Environmental tobacco smoke: formulating public health policy for environmental carcinogens
A recent article on environmental tobacco smoke in your journal (1)
and the correspondence that it provoked, contributed little to public
health policy. It was reasonable to conjecture that the outcome would be
unsatisfactory with the climate of distrust arising from the anti-smoking
activists’ conspiracy theories having been confirmed by legal discovery of
the tobacco industry’s confidential archives.
The problem for bodies concerned with influencing or formulating
public health policy in relation to lesser exposures to agents generally
acknowledged to cause cancers at higher doses, applies equally to “low”
levels of ionizing radiation, and to a large number of other potentially
carcinogenic environmental agents. Unfortunately with today’s expectations
that the excess mortality of a population exposed to a hazardous agent
should be less than 1:100,000, epidemiological methodology is unable to
validate such standards with any degree of confidence.
There are those who support continued exposure to low levels of
carcinogenic agents on the assumption that there is a threshold below
which there is no longer a risk, in the case of ionizing radiation there
are even some who maintain that exposure to low doses promotes longevity.
The more prudent public health experts subscribe to a 'no threshold'
policy for carcinogens, and while acknowledging that zero exposure to many
agents is not achievable for those numerous agents that enter the
environment by "natural" means, decline to approve their addition from
unnatural sources. For this reason they would recommend avoidance of
exposure to the carcinogens present in tobacco smoke forthwith, rather
than deferring a decision until the conversion of the sceptics.
(1 Enstrom JE, Kabat, GC. Environmental tobacco smoke and tobacco
related mortality in a prospective study of Californians, 1960-98. BMJ
2003;326:1057. (17 May.)
Rapid Response:
Environmental tobacco smoke: formulating public health policy for environmental carcinogens
A recent article on environmental tobacco smoke in your journal (1)
and the correspondence that it provoked, contributed little to public
health policy. It was reasonable to conjecture that the outcome would be
unsatisfactory with the climate of distrust arising from the anti-smoking
activists’ conspiracy theories having been confirmed by legal discovery of
the tobacco industry’s confidential archives.
The problem for bodies concerned with influencing or formulating
public health policy in relation to lesser exposures to agents generally
acknowledged to cause cancers at higher doses, applies equally to “low”
levels of ionizing radiation, and to a large number of other potentially
carcinogenic environmental agents. Unfortunately with today’s expectations
that the excess mortality of a population exposed to a hazardous agent
should be less than 1:100,000, epidemiological methodology is unable to
validate such standards with any degree of confidence.
There are those who support continued exposure to low levels of
carcinogenic agents on the assumption that there is a threshold below
which there is no longer a risk, in the case of ionizing radiation there
are even some who maintain that exposure to low doses promotes longevity.
The more prudent public health experts subscribe to a 'no threshold'
policy for carcinogens, and while acknowledging that zero exposure to many
agents is not achievable for those numerous agents that enter the
environment by "natural" means, decline to approve their addition from
unnatural sources. For this reason they would recommend avoidance of
exposure to the carcinogens present in tobacco smoke forthwith, rather
than deferring a decision until the conversion of the sceptics.
(1 Enstrom JE, Kabat, GC. Environmental tobacco smoke and tobacco
related mortality in a prospective study of Californians, 1960-98. BMJ
2003;326:1057. (17 May.)
Competing interests:
None declared
Competing interests: No competing interests