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E-letters: Electronic letters published:
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Real denial
- Jeffrey R. Johnstone, None (20 March 2009)
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Response to Pascal Diethelm and Martin McKee
- Jonathan H Bagley (27 February 2009)
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Response to G. Kabat
- Pascal A Diethelm, Martin McKee (25 February 2009)
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Denialism, Hookah Environmental Tobacco Smoke, and the "Overwhelming Consensus on the Evidence"
- Kamal Chaouachi (17 February 2009)
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On “Denialism,” Passive Smoking, Orwell, and the Search for Truth
- Geoffrey Kabat (16 February 2009)
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Response to Professor Siegel
- Martin McKee, Pascal Diethelm (13 February 2009)
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Danger: Public Health Could Become a Religious Movement
- Michael Siegel (11 February 2009)
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Jeffrey R. Johnstone, Self-employed Home, None
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Two examples of real denial. First, the 1998 WHO study of passive smoking and lung cancer, the largest case-control study yet conducted.: http://jnci.oxfordjournals.org/cgi/reprint/90/19/1440 “Results: ETS exposure during childhood was not associated with an increased risk of lung cancer (odds ratio [OR] for ever exposure = 0.78; 95% confidence interval [CI] = 0.64–0.96).” It is clear that the authors could not bear to put into words their own numerical results which show that passive smoking in childhood is associated with a reduced incidence of lung cancer. This was their only significant result, the other two exposures being spouse and workplace. Their quoted statement is at best deceptive. Second, a missing report from the US Surgeon General. In 1964 the American Surgeon General published "Smoking and Health", the first of many reports about public health. There are dozens of them.most of which relate to smoking and health. A list of them can be found at: http://www.surgeongeneral.gov/library/reports.htm But one is missing. At the time of the first report the Surgeon General had exercised his right to commission the Bureau of the Census to survey the population and compare the health of smokers, nonsmokers and exsmokers.The results were published in 1967 as`"Cigarette Smoking and Health Characteristics" with "William H. Stewart Surgeon General" on the title-page. The results were unexpected and, it seems, unwelcome: the healthiest people were not the nonsmokers but those who smoked 1 - 11 cigarettes per day http://members.iinet.net.au/~ray//sr10_034acc.pdf Forty years ago when antismoking hysteria had yet to develop this didn't matter too much. Today it very different: how can the message "there is no safe level of smoking" be promoted when we have evidence - from the Surgeon General himself - that a few cigarettes are not merely harmless but positively beneficial? The solution is simple. Delete it. It has been deleted and there is no trace of it at the Surgeon General site. These are examples of serious denial. Conflict of Interest:None declared |
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Jonathan H Bagley, Lecturer University of Manchester, M13
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The following extract from the paper perfectly illustrates why many people question the claims of anti-tobacco groups. "......while even now, despite clear evidence of rapid reductions in myocardial infarctions where bans have been implemented, there are some who deny that second-hand smoke is dangerous." England has a population of 51,000,000. The data for heart attack incidence for the period following the July 2007 English smoking ban is now available [1]. The most recent figure covers the period April 2007 to March 2008 and shows a year on year fall of 2%; compared to 2.8% for 06/07 and 3.8% for 05/06. Although the last period does not start in July 2007, it is implausible that the decline in the year following the ban exceeds 3%. The situation is similar in both Scotland and Wales. In the USA, smoking bans are often implemented county by county, do not cover all non-residential premises and appear to be frequently violated. The exact opposite has been the case in England. On one day, a total smoking ban was imposed on 51,000,000 people. There was no rapid reduction in myocardial infarctions. To argue otherwise using small samples from the target or similar populations is akin to attempting to overturn an election result by taking an opinion poll a week later. [1] HESonline. http://www.hesonline.nhs.uk Conflict of Interest:smoker |
