A FULL PAGE advertisement which has appeared in this newspaper and many others twice in the last few days insinuates that passive smoking is less risky than drinking a glass of chlorinated water, or eating a biscuit. Passive smoking (also described as second hand smoking, involuntary smoking and environmental smoke in effect, inhaling another person's poison) is "not a meaningful health risk", it assures us.
This is the work of Philip Morris, a company described by Sean Murray, its corporate affairs manager, as "the world's largest cigarette manufacturer", with a small market presence in Ireland mainly through Marlboro. Mr Murray declined to say how much Philip Morris is investing in the campaign but did concede that it targeted all major newspapers and journals in nine countries across Europe.
The background to this campaign is the commercial disaster facing the tobacco industry as more and more people believe cigarettes are lethal, sometimes even for nonsmokers. In Ireland, less than 30 per cent of now smoke and although the rates among the young remain static, the overall trend here, as throughout Europe, is downwards. Irish people are also relatively aware of the risks of second hand tobacco smoke.
The tobacco industry's response to health awareness in the Western world has been two pronged. It has targeted Asia, particularly Asian women, with a blitz of images presenting their product as glamour, allure and modernity rolled into a sophisticated smoke. In Europe, where people now believe tobacco can kill, different tactics are required. Philip Morris has now set itself up as benefactor of the common good. In Britain, for example, the Philip Morris Institute last week hosted a large conference, attended by Douglas Hurd, John Redwood and the Danish environment minister among others, to discuss Europe.
This image of public spirited concern suffuses Philip Morris's latest campaign, the goal of which is, they claim, "to share the scientific evidence on second hand smoke with the European public". And the clever way in which this evidence is presented could well lead the uninformed reader to agree with their assertion that there is no "sound justification for a campaign against second hand tobacco smoke". Here, three medical experts explain why they feel such a conclusion would be most emphatically wrong.
. Dr Luke Clancy, consultant respiratory physician at St James's medical director of Peamount Chest Hospital president of the International Union Against Tubercular and Lung Disease and chairman of Ash Ireland.
"Anybody who knows this game knows that absolute proof is impossible to come by and that is what Philip Morris are exploiting in their attempts to confuse. It was blindingly obvious for years that smoking led to lung cancer but it was incredibly difficult to prove. The problem is that people develop lung cancer when they are quite elderly and there have been so many other factors of influence in their long lives. It was much easier to get the data in relation to young babies and smoking mothers, for example. But if it was that difficult to prove that smoking was a problem, how much more difficult with passive smoking?
"Nevertheless, the overwhelming evidence from the bulk of the research is that passive smoking is injurious to health. It is implicated not just in an increase in lung cancer but in a wide range of problems bronchitis, bronchialitis and asthma in children both in utero and post delivery reduced lung function in children and adults asthma triggers in adults.
"Their advertisement and their information pack do not even mention these nonmalignant effects.
"Philip Morris spent a generation trying to claim cigarette smoking wasn't harmful this ad was the first time I had seen them admit smoking is a risk factor for disease. Now the evidence there is incontrovertible, they have turned to passive smoking.
But 150 international scientific and medical organisations have declared passive smoking to be harmful. Only one organisation, the tobacco industry, takes an opposing view. Is the rest of the world in a conspiracy or are the tobacco companies trying to defend the indefensible?
"I would like to pose the question as to what this campaign was trying to achieve. Was it an ad? If so, why did it not carry a government health warning? Why was the law of the land not enforced in relation to ads for cigarettes? If it was not an ad, what was it? Why are Philip Morris going into the health education business? It's worrying in this day and age with all we know about the dangers of cigarettes that this ad should have got through."
. Dr Bernadette Herity, Professor and head of the Department of Public Health, Medicine and Epidemiology at University College Dublin.
. Dr Herity questions Philip Morris's description of "meaningful" risk. "Leaving aside the many other risks to health posed by passive smoking and concentrating on lung cancer, the figure of 1.19, which when rounded up is really a figure of 1.2, represents a 20 per cent increased risk. Most people would regard such an increase in risk as sizeable and worth avoiding.
"Their comparison with biscuits and milk is not valid. You can avoid eating a biscuit or drinking whole milk if you wish. You cannot avoid second hand smoke.
"The best evidence about second hand smoke relates to its effects on children, something Philip Morris have completely ignored by focusing on lung cancer. Research into its worrying effects on children led on to research among adults it's a relatively recent field of inquiry but the combined research is quite convincing passive smoking is a risk to health.
"Philip Morris have been extremely selective in their presentation and their comments on epidemiology about confounding factors, for example, or the problems of inaccurate recall causing bias seem to imply that epidemiologists do not take such factors into account when compiling data, when of course they do.
. Dr Emer Shelley, Eastern Health Board specialist in public health medicine lecturer in epidemiology at the Royal College of Surgeons fellow of the faculty of public health medicine in Ireland and the UK.
Dr Shelley makes the point that the association of passive smoking with lung cancer would be well down the list of reasons for controlling smoke in public places. "No mention was made of the effects of environmental smoke on children or the foetus its contribution to respiratory illness in children, to asthma, to ear infection, to sudden infant death. Or to the fact that side stream smoke, the smoke from the burning tip of a cigarette, contains a powerful mixture of dangerous chemicals."
Then there is the issue of risk. "Relative risk, as quoted by Philip Morris, by and of itself is somewhat meaningless. We also need to look at absolute risk. For example, the contraceptive pill causes an increased relative risk of vascular disease but the absolute risk is so low to begin with that a small increase in relative risk remains very small." Not so for smoking.
Dr Shelley also says the seriousness of the risk must be considered. Factors that greatly increase the risk of contracting a cold, for example, will be taken less seriously than a small increase in something life threatening.
"Philip Morris make great play out of the issue of confounding factors," she says, that is, something else besides environmental smoke which could be responsible for the disease increases observed in non smokers. For example, they refer to a diet high in saturated fat. Their presentation of the data is misleading because those with the highest fat intake are substantially more likely to be smokers. An epidemiologist would develop separate data for fats and smoking to see if it still held true. By quoting confounding factors for smoking but ignoring them for other factors, Philip Morris are trying to have it both ways."
In referring to a ban on smoking, Philip Morris is once again being misleading, she says. "No government seeks to ban smoking but to control it for example, to have non smoking areas in restaurants for the majority of people who don't smoke. In the workplace, what we have is a voluntary code which does, as Philip Morris suggests, take into account the needs of smokers and non-smokers, with designated areas for smokers and the rest of the shared environment a smoke free zone.
In my experience, most smoking workers as well as non-smokers welcome such restrictions, because it helps them to keep down the quantity they smoke. I am not aware of any lobby in this country seeking to reverse these initiatives."
Dr Shelley also poses the question as to why Philip Morris, with their small market share in Ireland, spent such large amounts of money on an advertising campaign here. The answer, she feels, lies in Ireland's progressive attitude towards smoking "The European Union has looked to Ireland's legislation when drawing up guidelines," she says. "It is widely recognised that Ireland is progressive in this area.
