Where are the confounders?

David C Atherton, Director,
April 18, 2011

NOT PEER REVIEWED I am surprised that AIDS has not been blamed on passive smoking yet, if you excuse my irony.

Quite frankly this obsession with SHS being the cause of SIDS is quite depressing as an eager public lap up any chance to demonise smokers.

Looking at the empirical evidence it does not back up the hypothesis. As remarked here by UK journalist Charlie Booker in a piece entitled "Fiddling those smoking figures again." (1) "The only snag was that the years between 1970 and 1988, when cot deaths shot up by 500 per cent, coincided with the very time when the number of adults who smoked in Britain was falling most sharply, from 45 to 30 per cent. To anyone but a fanatical anti-smoking campaigner, this might have suggested that "environmental tobacco smoke" was unlikely to be the chief cause of cot deaths."

If look at the figures supplied by the UK's government's Office of National Statistics and look at Figure 2 graph Mr Booker is entirely correct. (2)

My smoking statistics are supplied by Action on Smoking and Health (3) and indeed confirm Booker's claims for a reduction in that time.

Also if you look at data on smoking rates smoking is often a sign of poverty, twice as many poorer people smoke than affluent people 30% vs 15% typically. Poverty often means you live in less hygienic housing and surrounds, rubbish, excrement and hypodermic needles etc. Greater densities of people to pass on virus and bacteria, closer proximities to industrial and car pollution. All these are confounders with smoking just a marker that you are poor. As this paper articulates (4)

This paper written by (5) Neuropathologist Hannah Kinney, MD, neuroscientist David Paterson, PhD, "and colleagues examined brainstem tissue from 31 infants who died from SIDS and 10 who had died from other causes. They documented the most comprehensive set of defects known to date: deficiencies in the serotonin receptor 5HT1A, an abnormally high number of neurons that make and release serotonin; a preponderance of immature serotonergic neurons; and insufficient amounts of the serotonin transporter protein, which "recycles" serotonin so neurons can reuse it. Male SIDS infants had significantly fewer 5-HT1A receptors than females, offering a possible explanation why boys succumb to SIDS twice as often as girls."

To be fair it does go on to say speculatively that "Although more research is needed, Kinney, Paterson and colleagues believe that factors such as maternal smoking and alcohol use during early fetal development may derail development of the brainstem serotonin system."

This paper certainly concludes that smoking is irrelevant. (6)

This paper also explores the much higher death rates among lower socio-economic groups (7)

In conclusion "Fiddling those smoking figures again" may have struck again.

1. http://www.telegraph.co.uk/comment/7530949/Fiddling-those-smoking- figures-again.html

2. http://www.statistics.gov.uk/articles/hsq/HSQ5SIDs.pdf

3. http://www.ash.org.uk/files/documents/ASH_106.pdf

4. http://www.springerlink.com/content/w5rrkdftaha6xgl7/

5. http://www.childrenshospital.org/views/december06/a_biological_cause_for_sids.html

6. http://resources.metapress.com/pdf- preview.axd?code=w5rrkdftaha6xgl7&size=largest

7. http://www.bmj.com/content/303/6808/964.abstract

Conflict of Interest:

7th April 2011 speaker at the "Tobacco dependence should be recognised by the state as a medical condition, not a lifestyle choice." My travel expenses were met by Pfizer.

Conflict of Interest

None declared