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Pascal A Diethelm, Public health consultant Geneva, CH-1204 Switzerland, Martin McKee
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In his rather emotional comments, G. Kabat, purporting to read our mind, claims that the 2003 BMJ paper he wrote with J. Enstrom is the "real target" of our Viewpoint. He should read carefully what we wrote. We presented their article simply as an example of "isolated papers that challenge the dominant consensus," to illustrate how these papers are used very selectively by those who deny any link between passive smoking and diseases. It is a fact that the tobacco industry has made extensive use of the Enstrom-Kabat paper in its denial campaign (unsurprisingly, as they paid and directed it). We mention how Japan Tobacco International still uses it to reject "the claim that ETS is a cause of lung cancer, heart disease and chronic pulmonary diseases in non-smokers." Another example is provided by Judge Gladys Kessler, who states in her Final Opinion that cigarette company BATCo promoted the EK study to "fraudulently deny ... that passive smoke is a health hazard to adults or children." [1, pp. 1555 -1556] Our statement that the EK paper was "later shown to suffer from major flaws, including a failure to report competing interests" is supported by the reference we cited [2]. Using internal tobacco industry documents, Bero et al. describe how the statement detailing the authors' competing interests, in spite of its length, "does not reveal the full extent of the relationship the authors had with the tobacco industry." Reading the section dedicated to the EK study in Judge Kessler's Final Opinion also reveals the enormous gap between the authors' statement and the evidence found by the US federal court.[1, pp. 1380-1383] Bero et al. also mention a major flaw of the EK study: there was no real "unexposed" group in the CPS-I dataset that Enstrom and Kabat used. Judge Kessler made the same observation: "The American Cancer Society had repeatedly warned Enstrom that using its CPS-I data in the manner he was using it would lead to unreliable results. Enstrom used only a small subset of the overall data, and, more importantly, the data corresponded to participants who enrolled in 1959, a time when exposure to tobacco smoke was common."[1, pp. 1382-1383] Members of the 2002 working group on involuntary smoking and cancer for the International Agency for Research on Cancer made the following assessment - reported in Judge Kessler's Final Opinion [1, p. 1382]: "Enstrom and Kabat's conclusions are not supported by the weak evidence they offer, and although the accompanying editorial alluded to 'debate' and 'controversy', we judge the issue to be resolved scientifically, even though the 'debate' is cynically continued by the tobacco industry." We therefore think that our statement that the EK paper was "shown to suffer from major flaws, including a failure to report competing interests" is based on solid references. Given what is today known about this paper, we stretch the charity principle to the maximum extent possible when we present it simply as an example of "isolated papers that challenge the dominant consensus." 1. Gladys Kessler, United States District Court Judge, Final Opinion, August 17, 2006 http://www.usdoj.gov/civil/cases/tobacco2/amended%20opinion.pdf 2. Bero LA, Glantz S, Hong MK. The limits of competing interest disclosures. Tob Control 2005;14:11826. Conflict of Interest:None declared |
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Kamal Chaouachi, Tobacco Researcher and Consultant Paris
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Two social scientists looked into
the “famous” case of ENSTROM & KABAT cited by DIETHELM & McKEE
(D&M)[1-3]. Interestingly, they found that “the public consensus
about the negative effects of passive smoke is so strong that it has become
part of a regime of truth that cannot be intelligibly questioned”[3].
