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Defending legitimate epidemiologic research: combating Lysenkopseudoscience

Epidemiologic Perspectives & Innovations2007, 4:11 doi:10.1186/1742-5573-4-11

James E Enstrom ([email protected])

ISSN 1742-5573

Article type Analytic Perspective

Submission date 11 March 2006

Acceptance date 10 October 2007

Publication date 10 October 2007

Article URL http://www.epi-perspectives.com/content/4/1/11

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Defendinglegitimateepidemiologicresearch:combatingLysenko

pseudoscience

JamesE.EnstromUniversityofCalifornia,LosAngeles,CA,USA

ScientificIntegrityInstitute,LosAngeles,CA,USA

Correspondingauthor:

JamesE.Enstrom,PhD,MPHUniversityofCaliforniaBox951772LosAngeles,[email protected]


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Abstract

ThisanalysispresentsadetaileddefenseofmyepidemiologicresearchintheMay17,2003BritishMedicalJournal thatfoundnosignificantrelationshipbetweenenvironmentaltobaccosmoke(ETS)andtobacco-relatedmortality.Inordertodefendthehonestyand

scientificintegrityofmyresearch,Ihaveidentifiedandaddressedinadetailedmannerseveralunethicalanderroneousattacksonthisresearch.Specifically,Ihavedemonstratedthatthisresearchisnotfatallyflawed,thatIhavenotmadeinappropriateuseoftheunderlyingdatabase,andthatmyfindingsagreewithotherUnitedStatesresultsonthisrelationship.Myresearchsuggests,contrarytopopularclaims,thatthereisnotacausalrelationshipbetweenETSandmortalityintheU.S.responsiblefor50,000excessannualdeaths,butratherthereisaweakandinconsistentrelationship.Thepopularclaimstendtodamagethecredibilityofepidemiology.

Inaddition,Iaddresstheomissionofmyresearchfromthe2006SurgeonGeneralsReportonInvoluntarySmokingandtheinclusionofitinamassiveU.S.DepartmentofJustice

racketeeringlawsuit.IrefuteerroneousstatementsmadebypowerfulU.S.epidemiologistsandactivistsaboutmeandmyresearchandIdefendthefundingusedtoconductthisresearch.Finally,IcomparecurrentETSepidemiologyintheU.S.withpseudoscienceintheSovietUnionduringtheperiodofTrofimDevisovichLysenko.Overall,thispaperisintendedtodefendlegitimateresearchagainstillegitimatecriticismbythosewhohaveattemptedtosuppressanddiscredititbecauseitdoesnotsupporttheirideologicalandpoliticalagendas.Hopefully,thisdefensewillhelpotherscientistsdefendtheirlegitimateresearchandcombatLysenkopseudoscience.


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BackgroundThisanalysispresentsadetailedresponsetotheextensiveattacksthathavebeenmadeonmyepidemiologicresearchintheMay17,2003BritishMedicalJournal ,EnvironmentaltobaccosmokeandtobaccorelatedmortalityinaprospectivestudyofCaliforniansduring1960-98[1].

IseektodefendthehonestyandscientificintegrityofmyresearchandIdirectlyrespondtomymostpowerfulcritics,whohaveattemptedtosuppressanddiscreditfindingsthatdonotsupporttheirideologicalandpoliticalagendas.Toputahistoricalperspectiveonthetacticsthathavebeenusedagainstme,IconcludebymakingananalogywiththepseudoscientificpracticesofTrofimDenisovichLysenko[2].Hopefully,mydefensewillencourageand/orhelpotherhonestscientiststodefendtheirresearchagainstunwarrantedandillegitimatecriticism.Thisanalysisdealswithseveralimportantelementsoftheattacks,withaprimaryfocusontheepidemiologicissuesinvolved.AdditionalelementsoftheattackarementionedbrieflyinthisanalysisandarepresentedindetailonmyScientificIntegrityInstitutewebsite,underResearchDefense[3].Beingattackedforpublishingunpopularscientificfindingsisnotuniquetomeor

myresearch.However,thenatureandscopeoftheattackstowhichIhavebeensubjectedisquiteunusualandneedstobedocumentedandaddressed.Beingabletodistinguishbetweenrealandimpliedscientificmisconductisimportanttotheintegrityofscienceingeneralandtotheintegrityofindividualscientistsinparticular.Falselyaccusinganhonestscientistofscientificmisconductisjustaswrongasscientificmisconductitself.ImplyingthatanhonestscientisthascommittedscientificmisconductbecausehehaspublishedunpopularfindingsorhasusedanunpopularfundingsourceiswrongandfallsunderthecategoryofscientificMcCarthyism[4].

Analysis

BackgroundonBMJPaper

IbeginwithapresentationofthebackgroundnecessarytounderstandtheissuesinvolvedwiththeMay17,2003BritishMedicalJournal(BMJ) paperthatIwrotewithDr.GeoffreyC.Kabat[1].Thisaccountprimarilyinvolvesmeandthusiswritteninthefirstperson,butitalsoreferstoKabatwhereappropriateandnototherwisenoted.Ourpaperfoundnorelationshipbetweenenvironmentaltobaccosmoke(ETS)andtobacco-relatedmortalityinaprospectivestudyofCaliforniansduring1960-1998,withsomeassociationsslightlybelowthenullandsomeslightlyabovethenull,butnonestatisticallydifferentfromthenull.Itconcluded,Theassociation

betweenexposuretoenvironmentaltobaccosmokeandcoronaryheartdiseaseandlungcancermaybeconsiderablyweakerthangenerallybelieved.Itisthelargest(intermsofstatisticalpower),mostdetailed(intermsofresultspresented),andmosttransparent(intermsofinformationaboutitsconduct)epidemiologicpaperonETSandmortalityeverpublishedinamajormedicaljournal.ThestudyisbasedontheCalifornia(CA)portionoftheoriginal25-stateCancerPreventionStudy(CPSI)[1].CACPSIwasbegunbytheAmericanCancerSociety(ACS)in1959andhas


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beenconductedatUCLAbymesince1991.KabatandIarebothwellqualifiedepidemiologistswhohavehadlongandsuccessfulcareersdatingbacktothe1970s,ascanbeconfirmedbyexaminingourepidemiologicpublicationsonPubMed.Ourpaperwasdeemedtobescientificallysoundandworthyofpublicationafterbeingpeerreviewedbytwodistinguishedepidemiologists,aBMJstatistician,andaBMJeditorialcommittee.Thedetailsoftheentirepeer

reviewprocessandthenamesofalltheindividualsinvolvedinthereviewprocessareavailableonlineasthePrepublicationhistory[5].ThepaperwassubjectedtothesamereviewprocessandselectioncriteriaasotherpaperssubmittedtotheBMJ,whichpublisheslessthan10%ofthetotalsubmissionsitreceives[6].Intheinterestoftransparencyandfulldisclosure,thepaperincludedthefollowingdetailedstatementsaboutthefundinghistoryofthestudyandthecompetinginterestsoftheauthors:Funding:TheAmericanCancerSocietyinitiatedCPSIin1959,conductedfollowupuntil1972,andhasmaintainedtheoriginaldatabase.Extendedfollowupuntil1997wasconductedattheUniversityofCaliforniaatLosAngeleswithinitialsupportfromtheTobacco-RelatedDiseaseResearchProgram,aUniversityofCaliforniaresearchorganisationfundedbythe

Proposition99cigarettesurtax(www.ucop.edu/srphome/trdrp).AftercontinuingsupportfromtheTobacco-RelatedDiseaseResearchProgramwasdenied,followupthrough1999anddataanalysiswereconductedatUniversityofCaliforniaatLosAngeleswithsupportfromtheCenterforIndoorAirResearch,a1988-99researchorganisationthatreceivedfundingprimarilyfromUStobaccocompanies.Competinginterests:InrecentyearsJEEhasreceivedfundsoriginatingfromthetobaccoindustryforhistobaccorelatedepidemiologicalresearchbecauseithasbeenimpossibleforhimtoobtainequivalentfundsfromothersources.GCKneverreceivedfundsoriginatingfromthetobaccoindustryuntillastyear,whenheconductedanepidemiologicalreviewforalawfirmwhichhasseveraltobaccocompaniesasclients.HehasservedasaconsultanttotheUniversityofCaliforniaatLosAngelesforthispaper.JEEandGCKhavenoothercompetinginterests.Theyarebothlifelongnon-smokerswhoseprimaryinterestisanaccuratedeterminationofthehealtheffectsoftobacco.[1].InitialAttacksonBMJpaper

Eventhoughourpapersatisfied(andinmanywaysexceeded)theacceptedstandardsofepidemiologicanalysisandwriting,itwasimmediatelyattackedbypeoplewhodidnotliketheresultswereported.BeginninginthedaysbeforeMay17,2003,ourBMJpaperwassubjectedtoalarge-scaleadhominemattack.Sinceourhonestyorscientificintegrityhadneverpreviouslybeenquestioned,suchanattackseemedtoustobequiteimplausibleandindeedincredible.BasedonwhatIhavelearnedsinceMay2003,Idescribethekeyelementsofthisattackinordertoexposethetacticsthathavebeenusedinanattempttodiscreditandsilencelegitimateepidemiologicresearch.AdditionaldetailsarepresentedonmyScientificIntegrityInstitutewebsite[3].Theattackhasbeenlargelyduetothefactthatwepublishedpoliticallyincorrectnullfindingsfromalong-termstudyprimarilyfundedbytheACS,butcompletedwitharesearchawardtoUCLAfromtheCenterforIndoorAirResearch(CIAR),anow-defuncttobacco-industryfundedresearchorganization.


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OnMay9,2003IlearnedthatourpaperwastobepublishedintheMay17,2003BMJandthatanembargoedBMJpressreleasewastobeissuedonMay13,2003.Thestrictpublication/broadcastembargoregardingourpaperwastolastuntil00:01hours(UKtime)onMay16,2003,whichwas19:01(7:01PM)EDTonMay15,2003inFloridaand16:01(4:01PM)PDTonMay15,2003inCalifornia.Duringthisperiod,theACSwasinformedofour

forthcomingpaperandthepressembargo.TheACSthenprepareditsownpressreleaseentitledAmericanCancerSocietyCondemnsTobaccoIndustryStudyforInaccurateUseofData.TheMay14,2003versionoftheACSpressreleasewasinsertedintoaMay15,2003emailmessageofStantonA.Glantz,Ph.D.,ProfessorofMedicineattheUniversityofCalifornia,SanFrancisco(UCSF).GlantzsendoutthismessageworldwidetohisUCSFlistservbeforethepressembargoended[7].TheofficialMay15,2003versionoftheACSpressrelease,whichadheredtothepressembargo,wasissuedinaseparatePDFform[8].ThenitwaspermanentlypostedontheACSwebsiteinaslightlydifferentformat[9].Theinstantaneousattackonourpaperappearstohavebeenacoordinatedeffort,primarilyorganizedbytheACSandGlantz.Glantzisawell-knownanti-smokingactivistwhohasworked

closelywiththeACSformanyyears[10].Aspartofthiscoordinatedeffort,GlantzorganizedaMay15,2003Miami,FloridapressconferenceinvolvingapanelofinternationalexpertsinordertodebunkourMarryaSmoker,GetLessCancerstudybeforethepressembargoended[11].AtthetimeoftheACSpressreleaseandtheMiamipressconference,neithertheACS,Glantz,ortheotherMiamiexpertshadaccesstothefullten-pageversionofourpaper,letalonetimetoreaditandcarefullyanalyzeit.ThefullversionofourpaperwasnotpostedontheBMJwebsite(www.bmj.com)untilthepressembargoliftedat7:01PMEDTonMay15,2003[1].TheonlyversionavailablewhentheembargoedBMJpressreleasewasissuedonMay13,2003wastheabridgedfive-pagepaperthatappearsintheprintversionoftheBMJ[12].Obviously,thesecriticschosetohastilywriteapressreleaseandholdapressconferencebasedonlimitedinformation.Theydidnothavetheintegrityorobjectivitytoreadourfullten-pagepaperortocontacttheauthorsbeforebeginningtheirattack,whichincludederroneousclaimsaboutthepaper'scontentandquality.TheACSpressreleasewasauthoredbyMichaelJ.Thun,M.D.,ACSVicePresident,EpidemiologyandSurveillanceResearch,andHarmonJ.Eyre,M.D.,ACSChiefMedicalOfficer.Thispressreleasemakesseveralentirelyfalsestatementsaboutthestudy,suchas:1)TobaccoIndustryStudywasPartofOrganizedEfforttoConfusePublicAboutSecondhandSmoke2)SocietyresearchersrepeatedlyadvisedDr.EnstromthatusingCPS-Idatatostudytheeffectsofsecondhandsmokewouldleadtounreliableresults3)thisstudyisneitherreliablenorindependent4)Thestudysuffersfromacriticaldesignflaw:theinabilitytodistinguishpeoplewhowereexposedtosecondhandsmokefromthosewhowerenot


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5)exposuretosecondhandsmokewassopervasive[in1959]thatvirtuallyeveryonewasexposedtoETS,whetherornottheyweremarriedtoasmoker.

