Effect Measure

If I am going to defend a public health heretic, I’d better get my disclaimers out on the table at the outset. The tobacco habit is among the world’s top public health threats and the purveyors of the deadly products that cause it have a lot to answer for. They belong in jail. As a public health scientist, I’ve never taken a penny from Big Tobacco and never will. But as a scientist I cannot fight them with half truths or lies any more than I can fight torture by torturing someone.

Religion distorts science and I’m not an adherent of any religion, including cults within academic public health. Cults like we find in the tobacco control community. The heretic they are trying to burn at the academic stake is Professor Michael Siegel of Boston University School of Public Health. His heresy was to publicly criticize the anti-smoking True Believers for blatant mistruths.

Here’s the statement Siegel objected to:

Even for people without such respiratory conditions, breathing drifting tobacco smoke for even brief periods can be deadly. For example, the Centers for Disease Controls [CDC] has warned that breathing drifting tobacco smoke for as little as 30 minutes (less than the time one might be exposed outdoors on a beach, sitting on a park bench, listening to a concert in a park, etc.) can raise a nonsmoker’s risk of suffering a fatal heart attack to that of a smoker .[7] (Action for Smoking and Health)

To say that breathing a half hour of second hand smoke raises a person’s risk to the level of a smoker is patently absurd. Siegel rightly challenged it:

“Either provide the evidence to back up ASH’s assertion that 30 minutes of secondhand smoke exposure increases the fatal heart attack risk of nonsmokers to the same level as active smokers, or else apologize to me for having improperly suggested that I am criticizing anti-smoking organizations for no valid reason.”

“I am challenging TobaccoScam, as well as other advocates and anti-smoking groups which have attacked me for criticizing what I believe are highly deceptive public communications, to provide evidence of each of the following: 1. Please document that the CDC has warned that 30 minutes of secondhand smoke exposure increases a nonsmoker’s risk of suffering a fatal heart attack to the same level as that of active smokers. 2. Please provide the scientific evidence to back up the assertion that 30 minutes of secondhand smoke exposure increases a nonsmoker’s risk of suffering a fatal heart attack to the same level as that of active smokers.” (Siegel’s blog, The Rest of the Story)

The tobacco companies are World Class Liars. You don’t need to fight them by being a liar, too. The case against smoking, whether first hand or second hand, is overwhelming. Smoking kills. But I have no respect for mendacious and stupid zealotry. You can’t be on the Side of the Angels if you are dishonest.

Because of their lack of respect for the truth, prominent members of the tobacco control community are in turn losing the respect of the academic community. Even as they try to isolate Mike Siegel, they are finding he can’t be isolated because most public health scientists, not blinded by their own zeal to rid the world of a true scourge, agree with Siegel, not his critics. He will soldier on despite being excluded from their inner circle. And he’ll do it with intellectual honesty.

Indeed, intellectual honesty seems to be the missing ingredient these days. I want to stop smoking as much as any one in public health. 160,000 people will die of lung cancer this year, primarily because of smoking. Because I believe that doesn’t mean I’ve checked my standards as a scientist at the door.

You can read all the sordid details at The Rest of the Story:Tobacco News Analysis and Commentary.

Comments

  1. #1 DAWIN
    November 18, 2007

    Gee. If sitting downwind of a smoker for 30 minutes is as bad as smoking then I’d better go buy a pack. I smoked for 20 years before I finally stopped.

    Of course smoking might be one way to save Social Security.
    Lung cancer is fairly cheap to treat compared to the other diseases that you get with old age. That’s if you include the monthly Social Security payments you save due to the early death. A lot of people wouldn’t even make it to 65.

    Perhaps we should give five packs of cigarettes to every man woman and child, beer dispensers in every car and outlaw medicine. Now that would save Social Security!

  2. #2 RIGOR
    November 18, 2007

    The same problem applies to environmental toxins. Too often, there is mis-representation of the science – either played down (industry) or played up (advocacy groups). A big part of the problem is the lack of a good science education that Carl Sagan has pointed out. The public is poorly equipped to make up its own mind.

    I’m sick of my wife telling me on a daily basis the latest cancer scare/food scare – people don’t understand that risk = hazard x DOSE – the same problem you have highlighted in your post.

  3. #3 Frank Mirer
    November 19, 2007

    Tobacco is the scapegoat for many other corporate sins, and for adverse effects of other products and exposures. And, conversely, many other industries commit the same sins of sinning and obfuscation.

  4. #4 Orac
    November 19, 2007

    I’m of two minds on Siegel, whose blog I’ve encountered before.

    While I tend agree with him on this particular iissue and am sometimes uncomfortable at the overblown claims made by some smoking control zealots, even as a cancer surgeon who’s seen first hand the horrible consequences of smoking both in my family and my professional life, I must point out that I’ve seen other posts on Siegel’s blog that look seriously crank-like to me. For example, I find it odd that Siegel complains so much about “science by press release,” when he championed a “study” by David W. Kuneman and Michael J. McFadden (a study to which he claimed to have contributed) on his blog before it was ever published. McFadden is a die-hard anti-SHS regulation advocate who runs a website called Pennsylvania Smokers’ Action Network, which features a particularly stupid bit of propaganda called Dissecting Antismokers’ Brains.

    You could chalk it up to intellectual honesty that he’d be willing to follow the data, no matter who’s analyzing it, but the way he championed the study on his blog made me very uncomfortable and raised big questions in my mind about his objectivity. I also note that the study, as far as I can tell from searching PubMed, still remains unpublished two years later.

