Thursday, October 09, 2008

Prominent Tobacco Control Researcher Cautions CDC that Helena Study Should Not Be Used to Conclude that Smoking Bans Immediately Reduce Heart Attacks

Despite a warning from a prominent tobacco control researcher, the Centers for Disease Control and Prevention used the evidence from the Helena study to widely disseminate to the public unsupported conclusions about the immediate effects of restaurant and bar smoking bans on heart attack rates.

Writing to the Centers for Disease Control and Prevention (CDC) about a draft of its commentary that accompanied the Helena study, this prominent tobacco control scientist wrote:

"I would be very cautious with this and I think the first couple of paragraphs are far too strong for the data presented in the paper. I have seen earlier drafts of this paper with more complete descriptions of the data that were far less compelling. In your discussion of the limitations you seem to believe that the numbers presented are per month. That is not true, they are for the 6 month interval (i.e., 3-4 cases per month), and the difference is largely in the first couple of months in the earlier drafts. Small numbers or no, it would be useful to know the distribution of current, former, and never smokers for the different years (would you feel differently if 70% of the 24 AMI [acute myocardial infarctions] in Helena during 2002 were current smokers for example). The reluctance to produce these breakouts is concerning.

To validate this article with a CDC editorial ("the answer is yes") runs the risk of the writers of the editorial being associated with the over interpretation of the data presented in the article and you should think carefully about it. At best this is a provocative observation, but to suggest that it demonstrates that smoke free ordinances can lower AMI rates is wishful thinking."

While the exact identity of the scientist who wrote this commentary is not known, I have narrowed it down to four possible individuals, each of whom is a highly-respected tobacco control researcher from within the anti-smoking movement. Each of these individuals has served as a frequent editor and reviewer of the Surgeon General's reports on smoking and health.

The Rest of the Story

The rest of the story is this: why is the opinion of this researcher, who clearly represents a substantial contingent within the anti-smoking movement, hidden upon secret documents that were only able to be obtained through a Freedom of Information Act request?

Why did this researcher, and others like him, who disagreed with the conclusions of the Helena study and the use of this study to argue that smoking bans immediately and dramatically reduce heart attacks, fail to make their concerns known more widely than just in this email?

If there are many others out there in the movement, who like me, believe that the Helena science is shoddy and that the findings have been over-inflated, then why have I been the only one willing to speak out?

And if my opinions are actually quite solid, as they appear to be from this highly respected researcher's commentary, then why have I been attacked viciously and consistently by the anti-smoking movement and accused of being an outsider and a traitor?

The answer is quite simple: because I went public with my comments. You aren't allowed to do that in tobacco control. If you dissent, you are allowed to write polite, personal, and private emails expressing your opinion, but you are not allowed to go public with your dissenting comments. You have to shut up and keep your opinion to yourself.

That is what many scientists in tobacco control did. And for good reason. If you go public, they will ruin your career. They will do everything they can to discredit you. You will be evicted from the movement. You will be accused of being a tobacco mole and a traitor.

What I want people to take away from this story, and the reason I think it is so vitally important, is that it demonstrates conclusively that my opinions regarding the shoddiness of the Helena study and the over-inflated conclusions from this study are shared by many other respected scientists within tobacco control. Many of my colleagues share precisely my views with regards to this area of research.

However, you will not find these views expressed publicly in any forum. To do so would be fatal to these researchers' careers in tobacco control.

Thus, the only views you will see from someone within the movement are my own. And the fact that I went public with these comments is what got me ex-communicated from the movement.

It is really a McCarthyist-like movement. You cannot express dissent publicly. You must tow the party line. You are allowed to disagree - privately. You are allowed to express your disagreement - privately. But you can't talk about it. You have to keep it to yourself. If you go public, that's it - you're ostracized, attacked, victimized. Thrown off the list-serves. Not allowed to present at conferences. Defamed behind your back.

The sad thing is that I was thrown out of the movement for expressing exactly the views expressed by this prominent, respected tobacco control researcher. He, like everyone else in tobacco control, knows that if he were to express these views publicly, he would be in the same boat as I am: sent away from the main ship to exile on a desert island. That's why it takes a Freedom of Information Act request to uncover these views of scientists from within the movement.

To interfere in any way with the movement's ability to promote smoke-free laws based on the most wild and exaggerated (and unsupported) claims is fatal to anyone's existence within the movement.

That more recent population-based studies do not support the Helena conclusion is of no consequence in this movement. Not because this evidence doesn't convince numerous scientists within the movement that the conclusions from Helena are wrong. But because there can be no public statement that anyone disagrees. The researchers have to keep it to themselves. They can discuss it amongst themselves, privately, in emails and at conferences. But they are not allowed to express it publicly. There can be no public debates about the established wisdom in tobacco control.

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