COLUMN ONE : Science Stokes the Tobacco Debate : Research on risks of secondhand exposure has fueled an anti-smoking revolution. Cigarette makers are fighting fire with fire, producing reports that discount the dangers.

He wanted his wife to quit smoking.

It was a simple wish, yet its consequences were profound. This was in the 1970s, in Greece, where smoking was as cherished a pastime as baseball in America. Dimitrios Trichopoulos didn’t care about bucking the tide. He simply detested his wife’s addiction.

A young cancer epidemiologist at the University of Athens, Trichopoulos tried the usual guilt trip. He told her she was hurting herself. On this, he said, the medical literature was clear. When that didn’t work, he told her she was hurting him--an argument he could not support with statistics. She didn’t believe it.

Ever the scientist, he set out to prove it.

That family argument wound up earning Trichopoulos a place in tobacco history. He was the first researcher to connect secondhand cigarette smoke with an increased risk of lung cancer.

He accomplished this in a somewhat unorthodox fashion, pirating $50,000 from one of his grants to conduct a survey of 189 nonsmoking women. (Greek officials, Trichopoulos says, would never have given him money to study the detrimental effects of a cash crop as lucrative as tobacco). He found that smokers’ wives were twice as likely to develop lung cancer as women married to nonsmokers.

It worked. “I convinced her,” Trichopoulos says. His wife quit.

The study did much more than clean the air in the Trichopoulos home. He published it in 1981, days before the publication of a larger study conducted by Japanese epidemiologist Takeshi Hirayama. These papers gave a huge boost to a grass-roots anti-smoking campaign that has dramatically changed the way Americans work, dine, travel and raise children.

This is the nature of the secondhand smoke revolution: a little bit of science--still emerging, not all of it conclusive--shaping a lot of public policy.

For anti-smoking activists, scientific research into the dangers of secondhand smoke has been a godsend. The high point came last year, when the U.S. Environmental Protection Agency declared secondhand smoke a “Group A” human carcinogen, reporting that it accounts for 3,000 lung cancer deaths each year. This placed it in the same deadly category as asbestos and radon; the agency concluded that the danger cannot be eliminated by using smoking and nonsmoking sections.

Thanks in large part to that report, secondhand smoke is now one of the nation’s most pressing and divisive public health issues. Coupled with allegations that tobacco companies have misrepresented the nicotine content in cigarettes--and tobacco executives’ denials--the issue is bringing public outrage to new heights.

But the tobacco industry is fighting back--hard. A coalition of farmers and manufacturers filed a lawsuit alleging that the EPA “manipulated and cherry-picked scientific data” and asked that a U.S. District Court judge in North Carolina nullify the report. In California, tobacco giant Philip Morris has placed a controversial initiative on the November ballot that would undo local ordinances designed to curb secondhand smoke and replace them with a looser standard.

And on Monday, cigarette maker R.J. Reynolds launched an aggressive public information campaign designed to stave off smoking bans by countering the widespread perception that secondhand smoke is dangerous. The company’s tactic: Fight science with science.

In full-page newspaper ads, R.J. Reynolds says its research shows that nonsmokers are exposed to “very little” secondhand smoke, even when they live or work with smokers. In one month, the company said, a nonsmoker living with a smoker would breathe the equivalent of smoking 1 1/2 cigarettes.

“Policies should be based on science,” Chris Coggins, the R.J. Reynolds toxicologist, said in an interview Wednesday. “I think that the (EPA) science is very, very weak.”

But the industry has a long way to go toward rolling back public policy on secondhand smoke.

More than 600 state and local ordinances restrict smoking in public places, including Los Angeles’ hotly debated restaurant ban. Across the United States, in cities large and small, a familiar sight has emerged: Smokers congregating outside.

The federal Occupational Health and Safety Administration is contemplating a ban in all workplaces.

This month, a congressional subcommittee approved a bill, introduced by Rep. Henry A. Waxman (D-Los Angeles), that would ban smoking in most buildings, except restaurants and private clubs.

There is no smoking on domestic flights. There is no smoking in the White House; First Lady Hillary Rodham Clinton will not tolerate it. There is no smoking with your Big Mac; McDonald’s recently banned tobacco in its corporate-owned restaurants. Taco Bell and Jack in the Box followed suit.

Last year, the U.S. Supreme Court ruled in favor of a Nevada prisoner who called his cellmate’s smoke cruel and unusual punishment. Custody battles have been settled by giving preference to parents who do not smoke.

The turnabout from a smoking to a smoke-free society seems to have occurred overnight. It could not have happened, anti-smoking advocates say, without science.