    In any case, a discussion of Siegel and why his actions bothered me broke out in the comments of a post that I wrote about SHS. McFadden and Kuneman showed up to defend their unpublished study and I asked them why, if Siegel had contributed so much analysis to it, he hadn’t signed on as an author.

  5. #5 FXR
    November 19, 2007

    Why thank you Orec; I hadn’t read the anti smokers brain before. I will be ordering a copy for sure, I found the excerpt to be enlightening. To bad more in the medical community didn’t share your open mindedness and fine taste in literature. McFadden has written a number of revealing and lobby group damning articles over the years to his credit, quite witty and always accurate backed up with proof.

    In the opposite corner we have the Health scare profession? Appearing to be strikingly similar to the same crowd who comprised the I G Farben cartel, back in the 30s, which, with its many corporate and “charity” foundation tentacles, still controls a lot of what we are allowed to see in the media today. Offering us the best in protection from injuring ourselves. At the cost of liberties and personal welfare such a cheap investment, in exchange for immortality. With so many deaths demonstrated to have been prevented, who would dare doubt them.

    Did you know as a surgeon for instance Smoking patches drastically increase the risk of birth deformities among the babies of expectant mothers who use them? [you are really a surgeon right?] You must know of course, 22% of Asthma is caused by aspirin? along with a significant association to Reyes syndrome. The public largely are unaware shouldn’t someone be informing them perhaps public health is just too busy to suffer the little things of late, like physical reality. Bayer is a spin off company of the former Farben dynasty, which for a time was run by an indicted Nuremberg Nazi war criminal. He rejoined the company immediately after they released him from prison. Their crowd didn’t allow alternate opinions either, nor did they suffer their critics well.

    The level of personal bashing whenever a medical mistake is pointed out today, is really incredible. Yet we still view doctors today as superior to those we experienced in the past?

    How soon we forgot.

  6. #6 west2
    November 19, 2007

    But as a scientist I cannot fight them with half truths or lies any more than I can fight torture by torturing someone.

    The end may in their opinion ‘be noble’ and therefore provides the justification for their actions. In the end who and what is to be believed? Science loses integrity and public health are the ultimate losers, as people will no longer have confidence in their proclammations.

    Orac – rather than make side remarks here, why not go to Dr Siegels blog and ask him directly? (apologies if you have done so already)

    west
    —-

  7. #7 Orac
    November 19, 2007

    I got into it with Kuneman and McFadden rather extensively last summer about this. I don’t recall whether or not Siegel ever responded though. I don’t think he did. Truth be told, though, I moved on months ago and had totally forgotten about this incident until seeing Revere’s post.

    It might be worth trying again.

  8. #8 Orac
    November 19, 2007

    Well, I headed over to Siegel’s blog to do just what was suggested, and I noticed that someone posted my comment above in its entirety in the comments after this post by Siegel, saving me the trouble.

    We’ll see what happens.

  9. #9 Dave K
    November 19, 2007

    Orec,

    I am David W. Kuneman, and I can tell you that the BMJ rejected our study, according to them…not because of any deficit in it’s content, but partially because they simply have too little space to publish every submission they recieve, and also because the Helena study, which was published in the BMJ, had pretty much been discredited already, and there was no need to publish ours to counter it. ( both pretty flimsy excuses, in our opinion)

    Dr. Siegel did go to the Health Care Cost and Utilization Project database, and verified that our data were real before making any public comments, either in favor, or otherwise about our work. It’s this simple…states which enacted complete smoking bans did not have any statistically different heart attack rates post ban than those which did not.

    After Pueblo was published in Tobacco Control, we submitted our study to them too, and were also rejected for baseless reasons. ( including the limited space excuse) It’s pretty obvious by now,- journals are participating in the antismoking movement by refusing articles not reporting results agreeing with consensus claims that are used to enact smoking bans.

    We have found publication bias to be only one of the ways selective science is used to advance the antismoking movement. Others are lack of funding for researchers who’s findings conflict with politically correct claims, (UCLA profesor Dr. James Enstrom’s experience speaks well as an example of this) and he has dared the American Cancer Society to analyze the rest of the CPS-I dataset to determine if secondhand smoke elevates lung cancer and heart attack risk, thusfar without results.

    If one ignores all evidence that the sky is NOT falling, what would be the remaining conclusion?- that’s all there really is to these secondhand science claims.

    DaveK

  10. #10 Bill Hannegan
    November 19, 2007

    Orac, could any study that came to the conclusions the McFadden/Kuneman study did find publication? Would having Dr. Siegel as an author help that much?

  11. #11 jen_m
    November 19, 2007

    Not that you asked me, Mr. Hannegan, but I think the credibility of the paper in the eyes of the journal editors would increase if there was at least one author who was affiliated with a research institution, and who had credentials suggesting some training in analysis of large public datasets; credibility of the researcher is essential to credibility of the journal, which is why PNAS gets away without peer review. Journal editors are very sensitive to the damage that can be done by publishing dishonest science, and there is some credibility lent by the processes of affiliation and accreditation.

    Certainly there are papers that have found inverse associations between certain types of health risk and tobacco use – nicotine is anti-estrogenic, so smoking has been found to be negatively associated with certain estrogen-mediated diseases. It’s not likely that the conclusions are the problem here.

    A bit of unsolicited advice: before I publicly claimed that my radical conclusions were the problem with a paper being bounced from multiple journals, I would make as sure as I could that every other aspect of the work was unassailable. Addressing every change suggested by every reviewer is a good start; asking fellow researchers to read and suggest improvements would help, too.

