AND RESTAURANT AIR
Categorical statement: There is no such thing as "clean air."
Probably not even on an Alp. (If the radon doesn't get you, the
altitude radiation will.)
And certainly not in any outdoor environment in any U.S. city. There
are, in city air, according to the New York Times, 320 toxic chemicals
spewed out by industry; that, plus emissions being leaked by every car.
(It's been said that a non-smoking jogger in Manhattan inhales the equivalent
of a pack of cigarettes for every mile she jogs.) And everything out there
is coming in here.
Indoor air comes from the same mother as outdoor air, though (and especially
in badly-ventilated buildings) indoors can add its own special touches.
Aside from whatever's growing in the ventilators (bacteria, fungi, and
molds including free-floating penicillin, candida, monilia and 27 others)
there's formaldehyde leaking from the foam rubber pillows, volatile compounds
leaking from the walls; disinfectants, cleaning solvents, pesticides; wax;
ozone from the copying machine, dander from the cat, dust under the scatter
rug, and gas from the stove.
Now add human beings. Not only are they exhaling carbon dioxide -- a
pollutant about to be restricted at Kyoto-- but they're shedding all manner
of viruses and bacteria. If they own pets, according to a recent
study, they're importing cat and dog dander in on their clothes and
sending it into the air. Then too, they're shedding respirable particulates.
Yep. That's right. According to OSHA "people contribute millions of particles
to the air, primarily through the shedding of skin scales" which OSHA lists
among indoor air pollutants.
- OSHA, Proposed Rule, Federal Register Vol 59, NO. 64,
So-- may we stipulate: "Clean air" does not exist, not even in a smoker-free
environment. And certainly not in a smoker-free restaurant.
Aside from all the above pollutants, possibly the most important source
of air pollution and floating carcinogens in restaurants is...
Here's one study among many that nicely makes the point. Conducted by
the British government's Health & Safety Executive, in 12 restaurant
Importance of Good Ventilation in Commercial Kitchens and Industrial Cooking
Areas" reports restaurant workers are exposed to:
"airborne chemicals including
[the carcinogens] heterocyclic amines (HA), nitrosamines, polycyclic aromatic
hydrocarbons (PAH), aldehydes, and various volatile organic substances.
Irritants such as acrolein, formaldehyde and acetaldehyde were detected..."
as were other respirable particulates.
Nonetheless, all these substances were found to be-- just as are the
substances in ETS-- below the airborne OELs (the Brit equivalent of OSHA's
PELS, i.e, Permissible Exposure Levels.)
Home cookers, nonetheless, have been warned by no less than Dr.
C. Everett Koop (quoting the American Institute of Cancer Research)
to beware of PAHs emitted into home air from meat fat sputtering and dripping--
as it were-- out of the frying pan and into the fire.
And the Sacramento Bee warns that "[cooking] fat, as it decomposes,
releases petroleum-based gases into the air that lodge in the lungs." 9/2/94
We wonder seriously if Mssrs. Glantz,
and Cherner would suggest that only
the acetaldehydes and acroleins that come from cigarettes, as opposed to
those that come from pork chops and burgers, are a threat to human health
(even though OSHA says the levels of both are "safe.")
Applying the same standards to the same carcinogens, one would then
have to conclude there's "no safe level of exposure to dinner."
Another danger lurking in restaurant air are those candles, romantically
burning on the tables. Depending, of course, on the size of the candle,
as few as 1 to 9 is said to be a risk. Or to quote the headline
from USA Today:
"Candles Might Be Polluting Your Home, EPA Says."
"Officials say pollutants
(particulates) from a burning candle can exceed the standards the Agency
sets for outdoor air quality." An EPA spokesman is quoted as saying, "If
I were someone who had a health problem like asthma...candles [are
something] I would get rid of." (June
STUDIES ON RESTAURANT WORKERS' HEALTH RISKS
Not that many studies have been done on the health status of restaurant
workers. One that's considered the gold standard and often quoted by the
health "advocates" is the study conducted by Michael Siegel, who sat at
his computer and dredged data from a series of unrelated, unspecific, and
often totally irrelevant sets of statistics.
Keeping in mind that this is the same Michael Siegel who was forced
to admit to "misrepresenting" facts elsewhere (see Attacking
The Messenger), here's an analysis of the Siegel study by independent
researcher Martha Perske.
Note: The Siegel study and its methodology are typical of other studies
of its ilk.