Furtherdistractingfromtheactualcontentofthestudyandthelegitimacyoftheanalysis,thepressreleaseaddedanumberofoutofcontextquotesfromformerlyconfidentialtobaccoindustrydocumentsthathadnothingtodowiththeconduct,analysis,orpublicationofthestudy.ForthepastseveralyearsthesedocumentshavebeenavailableonlinefromtheLegacyTobaccoDocumentsLibraryatUCSF[13],whichwasestablishedbyGlantz[14].Thesedocumentsarealsoavailableatotheronlinetobaccodocumentlibraries[15].Asshownabove,mytobaccoindustryfundingandcompetinginterestswereclearlyandaccuratelydescribedinmorethan200wordsintheBMJpaper[1].However,inordertoraisedoubtsaboutmyhonestyandscientificintegrity,theACSmadeagreatefforttolocateandextractselectivequotesfromtheprofessionalcorrespondenceIhavehadwiththetobaccoindustryduringmycareer.ThisadhominemattackdivertedattentionfrompaperitselfandobscureditscontributiontothebodyofepidemiologicevidenceregardingthelethalityofETS.AmajorelementoftheattackincludedthesubmissiontotheBMJwebsiteofover150mostly

negativeelectronicletters,knownasrapidresponses(rrs)[16].TheoverallcontentandnatureoftheserrswassummarizedbyaBMJassociateeditorinanAugust30,2003letter[17].ParticularlytroublingareMay19and20,2003rrsbyThun[18,19],aMay30,2003rrbyThunand13othermembersoftheInternationalAgencyforResearchonCancer(IARC)Working

Groupontobaccosmoke[20],andaAugust19,2003rrbyDrs.PhillipS.Gardiner,CharlesGruder,andFranciscoBuchtingoftheUniversityofCaliforniaOfficeofthePresident[21].Noneoftheauthorsofthesecriticismsevercontactedusforaclarificationofanyaspectofour

BMJpaperorourcontactswiththetobaccoindustrybeforepostingtheirrrs.Mostofthepresscoverageofthestudywasmutedorequivocalbecauseoftheissuesraisedby

theACScriticismofthepaper.TypicalofthistypeofnewspapercoveragewastheMay16,2003LosAngelesTimesarticleonpageA26,StudyDownplaystheHealthRisksFromSecondhandSmoke.ThisarticleconcludeswiththefollowingquotefromDr.JonathanSamet,ProfessorandChairofEpidemiologyattheJohnsHopkinsUniversityBloombergSchoolofPublicHealth:Wehaveoneveryflawedstudythatdoesnotfindanassociation.Itfliesinthefaceofsomuchevidenceandsomuchscientificunderstandingthatitjustdoesntcontribute.[22].

SupportiveCommentaryontheBMJPaper

AsupportivepressaccountappearedintheMay18,2003SundayTelegraphnewspaperarticle,Warning:thehealthpolicecanseriouslyaddleyourbrain,byRobertMatthews[23].Thearticlenoted,Morethananyotherhealthdebate,thequestionofwhethersmokerskillothersaswellasthemselvesisengulfedinasmogofpoliticalcorrectnessanddubiousscience.Othersupportivecommentariesalsoappeared.MichaelFumento,aSeniorFellowattheHudsonInstitute,wroteaSeptember11,2003syndicatedcolumn,Second-handSmokeisHarmfultoScience[24].ElizabethWhelan,D.Sc.,PresidentoftheAmericanCouncilonScienceandHealth(ACSH),wroteanAugust13,2004ACSHcolumnentitledAmericanCancerSocietya


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DangertoScience?[25].MichaelFitzpatrick,M.D.,ageneralpracticephysicianinLondon,wroteaNovember15,2004SpikedcommentaryentitledWehavewaysofmakingyoustopsmoking.[26].ThesecommentariesputourBMJfindingsincontextanddescribedtheexcessesoftheanti-smokingcriticswhoattackedus.

Twosociologists,Drs.SheldonUngarandDennisBray,noticedtherrsandtheothermediacoverageofmypaperanddescribedthephenomenathattheyobservedintheirownJanuary2005paper[27].TheydescribedindetailtheeffortstopreventthemakingofspecificscientificclaimsinanyorallofthearenasinwhichtheseclaimsaretypicallyreportedorcirculatedastheyrelatedtomyBMJpaper.Theirresultssuggestthatthepublicconsensusaboutthenegativeeffectsofpassivesmokeissostrongthatithasbecomepartofaregimeoftruththatcannotbeintelligiblyquestioned.Givenallthecontroversiesinvolvingotherepidemiologicriskfactors,suchas,hormonereplacementtherapy,airpollution,andvitaminsupplements,thisstateofaffairsregardingETSisquiteamazing.Indeed,theevidenceregardingthelethalityofETSisnotaregimeoftruth,butcollectionofweakresultsthathaveturnedintoacausalrelationshipbycarefullychosencommittees.AsIwilldiscusslater,theepidemiologicevidence

onthissubjecthaschangedinrecentyearsandneedstobecompletelyandobjectivelyreassessedinordertoreachavalidconclusion.AuthorsandEditorDefendtheBMJPaper

Theattackdescribedabovewasquitestartlingtomeassomeonewhosehonestyandscientificintegrityhadneverbeenquestionedduringthe33-yearperiodfromJuly1970,whenIreceivedmyPh.D.[28],untilMay2003[1].ItwasalsostartlingthattheattackwasinitiatedbytheACS,theveryorganizationthathadgivenmetheoriginalCaliforniaCancerPreventionStudy(CACPSI)datain1991uponwhichtheBMJstudywasbased.KabatandIdealtwithsomeofthe

initialcontroversybyrespondingtospecificcriticismsinourAugust30,2003BMJletter[29]andinourJanuary31,2004Lancetletter[30].Inparticular,intheseletterswerefutedthefivefalseACSstatementsshownabove:1)ThiswasnotaTobaccoIndustryStudy,butratheraUCLAstudyconductedbytwoqualifiedepidemiologistswithACScooperationupuntilpublicationoftheBMJpaper.ThiswasnotPartofOrganizedEfforttoConfusePublicAboutSecondhandSmoke,butratheritwasanaccuraterepresentationoftheresultsofonestudy.Thetobaccoindustryplayednoroleintheconduct,writing,orpublicationofthepaper,anddidnotevenknowitwasbeingpublisheduntilitappeared.

2)ItisacompletefabricationthatSocietyresearchersrepeatedlyadvisedDr.EnstromthatusingCPS-Idatatostudytheeffectsofsecondhandsmokewouldleadtounreliableresults.Indeed,theACSVicePresidentforEpidemiologypriortoThunworkedcloselywithmeontheoverallCACPSIfollow-upstudyfrom1991until2001becausehefeltthatthiswasavaluableproject.Hewasaco-authoronthefirstversionoftheETSandmortalitypaperwhenitwassubmittedtotheNewEnglandJournalofMedicine in2001andwasco-authoronmyfirstpublicationbasedontheCACPSIcohort,whichdealtwithsmokingcessationandmortality


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trends[31].Hewasnotabletoremainasco-authorontheETSandmortalitypaperafter2001becauseofhisretirementfromtheACSandhisgrowingdistancefromtheproject.3)Itisabsolutelyfalsethatthisstudyisneitherreliablenorindependent.First,thisstudyisjustasreliableasotherepidemiologicalstudiesthathavebeenconductedinasimilarmanner

Indeed,theBMJpeerreviewprocessfoundthattheresultsofthestudyweresoundandsufficientlyreliabletobeworthyofpublicationandtheACShasthusfaridentifiednospecificerrorsinthestudy.Second,thestudywasconductedindependentofinfluencefromboththeACSandthetobaccoindustry.4)ItisabsolutelyfalsethatThestudysuffersfromacriticaldesignflaw:theinabilitytodistinguishpeoplewhowereexposedtosecondhandsmokefromthosewhowerenot.Thiscohortstudywasdoneinthesamewayastheotherspousalsmokingstudiesandour1999follow-upquestionnairesurveyresultsclearlyshowedthatthereweresubjectswhohadvaryingdegreesofexposuretoETSasshowninTables4and5oftheBMJpaper.ThisissuewasclearlyaddressedintheBMJpaperinresponsetoThuns1999concernsaboutthisissue[32].

5)Itisabsolutelyfalsethatexposuretosecondhandsmokewassopervasive[in1959]thatvirtuallyeveryonewasexposedtoETS,whetherornottheyweremarriedtoasmoker.Theresultsofthe1999surveyshowninTable4oftheBMJpaperclearlyshowedthatamongneversmokersmarriedtoneversmokersasof1959,43.5%ofmalesand61.7%offemalesreportednoregularexposuretocigarettesmokefromothersinworkordailylifeasof1999.

AlthoughtheACSdisputesthevalidityofmy1999survey,theyhavenotconductedtheirownETSexposuresurveyoftheapproximately50millionAmericanswhowerebornbefore1950andwhoarecurrentlyalive.SuchasurveywouldyieldactualevidenceastowhetherornotallAmericansaliveduringthe1950sand1960swereequallyexposedtoETS.TheACScannotsimplymakeanunsubstantiatedclaimthatvirtuallyeveryonewasexposedtoETSandexpect

thisclaimtonegatealltheevidencepresentedinmyBMJpaper.Inadditiontothepublishedletterscitedabove,wesubmittedtotheBMJonJune30,2003ManuscriptBMJ/2003/084269,adetailedcommentarythatvigorouslydefendedspecificaspectsofourBMJpaper.Weshowedthattherewas,infact,substantialagreementbetweenourresultsregardingETSandthoseoftheACSandpointedoutinconsistenciesinACSfindingsthathadnotbeenpreviouslynoted.Unfortunately,onSeptember19,2003theBMJdeclinedtopublishthiscommentary,whichwouldhavehelpedresolvethecontroversythathaderuptedoverourBMJpaper.Wethenspentovertwoyearsattemptingtopublishvariousportionsofthiscommentaryinotherjournalsuntilwesuccessfullypublishedin2006,asdescribedinour

January24,2006rrtobmj.com[33].PortionsofManuscriptBMJ/2003/084269arepresentedlaterinthispaperandtheentiremanuscriptispostedforhistoricalreference[34].Inspiteofthenumerousattacksdescribedabove,theBMJhasstoodbehindtheBMJpapersince

itspublication.Forallofthevehemenceoftherrs,onlyabout3%referredtoactualdatainthepaperandnoneidentifiedanythingapproachingscientificerrororscientificfraud[16].Indeed,ourpaperwasrankedamongtheToptensfrombmj.comin2003[3531].BMJEditorRichardSmithstronglydefendedhisdecisiontopublishthepaperonbothMay18,2003[36]andAugust


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30,2003[37].Furthermore,Smithagaindefendedthisdecisioninhis2006book,TheTroublewithMedicalJournals ,inwhichhestateditwouldbeantisciencetosuppresssystematicallyonesourceofresearch[38].Todate,noimpropriety,bias,oromissionhasbeenidentifiedinthereviewprocessandnoerrorintheresultshasbeenidentifiedinthepaper,notevenbyThun,whoisinapositiontocheckourfindingsandtopublishadditionalfindings.

SupportforBMJpaperfromOtherEpidemiologicResearch

TofurtherdocumentthevalidityofourBMJfindings,KabatandIcomparedthemwiththeotherU.S.epidemiologicevidenceonETSandcoronaryheartdisease(CHD),inour2006peer-reviewedmeta-analysisofenvironmentaltobaccosmokeandCHDmortalityintheUnitedStates[39].Thiscomprehensivemeta-analysisfocusesontheU.S.cohortstudiesofETSandCHDdeathinneversmokers.Thesecohortstudiesareallfairlysimilarindesign;ETSexposurewasapproximatedbyspousalsmoking;CHDdeathwastheendpoint;andtheyconstitutevirtuallyalltheU.S.evidenceandthemajorityoftheworld-wideevidence.Incontrasttothepreviousmajor

meta-analysesonthistopic,suchastheonein1999byThun[32],ouranalysisincludestheresultsofour2003studyandthe1995studybyLeVoisandLayardbasedonCPSIdata[40].Wehaveappliedconsistentcriteriatotheselectionofresultsincludedintheanalysis.Theresultsaresummarizedintermsofoverallrelativerisksanddose-responserelationships.Inaddition,availabledataonmisclassificationofETSexposure,personalmonitoringofactualETSexposure,anddose-responsedataforactivesmokingarediscussedinordertocharacterizetheestimatesofETSexposureinepidemiologicstudies.ContrarytotheclaimsoftheACSandothercritics,ourresultsdonotdifferinanymaterialwayfromthoseoftheotherstudies,particularlyforfemales.AfurtherexampleoftheACSmisrepresentationsontheETSissuecanbefoundinthefollowingsimplecomparisonofstatementsaboutthefindingsintheirmajor1982CancerPreventionStudy(CPSII)cohort.IntheMay15,2003ACSpressreleaseHarmonJ.Eyre,MD,stated:CPS-IIisoneofmorethan50studiesnowpublishedthathaveshownnon-smokersmarriedtosmokershaveanincreasedriskoflungcancer[8,9].But,the1995doctoraldissertationbasedonCPSIIbyVictorCardenas,EnvironmentaltobaccosmokeandlungcancermortalityintheAmericanCancerSocietysCancerPreventionStudyII,wasinconclusive[41].Thedissertationabstractstates:Thisstudyfoundnoevidenceofanassociationbetweenself-reportedETSandlungcancerriskamongnonsmokers.However,usingspousalsmokinghabitstoassessexposure,wefoundETSisonlyweakly,andnotstatisticallysignificantly,relatedtolungcancerriskamongnonsmokingwomeninsevenyearsoffollow-upoftheCPSIIcohort.[41].EventhoughourfindingsareentirelyconsistentwithCardenasfindings,Eyreimpugnedourstudywithhisstatement:Badsciencecanhauntusforgenerations.Andregrettably,ifquestionablestudiesmakeittopublication,thedamageisdone.[8,9].Furthermore,wespecificallyrefutedtheunsubstantiatedclaimbyThunthatourBMJstudyisfatallyflawedbecauseofmisclassificationofexposure[42].ThunimpliedthatvirtuallyeveryoneintheU.S.duringthe1950sand1960swasequallyexposedtoETSbecauseitwassopervasive.Resultsfromfourindependentsurveys,aswellasour1999CACPSIsurvey,showthatAmericanswerenotequallyexposedtoETS.AdditionalsurveysshowthatexposuretoETScomesprimarilyfromspousalsmoking,notpublicsmoking,particularlyforfemales.Indeed,


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therewasaclearrelationshipbetweenspousalsmokingandself-reportedETSexposureamongneversmokerswholivedamajorportionoftheirlifebeforetheintroductionofrestrictionsonpublicsmokinginthe1970s.Oneofthesesurveysiscontainedinthe1995Cardenasdissertation[41].AlthoughThunservedontheCardenasdissertationcommittee,tomyknowledge,hehasnevercitedresultsfromthisdissertation.

