Americans have “Distorted View” of Public Health Threats, Expert Says
By Stephen J. Busalacchi

In droves, health-conscious Americans have turned to organic produce and bottled water, but why haven’t we recognized the more serious and more common threats to our well-being?

“There’s an imbalance between how the public perceives risks from environmental contaminants,” says Patrick Remington, MD, MPH, an epidemiologist and Associate Dean, University of Wisconsin School of Medicine and Public Health. We may be concerned about a slight odor in our water or pesticide residue on our fruits and vegetables, yet not think twice about having a drink in a smoky bar.

“One cigarette has more harmful chemicals in it than most Americans are exposed to in a year in the environment,” explains Remington. He says what’s happened is that people have an overly cautious stance regarding environmental contaminants, leading to a “distorted view of what really is a public health problem.”

 Without question, the ill effects of smoking are public health enemy number one. Yet, smoking is still allowed in many public places and work places, though that is changing in many states and entire countries. There is no doubt that working for months or years in an environment where smoking is allowed is dangerous to one’s health.

Even so, there are business owners and others who mimic tobacco industry arguments that cigarettes are a legal product and their use within private businesses should be self-regulated by those businesses. Besides, they argue, nobody is forcing employees to work at places that allow smoking.

It is an absurd argument, asserts Michael Fiore, MD, MPH, Director of the Center for Tobacco Research and Intervention at the University of Wisconsin-Madison. “As a society, we don’t tolerate the needless exposure of innocent people to toxins.” The tobacco industry’s argument, according to Fiore, is no less ridiculous than if “I felt it was my right to sprinkle a little asbestos dust around me just because I love to sprinkle asbestos dust.” 

 Even when people do rightly fear inhaling others’ smoke, they probably misunderstand that risk, too. Lung cancer from passive smoking is the most obvious concern to the public, but Dr. Remington says evidence shows keeling over from a heart attack is the likelier scenario.

“The estimate is that 50,000 (Americans) die each year from heart attacks related to passive smoking. That seems so implausible that most people don’t believe it until you look at the research,” says Dr. Remington. It may not seem so preposterous when you consider that inhaling cigarette smoke makes blood platelets stickier, predisposing people to blood clots.

The irony Remington sees is that we know how to stop premature death and illness from smoking tomorrow—through substantially higher cigarette taxes and indoor smoking bans—yet we as a society fail to act in any dramatic fashion.

“The only weapon that public health has in this battle is to enact policies which can de-normalize tobacco,” says Dr. Remington.

But can that happen if voters and politicians misunderstand the risks?

Stephen J. Busalacchi is a medical journalist and author of White Coat Wisdom: Extraordinary doctors talk about what they do, how they got there, and why medicine is so much more than a job. © 2008 See

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