D&M abuse of strong phrases and words such as “fake experts”, “denialism”,
etc. and even draw a parallel with a black period of Western history. As for
their critique of the former US
president, it would have been praised if it had been published when the
individual was still in office… In Europe, a top tobacco national
authority has recently exposed the fraud about the ETS science contained in a
supranational official report entitled “Lifting the Smokescreen”. Stressing
that this document had been used to support the passing of laws banning smoking
in public places (cafes, etc.), the critic literally asks: “Epidemiologic Study
or Manipulation ?”[4]. Indeed, among the 5,863 ETS(Environmental Tobacco
Smoke)-induced estimated deaths, 4,749 concerned everyday smokers and the 1,114
“non-smokers” happened to be former smokers... Consequently, the remaining risk
could hardly be attributed to ETS. Last but not least, all ethical norms were
actually violated since the report was openly sponsored by the pharmaceutical
industry [4]. Will hunters of “denialism” also say that this brave
scientist is a “fake expert” or a “denialist” or that he has conflicting
interests ? D&M
suggest a wise rule for debate: “[…] testing the strengths and weaknesses
of the differing views, […] and to accept principles of logic »[1]. Since the issue at
the core of D&M’s paper is about the great hazards of ETS, “the strength
and weaknesses” of DIETHELM’s views on this topic have been tested accordingly.
The Swiss expert has authored a scientific article (May 2007) on the hazards of
hookah (narghile, shisha) smoking [5]. The material was mainly based on
the pre-released information about a study on UFP (Ultra-Fine Particles) in
hookah smoke by MONN et al. later published in an anti-smoking research journal
[6]. Hookah ETS hazards are hyped and this practice would be highly
noxious for both the active and passive smoker. Its ETS is even more dangerous
than that of cigarettes
(Original in French: « la fumée passive produite par le narguilé est en
fait beaucoup plus dangereuse […] »[5]. DIETHELM’s
emphasis on the importance of the peer-review process for validating sound
science unfortunately collides with the scientific contents of his article on hookah
ETS. In fact, the expert has completely misunderstood MONN et al’ study which
did not analyse hookah ETS but only its MSS (MainStream smoke), i.e. the smoke
supposed to be inhaled by the hookah smoker [6]. If, in cigarettes, ETS is a rough
“sum” of EMSS (Exhaled MainStream smoke) and SSS (Side-Stream Smoke), aged and
diluted, the case of hookah is completely different because this kind of pipe
does generate almost no SSS… This fact was confirmed in a recent nuclear study
conducted by Egyptian and Saudi researchers”[7]. A few years earlier, a
US team pointed out that “one of the only articulated benefits to this
tobacco alternative is the minimal release of side-stream smoke, which would
ultimately place by-standers at risk for ETS exposure”[8]. Furthermore, What MONN et
al.’ study actually shows is that UFP and CO concentrations in hookah smoke
are 2.76 and 13.21 smaller, respectively, than in
cigarette smoke. This is not all as DIETHELM has also dismissed
important facts such as the very high proportions of glycerol and water in
hookah smoke. His emphasis on Carbon Monoxide is totally irrelevant because all published peer-reviewed studies
show that the mean expired CO levels in non-smokers exposed to hookah smoke virtually
do not vary: e.g. a study co-authored by HAMMOND, member of WHO TobReg [9].
Notably, DIETHELM relies to a great extent on the WHO flawed report,
peer-reviewed by the top experts of TobReg [10]. As for ETS “social aspects”, the WHO
experts were wrong when stating that it is common (“not uncommon”) for children
in the Arab world to smoke narghile with their parents [10]. Here,
DIETHELM appeared to be “more Catholic than the Pope” and stressed that
numerous parents (in Switzerland, apparently immigrants and likely from the
same region) allow their children, sometimes aged less than 12 years, to gather
at home and smoke hookah in group (Original: « […]
de nombreux parents, […] parfois de très jeunes adolescents de 12 ans ou moins
[…] dans le logement familial […]”). It appeared that the
authors of the WHO report had no data to support what they apparently put down
in a hurry. For this reason, DIETHELM is kindly requested to inform on the
scientific sources supporting his harder (than WHO’s) facts. Is this
the golden standard the critic of “denialism” wishes to use when assessing
opponents’ views ? Should
everyone blindly agree with a supposed « overwhelming consensus on the
evidence » ? Should we also name “denialists” DECKERS et al,
AL-NACHEF and HAMMOND and all researchers who come up with unexpected results ?
