Junkman Response to Neufeld Letter

February 23, 1998


Dr. Ellis J. Neufeld
Director, Clinical Hematology
Children's Hospital
300 Longwood Avenue, EN-307
Boston, MA 02115

Dear Dr. Neufeld:

I am responding to your letter dated February 10, 1998 to members of the TASSC Advisory Board.

You claimed that the Junk Science Home Page editorial titled "Secondhand Smoke and Asthma in Kids" is "incorrect" and "characterized by poor science and half-truths."

However, short of stating that asthma is exacerbated by respiratory infections and respiratory tract inflammation, which, in turn, are strongly associated with irritants like cigarette smoke and smoke from a wood stove, no facts and argument were offered to support your assertions about the editorial.

While smoke may indeed be a respiratory irritant for some, this was neither the thrust of the editorial nor the study in question [Gergen PJ et al, Pediatrics 1998;101(2):8].

The primary finding of the Gergen study was that "Among children 2 months to 2 years of age exposed to ETS, 40 percent to 60 percent of the cases of asthma...were attributable to ETS."—not whether ETS is a respiratory irritant.

But Gergen's study is incapable of establishing this attribution for the basic reason, as highlighted in the editorial, that many competing causes of asthma were not ruled out as being responsible for the observed association. Without ruling out confounding, the association cannot be established. And the lack of an association precludes attribution.

The Gergen study states in the in the introduction section—"Few studies have data on the many factors that contribute to respiratory health in the first 5 years of life (e.g., birth weight socioeconomic status, family history of atopy, day care attendance, and so forth, thus making it impossible to identify the independent contribution of ETS." But the Gergen study does not shed further light on children's respiratory health.

According to the Merck Manual of Diagnosis and Therapy (Sixteenth Edition), changes in temperature, atmospheric pressure, dust, fumes, food preservatives may cause or exacerbate asthma. The American Lung Association lists these factors: allergic reactions to pollens, feathers, molds, animals, some foods, and house dust; infections such as the common cold, influenza, and pneumonia; emotional stress and excitement; vigorous exercise; cold air; plastics, grains, metals, wood; air pollution, including cigarette smoke, ozone, sulfur dioxide, and auto exhaust; household products such as paints, cleaners and sprays; and medications such as aspirin.

But the Gergen study did not consider any of these factors. Adjustments were only made for age, sex, race/ethnicity, birth weight, day care, family history of allergy, breast feeding, education level of head of household and household size.

How can the Gergen study presume to attribute asthma incidence to ETS when relevant confounding risk factors were not considered? After all, elimination of confounding is basic to epidemiologic study.

So this study constitutes classic "junk science." The Gergen study has significant limitations that are not clearly and candidly acknowledged by its authors. And its conclusion is an overstatement of the data presented.

To make matters worse, the media erroneously proclaimed in its coverage of this study that "About half the early childhood cases of asthma, chronic bronchitis and wheezing are attributable to exposure to secondhand cigarette smoke, researchers said yesterday." [Reuters (February 3, 1998)].

I am not aware that the authors (or you) have requested that this misstatement be corrected—and Reuters has a far larger readership than the Junk Science Home Page.

While you and I would agree that smoking is inappropriate in front of children, junk science is not necessary to make this point.

Finally, the editorial and these opinions are clearly my own and are stated as such on the Junk Science Home Page. If you have substantive criticisms about material on the Junk Science Home Page, please feel free to forward them to me directly. If you would like to write a rebuttal to my editorial (or anything else posted on the page), I would be pleased to post it.



Steven J. Milloy
Executive Director

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