Wednesday, March 21, 2007

Anti-Smoking Group Attacks UCLA Researcher, Accusing Him of Scientific Misconduct; Trying to Make Him Fall Guy for Unfavorable Research Findings?

According to an article in a recent issue of Nature, the American Cancer Society (ACS) has accused UCLA professor and epidemiologist Dr. James Enstrom of scientific misconduct in his role in a 2003 British Medical Journal study which questioned the link between secondhand smoke and lung cancer among nonsmokers.

That article - which used data from the ACS Cancer Prevention Study and found no significant increase in lung cancer risk associated with exposure to spousal smoking - has received massive publicity, serving as the focal point for a campaign to eliminate tobacco industry funding of research at the University of California.

According to the article, the accusation from the ACS has prompted an internal University investigation to determine whether any scientific misconduct occurred:

"The latest round of debate began last autumn when the chief executive of the American Cancer Society, John Seffrin, wrote a letter to the University of California's board of regents arguing that tobacco funding should be banned. In the 12 October letter, Seffrin argued that tobacco-funded front groups "publicized misleading results" while giving "the false implication" that the society had endorsed the study. He cited Enstrom's BMJ article in particular, alleging that Enstrom "ignored" complaints of "fundamental methodological problems". ... Wyatt Hume, provost at the University of California's president's office, wrote to Seffrin saying that the university "takes allegations of scientific misconduct extremely seriously". If there is "specific information in support of an allegation of scientific misconduct against Enstrom", he wrote, he would relay it to officials at the Los Angeles campus so that they "can pursue the matter further". Shortly after, officials at the cancer society sent a seven-page list of what they cited as issues with the BMJ article. ... Officials at the Los Angeles campus "will conduct a thorough review of the documents" ... and "will take further steps to determine whether any research misconduct took place"."

Both authors of the study -- Dr. Enstrom and Dr. Geoffrey Kabat, formerly of SUNY Stony Brook, have vehemently denied any scientific misconduct:

"In an interview, Enstrom acknowledged receiving the various letters and corresponding with the University of California's authorities. "I am working on this with regents' approval," he said. "I am being allowed to defend myself by the appropriate people." He "absolutely" denies any misconduct in the study. And Kabat objects to the university's regent policies being based "on allegations motivated by a political agenda and unsupported by any facts"."

The Rest of the Story

According to the article, among the allegations that are part of the ACS complaint are the following: "top scientists at the cancer society say they repeatedly warned Enstrom of possible deficiencies in his analysis — particularly a 25-year gap in which exposure to second-hand smoke could not be verified. The society also says that when it gave Enstrom computerized records of study subjects, it was not aware that he was receiving funding from the tobacco industry. Later tobacco-related lawsuits revealed he had received money from industry funnelled through an organization called the Center for Indoor Air Research. And court records show Enstrom previously did consulting and research for attorneys defending the tobacco companies R. J. Reynolds and Philip Morris."

If these allegations are representative of the complaints in the ACS letter, then I don't see how this is anything more than a witch hunt to try to harass and vilify Drs. Enstrom and Kabat simply for having come to a conclusion that is unfavorable to the position of anti-smoking groups.

The presence of deficiencies in research is not scientific misconduct. Almost all research has some deficiencies. The inability to verify exposure of subjects at follow-up is not scientific misconduct, it is simply a limitation in the study methodology. This limitation could bias the results toward not finding an effect of secondhand smoke, but it is not misconduct to conduct a study that has methodologic limitations.

The failure to disclose one's other sources of funding to the ACS does not appear to me to be scientific misconduct. Unless Dr. Enstrom lied about having received tobacco industry funding (and I've seen no allegations of such), there is no misconduct. At the time he received funding, the ACS did not have a policy of refusing to fund anyone who has received tobacco money; thus, I don't immediately see why Dr. Enstrom would have had any obligation to disclose his previous funding sources. If the ACS failed to ask, then it's their problem.

Dr. Enstrom's previous work for the Center for Indoor Air Research and his consulting with attorneys representing tobacco companies are also not scientific misconduct. Failing to disclose his tobacco industry funding would be misconduct, but this funding was noted in a detailed disclosure in the paper. Since the conflict of interest was disclosed, I don't see what the basis is for a claim of scientific misconduct regarding the receipt of tobacco industry funding.

For the record, the article discloses the tobacco industry funding: "follow up through 1999 and data analysis were conducted at University of California at Los Angeles with support from the Center for Indoor Air Research, a 1988-99 research organisation that received funding primarily from US tobacco companies."

The article also discloses Dr. Enstrom and Kabat's work for tobacco companies: "In recent years JEE has received funds originating from the tobacco industry for his tobacco related epidemiological research because it has been impossible for him to obtain equivalent funds from other sources. GCK never received funds originating from the tobacco industry until last year, when he conducted an epidemiological review for a law firm which has several tobacco companies as clients. He has served as a consultant to the University of California at Los Angeles for this paper. JEE and GCK have no other competing interests. They are both lifelong non-smokers whose primary interest is an accurate determination of the health effects of tobacco."

It's clear that the American Cancer Society is unhappy with the results of the study and I can understand that. It's also clear that the ACS thinks the methodology of the study was severely flawed. And I can understand that as well. It's also clear that the ACS thinks that the tobacco industry used this study as part of its public relations campaign to undermine public health messages about the hazards of secondhand smoke. And I understand that as well.

But where we part company is when the ACS attacks the individual investigators, questions their personal character and integrity, and accuses them of scientific misconduct.

Based on my knowledge of the situation, this appears to me to basically be a witch hunt in which the ACS and others in the anti-smoking movement are taking out their displeasure at the publication of unfavorable results through an ad hominem attack against the dissenting voice. Sounds familiar, doesn't it? (Regular readers of The Rest of the Story will know what I am talking about).

The appropriate manner in which to respond to the paper is through an analysis and critique of its scientific validity. The funding source is a valid consideration as well, as it could be seen as a potential source of bias. That's all fair game. But turning this into a personal attack and crossing over from scientific validity concerns to scientific misconduct is crossing the line.

Questioning Dr. Enstrom's integrity as an individual is not appropriate in this situation. In fact, Dr. Enstrom is an individual and a scientist of the highest integrity. Those who are attacking him need to question their own integrity in turning to an ad hominem approach rather than sticking with a discussion of the scientific merits of the research.

Of note, the American Cancer Society is perhaps not in the best position to be questioning the integrity of others. This is a group whose president called the tobacco companies terrorists. It is a group which stands together with Philip Morris in promoting legislation that would provide unprecedented special protections to the tobacco companies and would shield the companies from any significant threat of litigation. It is a group which has misled the public about the health effects of secondhand smoke and encouraged other anti-smoking groups to make what amount to fallacious statements in order to increase the emotional appeal of the secondhand smoke message.

Before attacking others, perhaps the ACS should take a look at itself and get its own house in order.

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