Should SIEGEL be defamed the same way he who, interestingly, argued that ETS
kills over 50,000 US Americans each year and whose testimony expertise
contributed towards a 145 billion dollars verdict against tobacco companies [11]
? Or the only criterion should be the scientific merit of any contribution to a
debate ? Because of the lack of a free debate, even the Cochrane review (
“golden standard in evidence-based medicine”) on ““waterpipe”” proved to be not
empty of serious errors [7][12]. Criticising, pinpointing and
pinning down errors and debating is good for the advance of science. Finally,
D&M consider Galileo as a reference that tobacco “denialists” should
refrain from citing in support of their unacceptable views. What is not understood
here is that the problems related to tobacco and drug research and policy are
very similar. From there, Galileo is and will remain a universal reference [13].
____________ REFERENCES [1]
Diethelm, P, McKee, M. Denialism: what is it and how should scientists respond?
Eur J Public Health. 2009; 19:2-4. [2]
Enstrom JE. Defending legitimate epidemiologic research: combating Lysenko
pseudoscience. Epidemiologic Perspectives & Innovations 2007 (10 Oct);4:11. [3] Ungar
S, Bray D. Silencing science: partisanship and the career of a publication
disputing the dangers of secondhand smoke. Publ Understand Sci 2005;14:5-23. [4] Molimard R. Le rapport Européen Lifting
the SmokeScreen: Etude épidémiologique ou
manipulation ? [The European Report "Lifting the SmokeScreen":
Epidemiological study or manipulation?] Rev Epidemiol Sante
Publique. 2008 Aug;56(4):286-90. [in
French. Abstract in English] http://www.formindep.org/L-article-integral-du-professeur
[English full text translation] [5]
Diethelm P. Narguilé : attention, danger ! Dossier 07-003 - 2007-05-29. OxyGenève 2007 (May). http://www.oxygeneve.ch/dossier.php?id=67 (accessed 31 Jan
2009) [6] Monn Ch,
Kindler P, Meile A, Brändli O. Ultrafine particle emissions from waterpipes.
Tob Control 2007; 16: 390–3. [7] Khater AE, Abd El-Aziz NS, Al-Sewaidan HA,
Chaouachi K. Radiological hazards of Narghile (hookah, shisha, goza) smoking: activity
concentrations and dose assessment. J Environ Radioact. 2008
Dec;99(12):1808-14. [8]
Deckers SK, Farley J, Heath J. Tobacco and its trendy alternatives:
implications for pediatric nurses. Crit Care Nurs Clin North Am 2006
(Mar);18(1):95-104. [9] El-Nachef
WN, Hammond SK. Exhaled carbon monoxide with waterpipe use in US students. JAMA. 2008 Jan
2;299(1):36-8. [10]
Chaouachi K. A Critique of the WHO's TobReg "Advisory Note" entitled:
"Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended
Actions by Regulators. Journal of Negative Results in Biomedicine 2006 (17 Nov); 5:17. http://www.jnrbm.com/content/5/1/17 [11]
Siegel M. ASH Compares Critics Of Link Between Smoking Bans And Dramatic Heart
Attack Reductions AIDS Dissidents WHo Deny Link Between HIV And AIDS. Medical
News Today. 2009 (9 Feb) http://www.medicalnewstoday.com/articles/138355.php [12]
Sajid KM, Chaouachi K, Mahmood R. Hookah smoking and cancer. Carcinoembryonic
Antigen (CEA) levels in exclusive/ever hookah smokers. Harm Reduction Journal
2008 24 May;5(19) http://www.harmreductionjournal.com/content/5/1/19 [13] Small D, Drucker E. Return to Galileo? The
inquisition of the international narcotic control board. Harm Reduct J. 2008
May 7;5:16. http://www.harmreductionjournal.com/content/5/1/16 Conflict of Interest:
I have no competing interests. I have never
received direct or indirect funding neither from pharmaceutical companies
(nicotine ‘‘replacement’’ therapies and products) nor from the tobacco
industry. I have participated in the past in the design of a no-CO harm
reduction hookah project. More details about a defamation campaign regarding
the first E-Letter I sent in my life (Dec 4, 2004) can be found at: http://www.harmreductionjournal.com/content/5/1/19/comments#304579 More evidence in PubMed itself: http://www.ncbi.nlm.nih.gov/sites/entrez (enter “chaouachi k”) |
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Geoffrey Kabat, Senior Epidemiologist Albert Einstein College of Medicine, Bronx, NY 10461