    Every scientist sees a paper get bounced once in a while, and I know lots of very good public health scientists who have had to submit the same paper to several journals before it found a home. I’d pick my journal a little more carefully – it’s not surprising at all that BMJ, a very high-profile journal, bounced a paper from folks who’ve never had a first-author biomedicine publication.

    (I’m an epidemiologist, but I don’t do tobacco-related work.)

  12. #12 Bill Hannegan
    November 19, 2007

    Thanks jen_m. I am not so put off about the paper not being published. Rather I am put off by the lack of interest public health people have shown in what Kuneman and McFadden are on to. If smoking bans are failing to bring down heart attack rates in whole states that have passed them, one way or another that information should get out.

  13. #13 Orac
    November 19, 2007

    Every scientist sees a paper get bounced once in a while, and I know lots of very good public health scientists who have had to submit the same paper to several journals before it found a home. I’d pick my journal a little more carefully – it’s not surprising at all that BMJ, a very high-profile journal, bounced a paper from folks who’ve never had a first-author biomedicine publication.

    Indeed. As a surgeon and molecular biologist, I’ve had papers that I’ve had to resubmit multiple times to different journals before they were published, and there were nowhere near as controversial a topic as secondhand smoke. Real scientists just keep plugging away and resubmitting. Neither Kuneman nor McFadden are academics, nor are they affiliated with a university; there’s no doubt that adding Dr. Siegel to the list of authors of the study would greatly increase its chances of being published in a decent peer-reviewed journal. That’s why I asked the question, given that Dr. Siegel mentioned how he had contributed to the analysis. If he contributed that much, he should be an author.

  14. #14 daveK
    November 20, 2007

    Neither journal offered any criticisms of the science behind our work, except the BMJ suggested we try to isolate smokers’ AMIs from nonsmokers AMIs, – a standard they did not apply to the Helena Study, nor TC to the Pueblo Study. In both cases, the main reason given was only that the paper was of little interest to them…and suggested we submit it elsewhere.

    I am published in the field of food science technology several times, and as a coauthor in medical journals a few times. I am a retired pharmaceutical chemist, and have done statistical ananysis on projects submitted to the FDA in new drug applications many times.

    In fact, our paper was not very statsitically detailed, and neither journal asked for any more extensive statistical analysis than we offered. Quite the contrary, the BMJ suggested we take out the little statistical annysis we submitted because our findings were so obvious that they were deemed unnecessary.

    The part that bothers me the most, is that the medical community, at-large and increasingly aware of our findings, continues to allow publication of studies finding AMI declines in selectively chosen population sub-groups with bans, as if these are valid.

    Dave K

  15. #15 BrianB
    November 20, 2007

    My my, what an arrogant bunch you self-acclaimed ‘scientists’ can be at times!

    Orac, are you suggesting that the only ‘truth’ lies in pseudo-scientific ‘studies’ that happened to get published in the relatively few scientific journals out there? If so, I suggest you are wiling to see hyperbole and propaganda (otherwise know as ‘bias’) placed ahead of facts. Because in the analysis carried out by McFadden and Kuneman it was facts that were being presented, ie the true recorded counts of Acute Myocardial Infarctions in various US localities. Not some sample-based statistic arrived at by the application of abstruse and obscure statistical manipulations that are truly understood neither by the reader nor by the (epidemiological) researcher. Not some extrapolation from small and statistically insignificant Relative Risks or Odds Ratios to derived body counts in whole country populations. No, the simple unadulterated facts! With confidence ranges of width plus to minus nothing! You would do well to get an understanding of the difference between the (unpublished analysis of) facts and the exceedingly egregious (and published) garbage analysis in the ‘studies’ of heart attacks in the likes of Helena and Pueblo. There is no contest here!

    And Jen_M, do you really suggest that journals check “who had credentials suggesting some training in analysis of large public datasets”? Have you bothered to ready the many anti-smoking studies that have been published over the past 20-30 years? “Large public datasets”? You just have to be kidding here. “Small and insignificant samples” is a much better description in most cases.

    Still, what do I know? I’m only a mathematician who has spent the past 30+ years working with and analysing UK healthcare data, and clearly not a scientist since I have never had a ‘study’ published in a scientific journal.

    Oh woe is me!

    Brian Bond BSc.

  16. #16 Orac
    November 20, 2007

    Orac, are you suggesting that the only ‘truth’ lies in pseudo-scientific ‘studies’ that happened to get published in the relatively few scientific journals out there?

    Straw man argument, and a pretty sad and pathetic one at that.

    For your benefit, though, I’ll make it simple in my usual “arrogant” fashion (if I’m going to be called “arrogant” regardless of the situation why not just act arrogant, eh?): No, that’s not what I’m saying. However, peer review is an important aspect of science; it serves as a quality check. It’s a messy, highly imperfect system whose imperfections I’ve blogged about before, but I’ve yet to see anyone propose a better one for vetting scientific reports. Consequently, from my point of view, it is quite reasonable to wonder why an article has failed to pass peer review. Kuneman and McFadden’s study may be the bee’s knees (heck, I’d be very interested in seeing the rejection letter that BMJ sent Kuneman and McFadden), but failing peer review and then their apparently not resubmitting it to other journals do raise a red flag. Indeed, if there’s any arrogance here, it’s on the part of authors who can’t let go the fact that their article was rejected and move on form there.

    One of the hallmarks of a crank is to cry “martyr!” or “persecution!” and then attack the peer review system for excluding his work. And, to cut you off before you launch into another blatant straw man argument: Does that mean that anyone who complains about the peer review system is a crank? Of course not, but dismissing the peer review system as hopelessly corrupt in the context of complaining about not being able to get papers published in peer-reviewed journals is often a good indication of crankery.