“Twenty years ago, I tried to have one room in a cruise ship declared smoke-free and I was told I was crazy,” said John Banzhaf, a law professor at George Washington University who runs Action on Smoking and Health, or ASH. “Who at that time would have figured that 30% of all our businesses would be smoke-free today? . . . Things are moving amazingly quickly, and it is the scientific, medical underpinning that has changed the complexion of the issue.”

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Today, several hundred scientific studies link secondhand smoke to a variety of diseases: lung and other cancers, heart disease, respiratory infections including bronchitis and pneumonia, asthma and sudden infant death syndrome (SIDS), which claims the lives of babies as they sleep. This research is responsible for an oft-quoted statistic: About 53,000 Americans die each year from secondhand smoke.

“The evidence is so clear,” says Mark Pertschuk, co-director of Americans for Non-Smokers Rights. “Everybody and his brother is lining up to ban smoking.”

Yet the evidence, while compelling, is not as complete as Pertschuk suggests.

Of each year’s secondhand-smoke deaths, 3,000 are attributed to lung cancer, 12,000 to other cancers and 37,000 to heart disease, according to the Coalition on Smoking OR Health, a nonprofit group formed by the American Lung Assn., the American Heart Assn. and the American Cancer Society. The coalition also estimates that secondhand smoke accounts for 700 SIDS deaths a year.

Most scientists working outside the tobacco industry say the link between lung cancer and secondhand smoke is firmly established. But the evidence on heart disease--which accounts for nearly 70% of estimated deaths--is much newer, and not all scientists accept it. Only 14 studies have documented this link, and the federal government has not yet taken a position.

Nonetheless, public tolerance for secondhand smoke is waning.

A recent Gallup Poll showed 38% of Americans support a ban on smoking in restaurants--up 10% from three years ago. Support for workplace smoking bans is at 32%, up eight points from 1991. The poll also found 36% of Americans believe secondhand smoke is very harmful to adults, and 42% believe it is somewhat harmful.

“The tide has turned,” says Michael Eriksen, director of the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention. “I think an invisible line was crossed in terms of how the public feels about smoking.”

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The tobacco industry is trying its best to persuade people to cross back over that line.

The vast majority of the research on secondhand smoke is epidemiological, meaning it traces patterns of disease and finds connections, rather than proving cause and effect. Based on those studies, scientists are just beginning to conduct animal research to learn the precise biological effects of secondhand smoke.

Tobacco industry officials vehemently dispute the epidemiology, including the EPA report. They say some study subjects give inaccurate information about how much smoke they have been exposed to, or whether they have ever smoked.

R.J. Reynolds officials also cite a recent report by the Congressional Research Service--the research branch of the Library of Congress--that characterized the EPA’s data as “uncertain.” Coggins, the Reynolds toxicologist, complains that the EPA failed to include recent data that found no link between lung cancer and secondhand smoke.

“The epidemiological evidence is not sufficient to say that (secondhand smoke) poses a health risk,” says Gio Batta Gori, a toxicologist and consultant for the Tobacco Institute, a trade industry group.

The EPA says nonsmokers face a 19% increase in their risk of developing lung cancer when they are exposed to secondhand smoke--a figure Gori describes as “a whiff of a risk.” He says that if 2.5% of the study subjects misclassified themselves, the research would be invalid.

But the EPA, which estimates that 1% of subjects misclassified themselves, sticks by its findings. EPA Administrator Carol M. Browner calls the agency’s science “extensively documented” and said the R.J. Reynolds ads “will not distract the public from the real issue: that secondhand smoke poses a serious health problem.”

Most independent scientists agree that secondhand smoke causes death and disease in healthy nonsmokers. It is particularly harmful to people who have underlying illnesses--asthma, heart disease, bronchitis and other respiratory conditions--that are exacerbated by cigarette fumes. But questions remain about just how much exposure will make a healthy person sick.

While living with or working near a heavy smoker is a serious health risk, the dangers of casual exposure are less clear.

“If you were a patron and you go out to eat, say, once a week, I think the disease risk may, in fact, be negligible,” says Don Shopland, coordinator for the National Cancer Institute’s Smoking and Tobacco Control program. “On the other hand, if you are a waitress and have to work in that environment eight hours a day for several years, you have a very substantial disease burden.”

Still, Shopland says there is more than enough evidence to warrant smoking bans. He cites statistics showing that secondhand smoke-related lung cancer alone would kill 100 times as many people each year as asbestos. “And yet,” he says, “if you find asbestos in a school, they will close the school.”