Wefoundthatwhenallrelevantstudiesareincludedinthemeta-analysisandtheresultsoftheindividualstudiesareappropriatelycombined,currentoreverexposuretoETS,asapproximatedbyspousalsmoking,isassociatedwithroughlya5%increasedriskofdeathfromCHDinneversmokers,notthewidelycited25%inthemeta-analysesofThunandothers.Furthermore,wefoundnodose-responserelationshipandnoelevatedriskassociatedwiththehighestlevelofETSexposureinmalesorfemales.AnotherpaperwhichshedslightontheCPSIIfindingsconcerningETSisa1995analysiswhichlinkeddataonambientairpollutionfrom151U.S.metropolitanareaswithmortalitydatafromCPSIIindividualswhoresidedinthoseareas[43].Theresultsofthisanalysisshowedthatin

neversmokerstherewasastatisticallysignificantassociationofallcausemortalitywithbothsulfateandfineparticleconcentrationsaftercontrollingforcovariates,includinghoursperdayofETSexposure.Theauthors,oneofwhomwasThun,didnotreportthespecificresultsfortheconfoundingvariableofETSexposure.However,inordertoresolveamajordisputeoverthevalidityoftheresultsinthisairpollutionanalysis[44],areanalysiswasconductedin2000bytheHealthEffectsInstitute[45].TheCoxproportionalhazardsregressionmodel(PHREG)resultsincludedinAppendixFoftheresultingHEIReanalysisReportmakeitclearthattheindependentvariablepassive(hoursperdayofETSexposure)showsnoassociationwithmortalityfromlungcancer,cardiopulmonarydisease,orallcausesinneversmokers[46].ForlungcancerinCPSII,RR(passive)=1.020(0.938-1.110)formales,1.004(0.995-1.013)forfemales,and1.005(0.957-1.055)forbothsexes.TheserelativerisksagreewellwiththoseinmyCACPSIstudy,whereRR(7levelindex)=0.88(0.70-1.10)inmalesandRR(8levelindex)=0.97(0.90-1.05)infemales.ForcardiopulmonarydiseasesinCPSII,RR(passive)=1.004(0.987-1.021)formales,1.015(1.000-1.029)forfemales,and1.010(0.999-1.021)forbothsexes.ForallcausesinCPSII,RR(passive)=0.996(0.984-1.009)formales,1.004(0.995-1.013)forfemales,and1.001(0.994-1.009)forbothsexes.AkeyportionoftheactualPHREGcomputerprintoutforthesediseasesformales,females,andbothsexeshasbeenassembledandposted[46].ThePHREGprogramusedintheCPSIIstudy[43,46]isthesameasthatusedintheCACPSIstudy[1].

MyBMJresultsforcoronaryheartdiseasearealsoconsistentwiththoseintheWesternNewYorkStatestudypublishedintheOctober9,2006ArchivesofInternalMedicine ,whichfoundAfteradjustmentforcovariates,exposuretosecondhandsmoke[SHS]wasnotsignificantlyassociatedwithanincreasedriskofmyocardialinfarction[MI][47].Furthermore,thisstudyconcludedExposuretoSHShasdeclinedsharplyamongnonsmokersinrecentyears.IntheabsenceofhighlevelsofrecentexposuretoSHS,cumulativelifetimeexposuretoSHSmaynotbeasimportantariskfactorforMIaspreviouslythought.Thisstudywasentirelyindependentofmystudyandwasdonewithouttobaccoindustryfundingandcametothesameconclusionwithregardtoheartdisease.Finally,myBMJresultsforlungcancerintheCACPSIcohortareconsistentwiththoseoftheoriginal1981ACSanalysisofthenationwideCPSIcohort[48].


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Thisanalysisexaminedlungcancermortalityduring1960-1972andfoundComparedwithnonsmokingwomenmarriedtononsmokinghusbands,nonsmokersmarriedtosmokinghusbandsshowedverylittle,ifany,increasedriskoflungcancer.ThisanalysiswasentirelyfundedbyandconductedbyACSandcametothesameconclusionasmyBMJanalysis.

OngoingMisrepresentationsRegardingETS

Muchoftheevidenceaboveisnotbeingproperlypresentedandthereismisrepresentationofotherevidence.Forinstance,seriousmisrepresentationofCPSIIresultsisevidentwhenoneexaminesthe1997Cardenaspeer-reviewedpaper[49],whichwasbasedonthe1995Cardenasdissertation[41].Table4oftheCardenaspaperpresentsexposuretospousalsmokingamongwomenbythehusbandslevelofsmoking,butisdeceptivelylabeled.Womenwiththehighestlevelofexposure,labeled40+cpdbyspouse,haveaRRof1.9(95%CI1.0-3.6)andthePfordose-responsetrendis0.03.However,Table38oftheCardenasdissertationmakesclearthattheRRforspousesofcurrentsmokersof40+cpdisonly0.9(95%CI0.2-3.9)andthePfor

trendis0.34.IfitwerenotforTable38thereaderwouldnotknowthatTable4isbasedonthecombinationofcurrentandformersmokers.Thiscombinationofcurrentandformersmokersbycpdishighlyunorthodox,hasnotbeendoneinotherETSstudies,andisnotmeaningfulforassessingatrendbasedoncurrentspousalsmoking.TheCardenasdissertationmakesitveryclearthatthereisnodose-responserelationshipbetweenspousalsmokingandlungcancerinCPSII.KeysectionsofCardenasTables4and38areshownsidebysideinTable1belowandtheyrevealaseriousdiscrepancyinthepresentationofthesamedata.BecauseCardenasTable38appearstopresenttheunderlyingfindingsandbecausethesefindingscontradictEyresstatementabove,theACSshouldclarifythismajordiscrepancy.However,noclarificationhasbeenmadeandonlythepositivedose-responserelationshipinCardenasTable4isevercited[49].Forinstance,CardenasTable4findingsarenowcitedinthe2004WHOIARCMonograph83TobaccoSmokeandInvoluntarySmoking[50].Thismajor1452-pagereportcontainsareviewoftheepidemiologicevidenceonETSandlungcanceronpages1231-1271[51].ThesectionExposure-responserelationshipsonpage1236containsthestatementThestudybyCardenasetal.(1997)alsofoundasignificantexposure-responserelationship.Whenthehusbandssmoked1-19,20-39,>40cigarettes/day,therelativerisksforwomenexposedtosecondhandsmokewere1.1,1.2,and1.9respectively(pvaluefortrendtest,0.03).Inaddition,aJanuary2004JNCIsummaryofIARCMonograph83showsresultsfor>40cigarettes/dayinTable3anditcontainstheerroneousvalueRR=1.9[52].ObviouslyThun,amemberoftheIARCWorkingGroupforMonograph83,didnotnotifytheIARCWorkingGroupaboutthe1995Cardenasdissertation.Thistypeofselectiveanalysisandpresentationofresultshasbeentermedpublicationbiasinsituanditisoftendifficulttodetect[53].IwasabletodetectthisirregularityonlybecauseIknewoftheCardenasdissertation.Inotherscientificfields,thetypeofdatamanipulationdoneinCardenasTable4wouldmostlikelybetreatedasaseriousethicalviolation.Also,itisnoteworthythat14authorsoftheJNCIarticlesignedanAugust30,2003BMJlettercriticizingmyBMJpaper,butthenmadenomentionofmypaperintheirJanuary2004JNCIarticle.


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ContinuingACSCampaigntoDiscreditBMJStudy

AlthoughIhaverefutedtheerroneousstatementsintheirMay15,2003pressrelease,theACS

hasshownnointerestincorrectingtherecordwithregardtomeandmyresearch.Theirpressreleasehasbeenpostedonupto1,000locationsontheInternetduringthepastfouryears,basedonGooglesearchesofthephrase"AmericanCancerSocietyCondemnsTobaccoIndustryStudy.ItisstillpostedonmanywebsitesinadditiontoACSsownwebsite.OurBMJandLancetlettersandournewmeta-analysisdefendingthevalidityofourBMJpaperarebeingignoredbytheACS.Instead,theACSandotheractivistorganizationscontinuetopostdefamatoryinformationaboutusandourresearch.Ournewmeta-analysisshowsthattherelationshipbetweenETSandCHDinU.S.neversmokersisveryweak(estimatedrelativeriskof1.05withnodose-responserelationship)[39].YettheACScontinuestostateintheir2007CancerFactsandFiguresthatETScausesanestimated

35,000deathsfromheartdiseaseinpersonswhoarenotcurrentsmokers(page36)[54].ThesourcetheACSusesforthisCHDdeathestimateisa1992JAMApaper[55],eventhoughmorethan90%oftheU.S.epidemiologicevidencehasbeenpublishedsince1992.Ournewmeta-analysisshowsthatthevastmajorityoftheexistingU.S.evidenceoriginatesfromtheACSCPSIandCPSIIcohorts,yettheACSsimplyignoresordismissesmostofthisevidence.TheCPSIandCPSIIevidenceissummarizedinTable2below,whichistakenfromTable6ofourmeta-analysispaper[39].ContinuingGlantzCampaigntoDiscreditEnstrom

BeginningwithhisactivitiesatthetimeofthepublicationofourBMJpaper,Glantzhascontinuallyattackedmeandmyresearch,inspiteofthefactthatwearebothestablished,long-termfacultymembersintheUniversityofCaliforniasystem.Glantziswell-knownasalong-timeanti-smokingactivist[10,56],whoseultimategoalisachievingasocietyfreeofsmokers[57].However,asaUCfacultymember,heissupposedtoadheretotheUCSFCampusCodeofConduct[58]andtheUCStandardsofEthicalConduct[59].Forinstance,theCodeofConductstatesMisconductorMisconductinSciencemeansfabrication,falsification,plagiarism,orotherpracticesthatseriouslydeviatefromthosethatarecommonlyacceptedwithinthescientificcommunityforproposing,conducting,orreportingresearch.TheUCStandardsofEthicalConductstatesMembersoftheUniversitycommunityareexpectedtoconductthemselvesethically,honestly,andwithintegrityinalldealings.However,basedonhisclearlydocumentedwrittenandverbalattackonme,hehasnotadheredtothesecodes.Indeed,Ihavespentthepastfouryearsrespondingtohisfalseandmisleadingstatementsanddefendingmyhonestyandscientificintegrity.Thefulldetailsofhiscampaignaretooextensivetopresenthere,buttheselectedexamplesbelowdemonstratethetacticsthatheusedagainstmeandtheepidemiologicresearchthatIhavebeenconductingatUCLA.