COOKING THE BOOKS: A RESTAURANT STUDY
c. Martha Perske, 2000
In their efforts to ban smoking in restaurants, anti-smokers cite a
1993 study by tobacco-control advocate Michael Siegel, MD, MPH, "Involuntary
Smoking in the Restaurant Workplace," published in the Journal of the American
Medical Association (JAMA). Dr. Siegel is with Boston University's
School of Public Health.
According to Siegel's study, so say the activists, restaurant and bar
workers have a 50% increased risk of lung cancer due to environmental tobacco
What the public doesn't know is that Siegel's "50% increased risk" was
based on six studies that had absolutely nothing to do with environmental
tobacco smoke in restaurants or bars or anyplace else for that matter.
Out of the six studies used by Siegel, the only one to even mention
environmental tobacco smoke stated that the authors had no information
on ETS exposure, and therefore it was "not possible" to do an evaluation
(Keller and Howe, 1992.)
Despite the fact that it was "not possible" for the authors of this
study to do an evaluation of environmental tobacco smoke, Siegel nevertheless
took an increased risk reported in the study for white females currently
employed in eating and drinking establishment and-- with no evidence whatsoever--
implied that the increased risk was due to environmental tobacco smoke.
In fact, Siegel extracted data from all six studies that showed small
increased risks for lung cancer in food-service workers and implied that
the increased risks were due to environmental tobacco smoke, even though
there was no evidence in any of the six studies that food-service workers
had been exposed to tobacco smoke-- let alone for how long or at what levels.
Siegel concludes, in his study, that the evidence from these six studies
"suggested that there may be a 50 percent increase in lung cancer risk
among food-service workers that is in part attributable to tobacco smoke
exposure in the workplace," and in order "to protect these workers, smoking
in bars and restaurants should be prohibited."
"Suggests" that there "may be" an increased risk that is "in part" attributable
to tobacco smoke?
WELL, THAT'S NOT WHAT HE TOLD THE MEDIA
In contrast to his cautiously worded conclusion in his study, Siegel
told the New York Times that based on his results "it's really a life and
death issue" for restaurant workers who breathe smoke for long periods,
and that smoking in bars and restaurants should be prohibited. (NY Times,
Likewise, he told USA Today that secondhand smoke "has a devastating
effect" on restaurant workers and smoking in bars and restaurants should
be banned. (7/28/93)
SIEGEL'S 50% INCREASED RISK IS NOT QUITE A "LIFE AND DEATH ISSUE"
Even if Siegel's "50% increased risk" were on solid ground (which it
isn't), it only means that the relative risk was 1.50. According
to the National Cancer Institute, relative risks below 2.00 are considered
"small" and "may be due to chance, statistical bias, or effects of confounding
factors that are sometimes not evident."
Dr. Lynn Rosenberg of the Boston University School of Medicine agrees
that "epidemiologists normally take seriously" only relative risks of 3.00
or greater. (Wall Street Journal, 1/3/95)
Indeed, the U.S. Environmental Protection Agency refused to classify
electromagnetic fields as a cause of cancer "largely because the relative
risks... have seldom exceeded 3.0." (EPA, October 1990, p
6-2, "Evaluation of the Potential Carcinogenicity of Electromagnetic Fields.")
The following, based on
material provided by Ms Perske, discusses the 6 studies that Michael Siegel
used as the basis for his "50% increased risk." You will now see living
examples of How to Bias A Study, and see how ill-founded Mr. Siegel's conclusions
KELLER AND HOWE STUDY: Based on 1985-1987 data pertaining to
lung cancer and occupation among Illinois non-smokers, this was, in Siegel's
words, "unlike the other five studies [in that it] controlled for active
smoking by specification, rather than adjustment." The study authors
stated that they had no information on ETS exposure and therefore it was
"not possible" to do an evaluation. Nevertheless, Siegel used an increased
risk reported on one of the study's tables for white females currently
employed in "eating and drinking places" and implied it was due to environmental
SCHOENBERG STUDY: Based on 1980-1981 data pertaining to
occupation and lung cancer risk among New Jersey white males. From
this study, Siegel selectively used increased risks reported for bartenders
and other food service workers but ignored decreased risks for cooks and
food-counter workers. He also ignored the fact that the study classified
bartenders, cooks, food-counter workers and other food service workers
as "non-high-risk" for lung cancer. The study did not consider whether
these workers were or were not smokers.
ZAHM STUDY: Based on 1980-1986 data pertaining to occupation
and type of lung cancer among Missouri white males. The authors of this
study said their results may be "statistically unstable" and that the "small
numbers, the large proportion of unknown values, and the other limitations
suggest that the study's results be interpreted cautiously." Siegel ignored
these statements, threw caution to the winds, and used the statistically
insignificant relative of risk of 1.8 (based on only 24 cases!) for male
"food service workers."
