Leading Tobacco Control Scientist Tells Thousands of Advocates that Rest of the Story Author Has No Idea What He's Talking About

In an email sent to his announcement list of thousands of tobacco control advocates worldwide, a prominent tobacco control scientist tells advocates that I do not know what I am talking about and do not understand the scientific issues involved in communicating the acute cardiovascular health effects of secondhand smoke. In the message, he suggests that I am in no position to comment on the statements being made by anti-smoking groups about the acute cardiovascular effects of secondhand smoke and further, that it is irresponsible of me to do so because I have no understanding of the issues upon which I am commenting.

The message sent to an undetermined number of worldwide advocates, believed to be in at least the thousands, states:

"Michael Siegel simply does not know what he is talking about. I am attaching several peer reviewed academic reviews that show how all these things link together. Coronary flow velocity reserve is an important measure of the ability of the heart to respond to increases in demand and is closely related to endothelial and platelet function, both of which relate to both the chronic and acute risk of heart attack. It is well established that increased platelet activation causes platelets to stick to the vascular lining (the endothelium) and cause physical damage, which is important for the development of atherosclerosis. The acute effects can also trigger a heart attack in people at risk. No one is saying that one whiff of smoke causes a heart attack in everyone who breathes it. What the evidence shows is that there are substantial immediate effects that compromise the cardiovascular system and that, in some people, these changes are the same kinds of things that can trigger an acute event.

Journalists following Siegel's commentary should be aware that he is fond of quoting himself (his blog), not the peer reviewed scientific literature. In addition, while Dr. Siegel has published papers on other topics, he is not published in cardiovascular research.

A responsible scientist talks about things he or she actually understands."

The message included the text of my post, entitled "Conflating Coronary Blood Flow and Coronary Flow Velocity Reserve: The Basis for Anti-Smoking Groups' Misleading Health Claims" which I sent out to my own email list of tobacco control groups and reporters.

The Rest of the Story

Despite the derogatory and nasty statements made about me and sent to thousands of my friends and colleagues, and to prominent members of the media, and the suggestion that I am a complete fraud who talks about things of which I have no understanding, the ironic part of the rest of the story is that I wholeheartedly agree with everything Dr. Glantz states.

He is correct, I believe, in noting that the research literature documents that secondhand smoke causes platelet activation and platelet aggregation as well as endothelial damage, which are important in the development of atherosclerosis and which may also be involved in triggering acute coronary events among those with existing coronary artery disease. There are substantial immediate effects that cause compromise to the circulatory system and which, in some people (those with severe coronary artery stenosis) may possibly trigger an acute event (i.e., a heart attack).

Nothing that Dr. Glantz states is in any way inconsistent with my post.

So how could this be? How could it be that Dr. Glantz is basically condemning me and maligning my character (intimating that I am a complete fraud) in front of thousands of our colleagues and yet there is essentially no disagreement between us on the scientific issues?

The answer, I believe, is that Dr. Glantz is ignoring (or has not taken the time to read) my actual argument. I was not arguing in the commentary that brief exposure to secondhand smoke does not cause heart attacks in people with severe existing coronary artery disease. Nor was I criticizing any anti-smoking groups who are making such a statement to the public.

Instead, I was criticizing two specific statements made by two specific anti-smoking groups (although mirrored by similar statements made by a large number of other groups) that imply that brief secondhand smoke exposure can cause heart attacks in healthy young adults.

In fact, the statement by ClearWay Minnesota that I was criticizing stated explicitly that 30 minutes of secondhand smoke exposure decreases coronary artery blood flow in healthy young adults.

And the statement by the Association for Nonsmokers - Minnesota that I was criticizing implied that 30 seconds of secondhand smoke causes as much damage to coronary artery function as chronic active smoking. It mentioned nothing about people with existing coronary artery stenosis. It clearly represents itself as a statement about the general public exposed to secondhand smoke.

Moreover, the statement by the American Cancer Society and the Campaign for Tobacco-Free Kids stated that atherosclerosis (hardening of the arteries) is an "immediate effect" of secondhand smoke exposure. Again, this is not even remotely related to triggering of coronary events in people with high-risk heart disease; it is about whether a process that in smokers takes 20-30 years to develop can occur among nonsmokers in just minutes.

So as much as I respect Dr. Glantz and his scientific expertise, I do not believe his statement has any relevance to the discussion at hand, which is not about whether brief exposure to secondhand smoke can trigger an acute coronary event in someone who is at high risk for such an event. The discussion at hand is about: (1) whether or not it is accurate to tell the public that 30 seconds of secondhand smoke exposure is as bad as chronic active smoking in terms of damage to the coronary arteries; (2) whether or not it is accurate to tell the public that brief exposure to secondhand smoke decreases coronary artery blood flow in healthy young adults; and (3) whether or not it is accurate to tell the public that secondhand smoke can immediately result in hardening of the arteries, a process that takes 20-30 years to develop among active smokers.

