Het Ministerie van VWS heeft ingestemd in een onderzoek naar de toepassing van ventilatie als oplossing voor de blootstelling aan tabaksrook in de horeca. Hetzelfde is al eerder gebeurd in Toronto, Canada: de Black Dog studie.
Bijgaand verhaal beschrijft hoe de anti-rokenbeweging in Canada geprobeerd heeft de resultaten onder het tapijt te werken en, ondanks dit wetenschappelijk bewijs, bleef proberen door te drukken dat er een compleet rookverbod zou worden ingevoerd.
Het is allesbehalve ondenkbaar dat deze zelfde aanpak ook door het Ministerie zal worden gevolgd.
Men zij gewaarschuwd!
Sheela Basrur, Junk Science and Phantom Risks
You would have thought that between SARS and the looming return of West Nile that Toronto’s Medical Officer of Health would have a fairly full plate.
But the good doctor appears to never let real health risks get in the way of the important work of her unit- using junk science to stamp out phantom risks. So last Monday while the numbers of SARS deaths continued to grow Dr. Basrur and the Board of Health ran an eight hour meeting devoted to the hugely important health risk of, yes, Designated Smoking Rooms (DSR’s are fully enclosed and separately ventilated spaces where smoking in bars and restaurants is permitted.)
Dr. Basrur’s role in the phantom DSR health risk is an interesting one. In 1999 she presented the Board of Health and City Council with a paper outlining the “science” of secondhand smoke risks and a menu of policy options about what to do about this allegedly major health problem. Unfortunately Basrur’s understanding of the risks of secondhand smoke and the ways to deal with those risks was deficient in at least three respects.
First, true to the junk science tradition, she failed to provide any primary scientific studies that supported her claim that secondhand smoke is a substantial health risk for non-smokers, despite the fact there were more than 70 such studies on secondhand smoke and lung cancer risks alone at the time. But it wouldn’t do to have a Medical Officer of Health burdening her political masters or the public with the science of an issue.
Second, consistent with good junk science, Dr. Basrur ignored the most recent evidence available about the risks of secondhand smoke in public places. The evidence came from a very large study, conducted by the World Health Organization, in seven European countries over ten years. The study was particularly important since it specifically examined secondhand smoke risks in public places like restaurants- which was one of Dr. Basrur’s main areas of concern. The study found that there was no increased risk of lung cancer to non-smokers in restaurants- despite the large amount of public smoking in Europe. A very relevant finding for whether Toronto needed to be smoke-free, but also a terribly inconvenient one for Dr. Basrur.
Third, despite her training as a scientist, Basrur refused to accept the results of a scientific experiment on the effectiveness of ventilation in dealing with secondhand smoke, funded by the Ontario Restaurant Association. The experiment at Toronto’s Black Dog Pub was designed and carried out by the US Government’s Oak Ridge National Laboratory and the Center for Toxicology and Environmental Health. Since Dr. Basrur had claimed that ventilation of smoking areas could not protect non-smokers from secondhand smoke, the experiment at the Black Dog was designed to determine whether ventilation could indeed work.
The results were dramatic, but again very inconvenient for Dr. Basrur. They found that with properly designed ventilation the air quality in the non-smoking portion of the Black Dog was comparable to the air quality in a completely smoke-free establishment, even though the Black Dog permitted smoking next to the non-smoking area. So despite the Medical Officer of Health’s claims about ventilation failing to protect non-smokers, the real time experiment of the Black Dog proved that ventilation did work. Equally important in terms of health gains for both non-smokers and smokers, the study found that ventilation systems like those used in the pub provided a “substantial improvement in overall indoor air quality.
In a world where public health policy was crafted with more than a passing nod to rationality, the Black Dog experiment would have proved decisive. Here was proof- not in some obscure, far-off place, but right in the home town, that ventilation could be a win for everyone. Nonsmokers are protected from secondhand smoke, and gain a bonus from cleaner air. Smokers are allowed to smoke in properly ventilated areas. Restaurant and bar owners and employees sensitive to the economic impact of smoking bans can still cater to their smoking patrons. And public health achieves its goal of protecting nonsmokers from secondhand smoke.
But the Toronto of 1999 was not ready for rational public health policy when it came to public smoking. Despite the Black Dog results, Dr. Basrur, the Board of Health and City Council stubbornly clung to their junk science views that secondhand smoke kills and that the only solution is to ban public smoking. The reason for this attachment to junk science and phantom risk is to be found in the nature of junk science itself, for at bottom junk science is really not about science but about ideology, in this case the ideology that people- even adult people- should be prevented by every conceivable means from smoking.
