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SUPPLEMENTAL: Survey: should the editor resign? [Full text]

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If the Editor resigns, BAT wins and we lose.

Brendon Smith   (4 May 2001)

Live to fight another day

David Yates   (4 May 2001)

moral force needed at university

Norbert Hirschhorn   (4 May 2001)

Ends and means

Edwin Kirk   (4 May 2001)

No negotiation, no dialogue, no middle way.

Ian Wacogne   (4 May 2001)

Selling opinion

Graham Byrnes   (4 May 2001)

Just threaten to resign

Jayant Vaidya   (4 May 2001)

It's Tainted Money

Harley Stanton   (4 May 2001)

A step too far - In support of Richard Smith

Pamela A Hunter   (4 May 2001)

Classic No brainer

Victoria Williams   (4 May 2001)

Keeping things in perspective.

Ellen Goudsmit   (4 May 2001)

Stay there!

Trevor Kerr   (4 May 2001)

Powerful statement

David Wilkinson   (4 May 2001)

VICE chancellor

Bob Bury   (4 May 2001)

Returning the money is more powerful than resigning

V D Ramanathan   (4 May 2001)

Don't take further and don't give it back

Christopher Leung   (4 May 2001)

Proposal for analysis

V Vlassov   (4 May 2001)

Principles may cost

Martin Toal   (4 May 2001)

Tobacco companies should be isolated

Thomas Pfluger   (4 May 2001)

Any research money is good

Philip R Belcher   (4 May 2001)

Drug and tobacco money not fit for humanitarian projects

Syed Fayyaz Hussain   (4 May 2001)

Survey: should the editor resign

David W Evans   (4 May 2001)

Credit us with some intelligence

William Burrows   (4 May 2001)

The cost of accepting this money is too high

Mary E Black   (4 May 2001)

What was wrong with Uganda?

Frank Bloomfield   (4 May 2001)

Do You Really Want Us to Decide?

Jay Harlan Shores   (4 May 2001)

A Clash of Philosophies

William L Brown   (4 May 2001)

credibility

Carl Thomson   (4 May 2001)

To re- or not to resign

A Mark Clarfield   (5 May 2001)

You can't campaign without a clean conscience

Martyn Williams   (5 May 2001)

Case is Clear

Adam Goldstein   (5 May 2001)

Nottingham's Centre FOR Corporate Irresponsibility

Rick Bernardo   (5 May 2001)

Credibility to Tobacco Companies

A K C Peiris   (5 May 2001)

The Ethics of the CRC

Robert Dingwall   (5 May 2001)

Beyond the Absurd

Ann Maxwell Eward   (5 May 2001)

Matter of own conscience and ethics

Thomas Houston   (5 May 2001)

You Decide

Ana-Maria Valero   (5 May 2001)

Don't help the tobacco industry!

Olivier Irion   (5 May 2001)

Blood money

Fernand Turcotte   (5 May 2001)

Courage to stand behind beliefs

Megan Gutelius   (5 May 2001)

Tainted Money?

W L Hamilton   (5 May 2001)

Trusted to teach ethics?

Peter Ewing   (5 May 2001)

make good use of the money!

Roberto Fiszman   (5 May 2001)

no clean hands

Jeanne Wiley   (5 May 2001)

It is an ethical issue

Padraig Quinn   (5 May 2001)

BAT's Victory

Imran Aziz   (5 May 2001)

California debate

Frederic W Grannis   (5 May 2001)

Going Too Far

Charles Phelps   (5 May 2001)

Tobacco - a global issue

Mary Lyons   (5 May 2001)

Yes and No!

Chris Pearson   (5 May 2001)

Lead the way, Richard

Peter Tallentire   (5 May 2001)

The blood dimmed tide of anarchy is let loose upon the world

John Hopkins   (5 May 2001)

Lose the money but not the brains

Greta Ross   (5 May 2001)

Money for NRT

J H Yeoh, A Lim   (6 May 2001)

The righteousness and truthfulness of it all

Rakesh Bhargava   (6 May 2001)

Campbell duped by Big Tobacco

Maria Ellul   (6 May 2001)

We Medics Must Shun The Tobacco Industry

Iona Collins   (6 May 2001)

Magical money?

Dennis P Quinn   (6 May 2001)

Why this "polarisation?

B P van Leeuwen   (6 May 2001)

Having your cake and eating it too

Sheri Stoll   (6 May 2001)

Casual, not causal.

Gareth Lloyd   (6 May 2001)

Resignation is not victory for his cause

Shabeer Hussain   (6 May 2001)

Fighting Fund?

Peter Selley   (6 May 2001)

More harm than benefit for the University

Tim Doran   (6 May 2001)

Timing is everything!

Hazel Thornton   (7 May 2001)

Smoking should always be discouraged and demonised

Ann Dally   (7 May 2001)

Resign but why ask us?

Kwame McKenzie   (7 May 2001)

Knowing the difference

Edison Iglesias de Oliveira Vidal   (7 May 2001)

independent?

Antonio Lopez Pena   (7 May 2001)

'clean' drug trafficking

Mitzi Blennerhassett   (7 May 2001)

Resignation does not serve the greater good

Gina Brinsmead   (7 May 2001)

Every country is sponsered by BAT

Peter Birner   (7 May 2001)

nottingham and tobacco

S L Barley   (7 May 2001)

The editor of BMJ should not resign!

Val Gebski   (7 May 2001)

Causes worth quitting over

Ann Shillinglaw   (8 May 2001)

Not voting

Frank Leavitt   (8 May 2001)

A world of deceit.

Fernando Isaza   (8 May 2001)

Re: Casual, not causal.

S P Prabhu   (8 May 2001)

We all love the high moral ground

Sandy Bourne   (8 May 2001)

Nottingham return the money, and RS stand your ground

Sheelagh Noonan   (8 May 2001)

It's What you use it for

T Legg   (8 May 2001)

sombody, somewhere will pay the price

Hywel Williams   (8 May 2001)

The health establishment is corrupt!

Carol A S Thompson   (8 May 2001)

Such a low price!

Masoud Solaymani Dodaran   (8 May 2001)

Valour, integrity and hypocrisy

Ketan Dhatariya   (8 May 2001)

Stay and fight

Karen Klimowski   (8 May 2001)

Beyond BAT Sponsorship at Nottingham

John A White   (8 May 2001)

Economic fallacies and tobacco apologists

Rob Primhak   (8 May 2001)

The University badly needs this centre!

Robert Quigley   (8 May 2001)

To resign is to accept defeat

Anish Shah   (8 May 2001)

How much does a name cost?

Jack Boomer   (9 May 2001)

Mutiple misrepresentation

Lesley Fallowfield   (9 May 2001)

Tobacco U?

Ginny Lovell   (9 May 2001)

Tell tobacco thanks but no thanks

Clare Ryan   (9 May 2001)

I see in black and white

Paul Kerr   (9 May 2001)

Tobacco toffs buy submission

Cecilia Farren   (9 May 2001)

Re: Do not quit!

H Fung   (9 May 2001)

The editor should resign

B Sobolev   (9 May 2001)

Leave: Nottingham's loss, community's gain

Robert Ashwood   (9 May 2001)

Inside the tent pissing out

Peter Watson   (9 May 2001)

How would students view their benefactor?

Edward Parkes   (9 May 2001)

Stick by your principles

Mike Laurence   (9 May 2001)

No nexus

Fernando Cavalcanti   (9 May 2001)

public, private divide

Ann Naughton   (9 May 2001)

The Cancer Research Campaign: A Response

Jean King   (10 May 2001)

The position of the Cancer Research Campaign

Richard Smith   (10 May 2001)

Alice in Wonderland world

Selwyn St Leger   (10 May 2001)

PAY-BACK TIME

Edward Hanlon   (10 May 2001)

Let us take the example of the arts

Oliver Starr   (10 May 2001)

Of course you're a whore, my dear; all we're arguing about is your price!

David Sackett   (10 May 2001)

No to blood money

Christopher Carey   (10 May 2001)

Richard Smith is Right

Alma Rae   (10 May 2001)

conflict of interest

Tina Ambury   (10 May 2001)

Don't give BAT the Credibility

Vince Summers   (10 May 2001)

Crazy Logic

L Symonds   (10 May 2001)

Issues

James Curran   (10 May 2001)

Who's decision is it anyway?

Mark Waters   (11 May 2001)

More effect if editor remains at the professorship

Alexander Gatherer   (11 May 2001)

Survey: should the editor resign?

Mel Read   (11 May 2001)

Apologetics

Jessica Robbins   (11 May 2001)

why he should not resign

Janine Jurkowski   (11 May 2001)

Limits are matter of debate

Huup Dassen   (11 May 2001)

Should "money" come first?

Suthee Rattanamongkolul   (11 May 2001)

sour grapes and toffee noses

Tony Earnshaw   (11 May 2001)

The Readers Poll - an example of tabloid journalism

Peter Brindle   (12 May 2001)

Drug Cartel?

S W Liew   (12 May 2001)

Freedom, what freedom?

Ann Cheesman   (12 May 2001)

Good money, bad money, and "objectivity"

Dennis P Quinn   (12 May 2001)

Hear your conscience. Don't ask the readers

J K Anand   (12 May 2001)

Developing countries and corporate responsibility

Carol Campbell   (12 May 2001)

Medical journals have much to learn from tabloids

Richard Smith   (13 May 2001)

Pros and cons

James Austin   (13 May 2001)

"Tainted" and "untainted"

Peter Abbott   (13 May 2001)

Heroes and villains

John Hopkins   (15 May 2001)

"Objectivity" and ETS.

Edward L Sweda   (15 May 2001)

"Make the B******* sack You"

Avril Danczak   (15 May 2001)

Re: A Clash of Philosophies

Jon Krueger   (16 May 2001)

Disgusted

Delma Clifton   (16 May 2001)

suspicious agendas???

James Neil   (16 May 2001)

"Objectivity" Redux

Dennis P Quinn   (18 May 2001)

Nottingham and tobacco

Peter Davies   (18 May 2001)

Congratulations, Dr. Smith

Peter Bishop   (18 May 2001)

Should the BMJ accept Richard Smith's resignation

Anne Chang   (18 May 2001)

Re: "Objectivity" Redux

Edward L Sweda   (19 May 2001)

Re: Tents and pissing

Shah Ebrahim   (20 May 2001)

I Stand With Smith

Chris Thomas   (21 May 2001)

Are Tobacco comp[anies different from Drug Companies?

Bertrand M Bell   (22 May 2001)

Medical student view

Thirza Craze   (23 May 2001)

Drugs and tobacco

John Dowden   (27 May 2001)

Tobacco villainy

Mark Struthers   (27 May 2001)

Tobacco companies are a source of evil, whereas pharmaceutical companies are a source of good

Richard Smith   (28 May 2001)

The other side of the story

Rhona MacDonald   (30 May 2001)

Well Done

B C Rao   (31 May 2001)

BAT Funding - A paediatrician's perspective

Sue Franklin   (20 June 2001)

Response to Quinn

Simon Chapman   (7 November 2001)

ethics and tobacco

susanne stevens   (1 November 2002)

