Monday, October 13, 2008

CDC, Tobacco-Free Kids, and Scientific Editor of Surgeon General's Report Discussed How to Handle My Criticism of Misleading Public Statements

Their Decision:
Do Not Engage in Scientific Discussion; Keep It Ad Hominem or Simply Ignore Him

The Centers for Disease Control and Prevention (CDC), the Campaign for Tobacco-Free Kids (TFK), and the Senior Scientific Editor of the Surgeon General's report on secondhand smoke had a discussion about how to handle my criticism of the Surgeon General's press release, which misrepresented the science on the acute cardiovascular effects of secondhand smoke.

This discussion was in response to my blog post which argued that the press release issued by the Surgeon General's office was misleading because it claimed that: "Even brief exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and increases risk for heart disease and lung cancer, the report says."

The discussion also continued in response to my being quoted in a JAMA article about the Surgeon General's misrepresentation of the science in his press statements.

The Surgeon General's assertion is that brief exposure to secondhand smoke increases risk for heart disease and lung cancer, and that his report drew such a conclusion. The falsehood of the second part of that assertion is easily proven, since nowhere in the report does it conclude that brief exposure to secondhand smoke increases the risk of heart disease or lung cancer.

The falsehood of the first part of the assertion is also easily shown, since it takes many years of secondhand exposure to develop heart disease. A single, brief exposure cannot possibly cause heart disease. A person who is exposed briefly to secondhand smoke is not at an increased risk for heart disease due to that single exposure.

It's like saying that drinking a glass of whole milk increases your risk for heart disease. A single glass of whole milk may well cause endothelial dysfunction and platelet activation, as does any high-fat bolus. But the CDC would not warn the public that drinking a glass of whole milk increases the risk of heart disease. If you drank whole milk repeatedly and for many years, then it could contribute to an increased risk of heart disease. But not a single drink.

As far as brief exposure to secondhand smoke increasing the risk for lung cancer, there is simply no evidence that this is the case. The CDC could fall back on the notion that there is no threshold for cancer effects. But that reasoning would mean that the CDC should also be warning that eating any amount of peanut butter increases the risk of cancer (since it contains aflatoxin, a potent carcinogen). Clearly, one cannot assert that any exposure to something which contains a carcinogen is going to increase your risk of cancer. There needs to be evidence to back up such a claim.

This is the context of my criticism of the Surgeon General's press release. Note, also, that I was not criticizing the report itself. In fact, I used the report as evidence to support my contention that the Surgeon General's press remarks were misleading.

The discussion was initiated by the Campaign for Tobacco-Free Kids, which wrote a letter to the scientific editor of the Surgeon General's report, asking him to draft a response to my criticism: "I'm writing to explore your willingness to draft a response to some recent op-eds and blog entries by Dr. Michael Siegel from Boston University related to the recent SGR on exposure to secondhand smoke. As you may be aware, Dr. Siegel has become something of a resident contrarian on a variety of issues related to tobacco control, and one that he has focused on lately is the issue of short-term exposure to secondhand smoke and his contention/claim that the SG has misrepresented the science in general and specifically misrepresented the science within the SG report itself. While Dr. Siegel's postings on various tobacco control listservs may prove troublesome or irksome to some, they do not do any harm. But he now has begun to insert himself into local smokefree battles around the country and, whether he realizes/intends it or not, is providing ample fodder to the opposition and media calling into question the validity of the underlying science - even though he caveats his statements with saying he favors restrictions, etc...but he then proceeds to raise questions calling into question the science. ..."

"We were hoping that you, as the senior scientific editor of the SGR, might be willing to craft a response to Dr. Siegel that we could work with you in getting placed in various publications where Dr. Siegel has been appearing - the most recent being the St. Paul Pioneer Press in Minneapolis/St. Paul, Minnesota. ... While we would normally choose to ignore Dr. Siegel and not give him any more credence/attention than he deserves, we think his actions in taking his arguments to a broader, more public stage warrant a response."

In response, the senior scientific editor of the Surgeon General's report wrote: " first thought is to ignore Siegel and not 'dignify' his points of criticism with a response - I suspect that he will become silent if ignored, but if he persists or becomes more vocal, then let's discuss."

Tobacco-Free Kids responded: "That has been our general approach with Siegel and it has been mostly successful. What is different this time is he is not containing his 'opinions' to just his blog or various listservs but is doing it in a much more public forum via newspaper op-eds, he's been interviewed on TV, etc...".

The CDC responded: "I don't think anything we say is going to stop Mike, given the fact that the SG has said it, and that hasn't stopped him. Engaging just gives him an excuse to write another editorial, commentary, or blog."

In a separate note, CDC wrote: "It does not seem to be productive to engage Mike - he is not interested in discussing the science."

After the JAMA article appeared, the senior scientific editor of the Surgeon General's report wrote: "...a very disappointing story from JAMA--I am tempted to write to Cathy DeAngelis--what does not come across is the process of development of the SG reports, including the rigorous development and peer review--and offering a forum to Siegel who does not have the credentials to scientifically support what he is saying...".

The Rest of the Story

What is most fascinating about reading these exchanges is the trepidation of these groups to actually become engaged in a discussion of the science behind the Surgeon General's claim. Moreover, the discussion is not focused on whether my criticism has merit, but instead is focused on how to discredit me.

When it finally came down to it, the senior scientific editor of the Surgeon General's report made no comment about the scientific justification for the press release statement; instead, he resorted to an ad hominem attack on me, challenging my credentials to express my opinion. Interestingly, there was never any concern about my credentials in writing and reviewing numerous sections in prior Surgeon General's reports. I guess my credentials suddenly disappeared when I opined in a way that was unfavorable to the extremist claims of the movement.

The CDC comments are most interesting because they were written by a close colleague of mine from the Office on Smoking and Health, someone who I worked closely with for two years and who is very familiar with my scientific expertise in the area of tobacco control science. Those comments are also ironic, because I am very happy to be engaged in a discussion of the science. It is these groups which have refused to engage in such a discussion.

It is really instructive for me to see how these groups treat a former colleague who worked closely with them in formulating all kinds of scientific documents about the health effects of secondhand smoke. The way that these groups are treating me, I might as well have gotten a job working for the tobacco industry. You would never know that I am a colleague who worked in the same office at CDC and contributed to Surgeon General's reports.

It is clear that having an opinion that is viewed as being on "the other side" is fatal to your career in tobacco control. There simply is no room for dissent on the science. You automatically become an enemy, a member of the opposition, someone to be ignored or even worse - discredited. It is very much like a religion.

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