Pediatrics
March 2005
Changing Conclusions on Secondhand Smoke in a Sudden Infant Death
Syndrome
Review Funded by the Tobacco Industry
By Elisa K. Tong, MD; Lucinda England, MD; and Stanton A. Glantz, PhD
Prenatal and postnatal exposure to tobacco smoke adversely affects maternal and child health. Secondhand smoke (SHS) has been linked causally with sudden infant death syndrome (SIDS) in major health reports.
In 1997, PM (Philip Morris) commissioned a consultant, Frank Sullivan, to write a review, with coauthor Susan Barlow, of all possible risk factors for SIDS. The first draft concluded that prenatal and postnatal smoking exposures are both independent risk factors for SIDS. After receiving comments and meeting with PM scientific executives, Sullivan changed his original conclusions on smoking and SIDS. The final draft was changed to emphasize the effects of prenatal maternal smoking and to conclude that postnatal SHS effects were “less well established.”
Clinicians, parents, and public health officials are most vulnerable to the changed conclusions of the SIDS review. The national SIDS “Back to Sleep” campaign has been very successful in reducing SIDS rates. However, estimates of SIDS risk from SHS (odds ratios range from 1.4 to 5.1) have considerable overlap with estimates of risk from prone sleep positioning (odds ratios range from 1.7 to 12.9). With the Back to Sleep campaign well underway, efforts to address parental smoking behavior in both the prenatal and postnatal periods should be intensified.
http://pediatrics.aappublications.org/cgi/content/abstract/115/3/e356
Comment: What does the malfeasance of toxicologist consultant Frank Sullivan have to do with national health insurance? My response may be a stretch, but the issues are fundamental.
The opponents of national health insurance have framed the debate as the efficiency of the private marketplace in providing higher quality and greater value versus the inefficiency and poor value wrought by government bureaucracies. But the overwhelming preponderance of health policy literature indicates that this framing of the ideological divide is incorrect. In the financing of health care, the private bureaucracy has been profoundly inefficient, and the failure to provide adequate coverage has negatively impacted quality by leaving in place financial barriers to care.
In contrast, government bureaucracies have been much more effective in ensuring affordable access to care with greater efficiency through streamlined administration.
If the framing of the ideological divide as efficient markets versus inefficient government bureaucracies is incorrect, then how should this ideological divide be framed? One does not need to be an astute observer to recognize that the divide is between those who support freedom in the marketplace as a means to achieve maximum personal wealth versus those who support solidarity through government action to be certain that all of us have our most basic needs met first before we enjoy our hedonistic pursuits in the marketplace. This reframing of the debate over the ideological divide is not merely rhetorical, but it is fundamental because it places the issue of solidarity ahead of money in our society.
And today’s quote? The medical literature has been used in an attempt to preserve profits of the tobacco industry at a cost of loss of lives due to SIDS. What could be more fundamental than that? We have enough solidarity to be outraged by these individuals who would sacrifice infants’ lives for personal greed.
But do we have enough solidarity to act to save the lives of the 18,000 young adults who die prematurely each year due to lack of health insurance? Or is it more important to maximize the wealth of those who have learned the ways of success in the health care marketplace? This is really the way that we need to frame the debate.
Efficient free markets versus oppressive government bureaucracies? Balderdash! Let’s quit debating their ideology and start debating polices that save lives!
