Involuntary Risk

"The most inflammatory question of our time," proclaimed the full-page advertisements of a tobacco company last year. The question: "Hey, would you put out that cigarette?" To cigarette producers and to the nation's 60 million smokers, those sound like fighting words. But to nonsmokers, the request appears to be increasingly reasonable and justifiable.

Last week, in the Public Health Service's annual report on smoking, Surgeon General C. Everett Koop warned that so-called involuntary smoking -- simply breathing in the vicinity of people with lighted cigarettes in enclosed areas -- can cause lung cancer and other illnesses in healthy nonsmokers. Children of parents who smoke, the report stated, have more respiratory infections than children of nonsmokers. Infants of parents who smoke are hospitalized more often for bronchitis and pneumonia than babies in nonsmoking households. Furthermore, the Surgeon General warned that the risk of involuntary smoking may not be eliminated by separating nonsmokers from smokers within the same air space, a revelation that will certainly come as no surprise to nonsmoking frequent flyers or restaurant patrons who are seated near smoking sections.

"It is now clear that disease risk due to inhalation of tobacco smoke is not solely limited to the individual who is smoking," said Koop, who recently had a cervical disk removed and wore a massive neck brace as he announced the study. "The right of the smoker to smoke stops at the point where his or her smoking increases the disease risk of those occupying the same environment." While no hard estimate of the number of lung cancers or other diseases caused by involuntary smoking is yet available, the National Academy of Sciences suggests that it may be responsible for 2,400 lung cancer deaths annually.

The data in Koop's report, derived from dozens of studies that have appeared in scientific literature over the past several years, should fuel the campaign ; by doctors and antismoking advocates to impose more restrictions on smoking in the workplace and in public buildings and conveyances. Cigarette manufacturers are already taking issue with Koop's warning. Walker Merryman, vice president of the Tobacco Institute, a Washington-based lobbying group, says the evidence is incomplete and inconclusive. "It is clear that this is more of a political than a scientific report," he says, arguing that the link between passive smoking and disease is inferential.

In fact, no one knows exactly how smoking, passive or active, causes cancer; statistics merely show that it does. Koop compares the objection with ones made by the tobacco industry after the Surgeon General's landmark 1964 report that linked smoking to lung cancer. "The evidence is as strong against involuntary smoking as it was in 1964 against smoking itself," he says. "There is now a ground swell to move forward. If this evidence were available on another environmental pollutant, we would have acted long ago."