SURGEON GENERAL'S REPORT - 2006
(Click on a link to read one editorial or scroll down to read them all)
- The slippery slope - Walter E. Williams
- Killing the passive smoking debate - Michael Fumento
- Surgeon General's report on secondhand smoke -- same-old, same-old - Craig Westover
- Report's all smoke and mirrors - Sidney Zion
- A Pack of Lies; The surgeon general hypes the hazards of secondhand smoke - Jacob Sullum
- Did Carmona Read His Own Report? (Hit and Run) - Jacob Sullum
- "The Science Is NOT In" (Opinion / USA Today) - Jacob Sullum
- Don’t let freedoms go up in smoke - MIKE HENDRICKS (The Kansas City Star)
- New Surgeon General's Report on Passive Smoking - Dave Kuneman, (The Smokers Club, Inc.)
- Smoking Bans: Yet Another Liberty Down The Drain - Christopher Friend (The Evening Bulletin)
- Commentary: "Yet Another Liberty Down The Drain" - Michael J. McFadden (The Smokers Club, Inc.)
The slippery slope
Jun 14, 2006
by Walter E. Williams
Down through the years, I've attempted to warn my fellow Americans about the tyrannical precedent and template for further tyranny set by anti-tobacco zealots. The point of this column is not to rekindle the smoking debate. That train has left the station. Instead, let's examine the template.
In the early stages of the anti-tobacco campaign, there were calls for "reasonable" measures such as non-smoking sections on airplanes and health warnings on cigarette packs. In the 1970s, no one would have ever believed such measures would have evolved into today's level of attack on smokers, which includes confiscatory cigarette taxes and bans on outdoor smoking.
The door was opened, and the zealots took over. Much of the attack was justified by an Environmental Protection Agency (EPA) secondhand smoke study that used statistical techniques, if used by an academic researcher, would lead to condemnation if not expulsion. Let's say that you support the attack on smokers. Are you ready for the next round of tyranny using tactics so successful for the anti-tobacco zealots?
According to a June 2 Associated Press report, "Those heaping portions at restaurants -- and doggie bags for the leftovers -- may be a thing of the past, if health officials get their way." The story pertains to a report, funded by the U.S. Food and Drug Administration (FDA) titled, "Keystone Forum on Away-From-Home Foods: Opportunities for Preventing Weight Gain and Obesity." The FDA says the report could help the American restaurant industry and consumers take important steps to successfully combat the nation's obesity problem. Among the report's recommendations for restaurants are: list calorie-content on menus, serve smaller portions, and add more fruits and vegetables and nuts. Both the Department of Health and Human Services and the FDA accept the findings of the report.
Right now, the FDA doesn't have the authority to require restaurants to label the number of calories, set portion sizes on menus or prohibit allowing customers from taking home a doggie bag. That's for right now, but recall that cigarette warning labels were the anti-tobacco zealots' first steps. There are zealots like the Washington-based Center for Science in the Public Interest who've for a long time attacked Chinese and Mexican restaurants for serving customers too much food. They also say, "Caffeine is the only drug that is widely added to the food supply." They've called for caffeine warning labels, and they don't stop there. The Center's director said, "We could envision taxes on butter, potato chips, whole milk, cheeses and meat." Visions of higher taxes are music to politicians' ears.
How many Americans would like to go to a restaurant and have the waiter tell you, based on calories, what you might have for dinner? How would you like the waiter to tell you, "According to government regulations, we cannot give you a doggie bag"? What about a Burger King cashier refusing to sell french fries to overweight people? You say, "Williams, that's preposterous! It would never come to that."
I'm betting that would have been the same response during the 1970s had someone said the day would come when cities, such as Calabasas, Calif., and Friendship Heights, Md., would write ordinances banning outdoor smoking. Tyrants always start out with small measures that appear reasonable. Revealing their complete agenda from the start would encounter too much resistance.
Diet decisions that people make are none of anybody else's business. Yes, there are untoward health outcomes from unwise dietary habits, and because of socialism, taxpayers have to pick up the bill. But if we allow untoward health outcomes from choices to be our guide for government intervention, then we're calling for government to intervene in virtually every aspect of our lives. Eight hours' sleep, regular exercise and moderate alcohol consumption are important for good health. Should government regulate those decisions?
Killing the passive smoking debate
Jun 29, 2006
by Michael Fumento ( bio | archive )
“Secondhand smoke debate ‘over.” That’s the message from the Surgeon General’s office, delivered by a sycophantic media. The claim is that the science has now overwhelmingly proved that smoke from others’ cigarettes can kill you. Actually, “debate over” simply means: “If you have your doubts, shut up!” But you definitely should have doubts over the new Surgeon General’s report, a massive 727-page door stop. Like many massive reports on controversial issues, it’s probably designed that way so nobody (especially reporters on deadline) will want to or have time to read beyond the executive summary. That includes me; if I had that much time I’d reread War and Peace. Twice. But the report admits it contains no new science so we can evaluate it based on research already available.
First consider the 1993 EPA study that began the passive smoking crusade. It declared such smoke a carcinogen based on a combined analysis (meta-analysis) of 11 mostly tiny studies. The media quickly fell into line, with headlines blaring: “Passive Smoking Kills Thousands” and editorials demanding: “Ban Hazardous Smoking; Report Shows It’s a Killer.”
But the EPA’s report had more holes than a spaghetti strainer. Its greatest weakness was the agency’s refusal to use the gold standard in epidemiology, the 95 percent confidence interval. This simply means there are only five chances in 100 that the conclusion came about just by chance, even if the study itself was done correctly.
Curiously, the EPA decided to use a 90 percent level, effectively doubling the likelihood of getting its result by sheer luck of the draw.
Why would it do such a strange thing? You guessed it. Its results weren't significant at the 95 percent level. Essentially, it moved the goal posts back because the football had fallen short. In scientific terminology this is know as “dishonesty.”
Two much larger meta-analyses have appeared since the EPA’s. One was conducted on behalf of the World Health Organization and covered seven countries over seven years. Published in 1998, it actually showed a statistically significant reduced risk for children of smokers, though we can assume that was a fluke. But it also showed no increase for spouses and co-workers of smokers.
The second meta-analysis, published in the British Medical Journal (BMJ) in 2002, likewise found a statistical significance when 48 studies were combined. Looked at separately, though, only seven showed significant excesses of lung cancer. Thus 41 did not.