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OnJuly25,2003NealL.Benowitz,MD,UCSFProfessorofMedicine,andGlantzco-wroteaneight-pagelettertotheUCViceProvostforResearchLawrenceColemaninwhichattemptstomakethecasethatacceptanceoftobaccoindustryfundingforresearchviolatescurrentRegentsandUniversitypolicyandshouldbeended[60].Onpages3and4ofthislettertheyclaim:Themostrecentexampleofhowthetobaccoindustryusesfundingofuniversityresearchas

partofitsforpropagandacampaignisaMay17,2003studyfromUCLAonthehealtheffectsofsecondhandsmokepublishedintheBritishMedicalJournal ....Thereislittlepossibilitythatitwillbetakenseriouslyinscientificcircles....thispaperwouldgodownasonebitofpoorresearchdoneatauniversitywithareputationforhighqualityscholarshipthatslippedintoagoodjournalbecauseofthefoiblesofthepeerreviewprocess.OnMarch8,2005GlantzparticipatedwithotherUCfacultymembersinaSanFranciscobasedKQEDradioprogramentitledFundersandAcademicResearch:Forumassessesthecontroversysurroundingtherelationshipbetweenfundersandacademicresearch,whichcanbelistenedtoontheInternetandaudiofiles[61].DuringthisprogramGlantzattemptedtodiscreditwellqualifiedscientistsandtheirpeer-reviewedresearchpublicationsby

inappropriatelylinkingthemtothetobaccoindustry.ThescandalaboutmeandmyBMJ

studywasdiscussedduringminutes17-19ofthis52minuteprogram,whenGlantzmadeseveralclearlyfalseandinflammatorystatements.First,GlantzclaimedthattheBMJstudywasnotfundedbytheAmericanCancerSociety,butwasdonewithPhilipMorrismoney.Actually,thestudywasfundedbyACSfrom1959to1990,bytheUCTobacco-RelatedDiseaseResearchProgramfrom1991to1997,andbytheCenterforIndoorAirResearch(CIAR)from1998to2003.PhilipMorrisprovidednodirectfundingforthisstudyandhadnoroleinitsconduct.Then,GlantzstatedthatIwasadamnfoolwhowastoldbyACSthatImadeinappropriateuseofthedata,anunsubstantiatedclaimmadeonlyafterGlantzandACSlearnedofmyresults.Then,GlantzimpliedthatIwasadvocatingapro-tobaccopositionwhenIhaveneverdone.Finally,GlantzclaimedthesciencethattheUCLAstudydidwascrap,whereasitclearlyconformedtothestandardsofepidemiologicresearch.ThesestatementsindicatetheunprofessionalapproachusedbyGlantztoattackscientificfindingswithwhichhedisagreesandtoadvocatepositionsthatarenotsupportedbythefacts.

GlantzsargumentsforbanningtobaccoindustryfundingofresearchatUChavebeenrejectedinfavorofacademicfreedom.TheUCadministrationhasexpresseditsstrongsupportforacademicfreedomandUCViceProvostforResearchColemanhasstatedAcademicfreedommustbeabsoluteornoonehasit[62].OnMay11,2005theUCAcademicSenateadoptedastrongAcademicSenateResolutiononResearchFundingSourceswhichclearlysupportstherightofindividualUCfacultymemberstoacceptresearchsupportfromanysource,includingthetobaccoindustry,aslongasthisfundingadherestoUniversitypolicy[63].Inspiteofthisstrongfacultyresolution,inSeptember2006GlantzbroughttheissueofabanontobaccoindustryfundingtotheUCRegents,thegoverningbodyoftheUniversity[64].GlantzcitedmyBMJstudyasonerationaleforsuchabaninwrittendocuments[65]andinaJanuary18,2007presentationbeforetheUCRegents[66].TheUCRegentsrequestedadviceonthisissuefromtheUCAcademicSenate,whichspentseveralmonthscarefullyevaluatingthematter[67].Myperspective,includingadefenseofmyresearch,myfunding,andmyscientificintegrity,waspresentedtotheUCAcademicSenateinApril2007[68].InMay2007representativesoftheUCAcademicSenatevotedalmostunanimously(15to1bytheAcademicCounciland44to5


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bytheAcademicAssembly)infavorinacademicfreedomandagainstaproposedbanontobaccoindustryfundingadvocatedbyGlantz[69-71].OnefinalexampleofGlantzsunprofessionaltreatmentofmyresearchiscontainedinhisMay24,2005Circulationreport,whereheattemptstomakethecasethatpassivesmokinghasnearly

thesameimpactasactivesmokingoncardiovasculareffects[72].Inhismeta-analysisoftherelationbetweenETSandCHD,hefoundThepooledrelativeriskcomputedwitharandom-effectsmodel(computedwithStataVersion7)was1.31(95%CI,1.21to1.41),similartotheestimatesofearliermeta-analyses.Toachievethisresult,heomittedthetwolargeststudies,whichrepresentamajorportionoftheavailableevidence.MyBMJstudy,whichbeganin1960[1],wasomittedbasedonhisunsubstantiatedclaimthatithadseriousmisclassificationbiasandthe1995studybyLeVoisandLayard,whichalsobeganin1960[40],wasomittedwithoutcommentandwasnotevencited.However,Glantzincludedtheothercohortstudieswhichbeganinthe1960sand1970swithoutanycommentabouttheirmisclassificationbias.KabatandIfullyaddressedallthesestudiesandtheissueofmisclassificationbiasinour2006meta-analysis[39].GlantzsbiasedanalysisregardingtherelationbetweenETSandCHDisevident

whenhis2-page2005meta-analysis[72]iscomparedwithour12-page2006meta-analysis[39].JonathanM.Samet,M.D.,and2006SurgeonGeneralsReport

FalseandmisleadingstatementsaboutmyresearchwerealsomadebyJonathanM.Samet,M.D,M.S.,whohasplayedaprominentroleinreviewsoftheepidemiologicevidenceonETSforover20years.First,SametmadeastatementthatneitherhenoranyoneelsehassubstantiatedintheMay16,2003LosAngelesTimes,whenhedescribedmyBMJpaperasoneveryflawedstudythatjustdoesntcontribute[22].Then,heco-signedseriousaccusationsaboutmyresearchthatappearedinaMay30,2003BMJrapidresponse[20]andanAugust30,2003BMJletter[73].ThesetwoitemsstatedEnstromandKabatsconclusionsarenotsupportedbytheweakevidencethattheyoffer,andalthoughtheaccompanyingeditorialalludedtodebateandcontroversy,wejudgetheissuetoberesolvedscientifically,eventhoughthedebateiscynicallycontinuedbythetobaccoindustry.Tounderstandtheoutlandishnatureoftheseaccusations,recallthatweusedalargeandhighlyrespecteddatasetandacceptedepidemiologicmethods;wereportedstudydetailsinthepaperitself,inthe"PrepublicationHistory",andinoursubsequentletters;wehavesupportedourconclusionstoagreaterextentthancanbefoundforanyotherstudyofETSandmortality;ourmethodshaveneverbeensubstantivelychallenged;andourresultsareconsistentwiththeentirebodyofU.S.evidence[39].ThesestatementsfromSametmighthavebeensomewhatplausibleifhehadanyevidencethattherewereerrorsinmy2003paperorthatIwaspro-tobaccobasedonmyresearchbefore2003.Butneitherhenorothercriticshavemadeaplausiblecaseforfundamentalerrorsinmypaper,andIhaveneverbeenpro-tobacco.SamethasbeenawareofmyepidemiologicresearchsincewebothparticipatedintheAugust23-25,1978NationalCancerInstituteWorkshoponPopulationsatLowRiskofCancerheldinSnowbird,UT.Theproceedingsoftheworkshop,includingthelistofparticipants,werepublishedinJNatlCancerInst(JNCI)inNovember1980[74].IgavethreetalksatthisWorkshopandtwoofthemdescribedthereduced


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cancerdeathratesamongnonsmokers,onedealingwithMormons[75]andanotherdealingwitharepresentativesampleofU.S.nonsmokers[76].Indeed,IhaveinvestigatedthehealthylifestylesofMormonsandothernonsmokersduringmyentireepidemiologiccareer[77,78].FurtherevidenceofSamet'swillingnesstodismissscientificevidencewhenitdoesnotsupport

hisagendaappearsintheJune27,2006releaseandpublicationofthe727-pageSurgeonGeneralsReportonTheHealthConsequencesofInvoluntaryExposuretoTobaccoSmoke[79].SametwastheSeniorScientificEditorofthisreportandthemostinfluentialepidemiologistinvolvedwiththereport[80].Inaddition,GlantzwasaContributingEditorandThunwasaRevieweronthisreport.AlthoughSamet,Thun,andGlantzwerefullyawareoftheimportanceofmyBMJpaper,asevidencedbytheirextensiveeffortstodiscreditit,thepaperwassimplyomittedfromtheSurgeonGeneralsReportwithoutcomment.AsearchforenstromjoftheentirePDFversionofthereport[79],revealsthattheonlymentionoftheBMJpaperisintheAppendixonpage673,whereitislistedasoneofthepapersnotincludedinthereport.AnothersearchrevealsthattheBMJpaperwasomittedwithoutexplanationfromthedatabasefortheReport[81].ThisdatabasewaspreparedbyJohnsHopkinsUniversityandthe

CentersforDiseaseControlandPrevention'sOfficeonSmokingandHealth.Itincludesapproximately900keyarticlesregardinginvoluntarysmokinganddiseaseoutcomesandsupposedlyreflectsthemostrecentfindingsinthescientificliterature.Inordertoillustratetheselectiveandunscientificnatureofthisomission,IexaminedthereferencesusedinChapters1-10oftheSurgeonGeneralsReportandthereferencesintheAppendixthatwerenotused.Of38totalreferencesfrom2003,33wereusedinChapters1-10andonly5references,includingtheBMJpaper,werenotused.Of71referencesfrom2004,53wereusedand18werenotused;of39referencesfrom2005,26wereusedand13werenotused;of22referencesfrom2006,7wereusedand15werenotused.Insummary,thereportused119referencesfrom2003-2006,butomittedwithoutcommentthe2003BMJpaper.TheBMJpaperwastheonlyU.S.studyrelatingETStolungcancerandcoronaryheartdiseasethatwasomitted.Becauseofthisomission,theSurgeonGeneralsReportdoesnotaccuratelyreflectallthepeer-reviewedepidemiologicevidenceontherelationofETStolungcancerandcoronaryheartdiseasemortalityintheU.S.Chapter7,page423,reports:Thischapterconsidersthefullbodyofevidenceonsecondhandsmokeexposureandlungcancerpublishedthrough2002,theendingdateforthesystematicreviewoftheepidemiologicstudies.Basedoncomparingneversmokersevermarriedtoasmokerwithneversmokersnevermarriedtoasmoker,aworldwiderelativerisk(RR)of1.21(1.13-1.30)wasreportedonpage435.However,thereisnoreasonforanendingdateof2002,giventhatothersectionsofthereportciteresultspublishedduring2003-2006(bymycount119suchpublicationsarecited).Itappearsthattheendingdateof2002wasintentionallyselectedinordertoexcludemy2003BMJresults.Consequently,theaboveworldwideRRismisleadingbecauseitdoesnotreflectthatfactthatmyresultssubstantiallyweakentheU.S.evidence[1,29].Myownmeta-analysisofallU.S.spousalsmokingstudies,yieldsaU.S.RRof1.10(1.00-1.21),whichbarelyconstitutesarelationship.Chapter7containsthisinaccuratestatementonpage435:TherewerenosignificantdifferencesintheRRestimatesbygeographicarea;thepointestimatewas1.15(95percentCI,1.041.26)


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forstudiesconductedintheUnitedStatesandCanada,1.16(95percentCI,1.031.30)forstudiesconductedinEurope,and1.43(95percentCI,1.241.66)forstudiesconductedinAsia.Obviously,theRR=1.43forstudiesinAsiaisstatisticallygreaterthantheRR=1.15forstudiesinU.S.andCanadaandtheRR=1.16forstudiesinEurope.Indeed,thereissubstantialvariationaroundtheworldandalltheseresultscannotbeaccuratelyrepresentedbyasingleRRof1.21.

ThisgeographicvariationshouldhavebeenproperlyacknowledgedintheReport.Chapter8containsonpage521selectivecriticismaboutanddismissaloftheanalysisbyLeVoisandLayardofETSandCHDdeathsintheACSCPSIandCPSIIstudies[40].Thispaperisimportantbecauseofitssizeandstatisticalpower,asdiscussedinour2006meta-analysisofETSandCHDdeathsintheU.S.[39].Onebasisforthedismissalistheinaccuratestatement,Theinvestigatorsdidnotdistinguishbetweencurrentexposuresfromspousalsecondhandsmokeandformerexposures,nordidtheyseparatelyreporttheeffectofcurrentspousalsmokingontheriskofCHD.Table4oftheLeVoisandLayardpaperclearlyshowsresultsforthreelevelsofcurrentETSexposureforbothmalesandfemales.Furthermore,Table2belowsummarizesthedose-responserelationshipbetweenETSandCHDdeathsbasedontheresultsfromthethree

largestU.S.studies[1,40,82].Thereisnomeaningfuldifferenceintheresultsforthesestudiesandnodose-responserelationshipinanyofthem.Furthermore,notethatthemeta-analysisofETSandCHDissummarizedinFigure8.1onpage524.Sincethisfigureonlyshowsstudiesthrough2001itobviouslyomitsthe2003BMJstudy.TheBMJstudyhasamajorimpactonthemeta-analysis,aspointedoutinour2003BMJletter[29]andour2006meta-analysis[39].NotethatinclusionofBMJresultsyieldsarelativerisk(RR)ofCHDdeathintheU.S.of1.05(0.99-1.11),basedonacomparisonofcurrenttoneverexposuretoETS.ThisismuchlessthanthesummaryRR(exposed/unexposed)of1.27(1.19-1.36)containedinFigure8.1.TheSurgeonGeneralsReportshouldhavepointedoutthattheETSandCHDrelationshipismuchlargeroutsideoftheU.S.thanitiswithintheU.S.WeestimatedthattheRRoutsidetheU.S.isapproximately1.5[39]andthe1999Thunmeta-analysisfoundtheRRwas1.41(1.21-1.65)[32].ThislargedifferencebetweentheRRswithintheU.S.andthoseoutsideoftheU.S.isworthyoffurtherdiscussionandinvestigation,inordertodetermineifitisarealdifferenceorananomalyduetomethodologicalissues.TheIntroductionoftheSurgeonGeneralsReportmakesthestatementthatabout50,000excessdeathsresultannuallyfromexposuretosecondhandsmoke(Cal/EPA2005).EstimatedannualexcessdeathsforthetotalU.S.populationareabout3,400(arangeof3,423to8,866)fromlungcancer,46,000(arangeof22,700to69,600)fromcardiac-relatedillnesses,and430fromSIDS.[79].GiventhefactthatthetwolargestepidemiologicstudiesonETSandtobacco-relatedmortality[1,40]havebeenomittedfromtheSurgeonGeneralsReportandthefactthatthesetwoU.S.studiessuggestasubstantiallyweakerETSandmortalityrelationshipintheUS,theaboveestimateofexcessdeathsappearstobeanintentionalexaggerationofwhattheentirebodyofscientificevidenceshows.Acompleteevaluationofallthepeer-reviewedU.S.epidemiologicevidencesuggeststhatETSexposureisassociatedwithamuchsmallernumberoflungcancerandCHDdeathsinU.S.neversmokers.Furthermore,thereisnotacausalrelationshipbytraditionalepidemiologicstandards.