    As for your never having been published in a scientific journal, if that’s the case, then how do you know the peer review system is broken, never having submitted your work to it or participated in it as a reviewer? Of course, your rant about “simple, unadulterated facts” neglects the simple, unadulterated fact that (1) facts are necessarily presented and analyzed in a certain way when presented for publication, which means through the lens of the authors’ interpretation of them and (2) the analysis can at best only be as good as the source of the “facts.”

  17. #17 geo
    November 20, 2007

    Great discussion. I’ve been a participant in Dr Siegel’s blog from time to time. His whole blog is designed to shed light on overblown claims. His point is that if you don’t correct scientific inaccuracies, then people will suspect the entire issue…and his hypothesis has proven to be correct. Lot’s of smoker’s on his site with cognitive dissonance. They latch on to Dr. Siegel’s lifeline to reason out the value of immediate pleasure with a potential nasty health effect down the road. I think that’s the primary rub with health professionals. There is no doubt that second hand smoke policies saves lives. Still, there’s room for discussion on these heart attack claims. There’s been plenty enough research on the health effects of tobacco smoke over the past 50 years. No need to jump the gun with these overblown claims with very small numbers. They ought to be corrected.

  18. #18 Dave K
    November 20, 2007

    Let me quote orac here:
    “but failing peer review and then their apparently not resubmitting it to other journals do raise a red flag.”

    Now let me quote myself from above: ( I wrote this before orec’s quote)
    “After Pueblo was published in Tobacco Control, we submitted our study to them too, and were also rejected for baseless reasons.”

    Are we talking to a brick wall here? Is orac a man so caught up in his presumptions that he fails to notice what I just said? “None are so blind as those who will not see”… I respond.

    Now, before submitting to the BMJ, we did send a copy to Dr. Sigel, and he thought it was fine, and after rejection by the BMJ we again sent the manuscript to Dr siegel, along with the reviewers comments and Dr. Siegel still told us our manuscript was fine,could not understand the reason for rejection, and told us to simply give up and submit it to another journal,which we did.

    Now, to make this perfectly clear to everyone except orac, who will read what he wants to read, instead of what i’m about to say, :

    Our paper was not rejected by the BMJ because it failed technical review, it was rejected by the editorial board. We submitted an appeal, citing other articles and other researchers who wrote articles about publication bias sponsored by journal editorial boards, themselves, and were again rejected by the BMJ.

    Tobacco Control never would reveal to us who reviewed our manuscript there, or what that reviewer said. So, we were at a loss to respond to their rejection.

    Beyond that, anyone can easily access the HCUP database, and see for themselves what the AMI admission rates pre-and post ban actually are after states enact bans. and basicly re-do our study, and attempt to either validate or refute our findings. Yet, for all these attacks on our credibility, I am appalled that no one has actually done that.

    So, I guess all I’m trying to say, is that if the real debate here were the science, instead of personal attacks on McFadden and I, I would think orac would simply take a look at the HCUP data, and see if we are right or wrong.

    In the absence of that, I can only conclude that orac does not care about the science at all.

    dave K

  19. #19 Neil Schipper
    November 20, 2007

    1. Consider a 1 pack/day smoker aged 55 who’s smoked at that rate for 25 years. What is that person’s risk of getting lung cancer over the next ten years if he continues to smoke?

    2. Consider a 2 pack/day smoker aged 75 who’s smoked at that rate for 50 years. What is that person’s risk of getting lung cancer over the next ten years if he continues to smoke?

    Record your best guesses, and then check
    this chart for the answers (and to see the whole article and the source & context of the data, lop off the /T3 at the end of the URL).

    I put it to you that 99% of smokers would have guessed way high. And ponder the effect of second hand smoke on actual numerical cancer rates (and compare to the public perception of such rates). That’s what propaganda does: it helps people to know less truth.

    I’ve had some interest in the question of truth-telling about smoking for some time. As a previous poster noted, the tobacco cos. are world-class liars, but what happens when public health types also rely on distortions and exaggerations? Public distrust of and resentment towards the institution of science.

    By the way, I do understand that cancer is not the only risk associated with smoking, and if someone can point me to reliable data that associates pack-years with risk of heart disease, emphysema, etc, great. But I’ve found it hard to find straightforward risk stats on these things. It’s usually “95% of lung cancer is caused by smoking” or “x thousand deaths per year”, etc.

  20. #20 revere
    November 20, 2007

    Neil and DaveK: I am happy to support Mike Siegel in a dispute about a patently incorrect statement about 30 minutes of second hand smoke being equivalent to the risk of being a smoker for heart attacks. I did not go beyond that and I don’t know the details of the paper that Orac raised and you seem to be defending. It sounds like your methods are suspect since you are making an ecological comparison for which severe bias is known to be a strong possibility. Regarding Neil’s request for data and studies, just look at the Surgeon General’s Reports and the vast amount of supporting literature. Pulmonary and cardiovascular effects are dose related (which also makes biological sense) and I don’t see the sense of arguing it further. If you aren’t convinced by the current literature you will never be convinced so it is fruitless to argue it.

    I have seen too much blatant and reckless disregard of data and exaggerated statements from the tobacco control community who think it’s OK because they are on the Right Side (and they are on the right side, at least if you have a public health objective in mind). But intellectual honesty is still needed. My post was not in support of any smoker’s rights agenda. Smokers don’t have rights when it comes to harming others or asking me to pay for their pleasures. I am not sympathetic. But I am still a scientist and that’s what the post was about.