Meta-analysis, though, suffer from such problems as different studies having been conducted in different ways – the apples and oranges conundrum. What was really needed was one study involving a huge number of participants over a long period of time using the same evaluation.
We got that in the prestigious British Medical Journal in 2003. Research professor James Enstrom of UCLA and professor Geoffrey Kabat of the State University of New York, Stony Brook presented results of a 39-year study of 35,561 Californians, which dwarfed in size everything that came before. It found no “causal relationship between exposure to [passive smoke] and tobacco-related mortality,” adding, however “a small effect” can’t be ruled out.
The reason active tobacco smoking could be such a terrible killer while passive smoke may cause no deaths lies in the dictum "the dose makes the poison." We are constantly bombarded by carcinogens, but in tiny amounts the body usually easily fends them off.
A New England Journal of Medicine study found that even back in 1975 – when having smoke obnoxiously puffed into your face was ubiquitous in restaurants, cocktail lounges, and transportation lounges – the concentration was equal to merely 0.004 cigarettes an hour. That’s not quite the same as smoking two packs a day, is it?
But none of this has the least impact on the various federal, state, and city agencies and organizations like the American Lung Association for a very good reason. They already know they’re scientifically wrong. The purpose of the passive smoking campaign has never been to protect non-smokers, but rather to cow smokers into giving up the habit.
It’s easy to agree with the ultimate goal, but inventing scientific outcomes and shutting down scientific debate as a means is as intolerable as it was when Nazi Germany “proved” the validity of eugenics.
Surgeon General's report on secondhand smoke -- same-old, same-old
Posted by Craig Westover
Wednesday, June 28, 2006
I almost hate to make another reference to it, but once again we have to deal with a little bullsh*t in the philosophical sense. Bullsh*t is not lying. There may even be some truth in it, but to the bullsh*tter truth is irrelevant. His objective is to create an impression that does not necessarily have any connection to reality. That said, let’s look at the latest surgeon general’s comments on secondhand smoke. (My coments are based on the press releases and article below. Comments on the full report to follow.)
First let’s look at the headline as run in today’s Pioneer Press --
Secondhand smoke's dangers spelled out
Study says it kills 50,000 people a year; no exposure to it is safe
The subhead cites a “study,” which would lead one to believe that there is new evidence. We’ve found the silver bullet in the “mountains of evidence” folks like Bob Moffitt of the American Lung Association is always citing but never producing. Well, not exactly. In fact, No, not at all. The “study” is not a “study” at all, but a report. As the story states (but not until the last paragraph).
The findings of the new report will come as no surprise to scientists and physicians. It is simply a compilation of research that has been conducted over the past two decades.
So we are not dealing with new data or new findings. Some new people are looking at the data and drawing conclusions. The data hasn’t changed. So, let’s look at those conclusions.
There is no level of exposure to smoke that is safe and the children of smokers are at special risk, Surgeon General Richard Carmona said in releasing the new report.
"I am here to say the debate is over, the science is clear," Carmona said during a televised news conference from Washington. "Secondhand smoke is not a mere annoyance. It is a serious health hazard."
The first sentence is a compound sentence. The first clause is utter b.s.; the second is scientifically defensible, as I’ll discuss later. What does “there is no level of exposure to smoke that is safe” mean? Does it mean one inhalation an I’m dead? Does it mean one inhalation and the affects stay with me for life? Or is a clever way of avoiding the real question -- At what level of exposure does secondhand smoke become dangerous?
The phrase “there is no safe level of secondhand smoke” is a political statement, not a scientific one, which is a key point of discussion. Also a political point is Carmona’s statement, "I am here to say the debate is over, the science is clear." That’s a political statement, not a scientific statement. Science is a continual process, not one that ever arrives at conclusive proof. Take the well-documented and statistically valid connection between active smoking and lung diseases. Even today questions continue as why many smokers get lung cancer, for example, but other heavy smokers don’t.
Policy makers, by necessity must reach a conclusion in order to implement policy. Scientists are not bound by that restriction. So, understand Carmona’s statement for what it is -- a political statement, not a scientific one.
That said, the job of the policy maker is to look at the evidence and determine a policy that achieves the objective of public health in the least restrictive manner. The phrase “in the least restrictive manner” is not irrelevant in a free society. With that in mind, consider Carmona's statement.
The only way to combat the heath threat, he said, was to ban all smoking in public buildings.
No, that is hardly the only way. What is the objective here? It is to prevent people from involuntary exposure to secondhand smoke? Why not the extreme solution and prohibit smoking entirely? Or why not ban smoking in private homes where children are present? Those are ways to combat the threat. They are not taken, of course, because they are overly restrictive. From the article --
Although government cannot ban smoking in private homes, Carmona added, he strongly encouraged parents to step outside before lighting up in order to protect the health of their children.
For everyone else, Carmona said, the best advice is simply "stay away from smokers."
Let’s look at those comments. First, government can ban smoking in private homes. We ban meth consumption in private homes. We ban marijuana consumption in private homes. What Carmona is really saying is we don’t want to ban smoking in private homes. We don’t have the will to ban smoking in private homes. In other words words, even when we know scientifically there is a danger to children, we’re willing to back off the “no safe level of exposure" threat.
Further, Carmona’s recommendation is to “stay away from smokers.” Well, I used to be able to do that if I so chose. Now, I can’t walk past any public building or down the sidewalk past any bar without being involuntarily exposed to secondhand smoke. I don’t mind, but if you tell me there is no safe level of secondhand smoke, then smoking ban laws are actually putting me in more danger than I was before by driving smokers out on the street. Where is the cry for banning smoking anywhere in public?
The point is, while shouting "there is not safe level of exposure to secondhand smoke,” the actions of smoking ban advocates indicate they know that is b.s. The poison is, as it always has been, in the dosage.
So let’s summarize what we have so far. The government's report contains no new data. While making the claim that there is “no safe level of secondhand smoke” and calling for a smoking ban in all public buildings as the only solution, it accepts that young children and the rest of us may still be exposed to secondhand smoke. But if there is no safe level, how can that be acceptable?
Let’s move on and once again look at the (old) data.
Exposure of nonsmokers to tobacco smoke increases their risk of heart disease and cancer by as much as 30 percent.
That's a really misleading statistic. Let’s take a look at in the context of actual data.