If the Editor resigns, BAT wins and we lose. 4 May 2001
Brendon Smith, Staff Specialist - Emergency Medicine Bankstown Hospital, Sydney, Australia Send response to journal: Re: If the Editor resigns, BAT wins and we lose.	If Richard Smith were to resign, it would mean that BAT wins and we lose. Such a precedent would mean that if a company wanted to get rid of an academic who was committed to goals contrary to those of its shareholder's, then they would simply donate money to the institution where they work. The Editor's position should be secure, and not vulnerable to expressed views that may be contrary to commercial interests.
Live to fight another day 4 May 2001
David Yates, Brief intervention AOD corodinator perth WA Royal Perth hospital Send response to journal: Re: Live to fight another day	I am a health professional and committed to reducing the harm and mortality associated with tobacco use. My long experience in life has taught me not to trust the vast majority of corporate or even government institutions. Their instance modes operandum is to cover up the truth particulary when it involves money and litigation. Tobacco companies need to be banned from producing cigarettes and taking money from them is encouraging them to continue existing and is also unethical. I wonder what an ethics committee at the university has to say about all this? As for Professor Richard Smith he can only be commended for a man of high moral and ethical standards. But he is only one staff member in the university and should the deal continue I believe he can make a more valuable contribution as a 'thorn in the university's side' than by resigning. However should he choose to resign i will of course respect his decision. regards david yates
moral force needed at university 4 May 2001
Norbert Hirschhorn, consultant home Send response to journal: Re: moral force needed at university	Of course Nottingham should return the money. Under present leadership, it won't. Sir Colin won't resign, and therefore a strong moral voice, the editor of the BMJ, must bear witness from within the faculty.
Ends and means 4 May 2001
Edwin Kirk, Staff specialist in medical genetics Sydney Children's Hospital Send response to journal: Re: Ends and means	Professor Campbell's argument can be summarised in five words: the end justifies the means. This excuse has a long and bloody history, and it would be nice to think that it would no longer be put forward for serious consideration in discussion of such an important issue. It seems extraordinary that Prof Campbell should feel comfortable advancing this justification of the university's actions. The money should be returned forthwith.
No negotiation, no dialogue, no middle way. 4 May 2001
Ian Wacogne, Chief Resident Royal Children's Hospital, Brisbane Send response to journal: Re: No negotiation, no dialogue, no middle way.	I've voted in favour of Nottingham returning the cash, and in favour of Dr Smith resigning. The reason for the first is just obvious. The point was well made a while back. These are not people who you should even negotiate with. No dialogue, no voluntary agreements, no middle way. The tobacco industry lies and cheats and kills and then lies and cheats about it again. The only thing that works - and boy do they fight it - is the law. The threat of a law to prevent product placement of tobacco in movies? Consequence: a rapid and pre-emptive "voluntary agreement" which seems to have been toothless. (1) This is the way they work; give them an inch, they'll take a mile. The solution: Don't give them the inch. The reason for the latter is more complex. I have to work on the assumption that Dr Smith can afford to resign - financially - and that he perhaps just wants to do so with a little more moral authority. The phrase "inside spitting out" might come up in this debate, but he clearly can't kid himself any longer that he has any true power in the University to change their position - the only valid arguament other than financial for staying. 1. Sargent JD, Tickle JJ, Beach ML, Dalton MA, Ahrens MB, Heatherton TF. Brand appearances in contemporary cinema films and contribution to global marketing of cigarettes. Lancet 2001;357:29-32.
Selling opinion 4 May 2001
Graham Byrnes, Research Fellow University of Melbourne Send response to journal: Re: Selling opinion	Ironically it was Campbell's argument against returning the BAT funds that most persuaded me to believe they should in fact be returned. The vice-chancellor's comments appear to already betray a delicate awareness of not offending a sponsor. He rehearses the number of people employed by the tobacco industry (war is also good for unemployment figures) and the contribution tobacco taxes make to the national budget (but not the costs of treating the victims of smoking). Thus the issue is not just BAT attempting to buy some respectability, but the risk they will succeed in buying some biased research findings. This might arise through the instinct for financial self-preservation, or the self selection of research staff who are willing to work for a tobacco industry sponsored centre. As for Richard Smith's resignation, I would have prefered to abstain: I believe the decision should be his alone, taking account of myriad factors I cannot be aware of. Being forced to vote, I voted no.
Just threaten to resign 4 May 2001
Jayant Vaidya, Hon Lecturer/Specialist Registrar University College London Send response to journal: Re: Just threaten to resign	Just threaten to resign- and exert influence while you are in the position
It's Tainted Money 4 May 2001
Harley Stanton, Scientist World Health Organization Send response to journal: Re: It's Tainted Money	Its tainted money. BAT have been very agressive in Asia and continue to be so. The Asian views are expressed by BAT Chief Executive in Tobacco Asia, December 2000 -February 2001. This article even somewhat paradoxically offers money to WHO. The three fold expansion of BAT products in global exports in a little over a decade is providing the funding for Nottingham. It is funding from developing world exploits. Opinions should not mean the loss of position. Freedom to express an idea on an issue such as this is not a crime.
A step too far - In support of Richard Smith 4 May 2001
Pamela A Hunter, Freelance consultant and writer Sussex Send response to journal: Re: A step too far - In support of Richard Smith	I find Richard Smith's plea for the University to refuse the money from BAT entirely persuasive, and Colin Campbell's defence quite unacceptable. Whilst realising that Universities have to market themselves and bring in funds, surely there are limits as to the source of those funds? The attempt to justify accepting the money on the grounds that the Government get large sums of tax from the sales of tobacco suggests a frightening 'Alice through the looking glass' approach. The twisted logic used also it seems by the Cancer Research Fund is in a similar category. The predictions of the effects in the next decade or so of the increased consumption of tobacco in the developing nations should surely make us all determined to try and prevent this. Giving the oxygen of publicity to BAT is not the way to do that.
Classic No brainer 4 May 2001
Victoria Williams London Send response to journal: Re: Classic No brainer	I have to confess that I am not from the science or medical fraternity, but having read of the decision of Trent to accept funds from BAT I felt compelled to vote. The acceptance of this blood money is scandalous - on par with accepting money from a totalitarian dictator with an apaling human rights record - however badly the university may need these funds how can they accept this from a company who has been responsible for the death and sugffering of so many?? - I was on the caribbean recently and BAT brands were being given away to youngsters as young as 12 and 13 by half naked women - this is not a company with morals or one which any right and conscious individual or institution should want to be associated - it is for these reasons that I encourage Richard Smith to take a stand and resign and I for one would never encourage my offspring to study at Trent. From a conscious consumer.
Keeping things in perspective. 4 May 2001
Ellen Goudsmit, writer London Send response to journal: Re: Keeping things in perspective.	This is a matter for the University, not individual members of staff. It's something to be regretted but not a resigning matter for Dr. Smith. He has done nothing wrong.
Stay there! 4 May 2001
Trevor Kerr, Medical Microbiologist Southern Health, Victoria, Australia Send response to journal: Re: Stay there!	That money is tainted. The sickness in the University requires the presence of a physician.
Powerful statement 4 May 2001
David Wilkinson, professor of rural health adelaide university, australia Send response to journal: Re: Powerful statement	The reasons why Nottingham should return the money are obvious, and are as outlined by Richard. The reason why he should resign if the university does not return the money is because this would make a hugely powerful statement.
VICE chancellor 4 May 2001
Bob Bury, consultant radiologist Leeds General Infirmary Send response to journal: Re: VICE chancellor	I was staggered by the Vice Chancellor's blinkered and complacent arguments. Richard Smith quite rightly points out that BAT's motives are unlikely to be altruistic, and that much must be clear to even the most grasping of academics. The Vice Chancellor then illustrates this point quite nicely in his own argument: BAT refused to help with an 'underfunded Ugandan hospital', but were happy to stump up for the business school. Need anyone say more?
Returning the money is more powerful than resigning 4 May 2001
V D Ramanathan, Deputy Director & Head, Department of Pathology Tuberculosis Research Centre, Chennai, India Send response to journal: Re: Returning the money is more powerful than resigning	I have voted that Nottingham University should return the money to BAT because it is a large amount and such a gesture from a reputed university will be rather telling. On the other hand, one person's resignation, however good he might be, can be brushed aside and forgotten over a period of time and it is business as usual for the tobacco companies. That is why I feel that Prof.Richard Smith should NOT resign even if his vice chancellor feels otherwise. Perhaps, if ALL the professors in the medical school attached to the University resign, that might be more effective. A gesture, especially a heroic one, is lost if it does not confer a tangible, long term benefit. As a pathologist involved in tuberculosis research, too often I have seen the end result of tobacco and M.tuberculosis. Unless, we in the medical field do something collectively, the tobacco industries are going to be the cause of avoidable misery to millions of families. V.D.Ramanthan MB,PhD (London).
Don't take further and don't give it back 4 May 2001
Christopher Leung, Senior Lecturer, HK Institute of Vocational Education Hong Kong Send response to journal: Re: Don't take further and don't give it back	I think the University should not receive further tobacco sponsorship. As for the money already received, it might be financially not practical to return it back. If all the organisations that have previously received tobacco sponsorship would need to return all the previous tobacco donations before they can change their existing sponsorship policy, there will be little chance for them to adopt a cleaner sponsorship stand. It would also be undesirable if Prof. Smith has to resign from the Editorship just because tobacco company pay money to the employer of Prof. Smith. Tobacco comapny can then easily get rid of their enemies by doing business with or sponsoring the bosses of the anti-smokers.
Proposal for analysis 4 May 2001
V Vlassov, professor of medicine Saratov Medical university Send response to journal: Re: Proposal for analysis	Sir, would you please publish the voting data calculating results for separate countries? I believe that we can see very different approches to the problem
Principles may cost 4 May 2001
Martin Toal, Pharmaceutical Physician Biogen Send response to journal: Re: Principles may cost	Richard Smith is right to demand the return of BAT's money. Tobacco companies only contibution to medicine is to supply additional cadavers for medical schools or specimens for path labs. Richard Smith should not resign if the money is not returned. He should remain to observe the usage of the funds at the university and further publicise any additional ethical compromises that occur. Martin Toal Competing interests: Non-smoker, former public health physician.
Tobacco companies should be isolated 4 May 2001
Thomas Pfluger, medical journalist Freelance Send response to journal: Re: Tobacco companies should be isolated	Even if the money from tobacco companies was to be used in an anti- smoking campaign, it would be inappropriate to accept it. Smoking should become socially unacceptable, and the only way to achieve this is through isolation of the tobacco companies. University guidelines for sponsoring - whatever they state exactly - cannot prevent that the public will continue to see tobacco firms as normal or even generous partners to research, when in fact they should be recognised as producers of dangerous and completely useless material (the same ist true for arms manufacturers, by the way). They must become "socially unacceptable", just like smoking should. It is necessary to ban smoking ads to get there, but scientists must play their part too, by not accepting to cooperate with tobacco manufacturers anymore. Or would you take funding money from a heroin dealer?
Any research money is good 4 May 2001
Philip R Belcher, Senior Lecturer in Cardiac Surgery Royal Infirmary at Glasgow Send response to journal: Re: Any research money is good	I noted the negative response to accepting the "tainted money" but wonder how many of the respondents are research active and have any concept how hard it is to scrape together money for unfashionable research? Conflict of interest can be avoided. When you sup with the Devil you should use a long spoon.
Drug and tobacco money not fit for humanitarian projects 4 May 2001
Syed Fayyaz Hussain, Head of Pulmonary Section Aga Khan University Hospital Send response to journal: Re: Drug and tobacco money not fit for humanitarian projects	Tobacco like drugs and ammunition is responsible for killing and maiming millions of people. No matter how humanitarian your project is or how ambitious your plans are " NO AMBITIONS ARE LAWFUL THAT LIVE ON CRUELTY TO MANKIND". By accepting money from sources that are directly or indirectly responsible for human misery, we are endorsing and supporting them and contributing to their cause. The worthy Professor has put the medical community in a situation which it would liked to avoid. He should have thought and consulted more extensively before such an offer. We owe it to our patients to have courage to decline and denounce offers from such sources and to warn the public about the medical risks of using their products.
Survey: should the editor resign 4 May 2001
David W Evans, Retired physician Send response to journal: Re: Survey: should the editor resign	I find Richard Smith's arguments utterly compelling and typically lucidly presented. The tainted money should be returned. The question of his resignation is more difficult. There may be a case for remaining in the hope of influencing future decisions of an ethical nature, but the all too familiar ethics-free pragmatism of the Vice-Chancellor's defence appears to rule out any such possibility in the forseeable future. There is, perhaps, a greater possibility that the resignation of so respected a figure as the editor of the BMJ may have beneficial long term influence. David Evans, Cambridge.
Credit us with some intelligence 4 May 2001
William Burrows, Vice President, Investor & Media Relations Cambridge Send response to journal: Re: Credit us with some intelligence	People will draw their own conclusions about BAT's motives for sponsoring the Centre. Assuming BAT has no control over the Centre's output, all of the ethical issues cited by Richard Smith will have a full hearing. On the other hand, to prevent BAT from donating money would immediately taint the centre with bias. Ethics are personal, and there are few "absolute" positions that cannot be challenged. Debate, rather than censorship, is the way to resolve ethical issues. Nottingham should get its money, and Richard Smith should be free to resign because of his personal ethics.
The cost of accepting this money is too high 4 May 2001
Mary E Black, UNICEF country programme Sarajevo Send response to journal: Re: The cost of accepting this money is too high	I write from a country where smoking is the major killer and most teenagers smoke, including those at university. There are valiant but limited efforts underway to try and sstop this, but in a poor country with an economy in tatters and limited resources for health promotion, this is an uphill struggle. By contributing this money, BAT is not exhibiting corporate responsibility but corporate marketting, and surely the univeristy is not thinking it can change this? Alliances between places of learning, NGOS, international agencies and the corporate sector are increasing, as are the understanding of the norms and ethics that underly such alliances. Clearly this is not a " clean" source of funding for the university. If you take money like this you make a clear statement about where you stand on ethical issues relating to tobacco and teh tobacco industry. No ammount of justification, understanding of economic necessities, lining up the rules and regulations to support your case or cleverly constructive arguments can alter that. The Univeristy of Nottingham should be aware of the impact this choice may have in other countries and on young people. They will read of this "pragmatic" decision by an admirable institution, look round their own poor facilities and think... why not?
What was wrong with Uganda? 4 May 2001
Frank Bloomfield, Post-doctoral fellow University of Toronto Send response to journal: Re: What was wrong with Uganda?	Sir Colin lets slip an interesting piece of information - the University of Nottingham was unable to persuade BAT to donate money to a poorly resourced hospital in Uganda, yet they would provide large amounts of money to fund an International Centre for the Study of Corporate Responsibility in the UK. Perhaps the Centre's first act should be to investigate BAT's corporate (and social) responsibility. Although it would be sad to see Professor Smith resign, there are too many empty threats today. If he feels that strongly about the moral position his university has taken, and cannot persuade it to change its mind, he should resign as a matter of principle.