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AnAugust23,2006researchnewsandperspectivereportinJAMAquestionedvariousaspectsoftheSurgeonGeneralsReport,particularlyfindingsregardingtheacuteeffectsofsmallamountsofETSexposureandtheclaimbytheSurgeonGeneralthatThereisnosafelevel ofexposuretosecondhandsmoke"[83].ThisJAMAreportisparticularlynoteworthybecauseitquotestwoexpertswhohaveextensiveexperienceregardingtheETSissue.MichaelSiegel,

MD,MPH,aprofessorofsocialand

behavioralsciencesatBostonUniversitySchoolofPublicHealthandaprominenttobaccocontrolresearcher,toldJAMA"We'rereallyriskingourcredibility[aspublichealthprofessionalsorofficials]byputtingoutratherabsurdclaimsthatyoucanbeexposedbrieflytosecondhandsmokeandyouaregoingtocomedownwithheartdiseaseorcancer.Peoplearegoingtolookatthatandsaythat'sridiculous."Siegelsownpaperexpandingonthispointispublishedalongsidethepresentarticle[84].Furthermore,sinceMarch2005,SiegelhaspostedmanydetailedandinsightfulanalysesregardingETSandtobaccocontrolonhispersonalwebsite,TheRestoftheStory:TobaccoNewsAnalysisandCommentary[85].EachpostincludesCommentsfromreaderswhoprovideadditionalinsights.Forinstance,onJune28,2006,hepostedSurgeonGeneral'sCommunicationsMisrepresentFindingsofReport;TobaccoControlPractitionersAppearUnabletoAccuratelyPortraythe

Science[86].

JohnC.BailarIII,MD,PhD,aprominentepidemiologistandbiostatistician,whoisProfessorEmeritusattheUniversityofChicago,toldJAMA"Itdoesn'tmakesenseforthecardiovascularriskofsecondhandsmoketobeashighasonethirdoftheriskfromdirectsmoking....That'safarbiggerratiothanriskforlungcancerandit'shardformetobelievethatit'sreal"[83].ThesecommentsaresimilartothoseinhisMarch25,1999NEJMeditorialonETSandcoronaryheartdisease,inwhichhestatedIregretfullyconcludethatwestilldonotknow,withaccuracy,howmuchorevenwhetherexposuretoenvironmentaltobaccosmokeincreasestheriskofcoronaryheartdisease[87].

OnJune7,2006,just20daysbeforethereleaseoftheSurgeonGeneralsReport,theSelectCommitteeonEconomicAffairsoftheHouseofLordsinLondonissuedanimportantreportonthemanagementofrisk,whichsuggeststhatpassivesmokinginEnglandmaybearelativelyminorhealthrisk[88].ThecommitteeobtainedtestimonyfromProfessorSirRichardPetooftheUniversityofOxfordonFebruary14,2006[89].SirRichardstestimonyclearlystatesthesubstantialdoubtthathehasaboutthequantitativehealthrisksofpassivesmoking[90,91].Theveryfactthattwomajorreportspublishedinthesamemonth,June2006,cometosubstantiallydifferentconclusionsaboutthehealthrisksofETSindicatesthattheserisksarestilluncertainanddifficulttomeasureaccurately.FurtherevidenceoftheuncertaintyregardingthehealthrisksofETSiscontainedintheJune28,2007NaturenewsarticleonETS.VariousclaimsmadebyGlantzabouttheacuteandchronichealtheffectsofETSarequestionedbyPeto,Bailar,andSiegel,whorestatedtheirconcernsthatthedangersofETShavebeenexaggerated[92].Forinstance,PetostatedPassivesmokingmustkillsomepeople,butthebigquestionishowmany.ThisstatementclearlyunderscorestheexistinguncertaintyanddirectlycontradictstheJune27,2006statementbyU.S.SurgeonGeneralRichardH.CarmonathatThedebateisoverregardingthehealtheffectsofsecondhandsmoke[93].


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JonathanM.Samet,M.D.,andUnitedStatesofAmericav.PhilipMorrisUSA,etal.

OneparticularlyperniciousaspectoftheattackdescribedaboveisthefactthatmyBMJpaperisnowpartofthelargest($280billion)RacketeerInfluencedandCorruptOrganizationsAct(RICO)lawsuiteverfiled,UnitedStatesofAmericav.PhilipMorrisUSA,etal.[CivilAction

No.99-CV-02496(GK)][94,95].MyresearchandIaredescribedinadefamatorywayonpages821-830withinthesectionDefendantsUsedTheirJointlyControlledOrganizationstoPromoteTheirAgendaThroughSymposia,PublicationsandaRosterofLong-timePaidScientistsofthe2543-pagepretrialUNITEDSTATESFINALPROPOSEDFINDINGSOFFACT(July2004)preparedbytheU.S.DepartmentofJustice(USDOJ)[96].ThetrialtookplaceinfrontofU.S.DistrictCourtJudgeGladysKesslerfromSeptember2004thoughJune2005[94].Additionally,myresearchandIaredescribedinadefamatorywayinseveralplacesinthe2454-pagepost-trialdocumentUNITEDSTATESFINALPROPOSEDFINDINGSOFFACT(IncorporatingErrataofAugust16,2005)preparedbytheUSDOJ[97].Specifically,myBMJpaperislistedonpageviioftheTableofContentsunderthecategoryCookingtheBooks:TheManufactureofFalseSciencetoSupporttheIndustryPositiononETS.Onpage493itis

includedamongexamplesofscientificfraudandonpage589itisdescribedasatbestacontaminationofthescientificliteratureandatworstascientificfraud.Itisdiscussedindetailonpages609-615,wheretherearenumerousfalsestatementsanddistortions,suchas,theEnstrom/Kabatstudyisyetanotherself-serving,unreliable,andscientificallyquestionableproductoftheindustrysunabatedefforttoattackthescientificconsensusonpassivesmoking.Althoughnoactualevidencewaspresentedoferrorsinmystudyorofscientificmisconductonmypart,thelawsuitmakesitappearthatIhaveengagedinscientificfraud.TheavailableevidenceindicatesthatinsertionoftheBMJpaperwasacollaborativeeffortofGlantzandSharonY.Eubanks(D.C.BarNo.420147),DirectoroftheUSDOJTobaccoLitigationTeamfrom1999untilDecember2005,whensheresignedfromtheUSDOJ[98].ThefollowingbriefinCivilNo.99-CV-02496(GK),REPLYINSUPPORTOFTHEUNITEDSTATESTHIRDMOTIONTOCOMPELPRODUCTIONOFDOCUMENTSWITHHELDBYBROWN&WILLIAMSONBASEDONASSERTIONSOFPRIVILEGEORPROTECTION,waspreparedbyEubanksandsignedonDecember5,2003.ThisbriefispostedonthesamelistservthatGlantzhasusedtopostotherdefamatoryinformationaboutme[99].Pages8,9,and14ofthisbriefcontainamisleadinganddistortedpresentationofmyallegedtieswiththetobaccoindustrygoingbacknearly30years.ThispresentationlaterappearedintheJuly2004andAugust2005FindingsofFactoftheUSDOJlawsuit.This2003briefdoesnotpresentanyevidencechallengingmyhonestyasascientistorthevalidityofthefindingsinmyBMJpaper.Itissimplyanattempttosmearmyreputationwithinappropriatelyconstructedtiestothetobaccoindustry,basedonthefactthatIhadcorrespondencewiththetobaccoindustryregardingmyepidemiologicresearch.OnAugust17,2006DistrictCourtJudgeGladysKesslerissueda1,653pageFinalOpinionconcludingthatthetobaccoindustryhadengagedinracketeering[100,101].Elevenkeypagesfromherdecision,includingpagesdiscussingmystudy,wereassembledbyGlantzandpostedonaUCSFwebsite[102].TheKesslerdecisionincludesasectionentitledThe2003Enstrom/KabatStudyonpages1380-1383,aswellasotherreferencestomystudy.TheJudgerepeatedinheropinionanumberofthemisleadingandinaccuratestatementsaboutmystudy


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thatarecontainedinthe2004and2005FindingsofFact.However,theJudgeidentifiednospecificerrorsinthestudyandidentifiednoscientificmisconductbyme.AtnotimewasIevergivenanopportunitytochallengeorrefutethestatementsmadeaboutmeandmyresearchintheUSDOJFindingsofFact,inthetrialitself,orintheKessleropinion.Iamnowintheprocessofclearingmynameinconnectionwiththislawsuitandthispaperrepresentsamajorstepinthat

process.Furthermore,onOctober31,2006theU.S.CourtofAppealsoftheDistrictofColumbiaCircuitgrantedthetobaccoindustrysemergencymotiontostayJudgeKesslersfinaljudgmentandremedialorderpendingappeal[103].OnMay22,2007theU.S.CourtofAppealsissuedanordersettingthebriefingschedulefortheappeal[104].Informulatinghercommentsaboutmystudy,JudgeKesslerreliedheavilyonthetestimonyofSamet.Onpage765ofherdecisionshestatesDr.JonathanSamet,aGovernmentexpertwithextraordinaryqualifications,isaphysicianandepidemiologistwithextensiveexperiencetreatingpatientswithlungcancerandCOPD.Onpage1232shestates:Dr.SametisprofessorandchairoftheDepartmentofEpidemiologyattheJohnsHopkinsBloombergSchoolofPublicHealth.Heisalsoalicensedphysicianwhoisboardcertifiedinpulmonaryandinternal

medicine.Dr.SametisamemberoftheNationalAcademyofSciences'InstituteofMedicine,theBoardofScientificCounselorsoftheNationalCancerInstitute,andEPA'sCleanAirScientificAdvisoryCommittee.HeisarecipientoftheSurgeonGeneral'sMedallionandhasparticipatedasanauthorand/oreditorofnineSurgeonGeneral'sReports,includingasConsultingScientificEditorandauthorforthe1986Report.HehasparticipatedinfourNCImonographsinitsseriesonsmokingandhealth.Hechairedthe2002reviewofactiveandpassivesmokingandhealthfortheInternationalAgencyforResearchonCanceroftheWorldHealthOrganization....afterconsideringDr.Sametssuperbacademiccredentials,hisvastexperienceworkingonSurgeonGeneralReportsandNCImonographs,hiscontinuingpracticeofmedicine,aswellashisdemeanorandresponsivenesstocross-examination,theCourtfullycreditshistestimony.Onpage1234shestates:TheCourtacceptsandcreditsDr.Sametsconclusions,basedonhisexpertise,aswellastheotherfactualfindingsherein,thatexposuretosecondhandsmokecauseslungcancerandcoronaryheartdiseaseinadultsandanumberofrespiratorydiseasesinchildren.ItisworthrepeatingtheallegationsintheKesslerdecision,firsttopointoutthattheyarethesamefalseandmisleadingclaimsabouttheEnstrom/KabatstudybytheACS,Samet,Glantz,andothersthataredescribedabove,andsecondtoshowhowobviouslyincorrecttheyare.TheEnstrom/KabatstudywasnotCIAR-fundedandmanagedandwasnotfundedandmanagedbythetobaccoindustrythroughCIARandPhilipMorris.AlthoughthestudywaspartiallyfundedbyCIAR,itwasnotmanagedbyeitherCIARorPhilipMorris.Indeed,CIARassigneditsentireawardforthestudytoUCLAin1999justbeforeCIARwasdissolvedasaconditionoftheMasterSettlementAgreement[105].CIARdidnotevenexistwhenmystudywasbeingcompleted.Thestudywasconductedandpublishedwithoutanyinfluencefromthetobaccoindustry.TheclaimthattheAmericanCancerSocietyhadrepeatedlywarnedEnstromthatusingitsCPS-IdatainthemannerhewasusingitwouldleadtounreliableresultsisutterlyfalseandtheACShasproducednodocumentationtosupportthisclaim.TheclaimEnstromandKabat'sconclusionsarenotsupportedbytheweakevidencethattheyoffermadebySametandothersisutterlyfalsebecauseourconclusionsarefullysupportedbytheevidenceinourBMJpaper,asstatedearlier.