It honestly appears to me that Dr. Glantz did not actually read my commentary, because it would seem that if he did, he would have understood that I was not in any way suggesting that there is no evidence that acute exposure to secondhand smoke could potentially trigger an acute coronary event in an individual with severe heart disease. If he did actually read my commentary, then it is beyond me why he would misread it so badly, but I suppose it's always possible that I did not explain myself clearly enough.

When I stated that I was criticizing public health groups for implying that "a healthy young person exposed to secondhand smoke is at risk of death due to that exposure," what I meant was that public health groups should not be implying that brief secondhand smoke exposure poses a risk of death from a heart attack in a healthy young person. I certainly apologize if I failed to make that clear.

I don't exactly see how someone could misread what I wrote as criticizing these anti-smoking groups for stating that secondhand smoke exposure can precipitate an acute coronary event in people with severe existing heart disease, but if I wasn't clear, it is my fault and I apologize for the lack of clarity in my writing.

Just to make sure that it is clear now, what I intended to say when I stated that ANR, for example, is implying that "a half hour of secondhand smoke exposure impairs the body's ability to get life-giving blood to the heart, putting even a healthy young individual at risk of a heart attack and therefore of death," is that I am criticizing ANR not for stating that secondhand smoke can trigger a heart attack in someone with severe narrowing of the coronary arteries and a pre-existing atherosclerotic plaque, but for implying that a half hour of secondhand smoke exposure impairs the body's ability to get life-giving blood to the heart, putting even a healthy young individual at risk of heart attack and therefore of death.

I have so much respect for Dr. Glantz and I know that thousands of tobacco control advocates also do, so I am quite sure that there are thousands of advocates out there now who believe Dr. Glantz when he tells them that I am a complete scientific fraud who talks about things without really understanding what he is talking about. Obviously, any possibility of a career in tobacco control has been completely shot by this email announcement.

And the shame of the whole thing is that the email was completely irrelevant to the actual discussion. If I am going to be discredited and my career ruined, then I would love to be discredited and to have my career ruined based on something I actually said, rather than on something that I never said. If I had my druthers, I would choose to have a derogatory statement about me sent to thousands of colleagues address one of my many actual flaws.

While I have a lot of flaws, being a complete scientific fraud who talks out of my ear and pretends to be familiar with the science when I actually don't have a clue what I am talking about is not one of them.

I agree that a responsible scientist should only talk about things he or she actually understands. But I think this also applies to public health groups. Tobacco control groups should only present themselves as sources of accurate scientific information if they actually understand the medical issues about which they are communicating. And I would humbly and respectfully suggest that a group which tells the public that secondhand smoke can cause, as an immediate effect, hardening of the arteries, does not truly understand the pathophysiology of heart disease.

As a physician, I not only studied the pathophysiology of heart disease in medical school, but I also treated hundreds of patients with heart disease and acute coronary events (heart attacks). I took part in surgery on blocked coronary arteries (thank goodness I wasn't the one sewing in the bypass grafts). I followed a multitude of patients with severe coronary artery stenosis, which I measured directly by participating in the coronary angiography of those patients, and observed their progression or lack of progression to acute coronary events. I treated many patients with tissue plasminogen activator and aspirin in order to directly interfere with the platelet activation process, so as to decrease the likelihood of the triggering of an acute coronary event in these patients.

I think I know a little bit about this topic.

But frankly, I'm not sure that it even takes a physician to be able to suspect that something is fishy when an anti-smoking manual tells groups to inform the public that nonsmokers can develop atherosclerosis immediately after exposure to secondhand smoke. I don't think it would be unreasonable for a lay person to suspect that she had been misled by a statement that it takes only minutes for secondhand smoke to cause hardening of the arteries, when that person is aware that among active smokers, the same process takes many years.

I don't think it takes a physician to challenge the statement that 30 seconds of secondhand smoke exposure is as bad as a lifetime of chronic active smoking when it comes to coronary artery function. And I don't think it even takes a physician to read the statement in the Otsuka et al. paper which states clearly that there was no decrease in coronary blood flow in the study subjects, and to then question why anti-smoking groups are stating that secondhand smoke reduces coronary blood flow in healthy young adults.

As my readers hopefully know, I don't think that you have to be published in cardiovascular research to enter into this discussion intelligently. In fact, perhaps those who are furthest removed from the science and the agenda of tobacco control are in the best position to shed light on the implications of the statements being made by anti-smoking groups that I have cited and on whether or not those statements seem to be accurate and responsible communications based on even just the evidence that Dr. Glantz provides in his commentary, or based even on stipulating that everything Dr. Glantz states in his commentary is correct.