Do You Really Want Us to Decide? 4 May 2001
Jay Harlan Shores, Associate Professor of Medical Education Univ. of North Texas Health Science Center Send response to journal: Re: Do You Really Want Us to Decide?	Dear Dr. Smith, Why have you chosen to have the readership and professorate determine if you should retain your position on the faculty? We are only privy to our own values. We only can tell you what we might do in these circumstances. Holding a plebiscite on the issue and abiding by the outcome simply insures that you will make the more popular choice. I hope that you decide to stay on the faculty. For, if you allow your concerns to be heard and your influence to be felt by your peers and administrators, you will continue to participate in the forum that is the university. We need a wide and vocal variety of contributors to our deliberations. However, I cannot vote on the issue. To do so is, within my own values system, unethical. This decision is yours and should, for your own well being, be made solely upon your appraisal of the values conflicts involved. Sincerely, Jay H. Shores, Ph.D.
A Clash of Philosophies 4 May 2001
William L Brown, Senior Researcher Lansing Community College Send response to journal: Re: A Clash of Philosophies	I do not think that the University should return the money, since tobacco is a legal product that (despite its detractors) does have positive as well as negative effects. Although I do not enjoy the smell of smoke, I do believe that, if the tobacco industry wishes to fund research and/or education, the results will far outweigh any concerns one has over the health effects of smoking. I think that the editor should resign whether or not the University keeps the money, however, since he has demonstrated a remarkable lack of tolerance and decency. As an editor of a prominent journal, he has considerable power and, I suppose, he uses that power to oppose smoking of tobacco products. One does not have to be a supporter of the tobacco industry to see that his position smacks of bias and bigotry. This does not bode well for the future of research. It would be better, in my view, if the editor were to have attended to his editing and refrained from engaging in tobacco politics. This has, in my opinion, led to politicization of his publication, which is far worse in the long run than any problem brought on by the use of tobacco.
credibility 4 May 2001
Carl Thomson, retired home Send response to journal: Re: credibility	Doctors must act as advocates for the public on political issues regarding health matters. We will be seen as hypocritical and lose credibility with the public if the profession is seen to be taking any kind of sponsorship from the tobacco industry. Period.
To re- or not to resign 5 May 2001
A Mark Clarfield, head of geriatrics Ministry of Health, Israel Send response to journal: Re: To re- or not to resign	I admire Dr. Smith for many things, among others for his principled stand on so many important issues of which this last one is just another example. Clearly, with what we know today of the effect of tobacco on health and especially of the behavior of the big weed companies, a university cannot accept such money and at the same time expect to maintain the respect of its students, faculty and the community which supports its activies. As to whether Dr Smith should resign his position at the university, I voted "no" , not because I think necessarily that he shouldn't, but for two other reasons. First, because I (and I assume most readers of the BMJ) have absolutly no idea what his activities, arrangments and duties are at the university. More important, a wrenching decision such as this is in the end best left to one's conscience. I admit to some surprise at reading that Dr. Smith will be led by what the majority of readers (or more accurately , the majority of those that will respond to this question with all of the problems of the reliablity and validity of such "sampling"). In the end, only Dr. Smith can decide what is right for him to do vis a vis his connection to this university. Asking readers what the university should do seems to me a valid question to ask us. What Dr Smith decides should be up to him and him alone . From what I know of the man, he will do the right thing. Respectfully submitted, Prof A. Mark Clarfield
You can't campaign without a clean conscience 5 May 2001
Martyn Williams, Environmental campaigner Send response to journal: Re: You can't campaign without a clean conscience	I think Richard Smith has done us all a huge favour here and shown what a great campaigner he can be. The corporate takeover of academia and science is an insidious threat to all our progress. It isn't just the re- direction of research towards profit-making, it is also the privatisation of knowledge - seen at its worst in the "patenting" of gene sequences. This can only lead to yet further separation between the "haves" and "have nots" - the "haves" already have money and political influence to give them a head start - now they'll have research too. If Nottingham won't give the money back (and lets face it they won't) Richard Smith should keep his conscience clean and resign. Untainted he could continue to argue through the BMJ for fair and open academic research.
Case is Clear 5 May 2001
Adam Goldstein, asst professor family medicine univeristy of north carolina Send response to journal: Re: Case is Clear	This case is clear. A university accepting tobacco money for a corporate ethics ceneter is obscene, unethical and destroys the credibility of the University and those who placidly stand by with support. Would the Jewish Anti-Defamation League accept money from the Klu Klux Klan? Would a victim of rape accept a $10,000 diamond gift from her rapist? Would a pilot accept a package to deliver overseas from a known terrorist? The tobacco industry has a four decade pattern of marketing to children, minorities and women, overt criminal activity, attacking science and scientists, and buying silence. Manipulation at its most extreme. To think that this question has required a vote and debate to do what is ethical is almost as bad unless it leads to higher awareness of hypocrisy. Adam Goldstein, MD
Nottingham's Centre FOR Corporate Irresponsibility 5 May 2001
Rick Bernardo, Ethics, Health and Communications Consultant Minnesota Council of Churches Send response to journal: Re: Nottingham's Centre FOR Corporate Irresponsibility	In accepting millions from British American Tobacco (BAT) for an "International Centre for Corporate Social Responsibility," Nottingham University reflects an utter lack of integrity or even a concern for that. I see no credible role for such a "Centre" grown from such patently ugly roots. Profiting from products designed to kill people for profit is good? BAT is responsible for carnage of a scale difficult for humans to imagine. Promoting that is responsible? It makes a mockery of reason, academic or civilized. Nottingham University might as well go around saying bad is now good, and good is actually bad. It's clear from Campbell's responses he has little concept of what's at stake and the kind of people he is in bed with, and has not the earliest idea what corporate responsibility entails. And contrary to some respondents, ethics is not mere personal morality: it's the system by which we make moral choices with one another. Hitler's morality became an entire public ethic, a community mindset and structure for action, a set of reasons for acceptibility, which perpetuated and became the Holocaust and more. Campbell's apology for tobacco companies--he is naive or inauthentic if he does not see that's what he offers--lack fundamental references to common, shared, community structures for making moral choices responsibly: ends versus means, integrity, character, declared values, ownership of consequences, intent, or even relevent information. I am sickened. Nottingham's posture here would embarrass even a six- year old's sense of responsibility, corporate or otherwise. Rick Bernardo Ethics, Health and Communications Consultant, and Project Organizer Spirit of Life Project, Minnesota Council of Churches, 122 West Franklin Ave., Suite 100 Minneapolis, MN 55404 RickB@SpiritofLife.org
Credibility to Tobacco Companies 5 May 2001
A K C Peiris, Registrar/Surgery National Hospital of Sri Lanka Send response to journal: Re: Credibility to Tobacco Companies	By accepting the money earned by causing sickness in people especially in the developing countries like ours, Nottingham University is giving credibility to the tobacco firms and encourages them to go on causing sickness in people.
The Ethics of the CRC 5 May 2001
Robert Dingwall, Professor of Sociology University of Nottingham Send response to journal: Re: The Ethics of the CRC	I have no great love of the idea of taking money from the tobacco industry. However, I recognise that the public purse is not going to fund all the good things that universities might possibly do and is just as likely to attach compromising strings as a private or corporate donor. I am also old-fashioned enough to think that people who enter into voluntary contracts should stick by them unless there is a mutual agreement to change them. While two wrongs do not make a right, I am deeply troubled by the ethics of the CRC in entering into an agreement with the CVCP and then denouncing it as soon as a university accepts funding on terms that the CRC has agreed to be legitimate. The CRC does not have the excuse that this is an old agreement that has become irrelevant with the passage of time, nor can the CRC claim to have been coerced into signing it. No-one has shown that the University of Nottingham has acted outside the terms of that protocol. Our Vice Chancellor would be entitled to feel that he had been mugged by the medical version of political correctness with its characteristic indifference to the relevance of other moral values. I may not be thrilled by the news of the BAT funding but I can smell humbug just as strongly as tobacco smoke here.
Beyond the Absurd 5 May 2001
Ann Maxwell Eward, Director Spectrum Health Send response to journal: Re: Beyond the Absurd	I agree with Brendon Smith's response. If Richard Smith resigns, BAT wins; we lose. To accept funding from BAT for an International Center For Corporate Responsibility is beyond the absurd.
Matter of own conscience and ethics 5 May 2001
Thomas Houston, Director, Science and Community Health Programs American Medical Association Send response to journal: Re: Matter of own conscience and ethics	While it is important that the tobacco industry money be returned, it was not because of Professor Smith that the money was taken. His resignation, if it occurs, should be a matter of his own conscience and ethics. He should not be forced out of his position because of the actions of others, no matter how ill-advised.
You Decide 5 May 2001
Ana-Maria Valero, Research Associate University of Texas at El Paso Send response to journal: Re: You Decide	I agree with Thomas Pfluger, medical journalist, that smoking should become socially unacceptable, and the only way to achieve this is through isolation of the tobacco companies. And not just tobacco companies, buth other companies/corporations who manufacture or produce "stuff" that is harmful to the human body, a few being plastics, products that contain aluminum (research indicates it might cause cancer); additives, etc. Why do we have so many people dying of cancer and other illnesses? I truly believe that if harmful products were not in existence, America would be a healthier country.
Don't help the tobacco industry! 5 May 2001
Olivier Irion, acting head of Obstetrics Geneva University Hospital Send response to journal: Re: Don't help the tobacco industry!	The money from tobacco industry should not be accepted by a university. Not only research from this university might be suspected of being biased, but tobacco industry may use results of honest research to its development. We must not help tobacco industry to kill fetuses, children and adults for money.
Blood money 5 May 2001
Fernand Turcotte, Professor of public health Medical school Send response to journal: Re: Blood money	Tobacco money is blood money and no amount of institutional rationalization will change anything to this basic fact. Universities have a duty to tell the citizenry, the immensity of the threat tobacco use is for human health. Responsible universities will not peddle the nicotine cartel's irrelevant argument about the legality of tobacco products. It's not their legality that's the problem, it's their toxicity. Responsible universities will make sure to report constantly that tobacco use is a communicable disease disseminated by the tobacco industry, of which BAT is one of the more efficient members.
Courage to stand behind beliefs 5 May 2001
Megan Gutelius, Research Specialist Carnegie Foundation for the Advancement of Teaching Send response to journal: Re: Courage to stand behind beliefs	If you believe tobacco has a negative impact on human health, then have the courage to stand up for your convictions. You will have the support and gratitude of many people you will never know, but more importantly you will also be able to live with your conscience.
Tainted Money? 5 May 2001
W L Hamilton, retired Send response to journal: Re: Tainted Money?	I've always wondered why the anti-tobacco organizations find it perfectly acceptible to get all the money they can wrest from the tobacco companies and from smokers, but they viciously attack any other entity which accepts tobacco money. This sounds to me like greed, not public service. As for tainted money buying influence, why does the BMJ (and the anti -tobacco organizations) accept so much money from the multinational pharmaceuticals? There is no question that this money has strings and influences any group which accepts it. Perhaps that's why the BMJ is in favor of the pharmaceutical companies controlling nicotine rather than the tobacco companies. Those who live in glass houses shouldn't start a rock-throwing contest.
Trusted to teach ethics? 5 May 2001
Peter Ewing, General Practitioner Crieff Health Centre Send response to journal: Re: Trusted to teach ethics?	Following the death of press magnate Robert Maxwell,it rapidly became apparent that he was a criminally dishonest man who had stolen millions of pounds from the Mirror Group pensioners. This left one university with the not inconsiderable problem of what to do with their shiny new 'Robert Maxwell Conference Centre'. However, they did have the defence that they did not know that their benefactor was a lying crook who was happy to profit by making others suffer. In view of Nottingham University's stance, can they really be trusted to teach ethics to medical students?
make good use of the money! 5 May 2001
Roberto Fiszman, m.d. university hospital rio de janeiro Send response to journal: Re: make good use of the money!	The arguments that were exposed to keep the money are cynical and very poor, but if you thing again, why not use the money to "advertise" or fund research to fight tobacco use? It is funny how people look at somebody's life and career as something that should change like this, as nothing else mattered...
no clean hands 5 May 2001
Jeanne Wiley, on leave on leave Send response to journal: Re: no clean hands	None of our hands are clean. Take the money and use it to promote good. J. Wiley
It is an ethical issue 5 May 2001
Padraig Quinn, Learning Disabilities psychiatrist Bristol Send response to journal: Re: It is an ethical issue	In Short: the editor has given a clear ethical and passionate case for return of funds. The Vice Chancellr has nowhere suggested that he has wrestled with the ethical dimension. The editor is prepared to put his money where his mouth is i.e. by resigning. By contrast the Vice Chancellor seems more happy to put other people's money where his mouth is. I do not believe the Editor should resign. He's already doing a good and fearless job. Let us not forget the Weimer Republic when another man became Chancellor in 1993. He was virtually unopposed. 100 people in the 20th century is more than Hitler, Stalin and Mao did for put together. Please stay and fight Editor. Unless the battle is already sewn up. As to the vice-chancellor. Have you ever considered early retirement yourself? P. Quinn
BAT's Victory 5 May 2001
Imran Aziz, Lecturer in Respiratory Medicine University of Hull Send response to journal: Re: BAT's Victory	In my eyes University of Nottingham was a prestigious University, editor of BMJ, editors of Thorax, recent president of the British Thoracic Society all have close association with it. Now the situation has changed, the university has sold itself to the highest bidder and even the price is too low. So when BAT decided to advertise its name, it was no surprise that they chose the University of Nottingham. On paper the money could be for anything even tobacco control, BAT simply wanted its name to be accepted as a ?philanthropist. They did not need to advertise their products as the publicity generated by the debate is enough. The tobacco lobby is quite happy to market its lethal products to the third world and it simply required some kind of respectability. The University of Nottingham has provided that respectability. I would strongly advocate to the BMA and BTS to give serious consideration to changing the editors of their journals if the editors do not do the decent thing of resigning themselves.
California debate 5 May 2001
Frederic W Grannis, Head, Section of Thoracic Surgery City of Hope National Medical Center Send response to journal: Re: California debate	Nottingham U. should return the money. If they refuse, the editor must make the difficult decision as to whether he should resign. A similar debate is now ongoing in the USA, where the editors of "Burning Issues", the newsletter of the California state Tobacco Related Disease Research Projects (TRDRP) are questioning whether researchers who have taken money from tobacco industry sources should be funded by TRDRP. http://www.ucop.edu/srphome/trdrp/ http://www.ucop.edu/srphome/trdrp/nslttr301.pdf
Going Too Far 5 May 2001
