking root. "A very small minority of nonsmokers, along with the government," Silk said, "have created this atmosphere that sanctions disrespectful behavior toward smokers."
And while Glantz's vision of a smoke-free society has many supporters, Chapman, the editor of Tobacco Control, warned that such a scenario unjustifiably restricts smokers from engaging in a legal practice and risks damaging the reputation of the anti-smoking movement.
"We need to ask," Chapman wrote, "whether efforts to prevent people from smoking outdoors risk besmirching tobacco control advocates as the embodiment of intolerant, paternalistic busybodies, who, not content at protecting their own health, want to force smokers to not smoke even in circumstances where the effects are immeasurably small."
For Glantz, however, there's little room for compromise, given the health risks he's certain are posed by wafts of secondhand smoke, even outside.
"It is socially unacceptable to pollute the air and poison the people around you," Glantz said.Read
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