  21. #21 Neil Schipper
    November 20, 2007

    revere,

    I hope I didn’t the impression that “I’m not convinced”.

    Let me be clear: smoking is bad! I’m in favour of smoke-free restaurants and I’m in favour of taxes on cigarettes with rates driven by accurate data. (I do have trouble with the total ban in bars.)

    I haven’t looked into this recently, but I’ve had the perception that here in Canada cig tax rates are too high, while in the U.S. they’re too low. (I recall a chat with a retired Manitoba government economist, and when I proposed that the taxes were way out of whack with associated med costs, he, a non-smoker, laughed and said something like, “oh, totally! it’s a huge tax grab!”)

    Anyway, again, I never argue that smoking is not bad for health. I was expressing my frustration that it’s hard to find out “how bad” in a quantitative sense, since literature designed to inform the public seems to sidestep the key metrics:

    - age of death by num pack-years
    - age of onset of fatal/serious illness by num pack-years

    A couple of charts can capture quite nicely these risks. But they’re not shown — you have to dig so hard for the numbers — and this makes me suspicious.

    Um, so am I a crank?

  22. #22 Dan
    November 20, 2007

    Neil Schipper wrote: “I’ve had some interest in the question of truth-telling about smoking for some time. As a previous poster noted, the tobacco cos. are world-class liars, but what happens when public health types also rely on distortions and exaggerations? Public distrust of and resentment towards the institution of science.”

    This is what I have been trying, possibly without success, to say for sometime on Orac and MarkH’s blogs. When tobacco control makes more and more outlandish claims in support of smoking bans they undermine the credibility of the entire medical research profession. Dr. Siegel is one of the few that calls them on that, but he is also a very strong supporter of work related smoking bans and one of the early pioneers in the field.

    Revere writes: “I have seen too much blatant and reckless disregard of data and exaggerated statements from the tobacco control community who think it’s OK because they are on the Right Side (and they are on the right side, at least if you have a public health objective in mind). But intellectual honesty is still needed. My post was not in support of any smoker’s rights agenda.”

    I tend to agree with your statements. To be fair, I am a smoker, government scientist, and business owner. I do not believe that smokers have a right to smoke. I thinks that if the government thinks it is such a health concern they can ban it. Given that, if the government is not going to ban it, I feel I a business owner (I do not own a bar) that my property rights are being stomped on. If I own a bar (I don’t) it is my right to hire only smokers, put up a sign that smoking is allowed, and anyone who does not want to enter does not have to. No need for government intervention. However, tobacco control comes out with more and more outlandish claims in the attempt to denormalize smokers and comes up with dubious research or simply misrepresents the research to come up with more draconian restrictions. Their initial claims were to protect employees for second hand smoke. Now claims are made that the young die in large numbers from seeing smoking in movies, that smokers who smoke around there children are the equivalent of child abusers, etc. I applaud, Dr. Siegel for taken a stand against such claims at great risk to his career. While I understand the medical community would like to see smoker erased from this earth, I suggest that it is in your interest to stand against the baseless claims (only if you believe they are baseless) made by the TC community. The end, as you imply, does not justify the means.

  23. #23 Owl
    November 20, 2007

    Dr. Revere,
    To quote you:
    “It sounds like your methods are suspect since you are making an ecological comparison for which severe bias is known to be a strong possibility.”

    What an incredible statement as you just said that you do not know the details of the paper under discussion.

    As for the “Surgeon General’s Reports”. Hmmm, not a very convincing argument, didn’t one get fired three weeks or so after maintaining that an equally junk report was valid?

    Has any smoker asked you to pay for their pleasures? With all the tax that smokers pay, I would hasten to add that they pay a giant share of the non smokers medical costs as well. This is the case in the UK, I may be incorrect as regards the USA but I still find the comment rather odd.

  24. #24 revere
    November 20, 2007

    Neil: No, didn’t think you were a crank (I don’t throw that word around lightly or often and didn’t this time, although Orac did I recall). But there is a huge literature on effects of smoking including lots of quantitative estimates. I can’t give a cite because I’m not a specialist in this area (truthfully, I’m not even much interested in it). But I am a scientist and don’t like to see crap, even when it comes from people I otherwise agree with and I especially don’t like to see the way they are treating Mike Siegel, a scientist, a scholar and a genuine public health person.

  25. #25 revere
    November 20, 2007

    Owl: The main method was described. It is well known to epidemiologists. One of my graduate students wrote his dissertation on it.

    As for the “Surgeon General’s Reports”. Hmmm, not a very convincing argument, didn’t one get fired three weeks or so after maintaining that an equally junk report was valid?

    No.

    As for paying for a smoker’s pleasures, this was a reference to health insurance, medicaid and medicare.

  26. #26 Orac
    November 20, 2007

    In the absence of that, I can only conclude that orac does not care about the science at all.

    Oh, give me a friggin’ break. You guys are the ones whose websites alone are enough to make me question whether you can even maintain the pretense of objectivity long enough to do an analysis.

    In any case, a scientific manuscript should stand or fall on its own without requiring me to have to go through the raw data and redo the analysis. As I recall, four months ago when I first saw it I wasn’t that impressed (for one thing, a negative study can be negative because it’s truly negative or because there are other factors not taken into account), but perhaps over the long Thanksgiving weekend I’ll read it again and see if I was unfair. I tend to doubt that I was.

  27. #27 Orac
    November 20, 2007

    It occurs to me, DaveK, where can I find the full manuscript of your analysis? The article on your website is mighty short and thin, a mere outline and not manuscript length at all, as is the description of it on the ACSH website.