Charles Phelps, Librarian California State University, Long Beach Send response to journal: Re: Going Too Far	Normally I don't hold any admiration for universities caving in to noisy advocates of politically correct causes. But accepting money for a center for the study of corporate responsibility from a company whose raison d'etre is to get people, especially young people, addicted to a lethal drug is going way too far. It is so absurd that it is literally like something from a comedy. Sir Colin mentions that governments, including that of the UK, tax tobacco products and do meritorious things with the money thus generated. Although it is not entirely clear why he includes this in his argument, he apparently is trying to imply that tobacco companies are not all bad. It might be pointed out that tobacco companies did not impose the taxes upon themselves; they have lobbied against all proposed taxes upon them tooth and nail (at least they have here in the U.S., and I assume they have elsewhere). Much of the need for social services funded by tobacco revenue, especially medical and related services, is caused by tobacco. As for Dr. Smith resigning, I think he is far enough removed from the situation that there wouldn't be any real point in his resigning, unless (1) he could convince many other Nottingham University professors to resign along with him; or (2) he has an offer of a better job.
Tobacco - a global issue 5 May 2001
Mary Lyons, Senior Lecturer in Public Health Liverpool John Moores University Send response to journal: Re: Tobacco - a global issue	I am sure that Colin Cambell is right when he say that 'More than 100 million people around the world depend on the tobacco industry for employment.' Many of these employees are in very poor devloping countries that are dependent on the revenue from tobacco to survive. But this is no justification for supporting this harmful industry ans accepting this money. Does Colin Cmpbell seriously want to increase our overall dependence on tobacco by increasing the number of people who depend on this indutry for employment and research funding? As one of the countries that originally encouraged the tobacco industry in these countries, we in the UK have a responsibility and duty to reduce dependence on income from tobacco as this is the only way we can reduce the power of these companies. By accepting this money the University increases dependence on tobacco because the research centre and the people it employs will become dependent on the tobacco industry. To refute the acceptance of the idea that failure to suport the tobacco industry will increase unemployment and create economic hardship as an argument for accepting funding, I suggest that we look look up stream and encourage the development of other cash crops and other sources of research to replace income from tobacco and therby reducing this industry's attempts to gain more power through increasing people's dependence on this commodity at all stages in its life cycle.
Yes and No! 5 May 2001
Chris Pearson, Consultant ENT and facial plastic surgeon Gosport, UK Send response to journal: Re: Yes and No!	Yes: Richard Smith should put his money where his mouth is. Rhetoric and threats are no use to anybody, so if he feels uncomfortable about the situation, and has threatened to resign, he should do so. Now! No: Tobacco profits are a complex moral issue, but the money that has been given has been generated entirely legally. Not to accept it is prejudice. The rejection of prejudice is a paradigm which is currently at the forefront of our behaviour. Provided that the money has been given with no strings attached, it should not be returned.
Lead the way, Richard 5 May 2001
Peter Tallentire, Former director of personnel Self employed Send response to journal: Re: Lead the way, Richard	Oh dear, what Nottingham will do for money! Of course they should return it and try to make a virtue out of a cockup. And of course Richard should resign - it might encourage others at Nottingham to do so; it will certainly attract some beneficial publicity to the cause and he'll almost certainly be offered another post.
The blood dimmed tide of anarchy is let loose upon the world 5 May 2001
John Hopkins, GP Darlington Send response to journal: Re: The blood dimmed tide of anarchy is let loose upon the world	Dear Dr Smith, It can be argued that although elections are a necessary condition of liberal society, they are not a sufficient one. After all, the greatest tyrant of the last hundred years was elected on a popular vote around the time that Yeats wrote his famous poem. Freedom of thought also hinges on dissent, which is why Editors and University Professors are appointed with varying forms of tenure. Although difficulties may arise from such an arrangement, it is vastly preferable to one in which people are afraid to speak their minds. The Editor of the BMJ would get my vote anytime. If the professor of journalism at Nottingham University cannot agree with his Vice Chancellor then perhaps he should resign and publish a personal statement in the journal of which he also happens to be editor. Yours sincerely, Dr John Hopkins
Lose the money but not the brains 5 May 2001
Greta Ross, SCMO Community Health Send response to journal: Re: Lose the money but not the brains	The money is funding an institute which will be flawed from the start; if BAT want to be generous and really help reverse the damage they are causing, give the money to the medical and nursing schools. Richard Smith's loss to the University will mean BAT has succeeded in harming the development of the students in subjects such as probity, principle and courage. So, give the money back but Richard,don't go!
Money for NRT 6 May 2001
J H Yeoh, SpR Respiratory Medicine Heartlands Hospital, Birmingham, UK, A Lim Send response to journal: Re: Money for NRT	We politely suggest that the University of Nottingham could consider donating £3.8 million to smoking cessation services in Nottingham for the cost of nicotine replacement therapy. We would like to see Prof Richard Smith remaining in his post in Nottingham to continue with his current contribution against smoking.
The righteousness and truthfulness of it all 6 May 2001
Rakesh Bhargava, Professor of Orthopaedics SMS Medical College,Jaipur Send response to journal: Re: The righteousness and truthfulness of it all	Mr.Smth's argument are all absolutely tenable.What is more ,they are morally and ethically correct.From their tenor, it is also amply clear that they are from a deep sense of personal conviction and from the heart. There is little room for compromise when one is so conscientious and fastidious.Not that one should not be so.One should be, and once you are you should follow through with the logical response. That would be to resign."Live to fight another day" someone else says.That is an escapist attitude.You would keep living to fight another day on every issue of importance.What good is Smiths resignation going to do, one "swallow" as it is. I think all those who work at Nottingham University and feel likewise should resign.That would make more than a summer, a typhoon.
Campbell duped by Big Tobacco 6 May 2001
Maria Ellul, Director, Health Promotion Department Malta Send response to journal: Re: Campbell duped by Big Tobacco	If the likes of Sir Colin Campbell would have us believe that the money from BAT was accepted for a just cause he must be joking!! He is definitely missing the wood for the trees. He should be the one to resign and not Professor Smith. Please Professor Smith stay on because the war against big tobacco and its cronies is just starting and we are all going to be needed when the going gets tough. I write this after deep reflections following my attendance to last week's intergovernmental meeting in Geneva on the framework convention on tobacco control. Good luck and don't forget when the going gets tough the tough get going.
We Medics Must Shun The Tobacco Industry 6 May 2001
Iona Collins, SpR Orthopaedics Perth Royal Infirmary Send response to journal: Re: We Medics Must Shun The Tobacco Industry	As Medics, we may be the most informed people about smoking-related disease. We are regarded by the public as being responsible health professionals. We should, therefore, not confuse the public by, on the one hand, advising against smoking while on the other hand, accepting funds from the tobacco industry.
Magical money? 6 May 2001
Dennis P Quinn, Associate Professor Barry University, Miami Shores, Florida USA Send response to journal: Re: Magical money?	Those who think the University is contaminated by the money miss an important point. They seem to have a shamanistic notion of the power of money; that is, there are two types of money, “good” and “bad.” (As in good and bad magic.) In this case, the gift to the University by BAT is to support an important centre for study. But because the money comes from a source seen to be politically incorrect, the money is superstitiously seen to be “bad” and it is thought that bad jou-jou (luck) will follow its acceptance. However, cash from Big Pharmaceutical is thought always to be “good” money, the acceptance of which produces only good effects. Consider BMJ itself which is clearly influenced editorially by Big Pharmaceutical money. Anti-tobacco warriors don’t consider BMJ to be “tainted” by that money, and even support the objectivity of editor Smith who, with a straight face, quotes from Tobacco Control as if that publication were objective and scholarly.
Why this "polarisation? 6 May 2001
B P van Leeuwen, M.D. Pharm. Industry Send response to journal: Re: Why this "polarisation?	I wonder why this debate has to have an end in a verdict. Why can we not take the money, use it responsibly and remain debating? Indeed, the tobacco industry is legal, although it produces noxious products (like many others). Like we use the taxes for "good" purposes, we should put this money to better use than would the tobacco industry do itself (spend it on advertising). We should also remain vigilant that this does not lend respectability to a not so respectable comapany. I fail to see why the university should not accept money from a pornographer, by the way. A university should not take moral stances, it should offer the possibility to study, anything for that matter. In this vein we should also consider that many universities are supported (mainly) by "neutral" governements, who sell weapons to conflict areas. Furthermore, Smith should not resign. He should stay to keep up his vigilance aginst all the feared side-effects of accepting this money.
Having your cake and eating it too 6 May 2001
Sheri Stoll, Director Kent State University Send response to journal: Re: Having your cake and eating it too	You can not have your cake and eat it too. The school accepted the funding because it believed the source and purpose were acceptable. That is the administration's job. If the faculty member wants to be able to continue to do his job, then funding for his research and the daily operations of the institution must come from some where. If he believes that he is the appropriate person to become responsible for running an instituion and making financial decisions, then he is welcome to step down from his tenured-faculty position and make the difficult financial decisions.
Casual, not causal. 6 May 2001
Gareth Lloyd, Retired home Send response to journal: Re: Casual, not causal.	I am not satisfied that smoking kills. A link with cancer of the lung is cited as THE killer attribute of tobacco. It is becoming increasingly apparent that cancer anywhere in the body is more likely to have genetic or viral causes. At worst tobacco has a casual or facilitatory function in cancer deaths. Whilst I disagree with Richard Smiths uncompromising view that smoking kills I uphold his right to this opinion and it would be a sad world if he would be reqiuired to resign his academic position because he holds a strong opinion. While I may not live to see the day I am confident it will come when the currently alleged effects of tobacco will be debunked.
Resignation is not victory for his cause 6 May 2001
Shabeer Hussain, Professor of Medicine Jinnah Postgraduate Medical center, Karachi, Pakistan. Send response to journal: Re: Resignation is not victory for his cause	The University must return this money which the Tobacco company is giving to gain favour of medical community and the highly educated class. The resignation is not the answer as by going away he will not be there to point out any further effort by the tobaco companies to gain further support.His leaving the institution will be a sign of defeat and not victory for his cause. He must fight on till victory. All of us must give whatever support we can in this case and force the university with public support to over turn this descision. S. Shabeer Hussain Professor of Medicine JPMC, Karachi, Pakistan
Fighting Fund? 6 May 2001
Peter Selley, General Practitioner Bow, Devon Send response to journal: Re: Fighting Fund?	The BMJ has a circulation of several hundred thousand (1) and about seventy thousand web site visitors each week (2). 80% of voters in this poll are in favour of Nottingham University returning its funding to BAT. Should this not happen, may I suggest that the BMJ establishes a Fighting Fund – where supporters of this view could donate say 10 pounds (14 US dollars) by credit card over the internet to enable Dr Smith, should he so wish, to be continue as a professor in a different university. 1) http://www.bmj.com/aboutsite/index.shtml#1 2) http://www.bmjpg.com/template.cfm?name=ed_profile
More harm than benefit for the University 6 May 2001
Tim Doran, Lecturer University of Liverpool Send response to journal: Re: More harm than benefit for the University	The vice-chancellor appears to be reciting the tobacco industry's own mantra for justifying their activities- "we may kill millions, but we provide jobs." BAT are painted as charitable crusaders, single-handedly maintaining social security via tax revenues. The contention that smoking is purely about individual choice without external harms is also embarrassingly naive. I suspect that far from enhancing Nottingham's future reputation, this episode will identify the University as an institution whose social conscience can be bought for £3.8 million. This is a great shame for its staff and students, who have worked so hard to build a reputation for academic excellence. The debate between resigning on principal and fighting from within will continue with strong arguments on either side. My own feeling is that, having argued the case, the editor should step down. However, this is a personal decision, and probably shouldn't be decided on the results of an internet poll.
Timing is everything! 7 May 2001
Hazel Thornton, Independent Advocate for Quality in Research and Healthcare "Saionara", Rowhedge, Colchester. Send response to journal: Re: Timing is everything!	Richard Smith`s position in his University becomes untenable only after he has made every effort from within to fight the unethical situation he has identified. The time for a decision is when the feedback from his exposure of the issue has brought resolution one way or the other. Then, only he can decide what to do. Would that more individuals would follow Richard Smith`s example of speaking out to expose unacceptable situations and seeking viewpoints in order both to aid personal decision-making and ensure healthy functioning of institutions or organisations within our Society! Maintenance of high moral and ethical standards is not achieved by apathy and inaction.
Smoking should always be discouraged and demonised 7 May 2001
Ann Dally, Honorary Senior Research Fellow, University College, London Wellcome Trust Unit for the Hisrory of Medicine at UCL Send response to journal: Re: Smoking should always be discouraged and demonised	Anything that encourages smoking or enhances its respectability should be discouraged and avoided.
Resign but why ask us? 7 May 2001
Kwame McKenzie, senior Lecturer Royal Free UC Med School Send response to journal: Re: Resign but why ask us?	I must admit to being a little surprised when I came across this on the web. The premise is strange. If an unrepresentative sample of readers of the BMJ anywhere in the world vote one way or the other a Professor of Journalism will either resign or not over an issue on which he has very strong opinions. The Chair has nothing to do with the readers of the publication that the professor is editor of. It is difficult to see what purpose this serves apart from producing more cheap advertising for the tobacco industry - hopefully this spectacle will not go national. One could say that it produces interest in the journal, but does the journal really need this type of publicity? It is difficult to see, how one way or the other the Professor can carry on in his chair. It is difficult to see how he can continue to have the confidence of his department or his institution after these events. Chairs are not elected, they are not asked or expected to work democratically. They are chosen, hopefully, for their work and their integrity. They are not mere functionnaires. People like leaders with sound judgement and/or the courage of their convictions. Professor Richard Smith is a man who has displayed these qualities over and over again. Surely he is the only person who can decide this. He is the one who will either have to work at Nottingham or not. He is the person who knows the impact it will have on his efficacy as a vocal opposer of the tobacco industry. He is the only person who can really make a judgement as to what other effects this will have on his wider functioning. So why ask us? This sort of vote is not democratic. It is akin to tossing a coin. I cannot understand why a decision should be made in this way - unless it is really not that important! Some will say that this diminishes Professor Smith and undermines his opposition to tobacco. I am not sure about this but I really do not understand what the game is here! I would have thought a simple - I resign coupled with an editorial as to why and an attempt to get other medical researchers to follow-suit would have greatest impact, the current debate just muddies the water. I guess there must be more to it and hope that in the fulness of time we will know what is really going on. Kwame McKenzie
Knowing the difference 7 May 2001
Edison Iglesias de Oliveira Vidal Federal University of Rio de Janeiro - medical student Send response to journal: Re: Knowing the difference	I agree with Mr. Smith's point about the urge to returning that money back and there is not much I can say about it than has already been said. I just can't be so sure if leaving the university is the best way of fighting that wrong policy. I imagine it is quite important for the students to be in contact with the kind of ideas he is defending. I also believe that the choice to leave or not the university should be a decision of his own instead of one taken by a number of votes, since truth is not a matter of votes. "God, give me patience to accept the things I can't change, courage to change the things I can, and wisdom to know the difference." The whole point is always knowing the difference. This difference can only be known by himself.
independent? 7 May 2001