WILLIAMS STUDY: Based on cancer mortality data from the Third
National Cancer Survey. This study warned that a "cautious and conservative
approach should be followed in interpreting these data...Generally these
results should be used only as a research resource for the formulation
of hypotheses and planning of studies to follow up leads suggested."
(emphasis in original). Siegel disregarded these warnings and used
the lung cancer relative risk of 1.88 (based on only 12 cases) for female
"food service workers" (only) as if they were real and attributable to
environmental tobacco smoke.
LERCHEN STUDY: Based on 26 cases of lung cancer among males
employed in the "eating and drinking establishment industry,' in New
Mexico, 1980-1982. From this study, Siegel used the (non-statistically
significant) relative risk of 1.6 (based on 26 cases) even though
it was noted in this study that it would no doubt take a study of 10,000
lung cancer cases "to evaluate fully occupation and other risk factors
for lung cancer."
SINGLETON AND BEAUMONT STUDY: Based on California data from 1979-1981
pertaining to occupation and death due to various causes, including accidents
and suicides. Siegel cherry-picked from this study in that he presented,
among other things, lung cancer results for MALES in the category
of "other food service workers" and ignored the significant decreased lung
cancer risk for FEMALES in the same category.
|It must be underscored that none of these studies had any information
whatsoever on the subjects' exposure to secondhand smoke--how much, how
long, of if at all.
Further, despite the claims of the current mayor of New York City that
this Siegelian risk was attained after scrupulously adjusting for the subjects'
own smoking, this is not the case.
Though Siegel claimed the data from the Zahm study included smoking
histories of the subjects, Zahm himself states that the information on
smoking represented smoking status at the time of diagnosis only
and "may be inaccurate for the time period relevant for carcinogenisis."
And considering the circumstances of the interviews, it may be inaccurate,
Of the Singleton studies, Siegel admits (within his own paper) that
they merely "attempted to control for smoking, alcohol and socioeconomic
status indirectly by adjusting for national occupational
smoking and alcohol use rates imputed from the National Health Interview
Survey data." (emphasis added) Or in other words, he had no real
idea whether his subjects smoked, drank, neither or both.
And the Singleton studies account for the largest study population in
the whole canon. (260 cases). The number of cases in four other studies
are: Lerchen: 20; Schoenberg, 56; Zahm 24; Williams 12, with Keller ringing
in with a curt "NA."
RAISING THE BAR
Yet Siegel is treated seriously by legislators everywhere -- mostly
because they don't understand what he's about.
In his crusade for Prohibition, the current mayor of New York City has
proclaimed--with no citation (he doesn't need one; he's The Mayor!) that
bartenders inhale exactly 10 cigarettes per shift.
We can find no source for the claim.
We can, however, refer once again to the government's figures. According
to the NRC, DHHS and EPA, a nonsmoker inhales from 1/10th of 1% to 1% of
what's smoked around him. (Op cit)
Therefore: from 1,000 to 10,000 cigarettes would have to be quickly
smok-ed in this particular bartender's bar.
Further, if the Mayor can make assertions without citations, we can
certainly offer this-- as recently reported by United Press International:
"People who work eight hours a day in heavy-smoking environments had
the following CE's (Cigarette Equivalents): Sydney: 0.2; Prague, 1.4; Barcelona,
4.3. That's cigarettes PER YEAR."
Bloom, UPI Syndicate 8/22/02
This is actually in line with the findings of other studies (Phillips
1998; Hazelton Labs, 1994). Using personal air monitors on people exposed
to smoke in 12 cities in Europe, Phillips reported that non-smokers living
with smokers "smoked," on average, 6 cigarettes a year. The
Hazelton study produced 5 cigarettes a year.
-Phillips, To National Toxicology Program, Feb '99; Hazelton:
Environment Int'l, Dec 1994
Though all attempts to measure for such "equivalents" pass for iffy
(including the ones we like) the iffiest seem to come from the doodlings
of Michael Siegel.
To wit, here's Steve Milloy at
junkscience.com, discussing Siegel's
in-person testimony in 1997 before the Amherst, MA Board of Health,
which was considering-- and later voted unanimously for-- a ban. Speaking
to the Board:
"Siegel claimed his research
shows bartenders who do not smoke themselves inhale the equivalent of one-and-one-half
or more packs of cigarettes a day and that '220 bartenders working in the
state today, if they continue to work for 40 years, are going to die from
"But Siegel should know
better than to make such outlandish statements.