    Let’s put it this way: I care about the science enough to actually read your whole manuscript–if you make it available in the form you actually submitted.

  28. #28 Owl
    November 20, 2007

    Dr. Revere,
    1.
    I am sure that Mr. Kuneman can answer your first point better as to methods. I understand statistical analysis quite well and the refutation of the Helana/Pueblo analysies is quite plausable.

    2.
    I was referring to Richard Carmona who “quit” office a month after releasing a “controversial” report.

    3.
    Fair point. Here, it is estimated that smokers cause 1.7 billion GBP in costs and they pay approx. 10 billion GBP in tax.

  29. #29 jen_m
    November 20, 2007

    Mr. Bond: First things first – having an academic degree (not necessarily a PhD or MD), a publication record, or an affiliation with a research institution (including, of course, health departments and private institutions), are evidence that the author has had *some* training relevant to the data. Not unshakeable evidence; certainly not proof. They are proxies for what we’d really like to know, namely that the authors aren’t just making things up (in this case, obviously not, as the findings are explicitly and easily replicable using the same publicly available data) or misconstruing the information they’ve got.

    I would certainly accept that your work history constitutes evidence of your experience, and I would not be at all surprised if your data are published six ways to Sunday through a public health agency or private firm, as reports or texts or data dictionaries. (And if you have 30+ years of experience analyzing UK healthcare utilization data in a capacity *other* than professional, I salute you – I thought that not since the gentleman scholars of the 19th century had there been true amateur/hobbyist statisticians; even Mr. Gosset, “Student” of the t-distribution, engaged in his mathery for work reasons. And the editor of the journal that published most of his work knew exactly who he was.)

    I am not, again, surprised that BMJ bounced the paper at the editor’s discretion, because they are pretty famous and pretty full of themselves over there. They are also acknowledged, generally, as preferring papers not just from known scientists, but from physician-scientists. I really think that K & McF should keep trying to find a home for this paper. (Maybe Environmental Health Perspectives?) Moreover, as Dr. Siegel has helped them so much with the manuscript, it should be a simple matter for him either to stick his name on the paper, to get them the eye of editors, or to furnish an introduction. It shouldn’t take that much intervention just to get a paper published by people outside the scientific establishment, I agree – but the unfortunate fact is that it does. The difficulty of outsiders in getting work published is a separate problem from editorial and reviewer bias against the findings. In the interests of science, I think that just coping with the former problem (rather than trying to overcome it), is probably worthwhile, especially if it means contributing to the fight against the latter problem.

    I hope maybe Coturnix will chime in here, because it seems to me that the problem of outsiders publishing science, and the problem of publishers hoarding science, are rather closely related.

  30. #30 revere
    November 20, 2007

    Owl: Carmona did not have his appointment renewed. As SG he did virtually nothing — except a report on second hand smoke, which reports say displeased the Bush administration. They preferred he continue to do nothing and he later testified they suppressed his activities (he should have spoken up earlier; he didn’t). You can find our post on it here

  31. #31 Dan
    November 20, 2007

    The following are recently published journal articles that appeared in Epidemiologic Perspectives & Innovations that described want happens when researchers do not toe the tobacco control line:

    http://www.epi-perspectives.com/content/pdf/1742-5573-4-13.pdf

    http://www.epi-perspectives.com/content/pdf/1742-5573-4-11.pdf

    http://www.epi-perspectives.com/content/pdf/1742-5573-4-12.pdf

    The first link is to an article by I believe the editor of the journal, Dr. Carl V Phillips, who almost lost his job for accepting money to research smokeless tobacco. The second is by Dr. James E Enstrom, who defends his BMJ study using American Cancer Society (ACS) data whose funding was cut when the ACS realized that his study would show no significant risk of SHS. He then accepted funding from a tobacco funded research institute. The ACS now refuses to fund any researcher who has ever accepted money from big tobacco. The final link is a paper by Dr. Michael Siegel discussing the claims talked about in this thread and what happened as a result. Orac, if you are reading this, these are the same papers I was hoping you could comment on on your blog. Perhaps over the Thanksgiving weekend?

  32. #32 Dan
    November 20, 2007

    One farther comment, this article recently appeared in Skeptic magazine:

    http://www.nycclash.com/Zion-Skeptic-Science_And_SHS.PDF

    I do not subscribe to the magazine, but did find that link in the comments section of Dr. Siegel’s blog and along with the articles in my previous post, I ask Orac whether he could comment on them. His response was:

    “I saw that article and was appalled at how bad it was.( I wonder if someone should tell Skeptic Magazine that the website is violating their copyright.)

    However, they fail to note that in the same issue a strong rebuttal article was published.”

    I was not able to find a rebuttal online and therefore do not know what is says. However, I found the article reflects my views very well. Dr. Siegel is also mentioned in it. I have no affiliation with http://www.nycclash.com/ and only found it through a link on Dr. Siegel’s blog posted in a comments section.

    I am fairly new to blogs, now if anyone can point me to instructions as how to do inline links or those pretty quotes others seem to use that would be great.

  33. #33 revere
    November 20, 2007

    Dan: It’s OK to put links in just as the URL, as you did. Look up how to do “emphasis” in HTML. It’s easy, but if I do it here it will interpret it as HTML and you’ll see the result, not the syntax (I”m too tired to remember the escape for HTML or I’d use it).

    The reason I had to approve your comment is that the system sees links within the comments as possible spam and makes me check it first. Sometimes I don’t notice and comments are held for days at a time. I don’t censor comments but sometimes the system does it without my knowing.