I’ve asked Bob Moffitt of the American Lung Association to provide some statistical basis for this and other such claims. He has consistently declined to provide even a single study of his choice from the mountains of evidence. So I went out and found some.
A connection between lung cancer and secondhand smoke with a 30 percent increased risk can be found in two reports cited by the California EPA in study they did with the intent of proving evidence tht secondhand smoke is toxic environmental contaminant and smoking should be banned outdoors in public places. So this is not exactly a smoker-friendly study. I posted about it here; here’s a summary.
One can arrive at a 30 percent increase risk from two studies that tracked the incidence of lung cancer in non-smoking spouses of smoking spouses and non-smoking employees in smoking environments. What these two studies show is that the longer the duration of exposure to secondhand smoke, the greater the risk of lung cancer. But here’s the kicker for a policy maker -- in the case of spouses, the required duration of exposure before there was a correlation greater than 1.0 (1.0 means no connection) was after 29 years of exposure. In the case of an employee in a smoking establishment, the required exposure to exceed a risk of 1.0 was 21 years.
At 29 and 21 years respectively, the 95 percent confidence interval for the increased risk ranged from 1.03 to 1.50 -- an increased risk of 3 percent to 50 percent. The 30 percent figure in the article is pretty close to the mean of that distribution. What the full confidence interval indicates is that for these studies, there is as much likelihood that the real increased risk of secondhand smoke is 3 percent as it is 50 percent as it is 30 percent. In other words, to state there is 30 percent increased risk implies preciseness not supported by the data.
Let’s take it the next step. Fifty-percent, even 30 percent sounds pretty scary. But what does that mean in terms of real numbers. The rate of lung cancer among non-smoking individuals is about 10 in 100,000 people. If you’re a non-smoker, that’s your odds of getting lung cancer. If your spouse smokes, and you’ve been married 29 years or more, and we use the government’s 30 percent figure, your odds are now about 13 in 100,000. If you’re a non-smoker and you’ve worked in smoking environment for 21 years, you odds of getting lung cancer are about 13 in 100,000.
And those are general population statistics. If you otherwise take care of yourself, have regular check-ups, you odds are even better. If there's a predilection for cancer in your family, your odds a probably worse.
One final point. Generally epidemiologists require a risk factor greater than 2.0 to consider a correlation exists between a casual factor and an outcome. 3.0 to 4.0 is generally required to assume actual causation. Some epidemiologists I’ve talked with are willing to accept a 2.0 level for a correlation between secondhand smoke and lung cancer given the direct link of inhaling it into the lungs. Note that the government number, 1.30, doesn’t even reach this minimal threshold. These same epidemiologists require a higher risk ratio to associate secondhand smoke with diseases like heart disease where the physical connection is more tenuous.
[I’ve only seen a few studies, among them findings that the risk ratio for SIDS in homes where one or both parents smoke is about 4.0 -- strongly indicating a causal relationship with secondhand smoke. This is worth further study, and from the standpoint of protecting public health ought to be of greater concern than smoking bans in bars and restaurants.]
Even a brief exposure to tobacco smoke can increase risk, especially for people with heart and respiratory diseases.
Increase risk of what? Contracting lung cancer in 29 years? To be fair and not use the tactics of smoking ban proponents and twist statistics, I think this is just a bad statement of the notion that a person with existing health problems is more affected by secondhand smoke than others. Duh? These people are also at a greater risk from auto emissions, and the noxious odors from, say an ethanol plant. Again, the question is what are the policy implications of that statement?
Segregating smokers is not an effective technique for preventing exposure of nonsmokers, and even the best available technology does not cleanse the air adequately.
Again, the use of compound sentence where half has some basis in fact and half is pure b.s. It would stand to reason that the further away from a smoker one is, the less the impact of secondhand smoke, but again to be fair, there is some still some exposure. But the statement that even the best available technology does not cleanse the air adequately is absolutely misleading.
What the hell does “adequately” mean? To those who believe in abstinence only when it comes to smoking, “adequate” means “zero.” To the folks at OSHA and people in the real world, one measures contaminants in parts per million. OSHA has established safe-level standards for the various chemicals found in tobacco smoke. Various studies, including studies conducted by government agencies, find that ventilation can take contaminants hundreds of times lower than required by OSHA. Again, what are the policy implications?
Tobacco smoke contains at least 50 separate carcinogens and toxins, experts noted. Someone in a closed space with a smoker breathes in exactly the same chemicals as the smoker does. The fact that the nonsmoker is breathing in less of them than the smoker reduces the risk, compared to smoking, but does not eliminate it.
Again, this is a misleading statement that ignores the “poison is in the dosage” rule. It is also self-contradictory.
Are there 50 separate carcinogens and toxins in tobacco smoke? Probably, you can find smoking ban proponents throwing around numbers in the hundreds, which tends to question their dedication to the truth, but let’s accept 50. It passes the smell test. Many of these same carcinogens are also found in nature. The danger is not in the substance itself, but in the exposure. Never encountering secondhand smoke does not eliminate exposure (which means one could say “there is no safe level of exposure to life”).
Of course, exposure to secondhand smoke increases the one’s over all exposure to these carcinogens and toxins. But because one is also exposed simply by breathing the air on a busy street, we know that there is a level at which exposure is not dangerous. The scientific question then becomes at what level and what degree of exposure to secondhand smoke reaches that level.
We’ve already seen that in order to reach any correlation (to low statistically to establish causation) between secondhand smoke and lung cancer the required duration of exposure is 21-29 years for specific higher-risk subgroups of the population. But what about exposure to individual chemicals. These statistics have also been calculated and the results are ridiculous in the extreme. To reach deadly levels of the toxins in tobacco smoke, one would have to be in a tightly enclosed area inhaling the smokes from, in some cases, thousands of cigarettes per hour. If that is true, is it even logical to assert that ventilation can not reduce real risk to virtually zero?
Then there’s this -- The fact that the nonsmoker is breathing in less of them than the smoker reduces the risk, compared to smoking, but does not eliminate it
This is the statement of a person that said there is no safe level of exposure to secondhand smoke. There’s no safe level, but now you’re saying there are degrees of risk. What does that mean? The scare phrase “no safe level of exposure” constantly conflicts with not only real science, but the b.s. of smoking ban proponents themselves.