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Inaddition,SametmadeaninaccurateandincompletestatementinhisWrittenDirecttestimonyofSeptember20,2004(page184,lines8-9):Whenthe2002meta-analysiscarriedoutbyIARCwasredonein2004toincludethis[EnstromandKabat]study,thepositivefindingswereunchanged.[106].ThisstatementisinaccuratebecausetheAugust30,2003BMJlettersigned

bySametcorrectlystates:AddingtheresultfromEnstromand

KabattotheIARCanalysisreducesthepooledestimateto1.23.[73].Inaddition,thisstatementisincompletebecauseSametfailedtostatethattheEnstromandKabatresultsreducedthepooledriskratioestimatesforU.S.studiestoabout1.10forlungcancerandtoabout1.05forcoronaryheartdisease[39].TheEnstrom/Kabatsummaryriskratiosarefarbelowthewidelystatedsummaryriskratiosofabout1.25andarenotconsistentwiththeestimatethatabout50,000excessdeathsresultsannuallyfromexposuretosecondhandsmokeintheUS,asstatedonpage8oftheSurgeonGeneralsReport[79].SametmadeafalsestatementinthisSeptember20,2004testimonywhenheclaimed(page192,lines21-23):ExceptfortheanalysesofCPSIandCPSIIpresentedbyLeVoisandLayardin

1995,allotherstudieshavedemonstratedatleastamodestincreaseinriskforfatalandnonfatalCHDduetosecondhandsmokeexposure.[106].OurBMJstudyshowednoincreaseinriskforfatalCHD,otherthantheinsignificantstatisticalfluctuationthatwasalsopresentintheLeVoisandLayardpaper,andreferencetoourstudyshouldhavebeenincludedinSametstestimony.Sincenoerrorshadbeenfoundinourpaper,andsinceKabatandIhadclearlydeclaredtherewasnotobaccoindustryinfluenceonourresults(andnoonehasfoundanyevidencetothecontrary),ourresearchdidnotwarrantinclusionintheUSDOJlawsuit.ThecitationofourstudyintheKesslerdecisionappearstobeprimarilyduetothefalseandmisleadingstatementsaboutourresearchmadebySamet.AllofthiscastsdoubtontheabilityofSamettobeobjectiveregardingthesubjectofETS.FurtherevidenceofSametscampaignagainstmeappearedintheMay4,2007ChronicleofHigherEducationasatwo-page,15-inchby22-inchadvertisementWhydotheUniversityofCaliforniaRegentsstillcashchecksfromtobaccoracketeers?[107].ThisadvertisementbyCampaigntoDefendAcademicIntegrity[108]isanappealtoUCRegentstoimplementatobaccofundingbananditmakesdirectreferencetomeandmytobaccoindustryfunding.Statementsthroughouttheadvertisementfalselycharacterizemeandmyresearch:TomakevividhowBigTobaccoco-optedworld-classresearchinstitutionsforitsdisinformationandlegaldefensestrategies,theCourtcitedthemisuseofAmericanCancerSocietydatabyanon-facultyresearcheratUCLA...BigTobaccosinvestmentinUCLAboughtitthechancetoarguefalsely,usingUCLAsname,thatthescienceonsecondhandsmokewasinconclusive,tobattlepublichealthmeasures.WhateverthetobaccoindustrygainsfromtheUniversity,theUniversityloses.Thepublicloses,too.Thiscompoundingofthedefamationinthecourtpapersthroughpaidadvertisingwassignedby21prominentindividualswhoidentifythemselvesasamongthosewhosupportactionbytheUniversityofCaliforniaRegentstorefuseallfuturetobaccoindustryfunding.ThesignatoriesincludebothSametandEubanks,whoobviouslyhavebeendirectlyinvolvedinlobbyingtheUCRegents,apositionthatcompromisestheirobjectivitywithregardmyinclusionintheUSDOJlawsuit.Giventheobsessivefocusonmytobaccoindustryfunding,itisnoteworthythatthereisnoindicationofthefundingandcompetinginterestsof


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thoseassociatedwiththisadvertisement.TheChronicleofHigherEducationwebsitestatesthatatabloid-pagespreadadvertisementlikethisonecosts$22,630[109],asumunlikelytohavebeenpaidbythesignatoriesthemselves.Basedontherecordpresentedabove,EubankshasobviouslydealtextensivelywithbothGlantz

andSametregardingtheissueofmyBMJpaperandtheUSDOJlawsuit.SheinjectedherselfdirectlyintotheUCtobaccoindustryfundingbanissuewithalecturebeforetheRegentsonJuly18,2007,whenshedescribedtheUSDOJlawsuitanditsconnectiontoUC[110].SheclaimedthatJudgeKesslerwasaneutralfactfinder,afederaljudge,whomadeherfindingsofconspiratorialconductobjectivelybasedonafullandfairrecord.However,sheknowsthattherecordisnotobjectiveandthatIwasnevergivenanyopportunitytodefendmyselfandmyBMJpaperduringthetrial.InaneloquentdefenseofacademicfreedomatUC,the2006-2007UCAcademicSenateChairJohnB.OakleychallengedEubankslinkageoftheUSDOJlawsuittoUCandraisedtheissueofwhetherJudgeKesslersopinionwouldultimatelybeuphelduponappeal[11188d].AclearerunderstandingofthisentireissuecanbegainedbycarefullylisteningtotheEubanksandOakleyaudiofiles[110,111].

JonathanM.Samet,M.D.,andConflictofInterest

SamethasnotrevealedhiscompetinginterestsonthesubjectofETSastheyrelatetotheBMJrr[20],theBMJletter[73],theIARCReport[50],theJNCIarticle[52],theSurgeonGeneralsReport[79],hisUSDOJlawsuittestimony[106],ortheChronicleofHigherEducationadvertisement[107].GiventhatSamethascriticizedpersonswhodisagreewithhisviewsonETSbecauseoftheircompetinginterests,itisfairandreasonabletoaskwhyhehasfailedtoreporthisownsubstantialcompetinginterests.AcarefulexaminationoftheSurgeonGeneralsReportrevealsthatitcontainsnoconflictofinterestdisclosuresforSeniorScientificEditor

Sametorforanyoftheothereditorsorreviewers.Inaddition,anexaminationoftheotheritemsaboverevealstheSamethasnotdisclosedafinancialconflictofinterestwhichcouldhavecompromisedhisobjectivityonETS.Thisimbalancefurthersuggestthattheattacksonmyresearchhavenothingtodowithaprincipledconcernaboutconflictsofinterest,butarepurelyamatterofnotlikingtheresults.

Thearticle,smokeout!,intheSpring2003issueofJohnsHopkinsPublicHealth ,TheMagazineoftheJohnsHopkinsBloombergSchoolofPublicHealth[112]revealsthat,Afterthreeyearsofpreparation,Samettestifiedinthelandmark1998MinnesotatobaccotrialthatsmokingcausescertaindiseaseslikelungcancerandthatSametwasworkingonthefederalgovernments$289billionlawsuitthataccusestobaccocompaniesof50yearsofdeceptive

marketing,whichistheUSDOJlawsuitdiscussedabove.Later,thearticlestatedInMarch,theFlightAttendantMedicalResearchInstitutehonoredSametwiththeDr.WilliamCahanDistinguishedProfessorAwardand$600,000over3yearstocombattobacco-relateddisease.

AccordingtoFlightAttendantMedicalResearchInstitute(FAMRI)website,theDr.WilliamCahanDistinguishedProfessorawardtoSametduring2003-2006wasmadeinrecognitionoftherecipients'ongoingworkincombatingthediseasescausedbyexposuretosecondhandtobaccosmoke[11389a].Inaddition,Samethasaprominentroleinthecurrentmulti-million


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dollarJohnsHopkinsFAMRICenterofExcellence[114].ThisCenterwasestablishedin2005andcurrentlyhas30FAMRI-fundedresearchprojectsondiseasesandmedicalconditionscausedfromexposuretotobaccosmoke,includingonebySametonReducingtheRisksofSecondhandTobaccoSmokeGlobally[115].

FAMRIisafoundationestablishedasaresultofanOctober1991ClassActionsuitfiledinMiamisDadeCountyCircuitCourtinFlorida,knownasBroinv.PhilipMorris[116].Thissuitwasfiledagainstthetobaccoindustryonbehalfofflightattendantswhosoughtdamagesfordiseasesanddeathsallegedlycausedbytheirexposuretosecondhandtobaccosmokeinairlinecabins[117].AsettlementwasreachedinOctober1997betweentheplaintiffsandfourtobaccocompanies.TheSettlementAgreementincludedtheestablishmentofanot-for-profitmedicalresearchfoundationwithfundingbythetobaccoindustryof$300million.TheFoundationwastohavenotobaccocompanyinvolvement,otherthanfunding.Thepurposeofthefoundationwastosponsorscientificresearchwithrespecttotheearlydetectionandcureofdiseasesassociatedwithcigarettesmoking[118].FAMRI,asitwasactuallyestablished,hasadistinctlydifferentmission,whichistosponsorscientificandmedicalresearchfortheearlydetection,

prevention,treatmentandcureofdiseasesandmedicalconditionscausedfromexposuretotobaccosmoke.[117].SinceFAMRIsmissionstatementassumesthatdiseaseslikelungcancerandCHDarecausedbyexposuretotobaccosmoke,thisfundingsourcemayhaveinfluencedSametsdecisionsaboutwhichepidemiologicstudieshechoosestobelieveandwhichoneshechoosestoignore,andthusshouldhavebeendisclosed.AsnotedinanAugust23,2006JAMAeditorial,inpublishedarticlesitisimportantthatreadersareawareoftheauthorsfinancialrelationshipsandpotentialconflictsofinterestsothatthesereaderscaninterpretthearticleinlightofthatinformation[119].

JonathanM.Samet,M.D.,and1992EPAReport

Onemightwonderhowomissions,distortions,andexaggerationslikethosepointedoutabovecouldoccurinadocumentasimportantasaSurgeonGeneralsReportonETS.TobetterunderstandthisphenomenaonemustrealizethatSamethasdealtwiththeETSissueinthismannerformanyyears.Inparticular,heplayedamajorroleintheepidemiologicanalysisfortheDecember1992reportonETSentitledRespiratoryHealthEffectsofPassiveSmoking:LungCancerandOtherDisorders:TheReportoftheUnitedStatesEnvironmentalProtection

Agency[120].ThisEPAreportclassifiedETSasaGroupAhumancarcinogen,whichcausesabout3,000lungcancerdeathsperyearintheU.S.ThefindingsfromthisreportwereusedintheBroinv.PhilipMorrislitigationdescribedabove.TheepidemiologicmethodologyandconclusionsoftheEPAreporthavebeenseverelycriticized.Oneoftheharshestcritiquesisthe92-pageDecisionissuedbyFederalJudgeWilliamL.OsteenonJuly17,1998,whichoverturnedthereportintheU.S.DistrictCourt[121].Forinstance,inhisconclusionJudgeOsteenwrote:InconductingtheAssessment,EPAdeemeditbiologicallyplausiblethatETSwasacarcinogen.EPA'stheorywaspremisedonthesimilaritiesbetweenMS[mainstreamsmoke],SS[sidestreamsmoke],andETS.Inotherchapters,theAgencyusedMSandETSdissimilaritiestojustifymethodology.Recognizingproblems,EPAattemptedtoconfirmthetheorywithepidemiologicstudies.Afterchoosingaportionofthe


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studies,EPAdidnotfindastatisticallysignificantassociation.EPAthenclaimedthebioplausibilitytheory,renominatedtheapriorihypothesis,justifiedamorelenientmethodology.Withanewmethodology,EPAdemonstratedfromthe88selectedstudiesaverylowrelativeriskforlungcancerbasedonETSexposure.Basedonitsoriginaltheoryandtheweakevidenceofassociation,EPAconcludedtheevidenceshowedacausalrelationshipbetweencancerand

ETS.Theadministrativerecordcontainsglaringdeficiencies....InordertomorefullyunderstandtheEPAreportanditsinherentflaws,onemustreadthecompleteOsteendecision[121],aswellasthebooksPassiveSmoke:TheEPAsBetrayalofScienceandPolicybyDrs.GioB.GoriandJohnC.Luik[122],AshestoAshes:AmericasHundred-YearCigaretteWar,thePublicHealth,andtheUnabashedTriumphofPhilipMorris byRichardKluger[123],ForYourOwnGood:TheAnti-SmokingCrusadeandtheTyrannyofPublicHealthbyJacobSullum[124],andtheBrillsContentmagazinearticleWarning:SecondhandSmokeMayNOTKillYoubyNicholasVarchaver[125].Finally,onemustreadtheJanuary28,1993InvestorsBusinessDaily articleIsEPABlowingItsOwnSmoke?HowMuchScienceIsBehindItsTobaccoFinding?byMichaelFumento,whostimulatedmyown

interestintheETSissue[126].

