sample="quota" bates="690149447" isource="bw" decade="1980" class="ui" date="19850000" PASSIVE SMOKING: THE ISSUE IN THE NEWS Jerome R. Adams ABSTRACT A review of the academic and institutional research on passive smoking during the five years 1980 - 1984 and its consequent media coverage shows (1) that the issue is an emotional one, tied in many people's minds to active smoking, (2) one or two studies purporting to demonstrate the harmful effects of passive smoking receive the overwhelming bulk of media attention each year and (3) the range of studies on the subject remains unexplored by reporters. The dominance in the news of certain studies suggest that the emotional characteristics of the issue outweigh the scientific and that certain publicity-conscious researchers are taking their case to receptive reporters. This is an examination of newspaper and television coverage of "passive smoking" from January 1, 1980 to December 31, 1984, attempting to shed some light on the five-year flow of information from academic and institutional studies of the issue to the American public. Passive smoking is the measurement of smoke carried from the smoker to the nonsmoker inside the same room. Measured are one or several of the thousands of chemical components of tobacco smoke, and assertions are made as to the effect of those chemicals of the nonsmoker. At issue is a combination of "sidestream" smoke from the burning end of the cigarette and exhaled smoke. Such an examination cannot be simply quantitative -- counting the inches of newspaper columns, for example -- for several reasons. First, as will be shown, this is a highly emotional issue. Thus, opinions are being bolstered or, occasionally, weakened, but not changed. Furthermore, "measurement," as used above, is not a simple matter of calibrations on a ruler. In fact, it is measurement and its modern progeny, statistics, on which much of the early research turns. The measurement itself is in question as far as some academics are concerned, though it would be a mistake to think that the public shares, or even understands, that concern. Finally, as will be seen, passive smoking is inextricably tied to active smoking in many nonsmokers' perception. Even if icy-calm consideration were the rule at the research end of the information chain, the issue would still evoke certain gut responses among the public. Consider, as an example, this 102-word report by Dan Rather on the CBS Evening News, February 22, 1982: "The government today issued its strongest indictment yet of so-called passive smoking, saying nonsmokers, quote, should avoid being in a smoke filled room. As for cigarette smoking itself, the Surgeon General's annual report says smoking causes 30 percent of all cancer deaths in this country. The report says smoking this year will be responsible for 340,000 deaths, $13 billion worth of health care, and another $25 billion in lost production and wages. The report also linked cigar and pipe smoking and long-term use of snuff with cancer. The Tobacco Institute, an industry group, said today's figures, quote, are not essentially news." The word "smoke" or some derivative is used seven, "cancer" twice, and "death" once. To repeat, it would be a mistake to equate research into passive smoking with news about that research. This paper examines press coverage of passive smoking by dividing consideration of the subject five ways: 1. The "universe" that continues "coverage" is explained. 2. The "science" as it has developed is described. 3. Academic debate on the subject is described in contrast to public perceptions. 4. How the press has treated the subject is demonstrated. 5. Some speculation as to what the future holds is ventured. A. The universe: What makes news? For the purposes of this study, it is suggested that the flow of information has four phases: Research, either suggesting that passive smoking is harmful, that it is not, or that we don't know; Academic Debate, typically over methodology; Media Coverage; and Public Opinion and Policy Initiatives. Schematically, it might look like this: Note that policy and public opinion are, in a democracy, closely linked. Note also that placing "debate" with them implies that this neat schema is, in the real world, confused, sometimes angry, never perfectly clear. That is the way the issue of passive smoking has evolved. The function of academic debate is to distill knowledge. It tells us what science is. It tests research over the fire of standards. Once again, however, that is a theory that does not always survive the pressures of the real world, and this has had some effect on the issue passive smoking. Articles at that time portrayed a three-pronged theme: Pregnant women and young children might be at risk from passive smoking. Likewise, people afflicted with bronchial problems might also be affected. Beyond those concerns, however, there was nothing. In the 1980s the issue came of age. Early research on ambient smoke reported two things no longer mentioned, but which affect research by perverting its results. Researchers found that some people -- without regard to "health" -- have sensitive eyes and that airborne chemicals far below environmentally acceptable limits may cause irritation when there is no more than a whiff of smoke in a room. Further, psychological research reported that some people complain upon seeing cigarette smoke -- perhaps at the other end of a fairly big room. These are the modern counterparts of King James I, who complained in 1604 about smoking at court. Beginning about 1980, however, concerns became much more serious, though researchers continued to manifest a petulance and a sense of being driven by something other than attention to pure science. 1980 In 1980, among six studies of passive smoking, one was destined to define how the debate is to be conducted. It was joined by the Hirayama study in 1981 and these seminal works began to develop the issue, determined how it is to be regarded by the media, and established the pattern likely to continue. In March 1980, the New England Journal of Medicine published the results of a study by two men associated with the University of California campus in San Diego, an academic, James R. White of the department of physical education, and a physician, Herman F. Froeb. Their paper had been given the year before at the annual meeting of the American College of Sports Medicine, meeting in Hawaii, but it was the NEJM that made their research "news." During 1980, there were thirteen news stories inspired by the White and Froeb study, supported later in the year by a report from two researchers associated with the federal government. Although there was much discussion that year about Proposition 10 in California, a referendum to segregate smokers in public buildings, the White-Froeb