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9 Febbraio 2005 - Siamo lieti di presentare ai nostri lettori la lista aggiornata degli studi su fumo passivo e cancro polmonare. La lista include la differenziazione per categorie (esempio: lavoro, casa, infanzia, ecc.); questa spiega l'apparente raddoppio del numero degli studi, in realtà leggermente superiore a 70. Questa lista mette davvero la parola “fine” alla diatriba sul fumo passivo, perché dimostra conclusivamente, passo per passo e in un linguaggio estremamente semplice ed accessibile a tutti, l’incredibile falsa rappresentazione dell'evidenza usata per trasformare un non-pericolo in una “epidemia” e in un fenomeno di isterismo collettivo.

Raccomandiamo di leggere le informazioni necessarie per meglio comprendere il significato delle tavole.

(salta le informazioni e vai alle condizioni per la validità epidemiologica) || (salta tutto e vai alle tavole)

Incidenza di una malattia:  La frequenza con cui tale malattia appare nelle persone.

Rischio relativo, elevazione di rischio, RR: il rapporto tra l’incidenza di una malattia in un gruppo di persone che si crede sia esposto al fumo passivo (questo gruppo è chiamato caso) e l’incidenza della stessa malattia  in un gruppo non esposto al fumo passivo (questo gruppo è chiamato controllo).

Se l’incidenza tra gli esposti e i non esposti è la stessa il rischio relativo è 1 e non c’è alcun cambio di rischio. Se l’incidenza è più altra tra gli esposti, RR diventa più grande di uno e il rischio cresce. Se l’incidenza è più bassa tra gli esposti, RR diventa più piccolo di uno e il rischio diminuisce. Per dimostrare l’esistenza di un vero rischio, per gli studi che esaminano malattie multi-fattoriali (vedi sotto) l’elevazione deve essere almeno del 100-200% (RR=2 o 3); altrimenti, visto l’enorme margine di errore di questo tipo di studi, un’elevazione del 20% (RR=1.2), com’è la media nel caso del fumo passivo, non ha alcuna sostanza.

Fattore confondente (confounder) o concomitante: fattori e circostanze che contribuiscono alla malattia. Tutte le malattie attribuite al fumo (attivo o passivo) sono multi-fattoriali, cioè possono essere causate da diversi fattori che agiscono o individualmente o assieme ad altri – differentemente da malattie mono-fattoriali che hanno invece una sola causa, e le cui elevazioni di rischio possono essere accuratamente misurate. Le combinazioni con cui i confondenti agiscono sono infinite, e cambiano per ogni singolo individuo.

Studio longitudinale: uno studio che identifica gruppi o individui esposti o non esposti a condizioni potenzialmente tossiche, e li segue per molti anni.

Studio retrospettivo: uno studio basato sui ricordi di esposizione delle persone intervistate e non su misurazione diretta dell’esposizione.  Uno studio retrospettivo non ha modo di verificare l’accuratezza dei ricordi.

Studio caso-controllo: studio utilizzato quando non c’è altra possibilità se non quella di osservare le differenze di esposizione ai tossici in gruppi di gente con e senza la malattia. Gli studi caso-controllo sono necessariamente retrospettivi. In questi studi l’incidenza della malattia è zero nei controlli (gente non esposta) e 100% nei casi (gente esposta); ovvero, si sceglie solo la gente esposta che abbia già la malattia senza verificare cosa l’ha causata. Questi studi cercano di indovinare l’esposizione dei soggetti al fumo passivo basandosi su ciò che i soggetti dicono di ricordare e quindi inferire (indovinare) il rischio, puramente sulla base della differenza di esposizione ricordata dai soggetti esaminati durante le interviste. Infine si attribuisce la malattia già esistente (e che potrebbe essere stata causata da una qualsiasi combinazione di altri cofattori) al fumo passivo, di nuovo basandosi sulla differenza di esposizione riportata dagli intervistati. La schiacciante maggioranza degli studi sul fumo passivo è retrospettiva, e caso-controllo. Con questa qualità metodologica si procede a dire che il fumo passivo “avvelena” gli altri, e che “non c’è dubbio che il fumo passivo sia cancerogeno”.

Ipotesi: Una congettura che deve essere dimostrata con la sperimentazione.

Significato statistico: una coerenza numerica che indica solo che i dati facciano tutti vedere un beneficio o un rischio, e non un po’ di uno e un po’ dell’altro, come invece accade per  la maggioranza degli studi sul fumo passivo. Attenzione, non farti ingannare: “significato statistico” non vuol dire né che i dati siano accurati, né che il rischio/beneficio esiste, né che esso sia grosso. In breve, rischio con “significato statistico” (o “statisticamente significativo”) non vuol dire “rischio significante”, come invece la “salute pubblica”, i truffatori attivisti antifumo e i media loro portavoce ci lasciano intendere.

Intervallo di confidenza: il margine di certezza che non si siano fatti errori. Tale intervallo è del 95%. Per leggere la tavola sotto, semplicemente ricordarsi questa facile regola: per avere significato statistico di elevazione di rischio, i due numeri che definiscono l’intervallo devono essere maggiori di 1 (esempio: 1.3 – 4.7); per avere significato statistico di diminuzione di rischio (beneficio), i due numeri che definiscono l’intervallo devono essere minori di 1 (esempio: 0.6 – 0.9). Se l’intervallo è a cavallo di 1 (esempio: 0.7 – 2.3) lo studio è privo di significato statistico, cioè non dimostra proprio nulla.