2006CongressofEpidemiologyandTrofimDenisovichLysenkoAnalogy

Inordertoexplainthephenomenonthathasmadethisdefenseofmyepidemiologicresearchnecessary,GeoffreyKabat,SheldonUngar,andIpresentedasymposiumentitledReassessmentoftheLong-termMortalityRisksofActiveandPassiveSmokingatthe2ndNorthAmericanCongressofEpidemiologyinSeattle,WashingtononJune24,2006[127].Wedescribedmajormisrepresentationsthatarecurrentlyoccurringwithregardtotheepidemiologyofbothactiveandpassivesmoking,aswellasthesilencingofscienceassociatedwiththisareaofepidemiology.Ipresentedtherationaleforthesymposiumbasedonthefactthatimportantepidemiologicfindingshavebeenignoredormischaracterizedinpriorassessments.ThenIpresentedevidencethattheadverseeffectsofactivesmokingonmortalityarelessreversiblebycessationthangenerallybelieved,basedonrandomizedcontrolledtrialsinvolvingsmokingcessationandnaturalexperimentsinvolvingtheCACPSIcohortandseveralothercohorts[31,128,129].Kabatpresentedevidencethattherelationshipbetweenpassivesmokingandmortalityisweakerthangenerallybelieved,particularlywithintheUnitedStates,basedonourtworecentETSpapers[1,39].UngardescribedthesilencingofsciencephenomenonwithregardtoourMay17,2003BMJpaperthathedocumentedanddescribedinhis2005paper[27].Inthissymposiumweaddressedseveralimportantissues:1)theimplicationsofourreassessmentfortherelativedangersofactiveandpassivesmoking;2)thewayinwhichideologicalandpoliticalagendashaveinfluencedtheinterpretationofepidemiologicevidence;and3)theimportanceofseparatingnon-scientificagendasfromobjectiveassessmentofevidence.Wemadethecasethat:1)allepidemiologicfindingsmustbeevaluatedinafairandconsistentmannerinordertoobtainanaccurateassessmentofthemortalityrisksofactiveandpassivesmoking;2)epidemiologicfindingsmustbejudgedontheirmeritsandnotonextraneousfactors;and3)additionalepidemiologicresearchinthisareaneedstobeconductedfreeof


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partisanship.OurcompletepresentationsareavailableontheScientificIntegrityInstitutewebsite[130],andtheyincludeourPowerPointslidesandtheaudiofilesforourlectures.ItisquiteinformativetocompareourSymposiumwiththeJune23,2006lectureUsingEpidemiologicEvidencetoAdvanceHealth:DealingwithCriticsandCriticismsgivenby

SametatthesameCongressofEpidemiology[131].Sametdiscussedtheuseofepidemiologicevidenceinpublichealthpolicymakingwithregardtotheenvironmentalepidemiologyissuesinwhichhehasbeeninvolved.Inparticular,hediscussedtheepidemiologicevidenceontherelationshipbetweenpassivesmokingandlungcancerjustfourdaysbeforetheJune27,2006releaseoftheSurgeonGeneralsReportoninvoluntarysmokingforwhichhewasSeniorScientificEditor[79].Hetalkedaboutthecriticismofweakepidemiologicrelationships,suchasthosedescribedinmajordocumentslikethe2006SurgeonGeneralsReport.Buthefailedtomentionthatmuchofthiscriticismisduetothefactthathehasattemptedtoturnweakandinconsistentobservationalepidemiologicevidenceintoanundisputedcausalrelationship.Hetalkedabouthowcriticsraiseepidemiologicissueslikeconfoundingandbias,buthefailedtoacknowledgehisownbiasedpresentationoftheevidence,includingomittingmyBMJpaper

fromthereportandfailingtoacknowledgethattheU.S.evidenceisweakerthantheevidenceoutsideoftheU.S.

Also,itisquitetellinghowSametdismissedcriticsofthecausalrelationshipbetweenpassivesmokingandlungcancerbyclassifyingthemasstakeholderslinkedwiththetobaccoindustry.Heimpliedthatitisnotnecessarytoaddressthemeritsoftheircriticismssimplybecausetheyarestakeholdersindecisionsrelatedtopassivesmoking.However,hefailedtodisclosehisownfinancialintereststhatsurelyputhiminthestakeholdercategory.HecertainlynevermentionsthathisFAMRImoneyoriginatesfromthetobaccoindustry,makingitremarkablysimilartomyCIARfunding.Samet'slectureprovidesinsightintohisthoughtprocessesandthewaysinwhichhemanipulatesevidencetofithisvisionofanepidemiologicrelationshipwithpublicpolicyimplications.Thetranscriptofakeyportionofhislectureis

available[132],asistheaudiofile[133].WeconcludedourSymposiumbydrawingananalogybetweenthecurrentsituationinvolvingETSepidemiologyintheUnitedStatesandthehistoricalsituationinvolvingagronomistTrofimDenisovichLysenkoandplantgeneticsintheSovietUnionduringtheperiodof1927-1962[2].WhileitiscommontoinvokeGeorgeOrwellorJosephMcCarthyindiscussionslikethis,IbelievethelessonsfromtheadmittedlymoreextremeLysenkocasearemoreanalogousandinformative.AlthoughETSepidemiologicevidencehasneverbeenconclusive,severalmajorreportshavebeenissuedwithdefinitiveconclusionsaboutacausalrelationshipbetweenETSandmortality.AllmajorU.S.governmentandprivatehealthagencieshavedeclaredthatacausalrelationshipexistsandtheseorganizationshavecreatedaregimeoftruththatcannotbe

intelligiblyquestioned.Theseorganizationsthenuseanymeansnecessarytoenforcethisregimeoftruth.SincethepublicationoftheinfluentialnullfindingsinmyBMJpaper,whichcontradicttheregimeoftruth,Ihavebeensubjectedtoamassiveadhominemattack,mycareerhasbeenthreatened,andmypaperhasbeendismissedbecauseofitspoliticallyincorrectfindings.Inaddition,IwasinsertedintoamassivelawsuitbymyowngovernmentinamannerthatmakesitappearthatIhavecommittedscientificfraudandhavebeenengagedinracketeeringwiththetobaccoindustry.TherealsohasbeentheattempttoforcetheUniversity


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ofCaliforniatobanthetobaccoindustryfundingthatIhaveusedandtorestrictfutureresearchintheareasoftobacco-relateddiseasesthatIhavebeeninvestigating.LysenkousedhisinfluenceandbackingbytheSovietgovernmenttocreatea"regimeoftruth"andtostopothers'researchinordertopromotescientificallyinvalidvernalizationand

Lamarckianplantgenetics.Hewasalsosuccessfulinattackinganddestroyinghiscritics,likeNicolaiVavilov,whoespousedproperMendelianplantgenetics.BecauseLysenkoprevailedforsuchalongperiodoftime,cropyieldswerelow,Sovietagricultureregressed,andSovietcitizenssufferedgreatlyandmanyfacedstarvation.Duringthissameperiod,properplantgeneticsweredevelopedandimplementedintheU.S.andthisresultedinthegreatlyincreasedcropyieldsthathavemadeU.S.foodproductionsoincrediblysuccessful.TheentiresagaofLysenkopseudosciencehasbeenextensivelydescribedinwebsitesaboutLysenko[134],journalarticles[2,135],andbooks[136-138].ProminentU.S.epidemiologistsandactivistsarewieldinggovernmentalinfluencetodistorttheepidemiologyofbothactiveandpassivesmokingintheU.S.andarecontributingtoaLysenko-

likeresearchenvironmentwhereitisvirtuallyimpossibletoconductresearchthatproducespoliticallyincorrectfindings,suchas,thoseinmyBMJpaper.Muchadditionalresearchisneededbecausetheprimarytobacco-relateddisease,lungcancer,stillcauses160,000deathsperyearintheU.S.andwillnotgoawayanytimesoon.ThisLysenko-likeresearchenvironmentneedstoendandepidemiologistsmustbefreetoconductadditionalresearchontobacco-relateddiseaseswithavarietyoffundingsourceswithoutfearofthekindofattacksthatIhaveexperienced.

AChallengetoACSandMichaelJ.Thun,M.D.

SomeofthecontroversyabouttherelationofETSandtobacco-relatedmortalityinthelargestU.S.observationalepidemiologicstudiescouldbesettledifThunfully,fairly,andtransparentlyanalysestheCPSIandCPSIIcohortdatathattheACScurrentlypossesses.Becauseoftheirsizeandlengthofmortalityfollow-up,thesetwocohortscontainthevastmajorityofthepotentiallyavailableU.S.evidenceonETS,andarealreadythebasisforimportantU.S.evidenceonactivesmoking.GiventheepidemiologicexpertiseofThunandtheavailabilityoftheappropriateCPSIandCPSIIdata,suchananalysiscouldbeconductedinamatterofweeks.Intheinterestofbetterunderstandingcanceretiology,theACSshouldfullyanalyzetheseimportantdata.IhaveprovidedsampleTables3-7belowsothatThuncanpresentresultsthataredirectlycomparabletothosepresentedinmyBMJpaper[1].Inaddition,ThunshouldanalyzetheCPSIIcohortasanaturalexperimentofsmokingcessationandmortalitytrendsinamannersimilartowhatIhavedone.Suchananalysiswouldtestmyhypothesis,basedonanalysisoftheCACPSIandthreeotherU.S.cohorts,thatthelong-termadversemortalityeffectsofactivesmokingaremoredangerousthangenerallybelievedbecausetheyarelessreversiblebycessationthangenerallybelieved[31,128,129].TheACSowesittotheovertwomillionAmericanswhoaresubjectsintheCPSIandCPSIIcohorts,aswellastothoseAmericanswhosupporttheACS,toproduceepidemiologicfindings


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thataccuratelyandcompletelydescribethemortalityrisksofactiveandpassivesmokingintheirdata.InordertodetermineifafullanalysisofETSandmortalityintheCPSIIcohortsupportstheanalysisofETSandmortalityintheCACPSIcohortpresentedinmyBMJpaper,IsentThuna

June21,2007emailrequestthathecompleteTables5-7below.ThunrepliedwithaJune26,2007letterinwhichhegaveseveralreasonswhyhewouldnotcompleteTables5-7.HestatedInsummary,IdonotbelievethattheanalysesyourequestinCPS-IIwouldproducescientificallymeaningfulresults[139].HeindicatednowillingnesstodofurtherCPSIIanalysesofanykind,evenanalysesoftherelationshipofETStomortalityduringthepastfifteenyears.ThisisthelatestevidencesupportingtheextensivesilencingofsciencephenomenathatcurrentlyexistswithregardtoETSepidemiologyintheU.S.ToillustratetheexistingbiasinthereleaseofACSresults,itisquiteinformativetonotetheresponsebyThuntotheSeptember26,1994letterthathereceivedfromGlantz[140],regardingtheCPSIIanalysesthatLeVoisandLayardconductedin1994andpublishedin1995[40].

ThunsentGlantzadetailedNovember4,1994letterwhichincludedpreliminaryCPSIIanalysesandcriticismsanddescribedplanstodofurtherCPSIIanalyses[141].ResponsestoThunsCPSIIanalysesandcriticismswerethenmadebyLeVois[142]andLayard[143].AllofthiscorrespondenceandcommentaryreinforcesthecontinuingneedforafullandobjectiveanalysisoftheCPSIandCPSIIdatapossessedbyACS.

ConclusionItisverydisturbingthatamajorhealthorganizationliketheACShasmadefalseandmisleadingstatementsaboutmeandmyMay17,2003BMJpaperforoverfouryears.Itisfurther

disturbingthatprominentindividualslikeThun,Samet,andGlantzhavecontinuedtoattackthefindingsintheBMJpaper,eventhoughIhavepresentedextensiveevidencethatsupportsthevalidityofthesefindings.Inaddition,itisreprehensiblethattheBMJpaperwasinsertedintheUSDOJRICOlawsuitandomittedfromthe2006SurgeonGeneralsReport.Theseactionsmustbekeptinmindwhenevaluatingthehonesty,integrity,andobjectivityofthoseresponsible.Thesecriticismsmaysoundpersonallydefensive,andindeedwhenoneissopersonallyattacked,somepersonaldefenseisnecessary.ButthisisalsoadefenseagainstepidemiologybecomingLysenkopseudoscience,wherethevalidityofmethodsandstudiesisbasedmerelyonthoseresultsthatarepreferredbyinfluentialadvocatesandresearchersandcontraryresultsarediscreditedusingthetacticsofLysenko.Epidemiologicscienceisnotinherentlypseudoscience,

ofcourse,buttheprocessthathasledtomanycurrentclaimsaboutETSis.Hopefully,epidemiologycancontinueasafieldinwhichalllegitimateresearchfindingscanbepublishedandobjectivelyevaluated,includingthosefindingsconsideredtobecontroversial.However,thiswillhappenonlyifadvocacyorganizationsliketheACSandactivistslikeGlantzrefrainfromunethicallysmearinghonestscientistsandputtingoutfalseandmisleadingstatements.Inaddition,epidemiologistslikeThunmusthonestlyanalyzealltheepidemiologicevidencethattheypossessandfullyreporttheirresults,andepidemiologistslikeSametmustnot


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omitimportantandaccurateresearchfindingsfromamajordocumentsuchastheSurgeonGeneralsReport.SuchomissionsandactionshaveseriouslydistortedtheevidenceonthehealtheffectsofETSexposure,particularlywithintheUS.Hopefully,thisentireepisodewillhelppreventsimilarepisodesinthefuture.Furthermore,this

episodewillbeparticularlyvaluableifiteventuallyleadstoafullandobjectiveanalysisoftheimportantepidemiologicevidencethattheACSpossessesonbothactiveandpassivesmoking.Inthemeantime,epidemiologistsandothersinterestedinafullassessmentoftheavailableepidemiologicevidenceonthehealtheffectsofETSshouldcarefullyreadandstudythisdocumentandallthereferencesandtablesthatareincludedinit.