"In 1986, the Surgeon
General's report on secondhand smoke devoted a three-page section to the
concept of estimating cigarette-equivalents from second hand smoke.
After quantitatively demonstrating how cigarette equivalents can vary as
a measure of exposure, the Surgeon General concluded:
...these limitations make
extrapolation from atmospheric measures to cigarette equivalents units
of disease a complex and potentially meaningless process."
Milloy continues. "Secondhand
smoke differs greatly from what smokers inhale (i.e., mainstream smoke).
Secondhand smoke dilutes rapidly and changes chemically as it ages. Also,
smokers inhale mainstream smoke differently (deeper) than nonsmokers inhale
Further, Milloy goes on to question exactly which "research" of Siegel's
seemed to prove this cigarette-equivalent and death toll for bartenders.
An internet search revealed that no such study authored by Siegel had appeared
in print anywhere, or was scheduled for publication.
But, leave that for a moment; we'll get back to it soon. For now, let's
just deal with Siegel's 1997 premise: that bartenders were inhaling
a pack and a half a day. "Or more," to quote him completely. As revealed
by his "study."
For that to be true, using government calculations, we'd then have to
postulate exposure to from 3,000 to 30,000 smokes being smoked over 8 hours.
Which, apparently, Siegel did !!
In 1998, Mr. Siegel presented his study. Though it wasn't exactly a
study and it wasn't exactly presented. To this day, it hasn't
been published, and it hasn't been peer-reviewed. Probably on account
of it was work as a hired gun for The California Smoke-Free Bar Program
(BREATH) and a rehash of old news.
-Siegel, "Smoking and Bars: A Guide for Policy Makers,"
In it, Mr. Siegel informs us that a bar is over 4 times as smoky as
a house with a single smoker. He also informs us that "bar workers
inhale the equivalent [of] 0.6 cigarettes per day." Or 6/10ths of 1 cigarette.
Far cry from that pack-and-a-half.
So how does he get to a pack-and-a-half a day? By attempting
to deduce a much larger CE for only two of the constituents in secondhand
smoke, based on an assumption (revealed through a couple of footnotes)
that the bartender in question is exposed to over 3,200 cigarettes per
8-hour shift in a badly-vented environment, where burgers are being fried.
(Please refer back to Cooking.)
-Cudderback Et Al, "Occupational Aspects Of Passive Smoking,"
Jnl Ind Hyg V 37
Thus, Siegel maintains that for one single constituent (benzo(a)pyrene)
had never been measured in either study he cites, bar workers may inhale
the cigarette equivalent of, vaguely, from half a pack to two packs a day.
Of this one single element If they were, in fact, exposed to over
3,000 cigarettes. In bad ventilation, with the hamburger grill on "high."
This, indeed, is high nonsense. And no wonder it wasn't published.
Mr. Siegel's calculations also crash against the wall of some recent
American studies, conducted by the Oak
Ridge National Laboratories (US Dept of Energy) whose findings we report
in our section on Ventilation.
The Oak Ridge studies-- in restaurants and taverns in 17 US cities,
using 1500 nonsmoking waiters/ waitresses/ bartenders, showed exposure
levels of staff (via personal air monitors and serum cotinine levels) were
exceedingly-- in fact, quite surprisingly, low. And way below statistical
estimates by OSHA of what reality is like.
Then, too, there's a list of studies that attempt to deduce exposure
through the levels of serum cotinine, but without checking into the air.
So we need to explain cotinine and how it gets into "serum" (urine,
THE COTININE FACTOR
To begin with, by far the most plentiful-- and measurable-- part of
a cigarette (either first or secondhand) is simply: the nicotine.
The body then metabolizes nicotine into cotinine. Smoking, however,
isn't the only source of cotinine. The body also metabolizes foods
into cotinine--tomatoes, potatoes, eggplant, and various teas.
In fact, another study showed that eating a normal (4.9 oz) portion
of mashed potatoes produced the same amount of cotinine as 4 hours spent
having drinks in a smoky bar. And similarly, a rather long
lunch with a smoking friend can be easily equaled by a third of an
ounce of eggplant.
-"Relevance Of Nicotine Content Of Common Vegetables
To The Identification Of Passive Tobacco Smokers," Domino Et Al, Med. Sci.