And that’s the real point. There is no interest in the truth, scientific or otherwise on the part of these people. They want to live in a smoke-free world, and will settle for nothing else. That’s an admirable goal; we all would be better off if no one smoked (except of course for the bureaucrats whose jobs depend on tobacco taxes, but that’s another issue). But as admirable as that objective is, it does not justify any and all means to achieve it.
That brings us back to the policy maker as opposed to the scientist. Based on real data, the decision for a policy maker considering a smoking ban in private bars and restaurants is “Is a smoking ban in bars and restaurants warranted?” “Is it the least restrictive means of achieving the public health goal or reducing exposure to secondhand smoke.?
Looking at the first question. To answer “yes” based on the data, one is concluding that given a statistically insignificant correlation that even if accepted increases an employee’s risk of lung cancer from 10 in 100,000 to between 10.3 and 15 in 100,000, but only after 21 years of exposure, it is in the public interest to deny bar owners the right to permit people that voluntarily choose to do so to smoke on private property. It is in the public interest to effectively close down otherwise viable businesses that cater to smokers. It is in the public interest to cause people to lose their jobs to dubiously protect their health.
To answer “yes” to the second question, the policy maker must deny that people have the free choice to determine what they want in the form of entertainment. He must assume people should not be free to independently contract and choose where they work. He must decide that hundreds of times lower than OSHA safety standards is not “adequate” removal of smoke particles from the air.
But public health is not the objective. Banning smoking is. If this were a question of public health, we'd be talking about air quality standards like we do for every other type of air pollution. It's a bout a group of people using government's legitimate publich health authority to illegitimately impose their chosen lifestyle on everyone else.
In short, while smoking ban proponents will crow about the “new” report, it is simply more of the same-old, same-old. I’ll ask Moffitt for some supporting data; he’ll simply say this is another rock on the mountains of data and not supply any. Dave Thune will read the article and despite admitting he has no understanding of statistics will say, see the proof is irrefutable.
And more bars will go out of business and more employees will be out of jobs, but bars and restaurants will be smoke-free. All we have to do is wade through the toxic b.s. to get to them.
Report's all smoke and mirrors
Originally published on July 5, 2006
If President Bush announced that secondhand smoke kills more Americans than the Iraqi insurgency, AIDS, drunken drivers and Katrina put together, would we nod in agreement — or look to Bellevue, if not to impeachment?
Comes now Richard Carmona, the surgeon general of the United States, telling us that secondhand smoke kills 49,000 Americans a year — and there's no outcry, no notion that maybe this is nuts. Instead, the mass media buys it without question, and so apparently do the people.
Does anybody out there know anything about Carmona, or even that he's the surgeon general? In 2003, he appeared before the Congress and came out for prohibition of tobacco. Which doesn't exactly make him a neutral scientific observer of the danger of secondhand smoke.
In fact, his 700-page report is full of junk science, delivered across 20 years by a band of willful anti-smoke zealots who understood that in order to get people to quit the habit, they had to promote the idea that smokers were destroying innocent bystanders, including their own children.
What the surgeon general never tells us is that the whole deal is entirely statistical — there are no autopsies, no direct evidence whatsoever. It is all computer generated: The computer is asked, if secondhand smoke kills, how many people will it kill?
For active smoking, there is plenty of direct evidence. More smokers die than nonsmokers. What the anti-smoke zealots have brilliantly done is to conflate the two: Smoking kills, therefore secondhand smoking kills.
The evidence is decidedly the other way. Every major study tells us this, including those done by the World Health Organization, the Congressional Research Service, the U.S. Department of Energy and a massive 35-year study financed for years by the American Cancer Society.
Against all this, the surgeon general, who never conducted his own study, says that "the debate is over," there is no longer any question about secondhand smoke. Dr. Robert Madden, former president of the New York Cancer Society, and a chest and vascular surgeon, told me it's "baloney," nothing but "junk science."
Dr. Elizabeth Whelan, president of the American Council on Science and Health, is also a longtime opponent of smoking. But to her, the idea that a 30-second exposure to secondhand smoke can kill — as says the surgeon general — is "outrageous." "It violated the basic tenet of toxicology: 'Only the dose makes the poison.'"
But who cares for dosage, when the ends justify the means, and political correctness rules the world.
Sidney Zion celebrated his 40th year as a newspaperman with his return to the op-ed page of the Daily News in March 2003. During his career, he has covered law and politics for The New York Times, was a reporter and columnist for the New York Post and a columnist for New York Magazine and the Daily News. Zion has published five books, including two compilations of his columns and the novel "Markers," soon to be a TV series. He is the recipient of many awards, including the Overseas Press Club of America Award, the New York State Bar Association Award and the Ben Hecht Journalism Award. He is a member of the New York and New Jersey bars and was a federal prosecutor during the Kennedy administration.
The surgeon general hypes the hazards of secondhand smoke.
June 27, 2006
According to Surgeon General Richard Carmona, secondhand smoke is so dangerous that you'd be better off if you stopped going to smoky bars and started smoking instead. "Even brief exposure to secondhand smoke," claims the press release that accompanied his new report on the subject, "has immediate adverse effects on the cardiovascular system and increases risk for heart disease and lung cancer."
Among smokers, these diseases take many years to develop. So if you got your health tips from the surgeon general, you'd start smoking a pack a day as a protective measure.
But you may want to look elsewhere for medical advice. Carmona is so intent on promoting smoking bans—a key element of the government's campaign to reduce cigarette consumption—that he absurdly exaggerates the hazards of secondhand smoke, hoping to generate enough public alarm to banish smokers from every location outside the home.
As the report itself makes clear, there is no evidence that brief, transient exposure to secondhand smoke has any effect on your chance of developing heart disease or lung cancer. The studies that link secondhand smoke to these illnesses involve intense, long-term exposure, typically among people who have lived with smokers for decades.
Even in these studies, it's difficult to demonstrate an effect, precisely because the doses of toxins and carcinogens bystanders passively absorb are much smaller than the doses absorbed by smokers, probably amounting to a fraction of a cigarette a day. Not surprisingly, the epidemiological studies cited by the surgeon general's report find that the increases in lung cancer and heart disease risks associated with long-term exposure to secondhand smoke are small, on the order of 20 to 30 percent. Among smokers, by contrast, the risk of heart disease is between 100 and 300 percent higher, while the risk of lung cancer is about 900 percent higher.