study had an obvious momentum beyond that. Across the county, it was as though the media had been waiting for such a study. White and Froeb asserted that smokey atmosphere tends to cause obstructed airways in nonsmokers if they are exposed for extended periods. "Beware Smoky Rooms," Newsweek warned its three million readers. The supporting study by Repace and Lowery, which suggested that particulates in smoke in public places might be harmful, failed to attract the attention of the White-Froeb research. It would become, however, part of a growing corpus of information that would be advanced as "proving" a link between passive smoking and health problems. In addition to exciting press coverage, the White and Froeb also caused academic controversy. In the British-American publication Lancet, but mostly in the NEJM, researchers flailed back and forth over the validity of the study. In simple scoring, seven letters criticized the study, six supported its conclusions. So intense was the debate that it reached the popular press. Briefly, White and Froeb filled unusual roles as academic media stars. Such normally arcane arguments as the legitimacy of the FEF (forced mid-expiratory flow) and FEV (volume, as opposed to flow) measurements and the reliability of the spirometer (which measures respiration) spilled into the popular press. And, had the White-Froeb study been the last of its kind, the criticism might have thoroughly discredited the study. But the debate's having moved to the mass media had the effect of rallying support for the idea that all smoking is bad. Science was following opinion. Apart from the academic criticism, White and Froeb had provided anti-smoking forces with what the Washington Post called "hard evidence," and they were not going to be dissuaded by questions of methodology. The next year, 1981, would see this phenomenon in full flower. 1981 That was the year of what television talk-show hosts seemed to know only as "the Japanese study." That was enough. Takeshi Hirayama published in the British Medical Journal his study suggesting that nonsmoking Japanese wives of heavy-smoking husbands got cancer from the smoke in the house. Again, serious questions were raised about his methodology. Again, it made no difference in the popular mind. (Hirayama's views on passive smoking are strong enough that he once suggested in an interview that some nonsmoking wives of smoking husbands might be driven, by their plight, to suicide.) Given prevailing attitudes, such as a remark is an academic straw in the wind. More sensibly, a suggesting was made in 1982 by Gary B. Friedman in a study published in the American Journal of Public Health. He advised making passive smoking but one variable along with other atmospheric and ingested measures in any consideration of what causes disease. Smoking as the guilty party is not as clear when smoking is considered a part of a constellation of variables, Friedman wrote. 1984 In 1984, passive smoking returned to the public consciousness more strongly than ever. G. H. Miller presented his evidence that was designed to solve the methodological problems of Hirayama and Trichopoulos and show that women get cancer from their husbands' smoking. The Institute tried to show that Miller's statistics should be turned on their head. Miller's side was carried in an AP story in April, The Institute's side in a story in May. There was balance, but nothing changed. In the meantime, a wider variety of research than ever before was coming to light. It seems to have lent a new sophistication to media coverage just by virtue of its variety. Clearly, what has happened is that the issue has been kept aloft long enough for additional support to be gathered to hold it up. In 1984 and early 1985 there have been five major studies supporting the idea that passive smoking is harmful while two suggest there is no evidence of such an effect. (Much information on the subject went into testimony before the Civil Aeronautics Board.) The activity generated no fewer than eighteen news stories, most focusing on a few of the studies. In a sense, the issue has come of age. Now, continine, a metabolite of nicotine, is being measured in nonsmokers' urine. Research is being sharpened in attempts to demonstrate that some smoke is making its way to nonsmokers' metabolic systems. In the press, the issue is chic. "CBS has obtained the study," announced Bernard Goldberg on the CBS Evening News about Shigeru Matsukura's research, which replaced Hirayama's as "the Japanese study" even though Hirayama continues his efforts. In that CBS report, Repace appeared as a talking head. Finally, the Surgeon General, responding to public discussion and wanting to lay to rest any notion that he entertains doubt on the question, has pronounced the evidence that passive smoking is harmful "very solid." The phrase had the simple thud of news, and it was used by both Dan Rather and Newsweek. C. Conclusions 1. Imagine reaching into a bag of half a dozen eels, pulling one out and presenting it to the media. Now imagine, in the interest of fairness, dumping the whole bag. Obviously, neither of these is happening. Each year, one eel is slithering out of the bag on his own. It is helped into the light by either the New England Journal of Medicine or the British Medical Journal. Other eels get stepped on. Something other than scholarly rigor is elevating "research" to "news." It may be the assertiveness of the researcher, the simplicity of the conclusions, a buddy system, the prevailing mindset, or some conclusions, a buddy system, the prevailing mindset, or some combination of all these. Whatever it is, it makes people focus on something like Hirayama's "five cigarettes a day" rather than the fractional cigarettes (assumed to be inhaled by passive smokers) suggested by three parallel studies. (See Footnote 3) 2. To state the obvious, the emotional character of the overall issue of smoking infects consideration of passive smoking. Related to this is in fact that one's eyes and nose literally lead to one's conclusions about others' smoking. This influences research, making people believe that what smells bad is bad. 3. The Institute has tended to react to research. An alternative might be either to sponsor research with some adversary agency or to sponsor a seminar that brings together disparate views. The idea would be to respond to the reality of Point 1, to let several eels out of the bag at once. Reacting has now worked; a more aggressive, but fair, tactic might lead to a more two-sided presentation. It is with this last point in mind that the footnotes point to research, which has never seen the light of daily newspapers, where the conclusions are tentative, or, in some instances, actually refute the prevailing findings. (See Footnote 13) Footnotes