Thursday, August 19, 2010

The Enstrom Firing: Further Thoughts on the Stated Reasons for Termination and the Violation of Due Process

A. Alignment of Dr. Enstrom's Work with the Mission of the Environmental Health Services Department at the UCLA School of Public Health

The primary reason given for Dr. Enstrom's firing was that his department voted and decided that his research is not aligned with the department's mission, which is to explore the relationship between environmental exposures and human health.

If one actually reviews Dr. Enstrom's research over the years, one will see that his work is directly related to this mission.

A review of Dr. Enstrom's work reveals a number of important points:

1. He has conducted high-quality and important epidemiologic investigations of cancer and overall mortality which has played a significant role in helping to identify the critical factors that are most strongly linked with good health and decreased cancer and mortality.

2. He has collaborated with legendary experts in the public health field, including Lester Breslow and Nobel Laureate Linus Pauling, to explore the impact of basic health behavior practices on mortality.

3. Throughout his career, he has not been afraid to report the results of his research as they unfold: whether positive or negative. Many of his studies report "positive" findings (such as the link between smoking and alcohol and cancer/mortality) and many report "negative" findings (such as the link between dietary fat and cancer and the link between vitamin intake and cancer). He reports the results as they are.

Here is a sampling and brief summary of a portion of Dr. Enstrom's research over the years:

a. Cancer mortality among Mormons. Cancer 1975; Sep;36(3):825-41.

Showed that cancer mortality is significantly lower among a population with very low rates of smoking and alcohol use, supporting the conclusion that smoking and alcohol are strongly associated with cancer mortality.

b. Colorectal cancer and consumption of beef and fat. Br J Cancer 1975; Oct;32(4):432-9.

Questions link between beef and fat consumption and colorectal cancer.

c. Colorectal cancer and beer drinking. Br J Cancer 1977; May;35(5):674-83.

Demonstrates strong statistical association between beer consumption and colorectal cancer risk.

d. Multiple sclerosis among Spanish-surnamed Californians. Neurology 1978; May;28(5):434-8.

With EA Operskalski, suggests both genetic and environmental factors in the etiology of multiple sclerosis.

e. Cancer and total mortality among active Mormons. Cancer 1978; Oct;42(4):1943-51.

Demonstrates much lower rates of cancer and overall mortality among active Mormons, documenting the enormous role that smoking and alcohol play in human health.

f. Rising lung cancer mortality among nonsmokers. J Natl Cancer Inst 1979; Apr;62(4):755-60.

One of the first studies to document that lung cancer mortality among nonsmokers was rising, marking the need for a search to uncover the reasons for this increase. Suggested the need to search for a factor other than active smoking in explaining these rising lung cancer mortality rates.

g. Cancer mortality among low-risk populations. CA Cancer J Clin 1979; Nov-Dec;29(6):352-61.

Demonstrates the enormous link between basic health behaviors - such as smoking - and cancer risk and estimates that a huge proportion of cancer mortality could be eliminated by simply adopting basic healthy practices.

h. Persistence of health habits and their relationship to mortality. Prev Med 1980; Jul;9(4):469-83.

With Lester Breslow, discussed the role of basic health habits in explaining a large proportion of premature death.

i. Cancer mortality among Mormons in California during 1968--75. J Natl Cancer Inst 1980; Nov;65(5):1073-82.

Demonstrated strong link between lifestyle and cancer risk.

j. Cancer mortality among a representative sample of nonsmokers in the United States during 1966--68. J Natl Cancer Inst 1980; Nov;65(5):1175-83.

With F.H. Godley, this study was a sentinel one which documented the link between smoking and cancer.

k. Reassessment of the role of dietary fat in cancer etiology. Cancer Res 1981; Sep;41(9 Pt 2):3722-3.

Discusses methodologic problems in studies that linked dietary fat and cancer.

l. Mortality among health-conscious elderly Californians. Proc Natl Acad Sci U S A 1982; Oct;79(19):6023-7.