Antonio Lopez Pena santo domingo Send response to journal: Re: independent?	Even if some state the opposite, money does smell. In this case, tobacco's smell. Can a university take money from the Vatican to fund an abortion debate? The figure is called independence, that's all. Should you maintain it through such a risky way, let's go. But bear in mind that you will be all the time on the cutting edge of the razor. Good luck!
'clean' drug trafficking 7 May 2001
Mitzi Blennerhassett, secretary cancer support group (voluntary) home Send response to journal: Re: 'clean' drug trafficking	As a former cancer patient, I also have strong feelings on this subject. Let those in favour of keeping the money spend a week in a cancer hospital and realise the suffering. I remember the nights spent listening to someone trying to breathe, trying to cough; oxygen being rushed to her bed; the faces of the relatives. I can recall numerous cancer patients' stories told over the last 11 years. Cigarette smoke affects my eyes, nose, throat and chest, yet it is difficult to avoid as I walk around town. Students brave the cold and rain at college, clustering in doorways for a drag on the fag - but of course they are not addicted! What could be more criminal than enrolling them young? What logic decrees that we should abhor and penalise drug traffickers yet allow tobacco barons to continue the legalised killing with immeasurable cost to families and the NHS? The drunk driver is rightly penalised. Those who deliberately cause the deaths of milions are feted. Clearly, ethical considerations have no meaning for these people, or those who support them and, without discrimination, accept their money. I support Richard Smith's argument and urge him not to resign. We need him to uphold the principles which others lack.
Resignation does not serve the greater good 7 May 2001
Gina Brinsmead, Research Academic Faculty of Medicine and Health Sciences, University of Newcastle, NSW Australia Send response to journal: Re: Resignation does not serve the greater good	As a convincing proponent of the case against accepting tobacco money, Richard Smith represents an integrity that is increasingly at variance with the relentless corporatisation of our universities. Resignation in these circumstances is the expected noble gesture, and would no doubt provide him with some moral satisfaction. But a greater service to us all would be his remaining in his post, however uncomfortable this may have become, and continuing to propound his views to the next generation of medical journalists.
Every country is sponsered by BAT 7 May 2001
Peter Birner, Pathologist Inst. of Clincial Pathology, University of Vienna, Austria Send response to journal: Re: Every country is sponsered by BAT	It is a matter of fact that smoking kills people. But in the whole debate one fact should be not forgotten: Not only one university, but also each country recieves indirectly billions and billions from tabacco companies- i.e. taxes on tabacco products. Would it not be a problem for the secretaries of finance of a vast majority of countries, if all people would stop smoking overnight? As long as countries earn taxes from each cigarette sold, I think there should be no problem in recieving a donation from BAT for a field that is not related to smoking at all.
nottingham and tobacco 7 May 2001
S L Barley, retired n/a Send response to journal: Re: nottingham and tobacco	Resign: no question.
The editor of BMJ should not resign! 7 May 2001
Val Gebski, Senior Research Fellow NHMRC Clinical Trials Centre Send response to journal: Re: The editor of BMJ should not resign!	Perceived conflict of interest does not equate to impropriety. Research at arms length from a sponsor has equal credibility to that supported by Research Foundations. Good scienfific inquiry is judged by its scientific design and quality of the subsequent research. Provided the sponsor is at arms length then this position can be strongly defended. A conflict of interest usually arises when conditions (implied or otherwise) are placed on either the design, conduct or interpretation/dissemination of research performed related to the grant. However, if there is mutual interest in the answers to questions of public health interest then how it is funded has little to no bearing on the scientific integrity of the results provided independence is preserved. To simply damn the quality of scientific inquiry based on simply who is providing the funds is naive.
Causes worth quitting over 8 May 2001
Ann Shillinglaw Send response to journal: Re: Causes worth quitting over	If this were about torturing animals by conducting research on their living, sentient flesh, undoubtedly one must quit one's job. Otherwise, one risks offending the order of the universe, since animals were not created to be tortured and tested upon. However, tobacco is a man-made scourge that humans willingly take upon themselves. I am not a smoker and will never be one. But unlike captive animals, smokers are not chained in cages and forced to smoke. THerefore, to quit one's job over a societal wrong that people willingly chose for themselves is a bit of an over- reaction, in my view. Other issues, such as human and animal rights to be free of physical torture and abuse are much more important. If smokers want to shorten their lives, they have had a hand in their own demise, unlike captive humans and animals who have not asked to be harmed.
Not voting 8 May 2001
Frank Leavitt, Chairman, Centre for Asian and International Bioethics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, ISRAEL Send response to journal: Re: Not voting	The debate quite appropriately appeared while we have been discussing a related topic -- the question of "whistleblowing" -- in my bioethics classes for Bachelor's and Master's students in medical management and in nursing. Should a junior physician, a nurse, a student, or anyone else in a lower position in the heirarchy risk one's employment or career to complain about misconduct on the part of superiors? In the context of our discussion of this matter -- a matter which can be an extremely painful one for nurses, especially -- Dr Smith's dilemma seems a little strange. For he is not risking anything. A man with Smith's well-earned prestige can get a job anywhere he likes if he leaves Nottingham. At the same time, I do not think his act of quitting would encourage large numbers of people to act similarly, because large numbers of people do not have such stature, and would not be able to take the risk. Indeed the whole issue of the voting -- no matter how the vote turns out -- is unlikely to affect Nottingham University or the tobacco industry, and will probably only gain publicity for the BMJ. So thank you for giving us all a chance to vote, but I have to abstain.
A world of deceit. 8 May 2001
Fernando Isaza, Consultant Paediatrician Northwick Park Hospital - London Send response to journal: Re: A world of deceit.	A few years back I was Head of Paediatrics in a busy Teaching Hospital in Colombia. It was the peak of the narcotrafficking era, when drug lords were admired in the streets for their "charity donations". Money was not a problem. As usual in any health system, we had great needs; probably more than great, vital. Offers came. Cash, no questions asked, no bureaucracy, no audit of the expenses. No need for recognition or gratitude either. Seemed like Heaven at last. But we sat and discussed the situation. What about the Ethos of it?? Finally we turned down the offers politely. Better to get the money, probably thousand times less, from reliable and honest sources, did not matter how difficult it was, rather than from "the fountain of sin". Then we realized that "contamination" of the Country and Economy was so great, that wherever you were, "that" money was there. I believe similar situation is here. In this very specific case, the money came from the "source" without masquerading it. For that reason, I believe Nottingham University should refuse or return the money. The origin was clear. But I do not believe Dr. Smith should resign. He has made his point. His ideas are very clear; the ethos of the situation has been looked into. He should continue his preaching and where better than in the heart of "the place that succumbed to temptation"?? Fernando Isaza Consultant Paediatrician Northwick Park Hospital, London.
Re: Casual, not causal. 8 May 2001
S P Prabhu, Specialist Registrar in Clinical Radiology Bristol Royal Infirmary, United Kingdom Send response to journal: Re: Re: Casual, not causal.	I was shocked to read this comment by Dr.Lloyd. There has been enough research to prove that smoking can cause a large number of medical problems including coronary artery disese, peripheral vascular disease and lung cancer.It has also been shown that cessation of smoking can lengthen survival after previous myocardial infarction.The pathological specimen of smokers' lungs is ample concrete evidence that smoking kills. Besides, smoking kills those who suffer around smokers and inhale the poisonous fumes from sidestream smoke. Inspite of all these facts, Dr.Lloyd seems to have doubts about whether smoking kills!! I shudder to think what kind of advice Dr. Lloyd gives his patients about smoking!!
We all love the high moral ground 8 May 2001
Sandy Bourne, semi-retired psychoanalyst was consultant at the Tavistock Clinic Send response to journal: Re: We all love the high moral ground	It's almost impossible to avoid dirty money, direct or indirect benefits of evil, exploitation of the vulnerable, destruction of the environment etc etc. This doesn't mean a licence to ignore the whole issue just because you can't put the world right; and that is a common rationalisation for doing nothing ever and enjoying what you can grab with a happy conscience. However, if you do take a stand about some particular case, it is well to have some fairly clear idea of (a)the effect you expect to ensue; and is this the best way of achieving it and is it the effect you want? (b)are you just looking to occupy the high moral ground for reasons that may not amount to anything more than the wish to feel good? Why not take the money and use it to fight tobacco? Why so afraid of having dirty hands? From the outside it is impossible to guess what the effect of taking or rejecting the money will be; and all this moral revulsion comes cheaply, especially if it is not me paying. Richard Smith is best placed to judge the effect his resignation might have and should act accordingly but it should be strictly practical and not just a futile gesture - or even counter-productive. For instance, who will replace him in the job...?
Nottingham return the money, and RS stand your ground 8 May 2001
Sheelagh Noonan, Medical Knowledge Architect Ausdoctors.net, Sydney, Australia. Send response to journal: Re: Nottingham return the money, and RS stand your ground	I would like to see Nottingham University return the money, and I hope Richard Smith does NOT resign depending on the outcome. I also prefer that he decides for himself.
It's What you use it for 8 May 2001
T Legg self-employed Send response to journal: Re: It's What you use it for	I read in the book of Proverbs "The wealth of the wicked is stored for the righteous". I do not wish to be judgemental about the moral worth of the individuals in the tobacco industry, but the issue comes down to how the earth's resources are used. If the donation is put to good use, then there is positive benefit. Dr Smith should stay in his job, because he can continue to air the issues to a wide audience.
sombody, somewhere will pay the price 8 May 2001
Hywel Williams, Professor of Dermato-Epidemiology University of Nottingham Send response to journal: Re: sombody, somewhere will pay the price	I have voted in favour of returning the money to BAT. Whilst accepting the money is legal, it is unethical given the unethical way the tobacco industry has behaved in the past, and the way in which smoking-related deaths are now rampaging the developing world. Somebody, somewhere in the developing world is paying dearly for this signal of acceptibility for the tobacco industry. Somebody, who may be unware of the full dangers of encouraging their children to smoke. Somebody who may be more susceptible to the subtle forms of marketing such as sports sponsorship. Somebody who is unable to access e-mail and take part in this "legal" debate.
The health establishment is corrupt! 8 May 2001
Carol A S Thompson Send response to journal: Re: The health establishment is corrupt!	Those supposed harms of smoking that the health establishment constantly screeches in our faces are based on deliberate scientific fraud. The health establishment purposely uses confounding by infection to falsely blame smoking for diseases that are really caused by infection. And, they have caused the unnecessary deaths of millions by suppressing research on these infectious causes, while they ram their deluded ideology of blaming lifestyles down our throats. They have gotten away with it all these years by corrupt political means. See "The History of the Conspiracy Against Tobacco," http://ourworld.compuserve.com/homepages/CarolASThompson/ And, Richard Smith should resign regardless of what the University does, because he is one of those corrupt health fascist ideologues and GOOD RIDDANCE TO HIM.
Such a low price! 8 May 2001
Masoud Solaymani Dodaran, Ph.D. student Dept of Public Health Sciences, The University of Nottingham Send response to journal: Re: Such a low price!	The reality of our present world is that morality is dead among decision makers and the lack of morality is positively correlated with the rank of the decision makers. To keep the public in ignorance, now and again these decision makers try to pretend that morality is still alive. Asking the question "where as the money come from?" is an exception that is kept for the situations where a specific purpose is meant. This time the gamble is on the donated £ 3.6m of the University of Nottingham. Such a low price to sell the morality joke!
Valour, integrity and hypocrisy 8 May 2001
Ketan Dhatariya, SpR G(I)M, Diabetes and Endocrinology Darent Valley Hospital, Dartford, Kent Send response to journal: Re: Valour, integrity and hypocrisy	It is a return to an age of valour and integrity when a man of principles gives up a position of high value and prestige for his beliefs and values and is prepared to sacrifice himself for them. I applaud Richard Smith in bringing to the world's attention this despicable action by the tobacco industry which is trying to 'legitimise' itself by providing money for an academic position. Hypocrisy should not be allowed to go unchallenged.
Stay and fight 8 May 2001
Karen Klimowski, Technical Officer World Health Organization Send response to journal: Re: Stay and fight	Smith should stay within the University and fight them to return the money. If he resigns he is a martyr to the cause and quite possibly, be forgotten. If he stays, he can use his position to continue the fight and if the University gets tired of him and fires him, he can use it to his advantage and continue to speak out through the press.
Beyond BAT Sponsorship at Nottingham 8 May 2001
John A White, Senior Lecturer in Health Promotion Division of Public Health Sciences, University of Nottingham Send response to journal: Re: Beyond BAT Sponsorship at Nottingham	While I support Richard Smith's stance and denounce the University's decision to accept BAT sponsorship, there are other important issues beyond this debate. Currently all academic members of the Universities' Superannuation Scheme(USS) are, perhaps unknowingly, making a contribution toward the tobacco industry, since more than 10% of USS holdings are in BAT. While this may be good for the pension fund, I am disturbed that members of the scheme are not consulted about such investments, which may run counter one's to personal and professional ideals. It is hard to take the moral high ground in this debate without being prepared to withdraw from the USS or at least insist on a change of future investment policy. Can Richard make this his next campaign? Competing interests: health promotion educator, smoking cessation researcher.
Economic fallacies and tobacco apologists 8 May 2001
Rob Primhak, Senior Lecturer in Respiratory Paediatrics Children's Hospital, Sheffield Send response to journal: Re: Economic fallacies and tobacco apologists	Colin Campbell's justification of the tobacco funding is a perfect example of the insidious effect of such "donations". It is perhaps hardly surprising that he appears to feel it necessary to act as an apologist for the tobacco companies. However, the argument that curbs on the tobacco industry will damage out economy is one assiduously promoted by the industry, and contradicted by the World Bank, which has concluded that tobacco harms economies (1). It seems that BAT get more than respectability for their money. They get a prominent academic apologist who will argue their cause against the evidence. The raison d'etre of a tobacco company is to encourage addiction to a damaging and fatal drug, and the industry specifically targets the underage child and the less developed countries. Taking donations from such an industry is at best naive and at worst corrupt. Ref: Yach D. Tobacco control: form concern fo the lung to global political action. Thorax 2001;56: 247-8
The University badly needs this centre! 8 May 2001
Robert Quigley, Research specialist Health Development Agency Send response to journal: Re: The University badly needs this centre!	Big business is typically blind to issues of social responsibility - no surprises there. Unfortunately it now appears that this same trait is being displayed by a English University as it struggles for funding in a business-like funding environment. Nottingham University desperately needs guidance from an International Centre for Corporate Social Responsibility since the University cannot clearly see the unethical notion of accepting this money. Perhaps that will be the Centres first recommendation? I would also be interested in the moral stance of the staff within the business Division of the University. Does the University honestly believe that the graduates and/or the research that eminates from this Centre will not be immediately tarnished as socially irresponsible by the University's association with quite possibly, the worlds worst company, ever.
To resign is to accept defeat 8 May 2001