Because the associations found in the secondhand smoke studies are so weak, it's impossible to rule out alternative explanations, such as unreported smoking or other lifestyle variables that independently raise disease risks. Although the surgeon general's report concludes such factors are unlikely to entirely account for the observed associations, the truth is we don't know for sure and probably never well, given the limitations of epidemiology and the difficulty of measuring low-level risks.
Reasonable people can disagree about the meaning of these ambiguous data, and it's not surprising that supporters of smoking bans like Carmona are inclined to see a clear causal relationship, while opponents (like me) are inclined to be more skeptical. But there is no excuse for the kind of scare mongering in which Carmona engaged when he implied that you could drop dead from the slightest whiff of tobacco smoke.
Even supporters of smoking bans, such as longtime anti-smoking activist Michael Siegel, faulted Carmona for gilding the lily (blackening the lung?) by saying things such as, "There is NO risk-free level of secondhand smoke exposure." This position contradicts the basic toxicological principle that the dose makes the poison. Since it's hard to measure even the health consequences of heavy, long-term exposure to secondhand smoke, how could one possibly demonstrate an effect from, say, a few molecules? "No risk-free level" is an article of faith, not a scientific statement.
Speaking of which, Carmona was at pains to say he was merely summarizing the science, not making policy recommendations, even though he emphasized that smoking bans are the only way to eliminate the "serious public health hazard" posed by secondhand smoke. He is right about this much: The issue of what the government should do about secondhand smoke is independent from the issue of exactly how risky it is. Whether smoking bans are a good idea is a question not of science but of values, of whether we want to live in a country where a majority forcibly imposes its preferences on everyone else or one where there is room for choice and diversity
Hit and Run - Jacob Sullum
June 29, 2006
Michael Siegel, a tobacco control activist who supports government-imposed smoking bans, slams the Office of the Surgeon General for falsely claiming or implying that brief, transient exposure to secondhand smoke raises the risk of lung cancer, cardiovascular disease, and heart attack. The inaccurate or misleading statements appear not in the surgeon general's report on secondhand smoke but in the press release, fact sheet, and remarks by Surgeon General Richard Carmona that accompanied the report's publication. The press release, for example, claims that "even brief exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and increases risk for heart disease and lung cancer," attributing this finding to the report. Siegel, who believes that long-term, intense exposure to secondhand smoke (such as that experienced by people married to smokers for decades) can cause lung cancer and heart disease, faults the surgeon general for "distort[ing] the science in an effort to sensationalize it and increase the emotional impact of the communication":
There is absolutely no evidence to support this claim. Certainly, no evidence is presented in the Surgeon General's report to support this claim. And certainly, the Surgeon General's report draws no such conclusion. In fact, such a conclusion flies in the face of common medical sense. How could it possibly be that a brief exposure to secondhand smoke can cause heart disease? It takes many years for heart disease to develop. It takes years of exposure to tobacco smoke even for a smoker to develop heart disease. I estimate that it takes at least 25 years of exposure (based on the fact that very few smokers are diagnosed with heart disease before age 40).
So how could it possibly be that for an active smoker, heart disease takes 25 years of exposure to tobacco smoke to develop, but for a passive smoker, it only takes a single, transient, brief exposure?
It is also quite misleading to tell the public that a brief exposure to secondhand smoke increases the risk of lung cancer. There is certainly no evidence for this and the Surgeon General's report itself draws no such conclusion. In fact, the report makes it clear that most of the studies linking secondhand smoke and lung cancer studied nonsmokers with many years of intense exposure.
In his remarks, Carmona similarly claimed that "breathing secondhand smoke for even a short time can damage cells and set the cancer process in motion. Brief exposure can have immediate harmful effects on blood and blood vessels, potentially increasing the risk of a heart attack." Clearly, it's not just the news media that are misrepresenting the findings of the surgeon general's report. So is the surgeon general.
RE: "The Science Is NOT In" (Opinion / USA Today)
By Jacob Sullum
Wednesday, June 28, 2006
OPPOSING VIEW: Danger of secondhand smoke still debatable and doesn't justify bans.
Surgeon General Richard Carmona says secondhand smoke is a deadly public health hazard, lending support to government bans on smoking in private businesses. Surgeons general have been saying the same thing for two decades, but that doesn't make it right.
The dangers posed by secondhand smoke are debatable and likely to remain so given the limitations of epidemiology. It's well established that tobacco smoke can raise the risk of diseases such as lung cancer and heart disease. The question is how much it takes.
Because the doses absorbed by non-smokers exposed to secondhand smoke are much smaller than those absorbed by smokers, any health risks would be so small that it is difficult to confirm them in studies comparing, say, the spouses of smokers with the spouses of non-smokers. The weak, statistically insignificant associations typically found in such studies are consistent with a low-level risk.
They are also consistent with no risk at all if, for example, factors associated with marriage to a smoker (such as poor diet, lack of exercise, or unreported smoking by subjects believed to be lifetime non-smokers) independently raise disease risks. The surgeon general's report mentions such problems but concludes they probably cannot fully account for the observed associations. The truth is we don't know for sure and probably never will.
Nonetheless, I doubt that the average person encountering tobacco smoke in a bar or restaurant objects to it because he thinks his tiny risk of lung cancer might go up slightly if he stays there for several decades. The main complaint, as always, is the immediate smell and discomfort. Even if there is an added element of anxiety about long-term health consequences, that does not justify imposing a one-size-fits-all solution on every business in the country. Whether secondhand smoke is a health hazard or merely a nuisance, people who want to avoid it can do so by avoiding businesses that allow smoking. A free society that respects diversity should make room for people with different preferences.
-- Jacob Sullum, a senior editor at Reason magazine, is the author of For Your Own Good: The Anti-Smoking Crusade and the Tyranny of Public Health.
Copyright 2006 USA TODAY, a division of Gannett Co. Inc.
Don’t let freedoms go up in smoke
The Kansas City Star
Posted on Monday, July 03, 2006
I can’t hack secondhand smoke.
Still, maybe it’s time to rethink my past support for public smoking bans in light of last week’s report by the surgeon general.
Turns out the smokers are right. The anti-smoking zealots probably won’t be happy until smokers are jailed for lighting up in their own homes.
What convinced me of this is something that happened in California the day after U.S. Surgeon General Richard H. Carmona announced that there is no such thing as a safe level of secondhand smoke.
A California Senate committee advanced a bill that would turn smokers into criminals if they so much as lit up in a car with a young child in it. Kids 5 and under, to be more specific.