Others--including Trichopoulos--say the risks of secondhand smoke are not commensurate with the public outcry. The real health danger, they say, is to the smoker.

A smoker is 20 times more likely than a nonsmoker to develop lung cancer--a 2,000% higher risk. But, depending on the study cited, someone who breathes secondhand smoke is 1.19 times to 1.4 times as likely as a nonsmoker to develop lung cancer--a 19% to 40% higher risk.

There is yet another ironic twist to the way science has shaped public policy: Most laws designed to curb exposure are directed at places where adults congregate--restaurants and offices. But research shows the biggest danger is to children, particularly those whose parents smoke at home. They need the most protection, yet get the least.

According to the CDC, secondhand smoke causes up to 300,000 cases of bronchitis and pneumonia each year in children under 18 months. It can trigger or worsen asthma attacks, and may also be responsible for up to 26,000 new cases of childhood asthma each year. The agency estimates that 9 million youngsters under 5 live in homes with smokers and are exposed to secondhand smoke almost all day.

Some studies show sudden infant death syndrome is 2 1/2 times more likely to strike babies whose mothers smoke.

These figures have been used in education campaigns, including one by the CDC and another in California financed by Proposition 99, the anti-smoking initiative adopted in 1988. Studies show the campaigns are working; people are smoking less, and are more cautious about where they smoke.

Last year, 27% of California smokers reported they did not smoke in their homes--up from 18.8% in 1992, according to Stanton Glantz, a UC San Francisco researcher who has done extensive work on secondhand smoke. Among smokers who lived with small children, 45% said they did not smoke at home.

And no matter what the research shows, a few simple truths remain: The vast majority of American adults--76%--are not smokers. Many are annoyed by secondhand smoke. It might not make them seriously ill, but it makes their clothes smell and their eyes water. And they are no longer afraid to demand change.

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For the scientists who produced what law professor Banzhaf calls the “medical underpinning” of all this social policy, the current debate is another rung on the tall ladder of acceptance. Many, like Trichopoulos, had little funding and even less support from mainstream health groups, such as the American Cancer Society and the American Heart Assn., which call secondhand smoke a major threat.

Perhaps no researcher has struggled longer or harder than James Repace. He is a 55-year-old health physicist who, while working for the Naval Research Laboratory in Washington in the late 1970s, stumbled upon the idea that secondhand smoke could be measured as air pollution. Working nights and weekends, with a borrowed air-quality monitor, he took measurements at bars, bowling alleys and office buildings.

What he found surprised him: About 85% of indoor air pollution comes from tobacco. In Repace’s view, that makes secondhand smoke the biggest pollution problem in America--bigger, he says, than outdoor air pollution.

“The typical levels of particles in the air in the presence of smoking,” he says, “were worse than you would find on a busy commuter highway during rush hour.”

On a lark, he sent his findings to the prestigious journal Science. The study was published in 1980. R.J. Reynolds researcher Coggins says Repace’s work relied on outdated technology. But the Science article helped make Repace one of the nation’s leading authorities on secondhand smoke; the media often quote him and the government often uses him as an expert witness.

His success, however, has not been a boon to his EPA career.

In 1987, Repace was investigated for conflict of interest by the EPA inspector general after a Tennessee congressman complained that such outside activities prevented him from making a fair judgment about the dangers of tobacco smoke. Although he was cleared, he has been forced to leave the EPA. His bosses there, he said, have told him he is a lightning rod for complaints from the tobacco industry.

It is a conclusion that he does not dispute.

He had little to do with the landmark report declaring secondhand smoke a human carcinogen, and is “on loan” to OSHA. “At the moment,” he says, “I’m looking for other things to do.”

Trichopoulos’ career, meanwhile, has not suffered. Today, he chairs the epidemiology department at the Harvard School of Public Health, marking him as one of the most respected researchers in his field. It has been a long journey from Greece in 1980, when he says, he could barely get his secondhand smoke findings published.

The study finally appeared in the International Journal of Cancer. Trichopoulos believes that had Hirayama’s study not appeared soon after in the widely read British Medical Journal, neither would have been taken seriously.

In his Harvard office, Trichopoulos keeps a rejection letter he got from the editors of one prestigious academic journal. The letter foreshadows the political touchiness of the secondhand smoke debate. The scientist chuckles each time he reads it.

“The implications of your findings are enormous,” the editors wrote. “We believe you will be proved right. . . . You will probably tell us once again that we are chicken.”

Fighting Science With Science

These dueling advertisements--by the tobacco industry, above, and the U.S. Centers for Disease Control and Prevention, right--typify the public relations war over the health dangers of secondhand smoke.