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The viewpoint piece by Diethelm and McKee (1) presents itself as a disinterested commentary on the perverse phenomenon of “denialism” – the refusal to accept well-established facts. Jacob Sullum has already astutely pointed out how the authors themselves prefer to avoid any discussion of relevant facts when it comes to issues closer to their immediate concerns than AIDS and climate change, which they cite as prime examples of denialism (2). As the co-author of one of the few substantive studies cited by Diethelm and McKee (3) – clearly the real target that the authors had in mind -- I would add a number of points that readers should be aware of. These will add to the irony of these authors setting themselves up as lofty defenders of truth in science. First, Diethelm and McKee state that James Enstrom and I failed to fully disclose our competing interests in our 2003 article in the BMJ. In fact, our article carried a 208-word statement detailing in full our competing interests. This has all been aired in the rapid responses to the BMJ (4) and the paper was defended by the editor-in-chief Richard Smith (5) and by other editors (6). Apparently, none of this satisfied Diethelm and McKee nor apparently merits citing. For what purports to be an intellectual argument about the ability (or inability) of some to recognize and accept scientific truth, one of the things that is striking about this “viewpoint” is the authors’ failure to make any of the necessary distinctions needed to shed light on this phenomenon. They make no distinction between the incontrovertible evidence demonstrating that HIV is the cause AIDS and the inherently chaotic phenomenon of climate and climate change, where, rather than one truth, there is a range of opinion and a very wide range of estimates (7). More to the point, they make no distinction between the established health effects of active smoking versus those of passive smoking, or the effects of smoking bans. Finally, they do not distinguish between ignorance, or the irrational clinging to anti-scientific beliefs, on the one hand, and reasoned and documented scientific work that goes against their own entrenched beliefs, on the other. Diethelm and McKee are not interested in the facts that are relevant to the issue of passive smoking. If they had been, they would have acknowledged that the results presented in our BMJ paper do not differ in the slightest from those published by the American Cancer Society (8, 9). [We submitted 16 pages of supporting evidence to the BMJ on June 30, 2003 (8). Unfortunately, it was not published, mostly likely because of the furor created by persons like Diethelm and McKee. Another version of this evidence was published in 2006 (9).] They would have acknowledged that other large recent epidemiologic studies (10) have also found no association of ETS exposure with fatal disease. They would have referred to carefully done monitoring studies both in the U.S. and Europe, which suggest that average ETS exposure in the early 1990s, before stringent restrictions on smoking were enacted, indicated that average ETS exposure of never smokers was on the order of 1/1,000th that of the average active smoker (11, 12). And they would have acknowledged the fact that Sir Richard Peto testified before the House of Lords, making the point that, while undoubtedly carrying some additional risk to the never smoker, environmental tobacco smoke was too dilute to quantitate the risk, and emphasizing that it is active smoking that kills people (13). Is Sir Richard to be numbered among “denialists”? It is also relevant to note that neither Diethelm nor McKee has ever published any substantive scientific study dealing with ETS. This explains their lack of interest in what the actual evidence really shows. For their purposes, which relate solely to policy, as opposed to science, it is expedient to refer only to the activist consensus concerning ETS. Rather than engaging in a discussion of the scientific evidence, Diethelm and McKee prefer to engage in ad hominem attacks and to imply guilt by association – methods long-recognized in the field of rhetoric as the lowest form of argumentation. I pointed this out in my reply (14) to the very first “rapid response” to our BMJ paper by Martin McKee (15) in May, 2003 (which, it should be noted, he wrote 2 days before the full, 