With Nobel Laureate Linus Pauling, demonstrates link between healthy lifestyles and reduced mortality.

m. Cancer mortality patterns around the San Onofre nuclear power plant, 1960-1978. Am J Public Health 1983; Jan;73(1):83-92.

Showed no increase in cancer mortality surrounding the San Onofre nuclear power plant.

n. Trends in mortality among California physicians after giving up smoking: 1950-79. Br Med J (Clin Res Ed) 1983; Apr 2;286(6371):1101-5.

Documents substantial reduction in mortality associated with decrease in smoking.

o. The relationship between vitamin C intake, general health practices, and mortality in Alameda County, California. Am J Public Health 1986; Sep;76(9):1124-30.

With LE Kanim and Lester Breslow, shows no relation between vitamin C intake and mortality, but a strong relationship between basic health habits - such as not smoking, moderate alcohol intake, and physical activity - and decreased mortality.

p. Smoking cessation and mortality trends among 118,000 Californians, 1960-1997. Epidemiology 1999; Sep;10(5):500-12.

With Clark Heath of the American Cancer Society, demonstrates mortality reduction associated with smoking cessation.

q. Lifestyle and reduced mortality among active California Mormons, 1980-2004. Prev Med 2008; Feb;46(2):133-6. Epub 2007 Aug 3.

With Lester Breslow, shows strong impact of a healthy lifestyle on mortality and life expectancy.

This last publication in particular, which was published just two years ago, demonstrates that the work Dr. Enstrom is doing is directly aligned with the mission of the UCLA School of Public Health. In fact, he wrote the article with Lester Breslow, a legendary figure in the public health field.

I find it interesting that Dr. Enstrom was a researcher at UCLA for 34 years, but never before has the School questioned the alignment of his research with the "mission" of the School. A review of his research makes it very clear that his work is directly aligned with the mission of the School and that he in fact established a line of research that played a critical role in helping to elucidate the factors that are most strongly linked with cancer and with overall mortality.

This review confirms that Dr. Enstrom's work is directly aligned with the missions of both his Department and his School. The nature of his work is at the very core of public health: the search for the major determinants of human disease and death. A rejection of Dr. Enstrom's research as not being aligned with the mission of the School and Department is essentially a rejection of the basic idea of public health: to explore the causes of human disease and death.

I am now even more convinced that what UCLA was saying in asserting that Dr. Enstrom's research is not aligned with the Department mission is that his findings are not aligned with the Department's mission.

B. Violation of Due Process

In the Bakersfield Californian article, Dr. Beate Ritz - a faculty member in the Department of Environmental Health Sciences - admits that she had not read Dr. Enstrom's 2005 article on the relationship between fine particulate matter exposure and overall mortality. It is not clear whether she voted in the meeting, but if she did, it is an abomination because it is terribly unfair to judge someone's research without actually reading it. Moreover, if her level of unfamiliarity with Enstrom's work is indicative of that of other faculty members as well, then it appears very unfair for the faculty to have voted on Enstrom's termination because they would not have even considered the evidence. It is unclear whether Enstrom's publications were provided to the faculty members before the vote. But since Dr. Ritz admits she didn't read the 2005 article - which appears to be the central one in the whole debate - this doesn't bode well for due process in this indictment of Dr. Enstrom.

The most critical point remains as follows: Dr. Enstrom was denied the opportunity to present his side of the story to the faculty. He was not permitted to present his research on fine particulate matter and mortality. He was not permitted to testify in his own defense. This is a breach of both due process and justice.

ADDENDUM (August 20, 2010 - 12:15 pm): I have confirmed that Dr. Ritz did not participate in the vote and played no role whatsoever in the decision, as she as a secondary appointment in Environmental Health Sciences. Her primary appointment is in Epidemiology, so she does not participate as a voting faculty on EHS faculty appointment matters.

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