Buried in Dr. Basrur’s report is in fact an admission of this. She notes that “preventing people from smoking in public can also help reduce smoking rates by reducing the number of places where people can smoke.” So the truth is that this isn’t about protecting non-smokers at all. It’s all about preventing smokers from smoking. Whatever science says about secondhand smoker or ventilation is not really important so long as we can make it tough for people in Toronto to smoke.
But what about the Toronto of 2003? The 1999 by-law contained a compromise that allowed for DSR indefinitely. In January of this year, Dr. Basrur, in a new report to the Board of Health, urged the Board to “revisit”, read repeal, the City’s policy on DSR. Which is what, in the midst of one of its most significant health emergencies, the Board did last Monday.
Now Basrur’s new report is curious in a number ways. First, Basrur is still worried about the Black Dog. She continues to claim that its ventilation solution does not protect people from secondhand smoke when in fact the non-smoking section of the Black Dog has air that is equivalent to and in some instances better than the air in completely non-smoking establishments.
But what she fails to tell her Board and City Council is that not only has the Black Study now been published in a peer-reviewed scientific journal, (2002) but that in the year since its publication the journal has received no criticisms of it nor studies refuting its claims. So even more extraordinarily than in 1999 Dr. Basrur continues to make her junk science claims in the face of published, scientific evidence that she is wrong.
But Basrur’s report is curious in a second way. In 1999 she told her Board, Council and the public that “Full protection [from secondhand smoke] is achieved only in a smoke-free environment, or where there is a fully enclosed and separately ventilated DSR.” Why then were these rooms able to provide “full protection” in 1999 and not in 2003? What has changed? The supposed answer is an easy one-liner “the risk to employee health could be substantial.” There it is- junk science at its most blatant. Basrur feels no need to explain, no need to provide evidence, let alone scientific evidence, about the alleged risks of DSR, no need for anything more than an assertion. Has Toronto, for instance seen an increase in health related problems for employees working in DSR? Is there new, published scientific evidence about worker risk in DSR? The evidence from the US OSHA directly contradicts Basrur in that it suggests that work-related illnesses and fatalities for service industry workers have actually fallen despite substantial increases in employment.
Of course the real answer has nothing to do with employee health: Dr. Basrur simply doesn’t want people smoking anywhere in Toronto. DSR were simply a sham compromise to make the ban on public smoking appear less draconian.
Equally odd is the fact that Basrur neglects to tell her Board and City Council that last year British Columbia adopted a new regulatory regime to address exactly the problem that she thinks is insoluble- ventilation. The most important difference in BC’s approach as opposed to Toronto’s is that it is actually based on real science.
After examining the science behind ventilation and the likely secondhand smoke exposures faced by employees in DSR, the BC government brought in regulations which not only allow for DSR but also protect employee health by specifying the amount of time that any employee can work in a DSR during a 24 hour period. One can understand Basrur not agreeing with this approach, after all perhaps she knows something that the BC government and its scientists don’t, but not telling her Board and City Council looks a lot like a cover-up.
Finally, what about the regulatory principle that regulations should be consistent and certain without huge changes in direction? Since 1999 hospitality owners have invested significant amounts of money in DSR on the basis of a policy that permitted them indefinitely. They were told by the Medical Officer of Health that they provided full protection from secondhand smoke. Now, without a scrap of scientific support the same Medical Officer of Health is proposing a complete regulatory about face.
At the end of the day the most important issue here is not whether people can continue to smoke in DSR in Toronto, but whether public health policy will continue to be made based on a Medical Officer of Health’s junk science. Coupled with Dr. Basrur’s scientifically illiterate assault on pesticides (See Terrence Corcoran’s editorial from April 5, 2003), her recent policy work on DSR points to a deeply flawed understanding not only of science but of the way in which science should guide policy. For Dr. Basrur it looks increasingly like first you decide the policy and then you “create” the science.
The wonderful thing about science however, is that in the midst of all the subjective cut and thrust that is part of the public policy process, it provides one of the few reasonably objective measures of what is true. By allowing junk science to pass as genuine science and provide the basis for social regulations on smoking, pesticides or anything else, we not only devalue science but risk losing our single most valuable resource in the public policy process. And that is a sure preion for ill health.
John Luik is a public policy consultant.