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Peter N Lee, MA
Sutton, England

JAMA. 1992;267(24):3284.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Dr Steenland¹ estimates more than 35000 deaths from ischemic heart disease occur annually in the United States from exposure to environmental tobacco smoke (ETS), a number similar to previous estimates by Wells² and Glantz and Parmley.³ These estimates conflict with overviews of the evidence prepared under the auspices of a number of national authorities, none of which considered a causal relationship demonstrated.⁴ The estimates take the epidemiological evidence essentially at face value, making adjustments only for a limited number of sources of bias, and failing to reflect the fragility of the data.

Steenland does not even mention publication bias, although a number of prospective studies presented data on lung cancer but not on heart disease. Nor does he mention the general paucity of available data. Only three studies^5-7 with more than 120 cases have been published despite the relatively high incidence of . . . [Full Text PDF of this Article]

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