Thursday, January 23, 2014

BMJ Editorial: Holding the Line For Ignorance

The British Medical Journal grossly erred in its January 2 commentary, “Hold the Line Against Tobacco” (here), by editor Dr. Fiona Godlee.
BMJ asserts that e-cigarettes pose a “grave risk to public health because of their potential to renormalise and glamourise smoking.”  As Clive Bates pointed out in a scathing critical comment (here), “It requires heroic contortions of logic to regard the emergence of a product that is perhaps 99-100% less risky than cigarettes and a viable alternative to smoking as an adverse development… [The e-cigarette] should really be seen as a disruptive intrusion into the cigarette industry: a new high technology product entering the market for the popular legal recreational drug, nicotine, and posing a threat to the dominant and most harmful delivery system, the cigarette… Your editorial follows the established pattern of prohibitionist public health activists of focusing on minor or implausible risks for which no evidence exists in reality, while ignoring or diminishing the huge potential benefits that are real and visible from adopting e-cigarettes.”

Dr. Godlee’s commentary veers dramatically from the norms of science journal precision, as seen in this extraordinary claim: Moves by New York City Mayor Bloomberg’s administration “against tobacco, trans fats, and sugary drinks, and for promoting physical activity and calorie counts on menus, are credited with improving life expectancy among New Yorkers—now two years higher than the US national average.”

Nothing in the city’s formal report on life expectancy (here) even remotely supports this claim.  The report mentions anti-smoking policies, but offers no proof that they account for differences in mortality from heart diseases and cancer between New York and the U.S. as a whole.  Mr. Bates is right to call for “a BMJ special edition setting out the evidence for the effectiveness of these measures in improving life expectancy in New York.” 

The dominant theme of the BMJ editorial is revulsion of the tobacco industry: “E-cigarettes also legitimise the industry, buying tobacco companies a seat as ‘partners’ at the health policy table,” a position Dr. Godlee rejects.

The reality is that in the U.S., regulation of the tobacco industry has de facto legitimized it and guaranteed companies a seat at the health policy table.  Indeed, FDA officials are compelled to consider industry research and analysis, and if the FDA fails to do so it is subject to repercussions. 

Appropos of this, it is sadly worth noting that the FDA has also lapsed in its adherence to rigorous scientific principles.  Its recently released preliminary report on menthol (here), which I have commented on (here), is a case in point.  Lorillard last November submitted these scathing comments to the FDA public docket (here):

“Unfortunately, FDA’s review of the available scientific information on menthol cigarettes falls far short of FDA’s own established standards of scientific integrity and cannot be used to draw valid conclusions, nor can it serve as the basis for regulatory action.  FDA’s analysis suffers from many significant flaws and its conclusions are at times based upon unsupported speculation and conjecture. Many of the studies relied upon by FDA fail to meet the appropriate standard of scientific evidence, yet numerous high-quality studies are improperly and inexplicably discounted or entirely omitted.”  The 134-page submission backs the company’s claims with robust evidence. 

Rigorous standards imposed by regulation should apply equally to all parties, including regulators themselves.  Such standards may be especially uncomfortable for tobacco prohibitionists, who are prone to gross abuse of the facts.

1 comment:

Anonymous said...

Over the period 1990–2010, the increase in life expectancy for males in New York City was 6.0 years greater than for males in the United States. The female relative gain was 3.9 years. Male relative gains were larger because of extremely rapid reductions in mortality from HIV/AIDS and homicide, declines that reflect effective municipal policies and programs. Declines in drug- and alcohol-related deaths also played a significant role in New York City's advance, but every major cause of death contributed to its relative improvement. By 2010, New York City had a life expectancy that was 1.9 years greater than that of the US. This difference is attributable to the high representation of immigrants in New York's population. Immigrants to New York City, and to the United States, have life expectancies that are among the highest in the world. The fact that 38 percent of New York's population consists of immigrants, compared to only 14 percent in the United States, accounts for New York's exceptional standing in life expectancy in 2010. In fact, US-born New Yorkers have a life expectancy below that of the United States itself.