Acknowledgments

Myepidemiologicresearchandthisanalysishavebeenmadepossiblebecauseofthe36yearsofcontinuousandunlimitedacademicfreedomthatIhavehadattheUniversityofCalifornia,the

greatestsystemofhighereducationintheentireworld.Iamparticularlyindebtedtothespecificindividualswhohavegrantedmethisacademicfreedomandwhohaveunfailinglysupportedme.Inaddition,IwouldliketothankJosephTurneroftheAmericanLiteraryHistoricalSocietyandHaroldCallahanoftheSanFranciscoPoliceDepartmentfortheirvaluableassistance.

CompetingInterestsFundingofthispaperisthesameasthatofreference39.ThecontentofthispaperisbasedontheknowledgeIhaveacquiredduringmyentireepidemiologiccareer,duringwhichIhavehadmanyfundingsources.Mycompetinginterestsarefullydiscussedinthetextofthispaperandin

reference1andareknownworldwidethankslargelytotheeffortsofGlantz,Thun,andSamet.Mypersonalstakeinthemattersdiscussedhereshouldbeself-evident.Inordertoaddressconcernsaboutmycompetinginterests,thispaperisentirelytransparentanditscontentscanbeverifiedwiththereferencescited.

References1. EnstromJE,KabatGC.EnvironmentaltobaccosmokeandtobaccorelatedmortalityinaprospectivestudyofCaliforniansduring1960-98.BMJ2003;326:1057[http://www.scientificintegrityinstitute.org/BMJ051703.pdf]

[http://bmj.com/cgi/reprint/326/7398/1057.pdf].2. CaspariEW,MarshakRE.TheRiseandFallofLysenko.Science1965;149:275-278[http://www.scientificintegrityinstitute.org/Science071665.pdf].3. EnstromJE.ScientificIntegrityInstituteResearchDefense[http://www.scientificintegrityinstitute.org/defense.html].


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28

4. RothmanKJ.Conflictofinterest:thenewMcCarthyisminscience.JAMA1993;269:2782-2784[http://tobaccodocuments.org/pm/2048252499-2501.html][http://legacy.library.ucsf.edu/tid/sis65e00].5. EnstromJE,KabatGC.PrepublicationhistoryofEnvironmentaltobaccosmokeand

tobaccorelatedmortalityinaprospectivestudyofCaliforniansduring1960-98[http://bmj.com/cgi/content/full/326/7398/1057/DC1].6. BMJbackgroundandpolicy[http://bmj.com/aboutsite/aboutbmj.shtml][http://resources.bmj.com/bmj/about-bmj].7. GlantzSA.MEDIAALERT--StudyInaccuratelyUsesACSDatatoSuggestNoLinkBetweenSecondhandSmoke&LungCancerMay15,2003[http://www.ucsf.edu/its/listserv/stanglantz-l/0090.html]8. AmericanCancerSociety.AmericanCancerSocietyCondemnsTobaccoIndustry

StudyforInaccurateUseofDataMay15,2003embargoedpressrelease[http://www.scientificintegrityinstitute.org/ACSEPR051503.pdf][http://www.smokefreesouthdakota.org/press/03/051503.bmjstudy_acs.pdf].9. AmericanCancerSociety.AmericanCancerSocietyCondemnsTobaccoIndustryStudyforInaccurateUseofDataMay15,2003permanentpressrelease[http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Condemns_Tobacco_Industry_Study_for_Inaccurate_Use_of_Data.asp].10. RobinsonM.TiltingatTobacco.StanfordMagazineNov/Dec1996[http://www.stanfordalumni.org/news/magazine/1996/novdec/articles/tobacco.html].11. GlantzSA.PressconferenceinMiamibyformerSurgeonGeneralontobaccoindustryfundedstudyinBMJMay14,2003[http://www.ucsf.edu/its/listserv/stanglantz-l/0088.html].12. EnstromJE,KabatGC.EnvironmentaltobaccosmokeandtobaccorelatedmortalityinaprospectivestudyofCaliforniansduring1960-98(AbridgedPDF).BMJ2003;326:1057-1061[http://www.bmj.com/cgi/reprint_abr/326/7398/1057].13. UniversityofCalifornia,SanFrancisco.LegacyTobaccoDocumentsLibrary:ADigitalLibraryofTobaccoDocuments[http://legacy.library.ucsf.edu/][http://www.library.ucsf.edu/tobacco/]14. IrvineS.Tobaccodocumentstobeplacedontheweb.NatureMedicine2001;7:391.[http://www.nature.com/nm/journal/v7/n4/pdf/nm0401_391a.pdf].15. TobaccoDocumentsOnline(TDO)[http://tobaccodocuments.org/about.php]andTobacco.orgTobaccoNewsandInformation[http://www.tobacco.org/Documents/documents.html].


30/49

29

16. AllrapidresponsestoEnvironmentaltobaccosmokeandtobaccorelatedmortalityinaprospectivestudyofCaliforniansduring1960-98[http://bmj.com/cgi/eletters/326/7398/1057].17. TonksA.Passivesmoking:Summaryofrapidresponses.BMJ2003;327:505[http://bmj.com/cgi/content/full/327/7413/505].

18. ThunM.ResponsetoSimonChapman.May19,2003rapidresponsetobmj.com[http://bmj.com/cgi/eletters/326/7398/1057#32461].19. ThunM.AnAmericanCancerSocietyperspective.May20,2003rapidresponsetobmj.com[http://bmj.com/cgi/eletters/326/7398/1057#32482].20. HackshawA(for14ofthe25membersoftheIARCWorkingGrouponTobaccoSmokeandInvoluntarySmoking:BufflerP,DollR,FonthamE,GaoY-T,GuptaP,HackshawA,MatosE,SametJ,ThunM,StraifK,VineisP,WichmannH-E,WuA,ZaridzeD).Environmentaltobaccosmokeandlungcancer.May30,2003rapidresponsetobmj.com

[http://bmj.com/cgi/eletters/326/7398/1057#32784].21. GardinerPS,GruderCL,BuchtingF.Thecaseofthefootnotewaggingthearticle.August19,2003rapidresponsetobmj.com[http://bmj.com/cgi/eletters/326/7398/1057#35820].22. MestelR.StudyDownplaystheHealthRisksFromSecondhandSmoke.LosAngelesTimes,May16,2003,pageA26[http://www.scientificintegrityinstitute.org/LATimes051603.pdf][http://latimes.com].23. MatthewsR.Warning:thehealthpolicecanseriouslyaddleyourbrain.SundayTelegraph(London)May18,2003[http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2003/05/18/nsmoke18.xml].24. FumentoM.Second-handSmokeisHarmfultoScience.ScrippsHowardNewsService,Sept.11,2003[http://www.fumento.com/disease/smoking.html].25. DoveyT.AmericanCancerSocietyaDangertoScience?AmericanCouncilonScienceandHealthFactsandFears,August13,2004[http://www.acsh.org/factsfears/newsID.432/news_detail.asp].26. FitzpatrickM.Wehavewaysofmakingyoustopsmoking.SpikedHealth,November15,2004[http://www.spiked-online.com/Articles/0000000CA7A4.htm].27. UngarS,BrayD.Silencingscience:partisanshipandthecareerofapublicationdisputingthedangersofsecondhandsmoke.PublicUnderstandingScience 2005;14:5-23[http://www.scientificintegrityinstitute.org/PUS2005.pdf][http://pus.sagepub.com/cgi/reprint/14/1/5].28. EnstromJ,AkaviaG,CoombesR,DorfanD,FrybergerD,PiccioniR,PoratD,RaymondD,RileyK,RothenbergA,SaalH,SchwartzM,andWojcickiS. MeasurementoftheTwo-


31/49

30

PhotonDecayoftheKL0Meson.PhysRev1971;D4(9):26292637

[http://www.scientificintegrityinstitute.org/PR1971.pdf][http://prola.aps.org/pdf/PRD/v4/i9/p2629_1][http://www.slac.stanford.edu/cgi-wrap/getdoc/slac-r-125.pdf].

29. EnstromJE,KabatGC.Passivesmoke:Authorsreply.BMJ2003;327:504-505[http://www.scientificintegrityinstitute.org/BMJ083003.pdf][http://bmj.com/cgi/content/full/327/7413/504].30. EnstromJE,KabatGC.TheLancetscalltobansmokingintheUK.Lancet2004;363:398-399[http://www.scientificintegrityinstitute.org/Lancet013104.pdf][http://www.thelancet.com/journals/lancet/article/PIIS0140673604154469/fulltext].31. EnstromJE,HeathCW,Jr.Smokingcessationandmortalitytrendsamong118,000Californians,1960-1997.Epidemiology1999;10:500-512[http://www.scientificintegrityinstitute.org/EPID1999.pdf]

[http://tobaccodocuments.org/pm/2505585981-5993.html][http://legacy.library.ucsf.edu/tid/tbf19c00].32. ThunM,HenleyJ,ApicellaL.EpidemiologicstudiesoffatalandnonfatalcardiovasculardiseaseandETSexposurefromspousalsmoking.EnvironmentalHealthPerspectives 1999;107(suppl6):841-846[http://ehp.niehs.nih.gov/members/1999/suppl-6/841-846thun/thun-full.html].33. EnstromJE,KabatGC.UpdatedMeta-AnalysisonETSandCHDMortalityintheUS.January24,2006BMJrapidresponse[http://bmj.bmjjournals.com/cgi/eletters/326/7398/1057#126722].34. EnstromJE,KabatGC.ConflictingResultsonEnvironmentalTobaccoSmokefromtheAmericanCancerSociety.ManuscriptBMJ/2003/084269,submittedtoBMJonJune30,2003andrejectedonSeptember19,2003[http://www.scientificintegrityinstitute.org/BMJ084269.pdf].35. Toptensfrombmj.comin2003[http://bmj.com/cgi/content/full/328/7435/DC1?eaf].36. SmithR.Fromherotopariahinoneeasyjump.May18,2003BMJrapidresponse[http://bmj.com/cgi/eletters/326/7398/1057#32390].37. SmithR.Passivesmoking:Commentfromtheeditor.BMJ2003;327:505[http://bmj.com/cgi/content/full/327/7413/505-a].38. SmithR.TheTroublewithMedicalJournals .London:RoyalSocietyofMedicinePress,2006,page32.[http://www.lse.co.uk/ShowStory.asp?story=RO1929177J][http://www.amazon.com/Trouble-Medical-Journals-Richard-Smith/dp/1853156736].


32/49

31

39. EnstromJE,KabatGC.EnvironmentaltobaccosmokeandcoronaryheartdiseasemortalityintheUnitedStatesameta-analysisandcritique.InhalationToxicology 2006;18:199-210[http://www.scientificintegrityinstitute.org/IT030106.pdf][http://www.journalsonline.tandf.co.uk/link.asp?id=tu644n1t32650134].

40. LeVoisME,LayardMW.Publicationbiasintheenvironmentaltobaccosmoke/coronaryheartdiseaseepidemiologicliterature.RegulatToxicolPharmacol 1995;21:184-191[http://www.scientificintegrityinstitute.org/RTP1995.pdf][http://tobaccodocuments.org/pm/2057837379-7386.html][http://legacy.library.ucsf.edu/tid/yhy87e00][http://legacy.library.ucsf.edu/tid/sin01d00][http://legacy.library.ucsf.edu/tid/gwm50c00].41. CardenasVM.EnvironmentaltobaccosmokeandlungcancermortalityintheAmericanCancerSocietysCancerPreventionStudyII.Doctoraldissertation,EmoryUniversity,Atlanta,GA,1995.[http://www.scientificintegrityinstitute.org/Cardenas1995.pdf][http://tobaccodocuments.org/pm/2063620519-0720.html]

[http://legacy.library.ucsf.edu/tid/sqg22d00][http://il.proquest.com/products_umi/dissertations].42. ThunMJ.Passivesmoking:Tobaccoindustrypublishesdisinformation.BMJ2003;327:502[http://bmj.com/cgi/content/full/327/7413/502-c].43. PopeCAIII,ThunMJ,NamboodiriMM,DockeryDW,EvansJS,SpeizerFE,HeathCW,Jr.ParticulateairpollutionasapredictorofmortalityinaprospectivestudyofU.S.adults.AmJRespirCritCareMed1995;151:669-674.[http://ajrccm.atsjournals.org/cgi/content/abstract/151/3/669].44. KaiserJ.Showdownovercleanairscience.Science1997;277:466-9[http://www.sciencemag.org/cgi/content/full/277/5325/466].45. KrewskiD,BurnettRT,GoldbergMS,HooverK,SiemiatyckiJ,AbrahamowiczM,WhiteWH,others.ReanalysisoftheHarvardSixCitiesStudyandtheAmericanCancerSocietyStudyofParticulateAirPollutionandMortality:SpecialReport.Cambridge,MA:HealthEffectsInstitute,2000[http://www.healtheffects.org].46. KrewskiD,BurnettRT,GoldbergMS,HooverK,SiemiatyckiJ,AbrahamowiczM,WhiteWH,others.ReanalysisoftheHarvardSixCitiesS

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