Passiamo ora alla descrizione di ciò che è necessario a uno studio per stabilire una vera validità epidemiologica.

Condizioni necessarie per la validità epidemiologica

Le condizioni soddisfatte dagli studi sul fumo passivo

Per ragioni di brevità e chiarezza ci concentriamo qui sugli studi epidemiologici concernenti fumo passivo e cancro polmonare, i cui sponsor affermano sempre che rappresentano l’evidenza migliore e più forte dei rischi dell’esposizione al fumo passivo. Su tale base, le considerazioni concernenti l’affidabilità delle affermazioni per altre malattie che si afferma siano collegate all’esposizione al fumo passivo devono essere subordinate alle considerazioni sul cancro polmonare.

La credibilità dei criteri sopra è lapalissiana, facile da capire e comprensibile a chiunque sia interessato nella verifica dell’evidenza basata sui fatti. Su tale base sfidiamo chiunque ad esprimere discordia su quanto segue, che affermiamo essere valido per qualsiasi studio o qualsiasi meta-analisi finora condotta sul fumo passivo.

1.       È incontrovertibile che nessuno degli studi esistenti può garantire che le sue rappresentazioni numeriche di esposizione individuale al fumo passivo durante l’arco della vita ricordate dai soggetti intervistati siano misure vere di esposizioni reali.

2.       È incontrovertibile che nessuno degli studi esistenti può garantire che la tendenziosità (bias) dei ricordi dei soggetti intervistati abbia la stessa influenza sia sui casi sia sui controlli, e sui gruppi esposti e non esposti.

3.       È incontrovertibile che nessuno degli studi esistenti può garantire che la selezione dei soggetti e le tendenziosità su classificazione errata (misclassification ed altri bias) abbiano la stessa influenza sia sui casi sia sui controlli, e sui gruppi esposti e non esposti.

4.       È incontrovertibile che nessuno degli studi esistenti può garantire che noti fattori confondenti causali (causal confounders) abbiano la stessa influenza sia sui casi sia sui controlli, e sui gruppi esposti e non esposti.

5.       È incontrovertibile che nessuno degli studi esistenti ha garantito l’accuratezza delle informazioni cliniche concernenti patologie e diagnosi.

6.       È incontrovertibile che i risultati di vari studi concernenti il fumo passivo sono stati grossolanamente incoerenti e non riproducibili in modo affidabile.

7.       È incontrovertibile che solo una sparuta minoranza di studi ha riportato il margine di errore numerico a o sotto al 95% del livello di confidenza del significato statistico.

8.       È incontrovertibile che nessuno degli studi sul fumo passivo ha soddisfatto i criteri di causalità di Hill. *

9.       È incontrovertibile che nessuna meta-analisi degli studi sul fumo passivo è stata condotta sulla base di tutti gli studi disponibili, studi che esibiscono un’omogeneità di struttura e di condotta, e che abbiano soddisfatto i criteri di validità suesposti.

Una dettagliata considerazione di ogni singolo studio sul fumo passivo e cancro polmonare renderebbe questo rapporto inaccessibile alle persone non specializzate. Su richiesta però ci impegniamo ad offrire un’analisi dettagliata di ogni studio sotto-elencato per ciò che concerne le affermazioni sopraesposte.

Cionondimeno, i punti sulla coerenza dei risultati e del significato statistico possono essere presentati e capiti immediatamente con una semplice lista degli studi e dei rischi riportati. Sommari grafici sono anche forniti dopo la tavola.

Si ricorda al lettore che il significato statistico concerne solo il contesto numerico di uno studio, e si riferisce solo al campo di errore numerico di un particolare studio. Nessuna manipolazione statistica può migliorare al qualità dei dati raccolti, e quindi se i dati sono inaffidabili e corrotti ogni derivante stima statistica resta ugualmente inaffidabile e corrotta.

Per esempio, nessuna manovra statistica può migliorare la mancanza di affidabilità sull’esposizione al fumo passivo derivante dai ricordi delle persone esaminate in un particolare studio. Ne segue che uno studio con un’elevazione di rischio dal significato statistico non da alcuna assicurazione di essere credibile.  D’altra parte uno studio senza significato statistico – che faccia vedere un’elevazione di rischio o un beneficio -  è doppiamente inaffidabile: primo a causa dell’inaffidabilità dei dati di base, e secondo perché il margine di errore numerico è inaccettabile. In ogni caso, gli studi più grossi hanno un vantaggio statistico perché la dimensione dell’errore numerico è inversamente proporzionale al numero delle persone esaminate da un particolare studio.

Come tabella generale, ecco tutti gli studi disponibili fino a oggi concernenti l’esposizione al  fumo passivo e il cancro polmonare, classificati in tre categorie:

STUDI CONIUGALI - Studi su non fumatori conviventi con mogli, mariti o partner fumatori.

STUDI SUL LAVORO - Studi su non fumatori che lavorano in luoghi dove si permette di fumare.

STUDI SULL’INFANZIA - Studi su non fumatori esposti al fumo passivo a casa durante la fanciullezza e l’adolescenza.

The Evidence

L'archivio scientifico che scardina 50 anni di superstizioni sul fumo

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