10- page version of our paper was accessible). For Diethelm and McKee, nothing of note appears to have changed since then. Diethelm and McKee’s sleight-of-hand is to imply that there should be equal certainty across all the historical and scientific issues they mention. Thus, questioning the weak-to-null association of passive smoking with fatal disease is tantamount to Holocaust denial or denial that HIV causes AIDS. Their true goal is to assert the existence of an unquestionable consensus concerning passive smoking, and to discredit anyone who would dare to bring the best scientific evidence to bear on the question. It is thus highly ironical that in the opening of their piece, Diethelm and McKee echo George Orwell in his novel Nineteen Eighty-Four. Orwell was a withering critic of the ideology of Fascist and Stalinist regimes which impose a rigid dogma that overrides any relevant facts and which cannot be questioned. Rather than being able to tolerate legitimate scientific inquiry, Diethelm and McKee would set themselves up as the political commissars of right-thinking in public health. References 1. Diethelm P, McKee M. Denialism: what is it and how should scientists respond? Eur J Public Health, January 2009; 19: 2 - 4. 2. Sullum J. If You Question the Deadliness of Secondhand Smoke, You Might As Well Question the Deadliness of Zyklon B. Reason magazine (Feb. 13, 2009), http://reason.com/blog/show/131691.html 3. Enstrom JE, Kabat GC. Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98. BMJ 325 (May 17, 2003), 1057-1066. 4. Enstrom JE, Kabat GC. “The authors respond.” BMJ 327 (August 30, 2003), A501-A505) 5. Smith R. Comment from the editor. BMJ 2003;327:505. 6. Tonks A. Passsive smoking: summary of rapid responses. BMJ 2003;327:505. 7. Intergovernmental Panel on Climate Change (IPCC). Climate Change 2007: The Physical Science Basis. 8. Enstrom JE, Kabat GC. “Conflicting Results on Environmental Tobacco Smoke from the American Cancer Society.’ Manuscript BMJ/2003/084269, June 30, 2003 (http://www.scientificintegrityinstitute.org/BMJ084269.pdf) 9. Enstrom JE, Kabat GC. Environmental tobacco smoke and coronary heart disease mortality in the United States – a meta-analysis and critique. Inhalation Toxicol 2006;18:199-210. 10. Stranges S, Bonner MR, Fucci F, et al. Lifetime cumulative exposure to secondhand smoke and risk of myocardial infarction in never smokers: results from the Western New York health study, 1995-2001. Arch Intern Med. 2006;166(18):1961-7 11. Jenkins RA, Palausky A, Counts RW, et al. Exposure to environmental tobacco smoke in sixteen cities in the United States as determined by personal breathing zone air sampling. J Expos Anal Environ Epidemiol 1996;6:473-502. 12. Phillips K, Howard DA, Browne D, Lewsley JM. Assessment of personal exposures to environmental tobacco smoke in British nonsmokers. Environ Internatl 1994:20:693-712. 13. Peto R. Testimony before the House of Lords Economic Affairs Committee, Feb. 2006. 14. Kabat GC. Response to “Need for clarification of competing interest. BMJ.com, May 17th, 2003, http://www.bmj.com.elibrary.aecom.yu.edu/cgi/eletters/326/7398/1057#32294 15. McKee M. Need for clarification of competing interest. BMJ.com, May 15th, 2003, http://www.bmj.com.elibrary.aecom.yu.edu/cgi/eletters/326/7398/1057#32294 Conflict of Interest:None declared |
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Martin McKee, Professor of European Public Health LSHTM, London, WC1E 7HT, UK, Pascal Diethelm
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Professor Siegel completely misrepresents our position. We are not suggesting that those whom we define as denialists should be censored. Far from it. We simply propose that, as they established ground rules for debate that are not based on openness to evidence and scientific principles, we should recognise this and frame our arguments accordingly. Where there is genuine scientific controversy we, of course, believe in the need for informed and open debate using scientific evidence. However, this does not apply when one side uses highly selective evidence to suggest that there is genuine scientific uncertainty when this is not the case. Seemingly inadvertently, Professor Siegel makes our point. The 30% increase that he quotes is