Anish Shah, Medical Student Imperial College, London Send response to journal: Re: To resign is to accept defeat	A few points: 1. Colin Campbell, Nottingham's Vice-Chancellor, talks of a white paper saying "the government fully recognises the right of the quarter of the British population that smokes to do so and that it doesn't propose to infringe on that right". Does the government recognise, and does Campbell recognise, the equally important right of the person sitting next to the smoker, or the fetus inside the smoker's womb, to be in a smoke-free environment? 2. Nottingham University MUST return the money before their reputation is tarnished in the long-term. Just read the vast majority of the responses here to learn that most people believe their acceptance of BAT's money to be an utter travesty - a mockery of ethics in medicine and higher education. 3. Professor Smith should NOT resign for the following reasons: (i) It would not make much difference - certainly, it would probably not result in any change in policy in the university (ii) It would be an admission of defeat However, were he to be able to persuade several other professors at the university to threaten their resignation, the university may be forced to reconsider their decision, on logistical grounds. Or perhaps, instead of putting his job on the line, he should put his health on the line: hunger strike, Gandhi style. That would get Campbell thinking.
How much does a name cost? 9 May 2001
Jack Boomer, Provincial Manager, Clean Air Coalition of BC Vancouver, British Columbia Send response to journal: Re: How much does a name cost?	Give back the money? Definitely. It will send a strong message to other educational institutes and research organizations around the world that the organizations cannot be bought. The tobacco industry probably did a cost benefit analysis about the optimal amount to give to the University in order to entice them to accept the money and withstand the pressure that they would feel from accepting it. Resign? No way. We need someone with a conscience and with credibility to watch what happens in the University and with the funds, should the University accept them.
Mutiple misrepresentation 9 May 2001
Lesley Fallowfield, Director CRC Psychosocial Oncology Group School of Biological Sciences, University of Sussex Send response to journal: Re: Mutiple misrepresentation	The BAT money should of course be returned. Nottingham Vice-Chancellor's arguments are sophistry in the extreme. It is ludicrous to suggest that BAT money will not directly or indirectly benefit everyone working in the University. This position is every bit as daft as suggesting that smoking only affects addicts not everyone of us. Richard Smith should resign also for misrepresentation of the Cancer Research Campaign's position which is most definitely against the acceptance of tobacco money in institutions where its own grantees are working so very hard on research to counteract the medical effects of BAT's vile products. If the Campaign really had such a ludicrous code, so easy to manipulate, then I would resign from my position as a major grant holder.
Tobacco U? 9 May 2001
Ginny Lovell, hospice worker Send response to journal: Re: Tobacco U?	The forum provided here for the U.S. tobacco front group contingency still claiming there is some doubt about the devastation caused by tobacco consumption does nothing to camouflage yet another attempt by the tobacco cartel to manipulate "research" in the name of philanthropy. Return the money, maintain integrity and kudos all 'round to Richard Smith and his supporters for raising the profile a little bit more about what scam artists the tobacco cartel are. They think they can still get away with it - please send a clear message they are no longer fooling anyone (except a few die-hard smokers, pun intended).
Tell tobacco thanks but no thanks 9 May 2001
Clare Ryan, Critical Care Nurse Send response to journal: Re: Tell tobacco thanks but no thanks	By accepting money from tobacco, Nottingham acknowledge their university has a cheap price tag. Tobacco influence becomes attached to anything they have to say from now on. Give the money back, hire a professional fundraiser - and Richard Smith, if you find it necessary to resign, God bless you. I hope you will find another way to continue speaking out against an industry made rich by suffering.
I see in black and white 9 May 2001
Paul Kerr, spr haematology bristol Send response to journal: Re: I see in black and white	1. Research funded by a body that has an interest in an outcome of that research is tainted - the information gleaned from the International Centre will not be usable. Hasn't anyone been to a drug company meal? It's not that long ago that the BMJ carried an article about the use of Nazi medical research on Jews and whether that information could be used. The number of people murdered by the Tobacco industry dwarfs even the number murdered by Hitler. Hitler was a lunatic; the tobacco industry is a rational calculating profit making organisation. It is naive of Nottingham University to think that money from BAT is untainted and freely given - tobacco companies have been shown publicly to be liars. They are not a charity. Their raison d'etre is to make money. Return the money or prepare to have all your research (rightly) rubbished. 2. Resigning seems too close to a blame culture to me. If the editor cannot stomach working in a BAT sponsored environment then I sympathise. He should not feel that he ought to resign.
Tobacco toffs buy submission 9 May 2001
Cecilia Farren, Director 93 Cromwell Road Bristol Send response to journal: Re: Tobacco toffs buy submission	I have lived for 24 years in Bristol - a city linked to Nottingham through its tobacco twinning via John Player of Nottingham and WD & HO Wills of Bristol. Together they make up the force of Imperial Tobacco. I have seen how tobacco money buys compliance, gratitude and silence. Academics, politicians and civic minded people all in receipt of tobacco money always start with the phrase "Well, just because I accept tobacco money doesn't mean I'm going to start smoking!" They seem to miss the point that their silence and grovelling gratitude allows the killers to roam free inducing the young and less socially adept to be taken in by the lies and be induced to smoke. Bristol has hospital wings, schools, arts events, university buildings and research labs all named after the Wills benefactors. And you hear the comment - 'Wills has been so good to the people of Bristol'. How many Bristol children have been orphaned from Imperial tobacco cigarettes? How many children have spent time in hospital from passive smoking and how many babies have spent time in the high tech unit for babies damaged as a result of their mothers' smoking? And what of the 2000 + smokers who die in and around Bristol every year as a result of smoking? Gratitude?? Nottingham University has forfeited its integrity by accepting this money. It should give the money back and the BMA should distance itself from all links with such tainted money.
Re: Do not quit! 9 May 2001
H Fung, Deputy Director, Hospital Authority Hong Kong Send response to journal: Re: Re: Do not quit!	Professor Smith should NOT resign as fighting the tobacco industry is a longterm battle!
The editor should resign 9 May 2001
B Sobolev Send response to journal: Re: The editor should resign	Whether or not to stay on the faculty is a decision of Prof Smith. However, the editor Smith should consider resignation from his post at the BMJ. Engaging in political actions is not acceptable for anyone who has power to decide which manuscript goes first.
Leave: Nottingham's loss, community's gain 9 May 2001
Robert Ashwood, Nurse, Smoking Cessation Clinic Royal Hobart Hospital Send response to journal: Re: Leave: Nottingham's loss, community's gain	Nottingham's students would have benefited from Richard Smith's continued presence at the university. Future students could have Richard pointed out to them, his presence a discomfort to those who made the decision. Leaving, however, will continue to add to the wider stench from the Uni's decsion, (so contradictory, Tobacco companies surely are used as how-not-to in corporate ethic training, and this 'PR Coup' will be added to the list of don'ts). Tobacco Companies in the Developed World are feeling the pinch, it is far to soon to reward them for any claimed change in attitude to the communities they service. Reports of their activities in the developing world, demand rigorous scepticism of claims that they have changed. Conflict of interest: the writer has participated in research, workshops and seminars funded and supported by Pharmacia & Upjohn, and by Glaxo Wellcome, both makers of smoking cessation treatments.
Inside the tent pissing out 9 May 2001
Peter Watson, Consultant Physician Newcastle General Hospital Send response to journal: Re: Inside the tent pissing out	Nottingham University and we need Richard Smith to remain in post, continuing to remind us why Nottingham University was wrong to accept the money. Resignation, if noticed, will be quickly forgotten.
How would students view their benefactor? 9 May 2001
Edward Parkes, Health Promotion Specialist Send response to journal: Re: How would students view their benefactor?	How does the student rationalise the decision that they have made to be receiving an education that has direct links with the tobacco industry? What messages are these students being given, and what will their value- base be as they leave university, to shape the direction of future industry and commerce? This would be of particular relevance to those students who received a scholarship. Many of those scholarships are going to people from developing countries, where the tobacco industry are keen to increase their sales. How will students view their benefactor?
Stick by your principles 9 May 2001
Mike Laurence, GP Bacon Road Medical Centre, Norwich NR2 3QX Send response to journal: Re: Stick by your principles	Yes, resign - if your stand means anything, the university must suffer public embarassment. There is an ethical distinction between taxes on tobacco and direct donations. The former is compulsory, and opposed by the corporations. The latter is an attempt to increase the respectability of the tobacco companies, who are at the end of the day a bunch of cynical killers. Don't go soft like Blair did.
No nexus 9 May 2001
Fernando Cavalcanti, Adjunct Professor Universidade Federal Pernambuco Send response to journal: Re: No nexus	There is no nexus between the donation from the BAT for the creation of the International Fund and any member of the University. They are independents.
public, private divide 9 May 2001
Ann Naughton, Admin Director International Centre for Eye Health Send response to journal: Re: public, private divide	While I'm pleased to have the opportunity to vote on whether a public institution should accept BAT money, I do not wish to vote on whether Professor Smith should resign but your survey doesn't allow for this option. The question about resignation is, I think, very much a personal, ethical issue and the decision may also depend on practical circumstances. I don't want to be forced to take a position on so personal an issue. Would it be possible to add a 'don't know' option to the second question please?
The Cancer Research Campaign: A Response 10 May 2001
Jean King, Director of Education The Cancer Research Campaign Send response to journal: Re: The Cancer Research Campaign: A Response	The Cancer Research Campaign would like to take issue with Richard Smith's suggestion that we have said that it is 'all right' for the University of Nottingham to accept BAT's money. We are aware that this may well have been caused by the University's claims that it is in compliance with the Joint Protocol on Tobacco Industry Funding to Universities between the Campaign and the Committee of Vice-Chancellors and Principals of UK Universities ("CVCP") (now known as University UK). We have expressed our many concerns to Nottingham University over its decision to accept this funding. In response to our (and others’) concerns, the University simply advises that its decision to accept BAT funds is in compliance with the Joint Protocol. However, the University’s position is unsatisfactory to the Campaign for the following four reasons: 1. The Joint Protocol recommends that funding that is likely to show the tobacco industry in a favourable light should be rejected. Notwithstanding this guidance, we believe that the Nottingham University press release does, in fact, show BAT in a favourable light. 2. Compliance with the Joint Protocol does not give approval to or support for tobacco funding. The Joint Protocol outlines the circumstances where the Campaign may withdraw funding to an institution such as Nottingham University. 3. Nottingham University has not to date offered proof to the Campaign as to exactly how the BAT funding is in compliance with the Joint Protocol. 4. Nottingham University is making statements that link BAT to the Joint Protocol that bears our name, without consultation as to how such statements may negatively affect the name, work and goodwill of the Campaign. For all of the above reasons, the Campaign must continue to question the University’s decision to accept the BAT funding. Accordingly, the Campaign will be reviewing our position under the Joint Protocol as well keeping a watching brief over our future funding of research at Nottingham University.
The position of the Cancer Research Campaign 10 May 2001
Richard Smith, Editor BMJ Send response to journal: Re: The position of the Cancer Research Campaign	Professor Fallowfield writes that I have misrepresented the Cancer Research Campaign, but I don't think I have. Colin Campbell discusses the campaign's position in more detail in his piece, but in essence the acceptance of tobacco money is acceptable to the campaign so long as it isn't spent in any part of the institution that is receiving money from the campaign. The BAT money is going to the business school, which has no funding from the Cancer Research Campaign. The campaign's position has been very important to the university. It seemed to be central in the university deciding to accept the money. I find the campaign's position strange. Perhaps it would like to rethink. Professor Fallowfield might encourage it to do so. Richard Smith Editor, BMJ
Alice in Wonderland world 10 May 2001
Selwyn St Leger, Senior Lecturer/Consultant in Public Health Medicine University of Manchester Send response to journal: Re: Alice in Wonderland world	I believe that a university should, if it chooses, accept money from any lawful source so long as it does not come with strings inhibiting free academic debate which might include criticism of the donor organisation/industry. Richard Smith should not resign whatever the outcome. He should remain linked to the university so that he may continue to fight according to his principles. We live in an Alice in Wonderland world where, for example, on the one hand state funded health professionals and the government discourage smoking (e.g. through a high tax on cigarettes) and on the other hand the EU offers subsidies for growing tobacco in some member countries and seems unwilling to move toward a uniform policy on tobacco product taxation (hence smuggling). Until such idiocy is halted (and it is likely have a profound impact on cigarette consumption) I am not going to worry about doings at a minor university across the Pennines. I suggest that Richard Smith and everyone else who is getting so het-up concentrate their energies on encouraging European politicians to consider putting the general public interest ahead of that of powerful sectors (farmers and the tobacco industry). Surely, the one thing that almost all contributors to this debate would agree on is that eradication of cigarette smoking would be the social change that would have the greatest impact on the long term health of the population (notwithstanding baby bounties, wealth redistribution and other New Labour dogma).
PAY-BACK TIME 10 May 2001
Edward Hanlon, CONSULTANT PSYCHIATRIST GENERAL HOSPITAL, LETTERKENNY, CO.DONEGAL, ROI Send response to journal: Re: PAY-BACK TIME	If people dont smoke cigarettes they will find something else to choke on.Anyway, it's pay-back time for the Tobacco Industry.Take the money and stay put.
Let us take the example of the arts 10 May 2001
Oliver Starr, 3rd Year Medical Student University of Birmingham Send response to journal: Re: Let us take the example of the arts	The matter is simple to resolve: we need only to look to the novel of Captain Correli's Mandolin. When Greece looks to be invaded, the Greek President does not stand down and lose face, he remarks, in French: c'est un question d'honeur. As it is for Richard Smith.
Of course you're a whore, my dear; all we're arguing about is your price! 10 May 2001
David Sackett, Director Trout Research and Education Centre at Irish Lake Send response to journal: Re: Of course you're a whore, my dear; all we're arguing about is your price!	I propose another vote, this time on whether BAT or Vice-Chancellor Campbell are the bigger hypocrites. Is it more hypocritical for the manufacturers of a product that kills half its users to fund a center for "corporate social responsibility," or for a vice-chancellor of a laughing- stock university to justify hopping into bed with them because their lethal product is "legal?"
No to blood money 10 May 2001
Christopher Carey, health researcher Send response to journal: Re: No to blood money	I was astounded to learn that Nottingham University chose to accept money from BATco. It is difficult to understand why such a reputable academic institution would ever consider accepting money from an organization whose product kills those who use it. Is it not enough that big tobacco have perpetrated their lies and fraud on the public for the last sixty years? It is obvious they are now attempting to wheedle their way into respectability with blood money. Give the money back. Richard Smith, keep up the fight whatever you decide to do. If money is the only consideration, this tells everyone what they need to know about the integrity of Nottingham University.
Richard Smith is Right 10 May 2001
Alma Rae, Research Fellow Dept Psychological Medicine, Christchurch, New Zealand Send response to journal: Re: Richard Smith is Right	Richard Smith makes a series of compelling points all relevant to the question of whether universities should accept tobacco money. Colin Campbell, by contrast, makes a series of comments which, although true (tobacco is legal, etc) are not relevant to the heart of the question, and he ends with an utterly unsupported prediction that at some unspecified time in the future, few will object to this money having been accepted. To me, his view is surprisingly naive. Why does he think that British American Tobacco wasn't interested in funding anything until the Business School came along? He is playing into the hands of corporatism, which seeks to subvert the independent role of universities in society (to analyse and criticise without fear or favour) and to replace this with a corporate-friendly, hollow imitation of that role. This is in reality socially irresponsible, indeed, "corporate social responsibilty" is an oxymoron. Colin Campbell should read John Ralston Saul's "Unconscious Civilisation" without delay, and return the tainted money forthwith.