Res, 1993; 21, 571-2; Similarly, New England Jnl Med, Aug, 1993
Further, too, it's been noted that cotinine is only used as a "marker"
(for exposure to ETS) because it's possible to measure. Even the
California EPA has admitted, as most studies do, that the harmless "cotinine
does not serve well as a marker for the presence of other tobacco smoke
Then too there's this:
"There exists between individuals a genetically determined variation
(up to 50 fold) in the level of metabolism to cotinine from a given exposure.
-Nyberg Et Al "Misclassification Of Smoking Status,.."
Epidemiology, May 1997
Men metabolize cotinine faster than women, and whites faster than blacks
(by 30%) This would also apply to the cotinine metabolized out of
potatoes. And would indicate that either-- and/or-- women and blacks
would register higher levels than their white / male counterparts to identical
exposures. Further, eating a meal can affect metabolic speed.
-"Nicotine Metabolism Variables," Ahijevych Et Al/Agency
For Health Care Policy & Research (HS07373)
Nonetheless, it's used as a marker.
Okay-- let's get a baseline. Again, according to the government (NIOSH
Bulletin 54) a study by Cummings et al in 1990, showed the average concentration
of urinary cotinine in a pack a day smoker is approximately 1,200 ng/ml.
Another study, conducted by the National Research Council in 1986, showed
the average amount in a smoker was 1,825 ng/ml.
Another study, also reported by NIOSH, found that restaurant workers
who themselves didn't smoke, had urine concentrations of 56 ng/ml.
About 1/20th to 1/37th of the cotinine in a smoker.
And please remember that cotinine is a harmless metabolite and a rather
poor indicator of anything else in smoke.
Nonetheless, in a recent study (Wortley et al, a study the Mayor likes)
the blood levels of cotinine were carefully measured in 50 nonsmoking
restaurant workers, for a mean serum level of 0.62 (ng/ml.)
or 6/10th of a nanogram. This was higher than the levels recorded
in, say, farmers (0.13)
People who work in restaurants are exposed to more smoke than, say,
a farmer who works in the field. Um...okay.
-Wortley Et Al, "Exposure To Secondhand Smoke In The Workplace:
Serum Cotinine By Occupation," Jnl OCC & Env Med, 2002; 44 (6) (*)
Personal Correspondence w/ Lead Author
Nor is this study a breakthrough in any way. Remember, the serum
measured here is blood, not urine. According to a study sponsored
by ALA, the blood cotinine levels in less than pack-a-day smokers ranged
from 182- 249 ng/ml. That's a quantum difference from the 0.62 reported
by Wortley among nonsmoking wait staff.
- Ahijevych Et Al, In "Addiction Behaviors, " Feb,
And yet. A study by James Repace
measured the urine cotinine in waiters in Hong Kong and projected, solely
on the basis of their cotinine, that 150 would die.
-"Passive Smoking And Risk For Heart Disease And Cancer,"
But cotinine (have we mentioned?) is a harmless metabolite that indicates
nothing except exposure to nicotine (or nightshade vegetables) But, hey,
say it again:
"It is not known how levels
of cotinine measured relate to the biologically important components of
ETS other than nicotine." -Nyberg, Op Cit
Which leaves us with the general workplace studies--all epidemiological--
of which there aren't many. The largest American study ever done
(and sponsored in part by The National Cancer Institute) "Passive Smoking
and Lung Cancer in Nonsmoking Women," Brownson et al., 1992, reported:
"... no elevated lung
cancer risk associated with passive exposure in the
-American Jnl Of Public Health, Nov. 1992
Alas, complained EPA, this study (published in November '92) arrived
"too late" to be included in their (1993) report. Had it been so
(the largest study ever done!) and been thrown into the hopper, it would
have so tilted the weight that ETS could not, not even with lots of fudging,
have been classified as a risk or a Class A carcinogen.
As of 1995, there were 8 extant studies that looked into the workplace/
lung cancer data. According to one set of researchers:
"An EPA-style meta-analysis...demonstrates
no statistically significant
association for the data
in its entirety--or for any sub-group of American workers. The pooled risk
estimate [is] 1.0."
-"ETS Exposure, Lung Cancer And Heart Disease", Sears,
The studies were pooled into that "EPA-style meta-analysis" because,
the authors say, their results were so contradictory and mixed. Two showing
a slightly increased risk; two showing a slightly decreased risk, and the
The same authors point out that "it is difficult to draw any conclusions
concerning heart-disease risk in the US workplace because virtually no
such information on the US workplace exists."
None of this, however, prevents the zealots from hollering Wolf or stops
them from conjuring baseless death tolls, easily shattered by science and
sense. Take, for example, this crowning lulu
from Mayor Bloomberg of NYC.