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Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98

BMJ 2003; 326 doi: (Published 15 May 2003) Cite this as: BMJ 2003;326:1057

Rapid Response:

An interesting debate

Professor Repace I thank you for your reply.

As we all know the dose makes the poison. Let me ask you what would
you prefer, to be in a garage for a hour with a smoker or a car with its
engine running?

So let us consider the evidence that exists for SHS for PM2.5 and
other poisons and carcinogens.

In 1991 Drs. Gori and Mantel conducted an experiment on some of the
carcinogens in tobacco smoke and assumed the person was in a 100m3 room
sealed and unventilated.

"Estimated number of cigarettes required to reach TLV
levels from sidestream smoke emission of selected chemicals
in a sealed and unventilated 100 m3 enclosure (Gori and Mantel, 1991) (1)

(Please note: 100 m3 are equivalent to a room 22' x 21' x 8' ceiling,
or 3,696 cubic feet)

SSS = Side Stream Smoke (Worse than passive smoke, as it is measured
by holding the electronic sniffer right on top of the burning end of a
cigarette, thus prior to any environmental dilution) TLV = Threshold Legal

The first nimber is SSS Component mg/cigarette
The second is SSS output mg/m3
The third is Cigarettes required

Methylchloride 0.88 0.30 1,170

Acetaldehyde 1.26 180.00 1,430

Nitrogen oxides 2.80 50.00 1,780

Phenol 0.25 19.00 7,600

Benzene 0.24 32.00 13,300

Dimetylamine 0.036 18.00 50,000

Benzo(a)pyrene 0.00009 0.20 222,000

Polonium 0.4pCi 3pCi/l 750,000

Toluene 0.000035 375.00 1,000,000

Not one comes close to any physically attainable danger level.

You mention heart attacks, again since smoking bans have come in
where are the reductions? A meta analysis of heart attacks in America
conducted by the universities of Stanford and Wisconsin "examined a total
of 217,023 heart attack admissions and 2.0 million heart attack deaths in
468 counties in all 50 states over an eight-year period." Its conclusions

"1. "In contrast with smaller regional studies, we find that
workplace bans are not associated with statistically significant short-
term declines in mortality or hospital admissions for myocardial
infarction or other diseases."

2. "An analysis simulating smaller studies using subsamples reveals
that large short-term increases in myocardial infarction incidence
following a workplace ban are as common as the large decreases reported in
the published literature."

Other studies around the world have also confirmed that smoking bans
do not lead to less heart attacks, including the ill fated Scottish study.
Triumphed throughout the world as proof positive, the study was just
another example of the SHS junk science of publication bias. The project
leader Professor Jill Pell conveniently left out January and February
months, of course, which see the highest number of heart attacks. The
author Chris Snowdon under a Freedom Of Information Act request has
obtained the figures. They dropped by 7.2% and the next year by 7.8,
establishing a constant non correlation with smoking bans. "Scotland
enacted its smoking ban (April 2005 to March 2006), there were 16,199
admissions for acute coronary syndrome. In the second year of the smoking
ban (April 2007 to March 2008) there were 16,212 admissions – slightly
more than there had been before the legislation was enacted." (4&5)

The same is true for England, Wales, Australia and New Zealand. (5&6)
Infact heart attacks rose after the implementation of the smoking ban in

The Professor Glantz's Helena study has been widely criticised as
publication bias. (7)

Time prevents me giving a broader answer but I will return tomorrow
with some more comments. But suffice as to say there is precious little
evidence of any increased mortality from SHS.








Competing interests:
Director: Freedom2Choose a smokers rights group. We are not funded or expensed by pharmaceutical or tobacco companies

Competing interests: No competing interests

24 December 2009
Dave Atherton