conflict of interest 10 May 2001
Tina Ambury, Primary Care Physician in A&E North Manchester General Hospital Send response to journal: Re: conflict of interest	I thoroughy agree with Richard Smith's viewpoint and have cast my vote accordingly. However, I cannot help but wonder if the BMJ (both paper and electronic format) would have given this issue such prominence had Richard Smith not been its Editor. I also wonder if Richard intends to act on the result of the vote, notwithstanding whether it concurs with his own viewpoint.
Don't give BAT the Credibility 10 May 2001
Vince Summers, Hospital Pharmacist Borders General Hospital Send response to journal: Re: Don't give BAT the Credibility	The tobacco industry should not be allowed to gain credibility in the eyes on the public by funding supposedly independent research institutions, give the money straight back. Resignation? It's up to you!
Crazy Logic 10 May 2001
L Symonds, GP Bristol Send response to journal: Re: Crazy Logic	Colin Campbell's argument betrays a fundamental and perhaps deliberate ignorance of the fact that tobacco smoking kills. He states that the tobacco industry employs 100 million people worldwide and appears to argue in support of its continued proliferation and survival. This logic has the same surreal quality to it as the argument that the cocaine industry supports the employment of several million pimps, pushers, drug dealers and cocaine barons worldwide, and that this merits leaving the industry alone. Perversely for an academic, and in keeping with the ethos of his corporate bedfellows, he foresees world class management education for future business leaders, rather than a healthy society that constitutes a nations true wealth. Equally bizarrely, to demonstrate his masterly grasp of economic reality, he states that the government collects £8 billion in revenue annually in tobacco tax, whilst ignoring the amount that the NHS spends on smoking related illnesses each year.
Issues 10 May 2001
James Curran, GP Glasgow Send response to journal: Re: Issues	It is obvious that the University should not have accepted the money and should hand it back. I think that the editor's decision should be up to him. It is more difficult to decide, but on balance I think he should quit. However, as a reader of the BMJ, I think an important point is: if he stayed on at the University, would this a) cause a conflict of interest that he would have to declare when writing about the tobacco industry and/or b) cause problems when the BMJ publishes articles about tobacco industry funding of universities and research? This may also requiring a similar conflict of interest declaration, weakening the impact of the article. If either of these is the case, that would a strong reason for him to unfortunately leave the post, if the University did not return the money.
Who's decision is it anyway? 11 May 2001
Mark Waters, GP, Hereford Hereford, UK Send response to journal: Re: Who's decision is it anyway?	I feel there are two separate issues, and the decision-making processes should not be merged. It is for Nottingham University to choose their sources of funding. From what I have read, they have followed a careful process of consultation and consideration, and made a difficult decision in the real world of funding higher education. Not a perfect world, by any means! Whether the editor should resign is a separate matter. Richard Smith has been a very vocal and articulate opponent of tobacco promotion for many years. It would be inappropriate, and inconsistent for him to make this stand, and not then follow it through to its logical conclusion. It is a matter of personal integrity: he has to finish what he has started, or see his own reputation and credibility damaged.
More effect if editor remains at the professorship 11 May 2001
Alexander Gatherer, Retired, various projects OCMRS, Socio-Legal Studies, Wolfson College, Oxford Send response to journal: Re: More effect if editor remains at the professorship	Relying on memory, seldom does a retirement make a lasting impact. The decision by the University is unlikely to be changed. It would be much better to remain and use whatever continuing influence remains, to draw attention to the implications of the University's decision for the public health. We should also remind ourselves of the great need to have someone like the Editor in such a post, so that he can help to develop through academic circles the professionalism of medical journalism.
Survey: should the editor resign? 11 May 2001
Mel Read, Lecturer in Politics Queen's University, Belfast Send response to journal: Re: Survey: should the editor resign?	The money should be returned simply because BAT will almost certainly impose more stringent conditions on research projects and findings as time goes on. However, I'm not sure that the editor should resign. What would it achieve? Perhaps another victory for BAT? Moreover, more harm can be done to BAT in his present position by monitoring any restrictive practices and keeping a watchful eye on the company and reporting it, than if he was elsewhere. That's my view, for what it's worth!!
Apologetics 11 May 2001
Jessica Robbins, Postdoctoral Researcher University of Pennsylvania Population Studies Center Send response to journal: Re: Apologetics	The reasons why the University of Nottingham should return the money need no further elaboration. The question of whether or not Prof. Smith should resign seemed less clear to me--until I read the University administration's response, which could easily have been written by a tobacco industry lobbyist. The University seems already to have sold its conscience as well as its name, which must make it unappealing as an employer. I do foresee years of international amusement at the concept that academic study of corporate responsibility would be furthered by the acceptance of this gift.
why he should not resign 11 May 2001
Janine Jurkowski, PhD Candidates University of Illinois at Chicago Send response to journal: Re: why he should not resign	Hello, I think that if he stays, he can spend his time researching whether or not the tobacco company uses the money to frame research or whether or not the university remains an autonomous institution. A study of this can inform us all on whether or not a university or professional association should take money from corporations and how that money shapes the research and practices of the university or association.
Limits are matter of debate 11 May 2001
Huup Dassen, Medical journalist University Hospital Groningen (Netherlands) Send response to journal: Re: Limits are matter of debate	Of course I agree, like most readers responding that the University should return BAT's sooted money. However, Colin Campbell is of course right that smoking is legal and a matter of personal choice (I am a moderate smoker myself). I also understand why he writes that: "[...]in furthering the university's research -- and especially research that is relevant to the world's problems today -- we welcome diverse sources of funding." What he is saying is: never become too dependent upon one source of money (or wisdom or whatever). As a principle that might help to maintain the University's independece and academic freedom, I agree. But there is a limit. This limit is not always completely clear and should be a matter of permanent debate. Fortunately this example is not very difficult to judge, as Richard Smith clearly argued. But what if BAT's money went to the department of Organic Chemistry to set up a lab full of state of the art equipment, to study the structure of organic molecules in biological materials like e.g. fresh and dried tobacco leafs? Richard Smith should stay in Nottingham, whatever comes out of this poll. His university needs him. Apart from that, the small majority in favour of his resignation also consists of people who hold views opposite to his, who'd probably want the university to get rid of him
Should "money" come first? 11 May 2001
Suthee Rattanamongkolul, student University of Nottingham Send response to journal: Re: Should "money" come first?	The editor should not resign but the other. We know that smoking can kill. We believe that cigarette sales should not be promoted. We see that tobacco companies try to increase sales of cigarette. We are confident that BAT expected something from its donation to the Nottingham University. However, the university's executive administrators have adopted a different policy which is "money comes first" and also ignored where the "money" comes from. We are not living in the Robin Hood's time. As an academic institute, we have often been cited, therefore, there is certain ways of conducting its business. The university therefore should not accept the money regardless of the Cancer Research Campaign's opinion about it. The Nottingham University has tried to use that "money" to market education to the developing world. I believe that not all students from developing countries will appreciate this strategy because many developing nations suffer from the forced importation of cigarettes to their countries. Some might even condemn this idea. To Professor Richard Smith, many thanks for trying to maintain integrity of the university not the administrators. To BAT, I will very much appreciate it if you just sincerely stop trying to promote the sale of cigarettes.
sour grapes and toffee noses 11 May 2001
Tony Earnshaw, retired General Practitioner Send response to journal: Re: sour grapes and toffee noses	Corporate funding exists. Without tobacco tax revenues,Government spending would be severely restricted. Accept the funding. But, of course, Richard Smith should not fall on his sword. His positiion offers him more opportunities than most people will ever have to influence the public, and the profession, in ways to minimise tobacco hazards. He can continue to rail against the near criminal attitude of the barons, and be heard. Do not resign.
The Readers Poll - an example of tabloid journalism 12 May 2001
Peter Brindle, Wellcome Training Fellow University of Bristol Send response to journal: Re: The Readers Poll - an example of tabloid journalism	Editor It is disappointing to see the debate about the acceptance of funds from a tobacco company being trivialised by the readers' poll on whether or not Richard Smith should resign his Chair at Nottingham University. The BMJ is a journal that prides itself on publishing work from which conclusions are based on representative and statistically sound data. The BMJ is drifting into tabloid populism by suggesting that Richard Smith's decision to resign should depend on the result of readers' poll. Whose views is the poll meant to reflect? The small minority of readers who bothered to access BMJ.com and click their mouse in the right place is not representative of anybody other than themselves. Representative or not, it is surprising that Richard Smith believes that an important decision such as his personal position within a university should be decided by any poll. Smith's decision should be entirely his own and not dependent upon the whim of a wholly unrepresentative self-selected sample of readers' views.
Drug Cartel? 12 May 2001
S W Liew, Paediatrician Columbia Asia Medical Centre, Malaysia Send response to journal: Re: Drug Cartel?	Would the vice-chancellor have accepted the gift if it was from a Colombian drug cartel? I think not. But statistically tobacco cartels kills and maims more people than all the drug cartels put together.The only difference is that one is a legal business and the other is not. Think about it. Richard Smith should stay put. The only way to fight the enemies is to fight them from within.
Freedom, what freedom? 12 May 2001
Ann Cheesman, Clinical Research Fellow, Neurology Hammersmith Hospital, London Send response to journal: Re: Freedom, what freedom?	The acceptance of funding from any tobacco company by a respected university can only boost the image of an industry that should abstain from publicity. The fact that the money would finance a centre for the study of corporate responsibility can only further boost that image. There is much talk about the "freedom of the individual" to smoke but nothing of the loss of freedom to stop, even when someone would desperately love to. To me, on balance smoking takes away choice for the majority of smokers and leaves them with less control over their health, well-being and finances.
Good money, bad money, and "objectivity" 12 May 2001
Dennis P Quinn, Associate Professor Miami, Florida Send response to journal: Re: Good money, bad money, and "objectivity"	On May 6, 2001, I contributed a letter to this forum called “Magical Money?” I suggested that anti-tobacco activists and researchers seem to have a sort of schizoid view of industry money: If it comes from Big Pharmaceutical, it’s good money no matter what it’s used for; if it comes from Big Tobacco, it’s bad no matter what. In a private email challenge (May 9), Tobacco Control editor Professor Simon Chapman asked me to justify why the following sentence appears in my letter: “Anti-tobacco warriors don’t consider BMJ to be ‘tainted’ by that money, and even support the objectivity of editor Smith who, with a straight face, quotes from Tobacco Control as if that publication were objective and scholarly.” Mr. Chapman asks me to explain what I mean by the term “objective,” and he says the term “for years has been regarded as a fairly complicated issue.” I have responded to Mr. Chapman in a note to the TC forum and wish to share that with readers of BMJ. In common parlance, a primary adjectival sense of “objective” is “uninfluenced by emotion, surmise, or personal prejudice; based on observable phenomena; presented factually” (American Heritage Dictionary, 2nd College Edition) or perhaps, “expressing or involving the use of facts without distortion by personal feelings or prejudices” (Merriam Webster’s New Collegiate Dictionary, 9th Edition). These are the senses I intended. Rather than attempting a painstaking review of scores of articles published in TC over the years, I offer the following five items to support my suggestion that TC is no objective forum. First, the very name of the journal makes clear its objective: to control tobacco. One does not need to be a veteran on the front lines of the worldwide war against tobacco to know that “tobacco control” is a euphemism for “taxing and segregating smokers with the ultimate aim of prohibiting tobacco altogether.” That’s a fine plan if Mr. Chapman wants to follow it, but he cannot claim his journal is objective. Second, every truly objective study of the effects of ETS has shown either no negative effect on non-smokers or a barely significant one. Some studies have even produced statistically significant protective effects. The 1992/93 U.S. EPA report on ETS is null and void in most of its conclusions for the very reason that non-objective bias led to cherry picked data and false statistical conclusions. One would never learn that by reading anything about ETS in TC which continues to parrot blatant statistical untruths about ETS and its relationship to CHD and lung cancer. Third, on the March 2001 TC Online Top Ten Articles, we see an interesting phenomenon regarding the authors of these pieces. Ten of the authors are members of the TC editorial board: Sargent, Pierce, Gilpin, Choi, Jacobson, Warner, Henningfield, Benowitz, Slade, and Davis. So much for objective peer review: TC seems clearly to be one of those journals that thrives due only to self-referential publication. Not very objective. Fourth, the Associated Press (April 20, 1997) reported that “Australia’s principle medical advisory board massaged research results to suit recommendations to ban smoking in public places.” The article states in part: “In a letter to members of the working party, [Chapman] expressed concern that tables in the draft report did not show a high death rate from passive smoking.” It then quotes Editor Chapman as follows: “Journalists looking at that table (or being directed to it by the industry) will be hard pressed to write anything other than ‘Official: passive smoking cleared – no lung cancer.’” So here we have a study that does not lead to the conclusion that Professor Chapman wants, so it is altered. According to the Australian AP, the panel’s final report did not contain either Mr. Chapman’s concerns that the evidence was not in the direction he wanted, “nor did the final report contain the contentious table of data.” This report, therefore, is no more objective than is the one from the U.S. EPA. http://193.78.190.200/who/2308.htm" Finally, as regards money being good or bad depending on where it comes from, we have this June 1, 2000 report by Victoria Button, medical reporter for The Age, “Tobacco study funding attacked.” Ms. Button writes, “Advance photocopies of the report were distributed to journalists without any acknowledgement that it was funded by the drug company SmithKline Beecham.” She goes on, “One of the authors of the report, Simon Chapman . . . defended industry funding as standard academic practice. . . .” But Mr. Chapman’s hands were spanked anyway by Meredith Carter, executive director of the Health Issues Centre: “’If the cigarette companies funded research that wasn’t acknowledged we would be hopping mad, wouldn’t we?’ she said.” http://theage.com.au/news/20000601/A30178- 2000May31.html Yes, you sure would. The close relationships among TC contributors and its editorial board plus its commitment to tobacco eradication plus its cozy ties to BMJ mean that all research published in TC must be considered suspect as respects its objectivity. Too many of the articles in TC use tortured statistics to make their points and too many of its contributors are indeed warriors on the front lines of the war on smokers. Bias not science rules at Tobacco Control. I stand by my original statement. Dennis P. Quinn, PhD
Hear your conscience. Don't ask the readers 12 May 2001
J K Anand, Retired public health physician Send response to journal: Re: Hear your conscience. Don't ask the readers	Dear Professor Smith Whether you retire or not (from the professorship) is your own business. By all means decide what you deem fit and then let the world know. I doubt if the world cares. Now a word to Richard Smith, the BMJ editor - I ask you, is editorship not a full-time job? If it is not, then I trust that you receive a salary in proportion to your time commitment. If it is a full-time post, then please choose between editorship and the professorship. Don't tell me that you can cram 25 hours in to a 24 hour day. If you are over-worked, then it means that your physical and mental health will suffer (thereby damaging the interests of both your employers, and your family) and you are also depriving another human of his/her livelihood.
