Thursday, December 08, 2005

The Tobacco Control Movement: Why the Unique Distaste for Scientific Discussion and Challenge?

As a public health researcher and practitioner in a School of Public Health, I have had fairly broad exposure to a number of fields of public health research and practice. Over the past months, it has begun to strike me that the field of tobacco control is unique in its seeming distaste for, or lack of interest in, true scientific discussion and challenge to the science, which has become almost like a set of unassailable religious tenets of the movement.

I'm curious to hear from public health practioners in other fields whether they have observed anything similar, but from my discussions with a wide range of colleagues in public health, this phenomenon appears to be unique to tobacco control.

I'm not saying that there is no scientific discussion that takes place. It most certainly does. But what has become evident is that any scientific discussion seems to be confined to the scholarly journals and that the organizations and leaders who set the agenda have little interest in scientific inquiry. It seems, instead, that they are interested in finding science to use to support their agenda and in attacking any science (or the messengers of scientific findings) that runs counter to the agenda.

Perhaps the best example I can think of is the lack of debate over the assertion that smoking bans result in an immediate and drastic reduction in heart attacks. Here you have a study with essentially two data points - one before and one after a law. You have very little basis upon which to establish a secular baseline and a clear idea of the baseline variability in heart attack admission rates. You have two or three very small towns that have been examined. And you have very limited comparison groups. And what does all of this produce? Press releases and media claims that smoking bans are going to reduce heart attacks by 27% or 40%, depending on which small city you want to look at.

But what's even more surprising to me is that there is little or no discussion of the limitations of these studies in the literature or in the discourse of the movement. I made one attempt at trying to introduce such a discussion and was promptly and resoundingly beaten back and censored.

And those who have tried to introduce data to examine the research question more systematically have also bean beaten back; unlike me, they have been discredited before they even began because of the suspicion that they are tobacco fronts and have nothing of merit that they could possibly say.

This all comes as a great disappointment to me. Because I am in this field, in part, because I am trained as a scientist and a researcher and I trained under a paradigm in which the science dictates the agenda, and not the reverse.

It is leading me to question the importance of my own research. If the science doesn't really matter in the first place, then what is the need for me to continue my own research efforts? If the findings are going to be ignored (unless they support the prevailing dogma), then is there any point of actually doing the research?

I am not ready or prepared to throw in the towel yet, but I have to say that this is making me seriously think about my own research program and its importance, as well as the importance of any tobacco control research to begin with.

My research has been of great interest, it seems, among tobacco control practitioners. But is the reason for that because my research was of scientific value, or because my findings supported the prevailing agenda? Now I am beginning to doubt whether there is any true appreciation in the movement for good science, or whether the appreciation is simply for science that supports the dogma and supports the agenda.

It will be interesting to see how things unfold as time goes on, but for now, let me just say that I think the tobacco control field seems peculiarly unique in its seeming disinterest in scientific challenge and discussion. And it comes as a huge disappointment for me.

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