A first offense would get the puffer a warning. Second and subsequent offenses would bring a $100 fine.
The bill’s sponsor, West Hollywood Assemblyman Paul Koretz, a Democrat, claims to have grown up in a household with two chain smokers and now has studies to prove his parents were committing a form of child abuse, according to the Contra Costa Times.
“A child exposed to one hour in a smoking room or car is inhaling as many dangerous chemicals as if he or she smoked 10 or more cigarettes, according to the Mayo Clinic,” Koretz reportedly said.
Jeez, I don’t know of anyone who smokes 10 cigarettes an hour, which works out to about eight packs a day.
But I won’t dispute what the Mayo Clinic did or did not learn.
The evidence is clear, as the surgeon general said. Secondhand smoke is harmful, and we shouldn’t expose kids to it.
But how far are we going to go with that information?
In Kansas last week, health officials immediately began expressing support for a statewide ban on smoking in bars and restaurants.
That’s where the action is right now mostly. Smoking in the workplace has been outlawed most places.
Lawrence, Fairway and several other Kansas cities have enacted bans on smoking in bars and restaurants. Others are sure to follow.
The Kansas City Council passed its own ban some time ago, although it doesn’t kick in until a super majority of metro area communities also have similar smoking bans.
That will happen eventually.
So we can assume that, before long, states like Kansas and Missouri will do what California and several other states did years ago.
They will ban smoking in nearly all public places.
But that won’t be the end of it.
No, California, birthplace of trends, could be on the verge of turning smoking into a form of child abuse, as long as the smoking is done in the car.
Next it will be the home. You can almost bet on it.
States like Kansas and Missouri might follow.
And after smoking is criminalized in all its forms, what next? Fast food? Will we start fining fat parents for taking their fat kid out to Dairy Queen for a sundae? Or for playing their music too loud at the risk of harming young ears?
It is already moving in that direction. A slippery slope, they call it.
Now smokers are the ones whose freedoms are slip-sliding away.
How soon before it’s your turn or mine?
Puff on that as you celebrate freedom this Independence Day.
To reach Mike Hendricks, call (816) 234-7708, or send e-mail to email@example.com.
New Surgeon General's Report on Passive Smoking
By David W Kuneman
June 28, 2006
In typical antismoking activist style, the DHHS has just released a press release http://www.dhhs.gov/news/press/2006pres/20060627.html declaring that secondhand smoke is even more dangerous that previously believed. Yet, in the executive summary, reports that the risk association between secondhand smoke and lung cancer is still 1.2 to 1.3, and heart disease 1.25 to 1.3, which are same values claimed 20 years ago. Since these two diseases encompass most of the alleged deaths, then the content of the report actually says secondhand smoke is no more dangerous than generally believed 20 years ago.
According to the DHHS Press release, "Surgeon General Carmona noted that levels of continine -- a biological marker for secondhand smoke exposure -- measured in nonsmokers have fallen by 70 percent since the late 1980s, and the proportion of nonsmokers with detectable continine levels has been halved from 88 percent in 1988-91 to 43 percent in 2001-02." ( The report also says smoke exposure is down 68% in children) yet, the report does not investigate or reveal, if the prevalence of any of the conditions blamed on secondhand smoke have declined accordingly in the USA. In fact, the executive summary declares secondhand smoke still kills about 50,000 Americans/year, the same number which was claimed in the late1980s. How can it be if smoke exposure is down 70%, that secondhand smoke still kills the same number of Americans?, particularly since the executive summary claims many of the effects are immediate. If indeed many of the effects are immediate, then declining smoke exposure should cause immediate declines in the purported deaths. The summary also finds that the majority of remaining exposure is now in the home.
Remember, the bulk of the scientific evidence is that smokers of fewer than 5 cigarettes/day have the same health statistics as nonsmokers. This new report does not answer the question "How is it smokers of fewer than 5 cigarettes/day are as healthy as nonsmokers while those on average, exposed to the equivalent of 1/2 cigarette/day from secondhand smoke are affected?"
The executive summary of the report http://www.surgeongeneral.gov/library/secondhandsmoke/report/executivesummary.pdf
claims brief exposure to secondhand smoke can cause a heart attack, yet in Chapter 8 specifically states " Studies of secondhand smoke and subclinical vascular disease, particularly carotid arterial wall thickening, are suggestive, but not sufficient to infer a casual relationship between exposure to secondhand smoke and atheriosclerosis". Since these are the mechanisms by which heart attacks blamed on secondhand smoke occur, then this finding contradicts the claim short term or even longer term exposure can cause a heart attack. Yet, the summary does claim long term exposure is related to heart disease. It is amazing if you actually read the executive summary's report of the status of conditions usually associated with secondhand smoke, that most are still categorized as "insufficient or inconclusive evidence" and this includes breast cancer and children's ear infections.
This new report is mostly a rehashment of the 1992 EPA report, using the same arguments, and noting that the Tobacco Industry lawsuit ultimately failed because the EPA never attempted regulatory action. It is noted my, me, that the Surgeon General is also not going to attempt regulatory action, instead leaving it to local governments to risk any resulting lawsuits, because it is obvious if the EPA had undertaken regulatory action after 1992, they would have been found guilty as alleged by the Tobacco Industry, and the DHHS would too.
There is some new noteworthy information, of particular interest; a reference to Capes & Hi (2000) found that generally the smaller the study, the higher the likelihood of a positive correlation between secondhand smoke and disease. Epidemiology textbooks all teach that larger studies are more reliable than smaller ones. The Enstrom/ Kabat study, which is the largest of all the studies, of 35,000 nonsmokers found no risk from secondhand smoke exposure. This confirms the findings of Copas and Shi. Yet the executive summary ignores the possibility smaller studies are unreliable and should be questioned. It would be easy to run many small studies, and publish only the ones which found a risk, and this may actually be what has happened. Yet, the executive summary does not even mention the E/K study, which is the only truly "landmark" study released since the last Surgeon General's report on passive smoking and is also large enough to minimize all the confounding variables discussed more fully below.
Epidemiology text books also teach that cohort studies are more reliable than case-controlled studies. In evaluating the evidence linking secondhand smoke to heart disease, the Surgeon General's report should have included the findings by Enstrom and Kabat that a metanalysis of all cohort studies did not find a link between secondhand smoke and heart disease. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16399662&query_hl=1&itool=pubmed_docsum
This also should have been included in the section of the executive summary where the Surgeon General pretends to be concerned about bias problems with secondhand smoke studies. Indeed, when case-controlled studies consistently find higher risks than cohort studies, when small studies consistently find higher risks than large ones, positive bias is definitely operating.
