Friday, February 10, 2006

Passive Smoking

Dr Crippen of NHSBlogDoc posted earlier in the week on the topic of tobacco advertising that targets children in poisoning children again.

This led to a discussion on passive smoking, and Dr Dork has built upon the opinion he originally gave on NHSBlogDoc below.

Dr Dork doesn't like smoking, to be utterly frank. It is an addictive habit, and it kills many people. Dr Dork doesn't like things that kill people.

If one smokes in the privacy of ones own home, however detrimental to ones health it may be, this harm is limited to, well, oneself. When someone inflicts harm upon others as well, in Dr Dorks mind, it becomes a public health issue.

Passive smoking in confined spaces has been well estabilished to cause harm to innocent bystanders, and to employees working in those confined spaces. Some examples of research are provided Here and here and here and especially this below, which is the abstract from a 2001 meta-analysis (ie. statistical summation of all available evidence) from the Australian and New Zealand Journal of Public Health:

Aust N Z J Public Health. 2001 Jun;25(3):203-11.
Passive smoking and lung cancer: a cumulative meta-analysis.

Taylor R, Cumming R, Woodward A, Black M.

Department of Public Health and Community Medicine, Faculty of Medicine, The University of Sydney, New South Wales.

OBJECTIVE: To review the epidemiological evidence for the association between passive smoking and lung cancer. METHOD: Primary studies and meta-analyses examining the relationship between passive smoking and lung cancer were identified through a computerised literature search of Medline and Embase, secondary references, and experts in the field of passive smoking. Primary studies meeting the inclusion criteria were meta-analysed. RESULTS: From 1981 to the end of 1999 there have been 76 primary epidemiological studies of passive smoking and lung cancer, and 20 meta-analyses. There were 43 primary studies that met the inclusion criteria for this meta-analysis; more studies than previous assessments. The pooled relative risk (RR) for never-smoking women exposed to environmental tobacco smoke (ETS) from spouses, compared with unexposed never-smoking women was 1.29 (95% CI 1.17-1.43). Sequential cumulative meta-analysed results for each year from 1981 were calculated: since 1992 the RR has been greater than 1.25. For Western industrialised countries the RR for never-smoking women exposed to ETS compared with unexposed never-smoking women, was 1.21 (95% CI 1.10-1.33). Previously published international spousal meta-analyses have all produced statistically significant RRs greater than 1.17.
CONCLUSIONS: The abundance of evidence in this paper, and the consistency of findings across domestic and workplace primary studies, dosimetric extrapolations and meta-analyses, clearly indicates that non-smokers exposed to ETS are at increased risk of lung cancer. IMPLICATIONS: The recommended public health policy is for a total ban on smoking in enclosed public places and work sites.

Note: The emphasis is Dr Dorks. "ETS"= environmental tobacco smoke

It is difficult to design a trial to accurately measure the degree of impact of passive smoking. This is due to logistical problems in measuring the extent of exposure, and also, given that evidence is already there that there is some level of harm, it is highly unethical to knowingly expose anyone to passive smoke.

The evidence is there, it is strong, you just need to know where to look. The evidence of harm is strongest in regards to harm to the health of children and pregnant women. Dr Dork also feels strongly that it is an occupational health issue - does ones "right to smoke" in a pub override the right of the hotel employees to not have their risk of lung cancer, asthma exacerbations, even heart disease be increased ?

Does ones civil liberties, which Dr Dork greatly values, entail the right to cause harm to others in the pursuit of ones personal pleasure ?

Dr Dork is interested in what his readers think. He provides some case scenarios for consideration :

1. A mother of a young child with severe asthma smokes in her car, and in her home. The child has frequent episodes of asthma requiring hospital admission, triggered by the mothers smoking. Is this a form of child abuse ?

2. A pub employee of many years develops lung cancer of a type clearly associated with smoking. She has worked in a crowded, smoky pub for 25 years, but has never smoked herself. Is her employer, the pub owner, liable for her illness for exposing her to passive smoking ?

3. There is evidence that secondhand smoke can trigger acute cardiovascular illness, such as heart attacks and strokes, in those at risk for other reasons. A smoker blows smoke in the face of an elderly gentleman after the gentleman requests he not smoke around him. The elderly gentleman immediately suffers a heart attack and dies. Is this manslaughter ?

This is a thorny issue. Dr Dork doesn't pretend to have all the answers.

If you are a smoker and are considering quitting, Dr Dork recommends you go

1 comment:

Michael Price said...

Adenocarcinoma accounts for 29.4% of lung cancers. It usually originates in peripheral lung tissue. Most cases of adenocarcinoma are associated with smoking. However, among people who have never smoked ("never-smokers"), adenocarcinoma is the most common form of lung cancer. A subtype of adencarcinoma, the bronchioloalveolar carcinoma, is more common in female never-smokers, and may have different responses to treatment.

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