publicado em 12/12/2011 às 15h26:00
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What scientific controversies can tell us about the smoking ban?

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Maria Conceição da Costa, is a professor in the Department of Science and Technology Policy (DPCT) and the Institute of Geosciences (IG) of Unicamp
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Maria Conceição da Costa, is a professor in the Department of Science and Technology Policy (DPCT) and the Institute of Geosciences (IG) of Unicamp

The twentieth century was the setting for the establishment of the consumption of tobacco as a socially acceptable habit, and in some cases even desirable. During this period, the cigarette (emerged as a cheap substitute for cigars and cigarillos and at first seen as a morally questionable product) gradually became a mass-produced product, strongly associated with a symbol of masculinity, sophistication, emancipation and freedom. As pointed out by U.S. researcher Allan Brandt in his book The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America, the process of popularizing the cigarette was a significant and rapid change, closely related to a series of technological innovation, marketing and profound cultural changes.

In turn, the current century seems to be the backdrop for a backlash, even though the harmful effects of smoking have been known since the second half of last century, only recently the smoking habits have to be addressed with greater emphasis . If initially the fight against smoking was based on public policies for individual awareness about the dangers of tobacco, the newest way to combat the smoking habits are related to the prohibition of the consumption of tobacco in public places. In Brazil, this second trend is through the enactment of laws prohibiting smoking in indoor common use, for example, the Municipal Law No. 29.284/2008 city of Rio de Janeiro, Law No. 13,541 / 2009, the State of São Paulo, or the interim order passed by the Senate last November. The rationale behind these laws is very clear: if the active consumption of tobacco has negative effects on the smoker, it is also possible that passive exposure to tobacco smoke is harmful to health. Thus, the ban on smoking in public places would be a measure justified because it ensures that non-smokers are not subjected to any negative effects of smoking habits of others.

However, few people know that exposure to environmental tobacco smoke and its effects on human health are still open for discussion. It is true that smoking in public places can definitely be uncomfortable, but still do not know for sure if it is ultimately harmful. Unlike the existing scientific consensus on the effects of the active consumption of tobacco, the correlation between passive exposure to tobacco smoke and heart disease or lung cancer is less clear and may be questioned from different angles: the toxic components of Smoke acts the same way in active smokers and in cases of passive exposure? What characterizes passive exposure to environmental tobacco smoke, and the methods for their dimensioning and measurement? At what level of exposure to tobacco smoke is harmful? What is the role of other sources of environmental pollution in the causation, for example, respiratory diseases?

For some people, the skepticism and uncertainty may diminish the importance of such public health measures. For others, the existence of a consensus is not very significant, because ultimately, if uncertainty is preferable to adopt the precautionary principle and take a position that provides greater security. Anyway, as illustrated in the field of Social Studies of Science and Technology (ECST), scientific disputes are mainly interesting analytical opportunities. Thus, the study of the controversy over passive exposure to tobacco smoke can provide important elements for understanding both the functioning of Science, as the notions of illness, health and public life of our society.

One of the best-known controversy about ETS exposure has as its protagonists two U.S. researchers, James E. Enstrom and Geoffrey C. Kabat. Researchers in public health at the universities of California and New York respectively, they published in 2003, the British Medical Journal (BMJ), an article entitled Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98. Although the published work to follow all the precepts of scientific practice and have been subjected to peer reviewed journal, it was almost universally condemned for denying the existence of any significant relationship between secondhand smoke and heart disease and cancer . Not even the fact that researchers are based on an epidemiological study recognized (the Cancer Prevention Study - CPS I, produced by the American Cancer Society) avoided the controversy and the attacks on the credibility of the authors and even the magazine's editorial process.

The first and most common accusation of the article is about the involvement of the authors with tobacco companies in the U.S.. In fact, both authors were at some point related to cigarette manufacturing companies or law firms that represent these companies, featuring a clear conflict of interest. But what about their opponents, who also receive funding (government and private) to prove the negative effects of tobacco smoke? In this case, the idealization of science as a disinterested activity did not contribute to the solution of the impasse, and ended up focusing on only one side of the dispute. Analytically, if the allegations about conflicts of interest may lie with the authors of the study because they could not be applied also to his critics?

Beyond this point, other points arising from the controversy are noteworthy. First, as indicated by the anthropologist Mary Douglas, our notions of risk are socially conditioned and represent our ideals of collective security, welfare and normalcy. The processes of secularization and scientific mediation have made speeches on systematic risk replace more traditional notions as, say, sin or taboo. Its social function, however, is very similar: the perceptions of the risks are always politicized and individuals seek to conform to the collective ideals. Especially in the case of some chronic diseases, deviant behavior (such as smoking habits or diets high in fat) contradict established scientific and moral standards, turning people most to blame for the situation of his own illness. The link between disease and proscribed behaviors, and the medicalization of passive smoking (ie, its constitution as a subject susceptible to illness) built the notion of smoking as another culprit for the risks to the health of others. So even without a solid consensus on the subject, the smoking habits (and, therefore, smokers!) Came to be stigmatized and subject to extensive government control and social disapproval.

Briefly, the study of scientific controversies reveal social elements normally hidden in the construction of scientific statements. In the specific case of the effects of passive smoking, in addition to raise the issue of outside intervention and funding of scientific, sociological analysis demonstrates a commonly overlooked part of the large epidemiological studies and medical prescriptions: more than representations of an alleged objective reality, in many cases these technoscientific constructs reflect our collective ideals of security and well-being, by definition, are always socially contextualized.

Thus, instead of proceeding with a simple deconstruction of medical knowledge and epidemiological study of such social scientific statements can provide input for a broader understanding on the topics covered, their historical developments, and especially their broader social implications. Thus, we are working to understand the problem of hazardous effects of smoking without incurring a moralistic persecution against its major victims, the smokers themselves.

   Palavras-chave:   Tobacco smoke    Cigarette smoking    Habit    Lifestyle    Cultural changes    Article      
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