The report says nicotine and continene measurements are still the best biomarkers because they are specific for secondhand smoke exposure. The flip side of that coin, is that nothing else in secondhand smoke is specific to secondhand smoke, and present from so many other sources, tobacco smoke exposure cannot be determined by measuring them. This makes it obvious, the report is admitting most of the 5,000 "chemicals" in smoke are too often present from other sources for the elimination of the last traces of secondhand smoke to make any real difference in the public's assimilation of those other 5,000 chemicals. In fact, the FDA reports www.fda.gov/ohrms/dockets/dockets/99n1174/ts00020.pdf that many carcinogens are naturally present in foods, you'll note many of these are the same as the ones found in tobacco smoke.
The report does a good job describing the problems with measuring the health impacts of secondhand smoke exposure but then glosses over most of the problems, insinuating they are solved, when no conclusive evidence is presented that they actually are solved. The report admits it is plausible nonsmoking spouses of smokers are more likely to be ex-smokers than is usually assumed when studying the health impact of spousal smoke exposure. ( This, alone could explain all the body of evidence they quote from the literature) The report also admits nonsmoking spouses of smokers are more likely to engage in other risky health behaviors than nonsmoking spouses of nonsmokers, and that these could confound many conclusions of studies the report relies on to conclude secondhand smoke is still a serious health problem.
The report says many of these confounding factors are actually more risky than the risks found in the secondhand smoke studies. Apart from misclassification of ever-smoking status, the report recognizes diet and socioeconomic status as potent confounders. The report ignores the fact that smokers and therefore nonsmoking spouses are 1/3 more likely to be urban residents. Urban residency is considered to be a more serious risk for lung cancer and heart disease than secondhand smoke exposure. It is impossible for any secondhand smoke researcher to conclude anything unless urban residency is accurately controlled for. MORE http://kuneman.smokersclub.com/urban.html
Another essential element the Surgeon General missed is the overwhelming evidence that the positive confounders discussed are actually the reason why conclusions that there is no safe level of secondhand smoke exposure exist. If indeed, all the secondhand smoke risk claimed is actually due to the presence of confounders, then the actual amount of secondhand smoke exposure is not related to the rate of outcome of disease, and any secondhand smoke exposure contains all the same confounders at the same prevalence level, causing the study conclusions to be of the same magnitude.
This report is just another example of ignoring all the available evidence good science would consider if it really wanted to find the truth. To further illustrate this point, the claim in the executive summary that smoking bans do not harm business is something the Surgeon General's office has the resources to verify independently instead of relying on antismoking activists claims. Newspapers and state departments of revenue data http://kuneman.smokersclub.com/pueblobanloss.html, testimony to government agencies http://kuneman.smokersclub.com/MTsenate040703.html, U.S. Department of Commerce data http://kuneman.smokersclub.com/economic.html , studies by restaurant associations http://kuneman.smokersclub.com/DallasSmokingOrdinanceImpact.pdf, and even distinguished economists http://www.pubcoalition.com/ all raise the possibility that bans do hurt business. The Surgeon General's office has the resources to contact some of these sources and do it's own investigation. The fact that it obviously did not, only serves to prove the report is just serving as a sounding board for outrageous antismoking activist's claims without any regard for the truth.
Lastly the executive summary employs the same tactic used by antismoking activists to classify all claims that secondhand smoke is not dangerous as tobacco industry claims. The Surgeon General's office has to know the Library of Congress biostaticians still believe secondhand smoke cannot possibly cause all the disease the executive summary claims http://www.forces.org/evidence/files/crs11-95.htm, and they must know the Library of Congress is not an industry front group. Further, that OSHA has done it's own evaluation of the issue if there is no safe level of secondhand smoke and has found that low levels are probably safe http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=NEWS_RELEASES&p_id=17 and of course, that OSHA is not an industry front group.
Even distinguished professors not connected to the industry have questioned the claim http://bmj.bmjjournals.com/cgi/content/full/326/7398/1048?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=davey+smith&fulltext=smoke&andorexactfulltext.....
The antismoking activists must be gleeful that the new Surgeon General's report prepared at taxpayer's expense follows their previous successful approach of duping the public by selectively considering only evidence supporting the conclusion that secondhand smoke is a health risk. It is obvious the Surgeon General's office did not do their own research, yet represents that these findings are their own.
David W. Kuneman
Director of Research
The Smoker's Club, Inc.
Yet Another Liberty Down The Drain
The biggest threat America faces is not from outside invasion or the possibility of a terrorist attack. Rather, it comes from the American people themselves when they allow their Constitutional rights and privileges to be taken away. And the point that needs to be stressed here is that too many people are voluntarily surrendering their freedoms and liberties to a usurping government because they have bought into the guise that "they will be safer" and that "they have nothing to hide."
Nothing could be further from the truth.
I have always advocated "truth and accuracy" over "fair and balanced," because if you present an accurate portrayal of the truth, then there is no need to be artificially "fair." The truth is reality, plain and simple. The problem arises when certain segments of our society choose not to acknowledge the white elephant in the room, and in turn, pander to people's innate fears to gain more power.
One example that clearly illustrates this point is the rise of smoking bans.
There is currently a bill on Mayor Street's desk that will effectively outlaw smoking in all public buildings in the city, including restaurants and bars. What is absolutely mind boggling is the reason that the Mayor has given for not yet signing the ban. He has stated that the bill did not go far enough with the ban, because outdoor cafes would be exempted. Mind you, he wasn't concerned about uniformity with the law (in other words, if inside restaurants had to abide by the ban, then so should outdoor cafes). No, his reasoning was infinitely more out of left field. He said that smoke from OUTDOOR cafes could produce harmful second hand smoke to those people walking down the street. Additionally, all that billowing smoke would blow back into the restaurant, thereby affecting the patrons eating inside. I was unaware that smoke was a living, breathing and thinking malevolent entity that makes a concerted effort to do irreparable lung damage in the seven seconds it takes a passerby to walk by a restaurant. But that's just the beginning. The smoke, now on a high after a fresh kill, thirsts to commit more debauchery and makes a beeline through the door whenever it happens to open, seeking out all the other unsuspecting diners. What's really scary is that Mayor Street has a law degree. Not that I am a big fan of lawyers, but I thought law school taught logical and rational thinking. Did Mayor Street miss that part of the training?