obtained from studies that compare the risk of disease in spouses of smokers and non-smokers, a weak study design (we will not rehearse the enormous effort by the tobacco industry to discredit even that research or its covert work to promote so-called “good epidemiological practice” that would dismiss relative risks of less than 2 as being unreliable). However, where direct measures of exposure are used (cotinine), the risk is substantially greater (relative hazard for coronary heart disease and stroke 1.57 (95% CI 1.08 to 2.28)) 1 Yet this is only the beginning. As we have shown previously, the tobacco industry has long known (from its own secretly conducted animal experiments) that “room aged sidestream smoke” is much more toxic, volume for volume, than directly inhaled smoke,2 a finding that provides some explanation for the now common finding of rapid declines in coronary heart events following introduction of smoking bans.3 So there we have it. First, epidemiological evidence of association, with the association strengthened with improved measures of exposure. Second, biological evidence from animal studies. Third, a reduction in adverse outcomes after removal of exposure in natural experiments. All that is missing is a randomised controlled trial but it is difficult to envisage, given the need to show genuine equipoise, that any ethics committee would ever approve one. Martin McKee, Pascal Diethelm References 1. Whincup PH, Gilg JA, Emberson JR, Jarvis MJ, Feyerabend C, Bryant A, Walker M, Cook DG. Passive smoking and risk of coronary heart disease and stroke: prospective study with cotinine measurement. BMJ. 2004 ;329: 200- 5. 2. Diethelm PA, Rielle JC, McKee M. The whole truth and nothing but the truth? The research that Philip Morris did not want you to see. Lancet 2005; 366: 86-92. 3. Barone-Adesi F, Vizzini L, Merletti F, Richiardi L. Short-term effects of Italian smoking regulation on rates of hospital admission for acute myocardial infarction. Eur Heart J. 2006 Oct;27(20):2468-72. Conflict of Interest:None declared |
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Michael Siegel, Professor Boston University School of Public Health, Boston, MA, USA 02118
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Diethelm and McKee have endangered the integrity of public health by comparing those who challenge the conclusion that secondhand smoke causes heart disease and lung cancer with those who deny the Holocaust. As a primarily science-based movement, public health is supposed to have room for those who dissent from consensus opinions based on reasonable scientific grounds. To argue that those who fail to conclude that the small relative risk for lung cancer of 1.3 among persons exposed to secondhand smoke is indicative of a causal connection are comparable to Holocaust deniers is to turn public health into a religion, where the doctrines must be accepted on blind faith to avoid being branded as a heretic. While I personally believe the evidence is sufficient to conclude that secondhand smoke causes heart disease and lung cancer, there are a considerable number of reputable scientists who have come to different conclusions. While I believe those scientists are wrong, I would never argue that they are denialists, nor would I ever compare their dissent with Holocaust denial. Diethelm and McKee appear to be basing their assessment that secondhand smoke "dissenters" are "denialists" not on the reasonableness of the scientific arguments, but on the position of these arguments. This is a dangerous proposition which threatens the integrity of public health by turning it into a purely ideological movement, rather than a scientific one. Clearly, no dissent is allowable from the doctrines of tobacco control in Diethelm's and McKee's perspective. This perspective brands hundreds of reputable scientists throughout the world as denialists, no different from Holocaust deniers. While I disagree wholeheartedly with these scientists, I will stand up for their right to express their dissenting opinions without having their characters assassinated because of the direction, rather than the scientific reasonableness, of their positions. Conflict of Interest:None declared |
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