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PAPERS: Sarah Hill, Tony Blakely, Ichiro Kawachi, and Alistair Woodward Mortality among "never smokers" living with smokers: two cohort studies, 1981-4 and 1996-9 BMJ 2004; 328: 988-989 [Full text]

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Biophysical-Semeiotics Constitutions in bed-side Evaluating Mortality due to passive Smoking.

Sergio Stagnaro   (23 April 2004)

How exposed is the exposure?

Anne Loring, 48 Liverpool St Hobart Tasmania 7000   (23 April 2004)

Death and denial: Secondhand smoke mortality evidence, politicians and advocacy

George W Thomson, Nicholas A Wilson   (20 May 2004)

Biophysical-Semeiotics Constitutions in bed-side Evaluating Mortality due to passive Smoking. 23 April 2004
Sergio Stagnaro, Specialist in Blood, Gastrointestinal, and Metabolic Diseases Via Erasmo Piaggio 23/8 16037 Riva Trigoso (Genova) Italy. Send response to journal: Re: Biophysical-Semeiotics Constitutions in bed-side Evaluating Mortality due to passive Smoking.	Sirs, As allows me to state 46-year-long clinical experience whith the aid of Biophysical Semeiotics (See later on), the association between passive smoking and all cause of mortality (1) can be accepted, but with a precise limitation, according to Single Patient Based Medicine (2, 3) rather than EBM (See HONCode website, www.semeioticabiofisica.it, as well as www.microangiologia.it: SPBM). In fact, as author’s conclusion states, “mortality among never smokers was greater in those living in households with a current smoker”, but - I add - exclusively in individuals with some precise biophysical-semeiotic constitutions – diabetic, arteriosclerotic, oncological, dyslipidemic, hypertensive (See first above-mentioned website), and not certainly in “all” other people. In addition, as regards mortal heart events, we can now-a-days recognize “clinically”, and in a few minutes,symptomless individuals, apparently healthy, but at real risk of CAD, in a “quantitative” way (4, 5). Finally, oncogenesis is based necessarily on the overlooked Oncological Terrain, I described earlier in a lot of papers (See: Oncological Terrain in the cited website and in its Bibliography) as well as in my next book (6). 1)Hill H., Blakely T., Kawachi I., Woodward, Mortality among "never smokers" living with smokers: two cohort studies, 1981-4 and 1996-9. BMJ 2004;328:988-989 (24 April), doi:10.1136/bmj.38070.503009.EE (published 5 April 2004) 2) Stagnaro S. http://bmj.com/cgi/eletters/326/7398/1048#32299 , “Single Patient Based Medicine” versus EBM. (16 May 2003). 3) Stagnaro S. http://bmj.bmjjournals.com/cgi/eletters/327/7427/1324,Biophysical Semeiotics, EBM, and SPBM useful in treating children with soare throat. (5 December 2003) 4) Stagnaro-Neri M., Stagnaro S., Deterministic Chaos, Preconditioning and Myocardial Oxygenation evaluated clinically with the aid of Biophysical Semeiotics in the Diagnosis of ischaemic Heart Disease even silent. Acta Med. Medit. 13, 109, 1997 5) Stagnaro S. A clinical efficacious maneouvre, reliable in bed-side diagnosing coronary artery disease, even initial or silent, as well as “heart coronary risk”. 3rd TCVC Argentine Congress of Cardiology, September 2003 . http://www.fac.org.ar/tcvc/marcoesp/marcos.htm 6) Stagnaro-Neri Marina, Stagnaro Sergio. Introduzione alla Semeiotica Biofisica. Il Terreno oncologico”. Travel Factory SRL. info@travelfactory.it, Roma, 2004. Competing interests: None declared
How exposed is the exposure? 23 April 2004
Anne Loring, Paediatric Nurse Royal Hobart Hospital, 48 Liverpool St Hobart Tasmania 7000 Send response to journal: Re: How exposed is the exposure?	Ever since the dangers of passive smoking were first brought to the attention of the general public, attempts - some genuine, some lip service only - have been made by many smokers to minimise exposure to others of their smoke. These attempts typically include: going outside the house to smoke; allocating one room in the house to smoke in; opening windows in houses/cars; using extraction fans; standing at the far end of the room................. I look forward to a study that evaluates the effectiveness or otherwise of such measures. Smokers as a group, I have found, have blinkers on about the harmfulness of this habit - to themselves and others - and it seems only well-publicised hard data provide the necessary impetus to force change. We're getting there, but have such a long way to go still! Competing interests: Expecting my mortality to be 15% higher than it might otherwise have been.
Death and denial: Secondhand smoke mortality evidence, politicians and advocacy 20 May 2004