  34. #34 Neil Schipper
    November 21, 2007

    In my earlier post (Nov 20, 3:48pm), I invited people to make 2 guesstimates, and I included a link to the “answers” from a source which I assume most will agree is quite trustworthy.

    I’m really curious to know whether others find the given values as surprising as I did!

  35. #35 geo
    November 21, 2007

    Neil: Not really that surprising knowing the lifetime use of tobacco results in 12% lung cancer rate. (Which is an artifact of the difficulty in quitting) It is pretty scary knowing that your ten year risk of lung cancer after smoking for 25 years is 2% or so given the virtual death sentence that this disease has. In most areas, lung cancer begins showing up statistically around age 45 or so.
    But I also agree that most people think the percentage would be higher. Lung cancer is a pretty hard disease to “catch”. You have to have a lot of insult to the tissue, which unfortunately, tobacco smoke does over a 30 pack year history.

  36. #36 Dave K
    November 21, 2007

    Orac,

    we are still submitting to other journals, if we put up the paper, then they can reject it because it has already been published online, even if it’s just by us, on say, an Internet page.

    This can give you a pretty good idea of what we did, which is far more involved than the 2 year interval study posted on my page;

    i will put up our data on new york ami admissions which we obtained from the Healthcare Cost and Utilization Project

    1997-29316amis; 1998-28828amis; 1999-30636amis; 2000-32236amis; 2001-32225amis; 2002-31728amis; 2003-31888amis.

    Now, the NYS ban took effect July, 2003, and does anyone see an impact due to the ban during the second half of 2003?

    Here is the whole USA for the same period: 1997 441497; 1998-468771; 1999- 462767; 2000-479000; 2001- 487010; 2002-499730; 2003-485953. Note the whole usa behaves the same way as NYS. ( within reason)

    This is the way the data were presented to the BMJ, the other states with bans had similar trends, but i cannot type the whole paper here. We also obtained states which prohibited local bans, and had no state ban, and those data trended just like the USA and the above NYS data too.

    By the time we submitted to Tob Cont, HCUP had released another years worth of data, so we incluided that too. and still no diff in the ban states.

    In our BMJ submission, we also included polynomial regression equations which described the trend lines for all the states, and the USA and we computed condifence intervals. Since then, HCUP has released 2004 and 2005 data. When we take the regression equations we developed based on 1997-2003 data, and use them to calculate how many amis to expect in 2004 and 2005 , those estimates agree very well with the actual number of amis reported by HCUP in 2004-5. and the actual data are always within our confidence intervals. This holds true for the USA, NYS, all other ban states, and states which still prohibit local bans, and have no state ban.

    We conclude that since the ban states were still following the same regression curves established pre ban, that no new criteria affecting ami admission trends had been introduced post ban, and THIS INCLUDED THE DECLINE IN EXPOSURE TO TOBACCO SMOKE, as a possible criteria which could have affected ami admissions causing those regression curves to drop faster than the equations predicted, if no ban had taken place.

    in other words, nothing good happened.

    So, I’m sorry but that’s the best i can do here. dave K

  37. #37 dave K
    November 21, 2007

    as soon as I clicked post, i realzed someone is going to ask what the 2004 and 2005 data for NYS and the USA are so,

    NYs 2004- 30876 2005- 28502

    USA 2004- 446100 2005- 419925amis

  38. #38 Dan
    November 21, 2007

    Dave K., why not send an electronic copy to Orac via Email. Before I am allowed to publish in the open literature I have to get two internal technical reviewers to sign off that the technical content is correct, go through English majors to make sure all the I’s are dotted and the T’s crossed, and go through OPSEC review to make sure I am not giving away national security information. Sending a copy for review is not considered published. You are correct that if you publish on the internet, the paper will not be published by a journal as they only accept papers not previously published.

  39. #39 dave K
    November 22, 2007

    Yes, dan, that’s exactly what we are concerned about. ( internet prepublication)

    remember, we did run the final manuscript past Dr. Siegel before submitting to the BMJ, so, in fact he did fulfill the internal reviewer role.

    Last night, I gave this whole discussion some thought.

    You, see, the whole idea that some meaningful decline in ami admissions post ban, is , on the face of it, so patently ridiculous, that really, I can see why any journal which has not published a paper claiming bans DO cut amis would reject it.

    For, example, what would happen if I submitted a paper finding males who chew their fingernails have the same prostrate cancer rates as males who do not? Why would any ethical journal publish a paper like that?… such information, in the real world is useless. and such a paper would be a waste of journal space.

    really, this is probably what McFadden and I are dealing with here…. Let’s face it… deep down inside, every technically competent person knows that bans do not immediately cut ami rates in a way which could be statistically identifiable. Even among those who believe smoke elevates coronary risk in nonsmokers, almost all beleive it takes years of exposure, and years of abstinance to cause any real change in outcomes.

    So, like in the prostrate cancer example above, I can really see the other side of the argument here… The only journals which would have any ethical responsibility to accept our paper,( eg “set the record straight”, so-to-speak), are the same ones which have already crossed the line and knowingly published misleading papers claiming bans have an immediate positive impact on ami rates.

