BMJ, doi: 10.1136/bmjusa.03070003, (Published 30 July 2003)

As of June 15, 2003, this controversial study had generated 130 Rapid Responses, which can be read in their entirety at http://bmj.com/cgi/eletters/326/7398/1057. The responses addressed a variety of issues, although most focused on the propriety of publishing research supported by the tobacco industry, on the authors' ties to that industry, and on methodologic aspects of the study (in particular, the methods used to define exposure, discussed in the editorial on page 352). Space does not permit a fair and balanced sampling of the extensive colloquy contained in the Rapid Responses, but the following edited excerpts capture some of the intensity:

Letter

RAPID RESPONSES FROM BMJ.COM

From BMJ USA 2003;July:373

Editor — The study compares 8-10 hours of exposure to environmental tobacco smoke among spouses of "never" smokers with 12 hours of exposure among spouses of "ever" smokers.

University College London, London, UK. j.vaidya{at}ucl.ac.uk

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Editor — All this study proves is that secondhand smoke exposure in the home is no worse than secondhand smoke exposure anywhere else.

Vancouver, British Columbia. serakirk{at}hotmail.com

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Editor — I think it's fair to say that housewives tended to stay at home. The female working population tended to be young and single. Other than occasional trips to the grocery store and the occasional night out, where would other exposures have come from?

austinj{at}access.net

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Editor — I note in the data an apparent trend in the direction of reduced risk of female deaths from coronary heart disease with increasing spousal cigarette consumption.... It seems highly implausible that one should see a trend of diminishing risk with apparent increasing exposure.... In the absence of an explanation, it remains most likely that the statistics are wrong.

Northumberland, Tyne & Wear, Strategic Health Authority, Newcastle upon Tyne, UK. eugene.milne{at}ntwha.nhs.uk

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Editor — "The editors believe that this opinion piece is full of speculative assumptions of doubtful scientific value. We could not judge the merit of your criticisms because your own data and methods were so inadequately described." The letter was written in 1996 by the Deputy Editor of JAMA in response to an earlier submission by Enstrom of his tobacco-industry sponsored study.

OxyGenèe, Geneva, Switzerland. diethelm{at}oxygeneve.ch

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Editor — Evidence-based medicine is a wonderful thing. It seems as though one takes the evidence one likes and uses it, and ignores the rest.

Shelton Hospital, Shrewsbury, UK. smn{at}clara.co.uk

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Editor — Scientific research ought not to be judged upon the consistency of the findings with our preconceived notions of what "ought to be"... The BMJ should take solace that it is only being bashed verbally. Galileo paid a greater price for promulgation of his research that challenged the worldview of the catholic majority.

University of Massachusetts, Dartmouth, Massachusetts. lnason{at}umassd.edu

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Editor — The tobacco industry will get substantial mileage from this flawed article. The industry will no doubt widely publicize the study and, in doing so, confuse the public and legislatures regarding the risks associated with environmental tobacco smoke.

University of California, San Francisco, San Francisco. mmartinmd{at}earthlink.net

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Editor — Developing countries are struggling to introduce tobacco control measures, often in the face of considerable opposition. It is unfortunate that the take-home message from this article may be that such measures are probably unnecessary.

Asian Consultancy on Tobacco Control, Hong Kong, China. jmackay{at}pacific.net.hk

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Editor — Only a retraction could stem some of the damages to public health goals that have already been inflicted by this paper.

bero{at}medicine.ucsf.edu

University of California, San Francisco, San Francisco, CA

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Editor — Although highly entertaining to witness, the righteous indignation displayed here and in the American media from anti-tobacco activists is disingenuous at best.... As the hue and cry from those with a financial stake in the debate increases, so too does my certainty that Enstrom and Kabat have struck a nerve too long left dormant.

Duluth, Minnesota. unklscrufy{at}chartermi.net

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Editor — Are the 310 words written under "funding" and "competing interests" a BMJ record?

University College Worcester, Worcester, UK

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Editor — I would try to dissuade anybody from accepting tobacco company money. Isn't it thus hypocritical to publish research funded by the industry? To my mind it isn't. I'm setting the ethic that all science should be published above the ethic that you shouldn't take money from the tobacco industry. Once the research has been done it should be published, and if it passes our peer review process it can be published in the BMJ.

rsmith{at}bmj.com

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Editor — In studies sponsored by the pharmaceutical industry, [medical journals] mostly allow conflicts, provided they are reported accurately. We deplore them in tobacco-sponsored research. One might argue that these sources of funding are qualitatively different: The first does not set out to sell a product knowing that it kills, while the second surely does. But there are many examples of how both tobacco and pharma have tried to undermine the independence and rigor of research, deliberately bias policymakers, gouge huge profits, and so on. Could this paper provide a useful opportunity for us all to clarify what is an acceptable conflict?

richard.horton{at}lancet.com

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Editor — The question facing us is whether the authors changed their results or methodology because of the source of their funds. No one in the responses you have published has suggested that they did.

Sherman, Connecticut. GNSirkin{at}aol.com

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Editor — An assessment of 106 review articles on passive smoking found that 37% concluded that passive smoking was not harmful to health, 74% of which were written by authors with industry links. In multiple logistic regression analyses the only factor associated with concluding that passive smoking was not harmful was affiliations with the tobacco industry.

Action on Smoking and Health, London, UK. deborah.arnott{at}ash.org.uk

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Editor — When a funding source has such a nefarious history, and has demonstrably used science for its own political and business goals, I believe the BMJ must formally adopt strict rules governing the examination of that source's submissions, authors, and provenance—a due diligence that goes as far beyond the usual as the industry's historic depredations have gone.

Tobacco.org. gborio{at}mindspring.com

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Editor — More than a quarter of a billion dollars has been invested in anti-tobacco research through the Robert Wood Johnson Foundation, a daughter company of Johnson & Johnson, which sells nicotine replacement therapy products that compete with the tobacco industry in the nicotine market.... All of these studies were accepted by the anti-tobacco industry as being real. Nobody complained about competing interests.

Forces International, Netherlands wiel{at}forces-nl.org

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Editor — The cogency of an argument should not depend on who makes it.

Encino, California. kshonbo{at}hotmail.com

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Editor — The hostility displayed here shows why researchers feel pressured to design and carry out only smoking-related research likely to give results supporting anti-smoking efforts.

Cantiloper{at}aol.com

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