George W Thomson, Research Fellow Department of Public Health, Wellington School of Medicine, University of Otago, 6002, Nicholas A Wilson Send response to journal: Re: Death and denial: Secondhand smoke mortality evidence, politicians and advocacy	We welcome the additional substantive evidence by Hill et al, based on national census and mortality data, on the risk of death from second- hand smoke (SHS) exposure.1 There was already sufficient evidence linking SHS to adverse health effects to justify the widespread implementation of smokefree environments legislation in public and work places. Nevertheless, additional high quality evidence is of value, as both the tobacco industry and some lawmakers continue to cast doubt on this risk to health. For example, in the New Zealand context, British American Tobacco (BAT) were reported to say to the Health Select Committee of Parliament in November 2002 that: ‘in our view, it has not been established that ETS exposure genuinely increases the risk of nonsmokers developing lung cancer or heart disease’2 Currently, the BAT New Zealand website states: ‘… we think that many of the claims against environmental tobacco smoke have been overstated. Specifically, we don’t believe that it has been shown to cause chronic disease, such as lung cancer, cardiovascular disease or chronic obstructive pulmonary disease, in adult non-smokers. …. the studies on lung cancer to date suggest that if there is a risk, it is too small to measure with any certainty. ….’3 These reservations about the evidence on SHS harm appear to be shared by some New Zealand politicians. During the parliamentary debates in late 2003 on the New Zealand Smoke-free Environments Bill, Members of Parliament (MPs) from three different parties cast doubt on the evidence – Doug Woolerton, Richard Worth and Peter Dunne.4,5,6 Mr Dunne is the leader of the United Future Party, on which the current Labour-led Government has been relying for support for much of the time since the 2002 election. In an attempt to substantiate a claim that ventilation could be used to adequately deal with SHS, Dunne referred to a BMJ article – apparently that by Enstrom and Kabat7 – saying ‘the article states that the actual risks associated with [SHS] are minimal’.6 A fourth New Zealand MP, Dail Jones,8 doubted the adequacy of the methods used to estimate the mortality from SHS in New Zealand.9 In 2002, the then leader of the Parliamentary Opposition, Bill English (an ex Minister of Health), justified his support for smoking in bars by describing the consequent danger as ‘a small health risk’.10 Politicians’ inability to understand, or refusal to accept, the evidence on SHS is an argument for providing additional robust data linking SHS to increased mortality rates. It is also an argument for the increased investment in advocacy by health organisations, to help ensure that such evidence is accepted and acted on by policymakers.11,12 References 1) Hill S, Blakely T, Kawachi I, et al. Mortality among "never smokers" living with smokers: two cohort studies, 1981-4 and 1996-9. BMJ 2004; 328(7446):988-9. 2) New Zealand Press Association. Tobacco giant asks for balanced approach to new smoking bans. Wellington, INL Newspapers. 6 November 2002. 3) British American Tobacco New Zealand (2004) Environmental tobacco smoke. Auckland, British American Tobacco New Zealand. Accessed May 17, 2004. http://www.batnz.com/oneweb/sites/BAT_5LPJ9K.nsf/vwPagesWebLive/802 56D0B004C1BC780256ABE005B6B21?opendocument&DTC=20040414 4) Woolerton R. Speech on the Smoke-free Environments Amendment Bill: In Committee. Wellington, New Zealand House of Representatives Parliamentary Debates (Hansard). October 15, 2003. 5) Worth R. Speech on the Smoke-free Environments Amendment Bill: In Committee. Wellington, New Zealand House of Representatives Parliamentary Debates (Hansard). November 12, 2003. 6) Dunne P. Speech on the Smoke-free Environments Amendment Bill: In Committee. Wellington, New Zealand House of Representatives Parliamentary Debates (Hansard). November 12, 2003. 7) Enstrom J, Kabat G. Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98. BMJ 2003; 326(7398):1057-61. 8) Woodward A, Laugesen M. How many deaths are caused by second hand smoke? Tobacco Control 2001;10:385-388. 9) Jones D. Speech on the Smoke-free Environments Amendment Bill: In Committee. Wellington, New Zealand House of Representatives Parliamentary Debates (Hansard). October 15, 2003. 10) English B. Interview on Radio New Zealand: Morning Report. Wellington, Newztel. 1 July 2002. 11) Asbridge M. Public place restrictions on smoking in Canada: assessing the role of the state, media, science and public health advocacy. Soc Sci Med 2004; 58(1):13-54. 12) Chapman S, Wakefield M. Tobacco control advocacy in Australia: reflections on 30 years of progress. Health Educ Behav 2001; 28(3):274-89. Competing interests: George Thomson: Contracts with ASH NZ, NZ Cancer Society, NZ Heart Foundation, NZ Smokefree Coalition