Here's the deal. Does secondhand smoke cause cancer, premature death and other health problems? The answer is inconclusive at best, especially since the EPA's 1993 study about the ill-effects of secondhand smoke was found to be "junk science" and wrought with technical and procedural errors (it was later invalidated by a federal judge based on these reasons).
The EPA had concluded that secondhand smoke generated severe ill-effects, but concluded this BEFORE it actually conducted the study and compiled data in a very selective manner, cherry-picking only that information which supported its "conclusion" (can anyone say "WMD in Iraq"?).
Common sense needs to be applied here. If there are children living in a household where smoking is prevalent, then yes, resultant ill effects such as asthma are likely to occur. The same holds true if one's work environment is smoky on a regular basis. No argument here. But is secondhand smoke really harmful to people walking down a public sidewalk? Are people truly susceptible to smoke traveling (and dissipating) from outside a restaurant to the inside? What Mayor Street has to understand is that, while an indoor smoking ban is acceptable to a large percentage of the population, his version is too extreme. There will be a backlash, which would be a good thing. Perhaps people will finally focus on how smoking bans are extremely detrimental to business, such as the data coming out of New York and New Jersey. When the neighborhood tavern closes after several generations of operation, there will be no question as to why.
(As a brief aside, New Jersey demonstrated unprecedented hypocrisy when it passed a statewide ban on smoking in most public places and restaurants - except the casinos. What an insult to its people! You cannot have it both ways. Is this about health ... or money?) Here's the key. Smoking is still legal in this country. Until that changes, the government should not have any legal authority to meddle in the affairs of private, free market companies and impose undue regulations on them. That is the beauty of a capitalistic society - let the market decide the fate of smoking. A generation ago, smoking was much more accepted, and there were considerably more smokers than there are today (remember when smoking on an airplane was commonplace?). Now, however, smoking is generally viewed as a disgusting and shameful habit, with more and more smokers lighting up in private so as to avoid disdain from their friends and co-workers. And given this change of public opinion, more restaurants are exercising their business sense and eliminating smoking altogether. So why the need for a ban? It is just another power grab by a government that thinks it has all the answers and knows what is best for its subjects.
No one is forced to patronize a restaurant that allows smoking; that is the free choice of an individual. If one does not like a smoke-filled restaurant, there are two obvious choices. He or she can either choose the "Non-Smoking" section, or choose to spend his or her money elsewhere at a restaurant that, on its own accord, does not allow smoking. An increasing number of establishments are even installing a separate, sealed room for smokers. Whichever paths these restaurants choose, they are making business decisions, driven by the forces of the free market.
What is the most startling aspect of this whole debate is the number of smokers who somehow think that, by being politically correct and agreeing with smoking bans, that they will somehow remain in the good graces of colleagues. What they don't yet understand is that smokers are the last minority in this country with no rights, and by surrendering their legal right to smoke a legal cigarette, the door is shutting on them that much more. The mentality among those advocating a smoking ban is the same as many people's blind acceptance of the federal government's program of reading its citizen's e-mail, sifting through phone records and eavesdropping on phone conversations. It is increasingly commonplace to hear statements such as "I have no problem with the government listening to my phone calls or reading my e-mail. I have nothing to hide."
That's not the point, and also happens to be completely inaccurate. Everyone has personal aspects of their lives that they want and need to be kept confidential and private. That said, the U.S. government is the last entity on earth that one would want to have access to personal data. Is there anything the government can keep secret or not botch? The opportunity for a massive, bureaucratic government to take personal information and use it against its citizens is too tempting to pass up, and has already been in practice for some time. Is it really anyone's business, especially that of the government, to know what books you buy at the bookstore or check out of a library?
Once a right is taken away, or voluntarily given up, regardless of its nature, it is rarely reinstated. Conversely, more rights are targeted. What will it be next? Alcohol? Fast food? Both have aspects that could be construed as contributing to "ill health." Why not regulate them, or ban them altogether? Efforts for both are well underway.
We should be much more concerned about voluntarily giving up our rights rather than having them taken away. When America's system of free markets, liberties and personal choices erode, we will have become the very essence of everything we have always fought not to become. And that will be the greatest travesty of all.
MICHAEL J. McFADDEN
Author of "Dissecting Antismokers' Brains"
"Yet Another Liberty Down The Drain"
I enjoyed the excellent piece by Christopher Friend, (July 21st, "Smoking Bans...") but would like to add a bit to it.
People have become increasingly concerned about even small encounters with secondary smoke since the release of the new Surgeon General's Report. It's important to understand two things about this report however, and neither of these things has been given enough attention by the media.
First of all, the report is not in any sense a "new study." It is simply a review of a great number of studies done in the past, many of which have been shown to be deeply or even fatally flawed. The only thing "new" about it is that the Surgeon General has offered his opinion that the Report shows a danger from low levels of smoke and his further opinion that public smoking should be banned.
Secondly, despite the phrases supplied by the antismoking lobby and the media (and, sadly, by the Surgeon General himself), there is nothing in that report that actually indicates any threat at all from diluted encounters with tobacco smoke, much less the "trace levels" warned about. The studies that such claims are based on subjected volunteers to smoke levels ten or twenty times as high as those found in the middle of pressurized aircraft smoking sections back when smoking was allowed.
The Report is available online. Download it and search for the phrase "trace levels" and you'll find it simply is not there. Do a search for "Otsuka" and read the references to the studies justifying the claim: the CO levels of 6 or even 30 ppm are nowhere near the 1.4 ppm found by the 1989 US DOT report on airline smoking sections.
A normal nonsmoker, even most asthmatic nonsmokers, have nothing to fear from the levels of smoke they'll encounter in any decently ventilated bar/restaurant. The few exceptions to this rule probably suffer more of their symptoms from the fear and stress brought on by scaremongering reporting than from the smoke itself.
There simply is no scientific or medical justification for government imposed smoking bans other than to manipulate smokers so as to pressure them to quit. Antismokers feel the lies are worth the end result.
I do not agree: political decisions affecting the lives and livelihoods of millions of Americans need to be based on truth, not on exaggerations, spins, or outright lies.
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