    This seems like we’re in a catch22 situation to me…. any other ideas?

    if so, this line of thought should be considered as an alternate explanation, by anyone who makes public staements that we must be technically flawed because our paper has not been accepted.

    dave K

  40. #40 dave K
    November 22, 2007

    happy thanksgiving everyone… Dave K

  41. #41 Neil Schipper
    November 22, 2007

    dave K,

    If there is no way to get published, my meagre suggestion is to try to find a sympathetic reputable person active in the general subject area (revere? someone who sits on a relevant journal’s editorial board?), and ask them to send your paper to double (or triple or .. ten times) the normal number of reviewers for publication. If this additional level of review finds no fault with the science, release the paper (along with the stories of how you tried to get it published and of how much review it underwent) to the web and the press. There should be no need to claim conspiracies; just getting the info out should be enough to garner some media attention.

  42. #42 Dave K
    November 23, 2007

    Neil, we did that. Please see the below link at the american council on science and health

    http://www.acsh.org/news/newsID.1600/news_detail.asp

    but beyond that, we cant send the manuscript to more than one journal at a time.

    Dave K

  43. #43 Owl
    November 24, 2007

    Dr. Revere,
    I think you just made my point, the SG is just a political tool and should not be taken seriously (you implied that he/she should be taken seriously).

    One further point. We are only discussing the physical welfare but no one mentions the mental health concerns.

    I have seen the social destruction of society in western Ireland due to this smoking ban. Where previously elderly people met at their local pub and enjoyed social interaction we now have a new problem called social isolation. The mental hospital are filling up with people who had no problems before. How do you justify this? I do realize that this is seldom reported, but my family comes from the west of Ireland and they have a serious problem.

  44. #44 Mitchell
    November 29, 2007

    “peer review is an important aspect of science; it serves as a quality check.”

    Let me rephrase this: “… it should serve as a quality check.” In many cases it simply serves as a stamp of approval. There is no guarantee that reviewers thoroughly check the data and methodology.
    Read: The Trouble with Medical Journals, R. Smith, http://www.lse.co.uk/ShowStory.asp?story=RO1929177J

  45. #45 Michael J. McFadden
    February 18, 2008

    I’m just finding this discussion now in an accidental pass-thru!

    Hello again Orac. :) If you remember, we had an extensive discussion last summer but I believe it was about the “no safe level” argument and whether it would be true for other carcinogens (such as alcohol and its miniscule evaporated presence in the air) as well as secondary smoke.

    I see Dave posted a more detailed exposition of our study and you were planning to get back to things here after Thanksgiving. It’s now February so I’m assuming you just misplaced it (no harm there… I’ve innocently misplaced net discussions in the past as well) but maybe it will now pop back up on your next visit.

    I wanted to add and emphasize two points Dave made:

    1) We have indeed resubmitted the study, to two different journals, and plan to do so again in the future. Meanwhile roughly a half dozen contrary studies, patterned largely after Helena and repeating various of Helena’s failings, have been published and have done a very significant amount of political damage as they have been cited unopposed in their conclusions at numerous smoking ban hearings around the world. You’ll note the title we chose for the ACSH article… the full title would be “A study delayed is a study denied”. The BMJ had a particular responsibility to repair the damage it had done through the publication of a scientifically shoddy study published for political reasons. They chose not to do so, and the rationale for that choice brings me to point #2.

    2) Dave mentioned the reasons for our rejection by the BMJ but I do not feel he was clear enough. Rejection was NOT recommended in peer review, and the study was NOT rejected for being bad research. In the words of the BMJ editor,

    “1. Our main problem with the paper was that we did not think it added
    enough, for general readers, to what is already known about smoking and health”

    Now note, our paper reached a diametrically opposite conclusion than that which the BMJ had previously published. That opposite conclusion was published in literally hundreds of newspapers, was featured on all major TV networks, and garners over 50,000 hits on a proper Google search. And yet the BMJ felt that a corrective study, one based on population base over 1,000 times as large and using fully verifiable public data, one reaching a radically different public health conclusion that could affect hundreds of millions of people, had not “added
    enough, for general readers, to what is already known about smoking and health”.

    Does that explain why we felt justified in filing an appeal or claiming foul?

    By the way… the “appeals process” at the BMJ was interesting in itself. The responding editor gave our paper to one colleague to look over and concur in the rejection decision. I had to wonder at the time if this was their standard appeals process: it seemed a bit slipshod. Of course it came on top of another oddity: instead of our paper being considered by the BMJ standard “hanging committee” it was considered by something they called a “mini hanging committee”.

    Comments?

    Michael J. McFadden
    Author of “Dissecting Antismokers’ Brains” (the book so carefully read and glowingly reviewed by Orac above)
    http://www.TheTruthIsALie.com

  46. #46 ib0
    August 12, 2008

    peer review is an important aspect of science; it serves as a quality check.”

    Let me rephrase this: “… it should serve as a quality check.” In many cases it simply serves as a stamp of approval. There is no guarantee that reviewers thoroughly check the data and methodology.
    Read: The Trouble with Medical Journals, R. Smith, http://www.lse.co.uk/ShowStory.asp?story=RO1929177J

    what ?

  47. #47 pauls lane
    August 12, 2008

    hmmmm…I belittled ‘peer review’ several months ago and revere accused me of being a troll….

  48. #48 revere
    August 12, 2008

    Of course this issue has nothing to do with peer review or its real problems. It wasn’t that you criticized peer review, BTW, but the way you criticized it. There is much to criticize but it should be informed and intelligent.

  49. #49 pauls lane
    August 12, 2008

    I’ve participated in peer reviews, not medical, but technical: manuals, documentation, papers, etc., on computer security, network security, communications security and the like. I know what happens and when politics enters into the equation, and it will and does revere(climate change being a prime example), I stand by my statement of several months ago.

  50. #50 pauls lane
    August 12, 2008

    I should have said, ‘when
    politics and large sums of money enter into the equation’…..