Developing countries and corporate responsibility 12 May 2001
Carol Campbell, CMO, Community Paediatric Dept, Foyle H&SS Trust, Londonderry Bridgeview House, Gransha Park, Londonderry Send response to journal: Re: Developing countries and corporate responsibility	Of all Sir Colin Campbell's unbelievably naive justifications for accepting tobacco industry funding, the saddest is tucked in near the end of his article: "[BAT] funding will support ... an annual appointment of a visiting professor or scholar from the developing world, and scholarships for students of outstanding academic merit from developing countries." These are the countries where tobacco markets are growing fastest and whose laws and medical systems are least able to protect them from the consequences. It is beneath contempt that a Western university should associate itself with BAT's marketing strategies in this way. The University should return the money. The Cancer Research Campaign should carefully consider and clarify its position in respect of further funding of research at Nottingham. Tobacco marketing via the prestigious university system must ultimately affect cancer incidence. If Richard Smith resigned, his gesture would unfortunately be quickly forgotten and he would presumably be replaced with a "tobacco-compliant" successor. For these reasons, he should remain to fight the battle within the University. Carol Campbell
Medical journals have much to learn from tabloids 13 May 2001
Richard Smith, Editor BMJ Send response to journal: Re: Medical journals have much to learn from tabloids	It never ceases to amuse me that when people don't like something that the BMJ does they accuse us of "tabloid journalism." Perhaps they imagine that we burst into tears when so accused. In fact, I'm usually delighted. We have a great deal to learn from tabloid journalism. The great thing about tabloids is that millions of people buy, read, and enjoy them, whereas most medical journals are read by few and enjoyed by even fewer. Half of the scientific journals in libraries are not consulted once during a year, and half of all scientific studies are never cited once. The pompous and snobbish sometimes imagine that any fool could edit a tabloid newspaper, but it takes great talent--much more than to edit a medical journal. The main reason to conduct a poll over whether I should resign from Nottingham was to draw attention to the particular episode in Nottingham and the broader question of tobacco sponsorship of academia. In this we seem to have succeeded. When Nottingham first made the announcement before Christmas there was depressingly little debate, even in the BMJ. This time round the debate has been hot. I've also learnt a lot from the vote. I imagined that 80-90% would say that Nottingham should give the money back and that a similar proportion would say that I should resign. I was right about the first part of the vote but wrong about the second part. It was a much smaller majority for me to resign, reflecting the important debate over whether it's better to be in the tent pissing out or outside the tent pissing in. There is wisdom to be had from plebiscites. This was not an attempt to find out what the total universe of BMJ readers thought (if such a universe could even be defined) but rather what was the view of those who felt strongly enough to vote. That's how democracy works, and Dr Brindle will have observed that it's the dominant and most successful form of government. Richard Smith Editor, BMJ
Pros and cons 13 May 2001
James Austin, SpR Anaesthetics Oxford rotation Send response to journal: Re: Pros and cons	What are the consequences if Nottingham University accepts the money? a. They will have £3.8 million to spend on researching and teaching corporate responsibility. I trust no strings are attached from BAT, so the money could be used "against" BAT and other irresponsible corporations. But will this deal jeopardise the chances of Nottingham finding similar sponsorship elsewhere? b. In the public and medical eye, the Centre and Nottingham University at large would (rightly or wrongly) be tainted by their decision. This would discredit the value of the work of the Centre. c. BAT would (rightly or wrongly) be able to pat itself on the back, and perhaps wrest commercial kudos out of the deal. What are the consequences if Nottingham University returns the money? a. That's £3.8 million less to spend on the Centre - but perhaps a strong move to attract alternative funding. b. In the public eye, Nottingham would have achieved greater credibility on issues of corporate responsibility through its own corporate actions. c. The tobacco industry would have suffered one more public spit in the eye. With the amount of publicity the issue has gained, I suspect that the benefits of refusing the money outweigh the £3.8 million's worth of research and teaching - I think Nottingham should return the money. As to whether Professor Smith should resign: I identify most with the response of Professor Shore, namely that he should never have put it up to public vote - this smacks of a web publicity stunt. I agree with those who say that Prof Smith would have greater influence from within the University, and should certainly feel under no pressure to resign; but if he finds his position there untenable, he should be free to make his own decision based on his own ethics and circumstances. James Austin
"Tainted" and "untainted" 13 May 2001
Peter Abbott, retired Send response to journal: Re: "Tainted" and "untainted"	The University should not refuse the gift and the Secretary should not resign. In this mixed up world it is impossible to separate "tainted" companies from those which are completely "untainted". Under these circumstances gifts should be accepted from companies which are legal and where the gift is clearly not going to be used to distort the truth. In this case the gift has been totally separated from research on the effects of nicotine and should be accepted. For these same reasons the Secretary should not resign.
Heroes and villains 15 May 2001
John Hopkins, General Practitioner Darlington Send response to journal: Re: Heroes and villains	Dear Dr Smith, As you say, the tabloids can teach us a lot about good communication. At best they are accessible, well written and informative. However, at their worst, they can oversimplify and even distort complex problems, sometimes by using the device of “heroes and villains”. A good example of this, in my view, was this week’s BBC report on tranquilliser dependence. One of the most difficult clinical issues facing primary care was defined largely in terms of GP’s failure to follow Government guidelines. In the case of University funding, the specifics of the Nottingham case are part of a much wider debate about where money for higher education and research comes from. When this country is wealthier than it has ever been, one might ask why Vice Chancellors should have to spend time hawking their Universities around the private sector. Yours sincerely, Dr John Hopkins
"Objectivity" and ETS. 15 May 2001
Edward L Sweda, Senior Attorney Tobacco Control Resource Center Send response to journal: Re: "Objectivity" and ETS.	Mr. Quinn's response shows that he has swallowed -- hook, line and sinker -- the tobacco industry's disinformation campaign on the hazards of ETS. "Determined to keep reports about secondhand-smoke from mushrooming, the tobacco industry mobilized a counterattack in the mid-1980s to systematically discredit any researcher claiming perils from passive smoke." Hwang, S., "Tobacco Memos Detail Passive-Smoke Attack," Wall Street Journal, 28 April 1998, B1, B8. Perhpas Mr. Quinn considers The Lancet to be an "objective" medical journal. He should read about the tobacco industry's multi-million dollar campaign to undermine IARC's study on ETS. See Ong, E. and Glantz, S., "Tobacco Industry Efforts Subverting International Agency for Research on Cancer's Second-hand Smoke Study," The Lancet 2000; 355: 1253-59. In 1998, the Pioneer Press (St. Paul, Minnesota) reported that the tobacco industry paid 13 scientists a total of $156,000 to write letters to influential publications criticizing the 1993 Environmental Protection Agency report on secondhand smoke -- the same report Mr. Quinn disdains. See Hanners, D., "Scientists Paid to Write on Tobacco," Pioneer Press, 4 August 1998, 1A. I wonder whether Mr. Quinn believes those industry- purchased letters were "objective."
"Make the B******* sack You" 15 May 2001
Avril Danczak, GP Alexandra Practice Manchester Send response to journal: Re: "Make the B******* sack You"	Dear Dr Smith, Thank you for raising this important issue. If you resign you won't be able to protest in future. Stay there. Give then a hard time, and as Marshall Marinker has famously remarked "Make the B****** sack you" They will get more bad publicity if they try to gag you that way and in post you can keep working for good priciples. Well done. Avril Danczak
Re: A Clash of Philosophies 16 May 2001
Jon Krueger Send response to journal: Re: Re: A Clash of Philosophies	It's amazing to hear in 2001 that in opposing preventable disease and death one should avoid "engaging in politics". It might be understandable to hear such things 30 years ago. Say in the 70s, when a trustee of the American Cancer Society actually advised "we are an anti-cancer society and not an anti-smoking society." Thirty years later, the ACS knows better. Just as any health professional or scientist now knows: you can't be anti-cancer without being anti-smoking. And you can't be effective against tobacco disease and death without effecting policy change. To call this "politics" and condemn it as such, is to advocate being ineffective.
Disgusted 16 May 2001
Delma Clifton, Lecturer Central Queensland University Send response to journal: Re: Disgusted	I was disgusted to read the vice-chancellor's response. Frankly, I expected a more reasoned academic argument rather than a rehash of the tobacco company's justification of their immoral industry. Professor Smith should resign - a man of his ethics would be welcome anywhere in the world. Save us from Vice-chancellors who persist in viewing universities as a business rather than a service.
suspicious agendas??? 16 May 2001
James Neil, sho medicine Kingston upon Hull Send response to journal: Re: suspicious agendas???	Both questions beg answers. However one must consider whether this is a genuine attempt on the part of BAT to fund such investigations. One would feel obliged to discover whether the company has any control over the provision of these funds and/or any get out clauses if the centre happens to cast some of the guilt in there direction. As any impartial investigation would most likely have to conclude such to be the case, perhaps we should watch and wait to see if the centre can fulfil a useful function and reflect accurately on the situation at hand before we condem the use of 'dirty money'. The situation would have been improved had the company parted with a less microscopic part of it's revenue to atone for its possible past sins.
"Objectivity" Redux 18 May 2001
Dennis P Quinn Send response to journal: Re: "Objectivity" Redux	Mr. Sweda has swallowed more than fishing tackle. He does not know the science of ETS but only the “disinformation” of the anti-smoker industry which is one of the clients that supports him financially. The WHO/IARC study refutes its own press release. While acknowledging a slight correlation between ETS and health problems in nonsmokers living or working with smokers, WHO reports that “neither increased risk was statistically significant.” But enough about ETS. Let us move on to Mr. Sweda’s shock, SHOCK, that the tobacco industry paid scientists money for their research and writing. What he has condemned the tobacco industry for is common practice among the pharmaceutical companies . Even worse, such a justifiably prominent publication as The New England Journal of Medicine has disclosed instances of pharmaceutical-funded, ghost-written reports, editorials, and letters appearing over a researcher’s name in peer reviewed medical journals. Not even the tobacco companies have been accused of that. And yet, Mr. Sweda’s organization, the Tobacco Control Resource Center has happily accepted pharmaceutical money as have the British Medical Journal, Tobacco Control, and its editor, Simon Chapman. So much for objectivity. Dennis P. Quinn Miami, Florida
Nottingham and tobacco 18 May 2001
Peter Davies, Consultant Chest Physician Liverpool Send response to journal: Re: Nottingham and tobacco	Sir, I am grateful I do not draw a salary from Nottingham University as I would feel compelled to resign in protest at its acceptance of tobacco money. Surely the best practical policy is to boycott every aspect of the University. Do not apply for jobs, student places etc: until the university slips into the academic oblivion it deserves.
Congratulations, Dr. Smith 18 May 2001
Peter Bishop Send response to journal: Re: Congratulations, Dr. Smith	Dear Dr Smith I just read an article on BBC News Online regarding your resignation at Nottingham University, due to its acceptance of funding from a tobacco company. I would like to commend you for your principled stance on this matter. Clearly, you will suffer a substantial detriment, as a result of your actions, whilst standing-by that which you whole-heartedly agree with. If more people stood up to that which they believed in, in this world, taking it on-the-chin in the process, this world would be a much better place for all of us. Well done and I wish you the best of luck. You will always have my support. Best regards, Peter Bishop
Should the BMJ accept Richard Smith's resignation 18 May 2001
Anne Chang, Assoc. Professor of Paediatrics Flinders Uni NT Clinical School, Alice Springs Send response to journal: Re: Should the BMJ accept Richard Smith's resignation	Amongst other things, Richard Smith is applauded for his stance against 'tobacco tainted institutions', his many articles for the disempowered and being true to his word. The challenging question now is whether BMJ should accept Prof Smith’s resignation, for unlike other academics, I believe that if Prof Smith resignation is accepted, BATS win and we lose. We do need someone effective in the fight against the tobacco industry as the editor of a prestigious medical journal. I do however respect Richard Smith’s wishes and wonder if he would reconsider another vote by BMJ readers?
Re: "Objectivity" Redux 19 May 2001
Edward L Sweda, Senior Attorney Tobacco Control Resource Send response to journal: Re: Re: "Objectivity" Redux	I suppose Mr. Quinn would have us believe that the U.S. National Toxicology Program, which in 2000 added ETS to its official list of known human carcinogens, is part of the "anti-smoker industry" that he bemoans. Maybe we should just ignore some of the constituents of tobacco smoke (like 4-aminobiphenyl, arsenic, benzene, 1,3-butadiene, cadmium, chromium VI, 2-naphthylamine and vinyl chloride) and ignore the the middle ear infections and acute lower respiratory tract infections (e.g., bronchitis and pneumonia) in children. How about ignoring the increased rates of heart disease mortality and acute and chronic coronary heart disease morbidity and nasal sinus cancer in adults? (The California EPA 1997 Report -- which the agency prepared after soliciting input from all interested parties, including the tobacco industry and its consultants -- concluded that ETS exposure causes these effects.) So that smokers like Mr. Quinn are not inconvenienced by having to postpone the act of smoking while in public, there are those who pretend that ETS is a mere annoyance instead of a threat to human health. They should speak to the family of Dr. Abid M. Hanson, a 52-year-old nonsmoker who died from an asthma attack after being exposed to ETS aboard an Olympic Airways flight from Athens to New York. See Husain v. Olympic Airways, 116 F.Supp.2d 1121 (2000).
Re: Tents and pissing 20 May 2001
Shah Ebrahim, professor of epidemiology of ageing University of Bristol Send response to journal: Re: Re: Tents and pissing	Richard Smith raises the question - is it better to be in the tent pissing out or outside the tent pissing in? What is really important, Richard, is that you just keep pissing. Particularly on a Vice-Chancellor who appears to have such a hold on his Faculty of Medicine that only one professor, one senior lecturer and two students from Nottingham have dared to speak out against his actions.
I Stand With Smith 21 May 2001
Chris Thomas, Manager Oncology Disease Management Company Send response to journal: Re: I Stand With Smith	Professor Smith's ethical stand should inspire us all, so I Stand With Smith. The Center for Corporate Social Responsibility is already open and Professor Smith is its greatest teacher. The first lessons have been: that an individual’s ethics drives corporate –and university– ethical practices; and that businesses can’t buy and sell integrity no matter how they try. The issues are about tobacco and money, but the lesson is about individuals standing up for the ethical positions. The other lesson we’ve learned is to beware of corporations spending millions on "corporate social responsibility" because they are trying to hide something, while continuing to do business as usual. Tobacco executives must really think people are stupid –perhaps because their customers are, after all, smokers– but did they really think people would not see through this? Professor Smith, I salute you for taking the ethical stand, because you demonstrated what “social responsibility” really means and your University will learn that lesson sooner or later. Professor, your Centre for Social Responsibility is already a great success! Chris Thomas
Are Tobacco comp[anies different from Drug Companies? 22 May 2001
Bertrand M Bell, Professor of Medicine Albert Einstein College of Medicine Send response to journal: Re: Are Tobacco comp[anies different from Drug Companies?	In the U.S. the pharmaceutical industry has with alleged "unrestricted funds" taken control of continuing medical education and graduate medical education. This "unrestricted" funding "supports" the educational mission of the medical schools and the academic medical centers. and if you ask them does not influence their educational programs.In addition the industry indulges doctors, deans, presidents of academic societites etc. with "free" dinners, golfing weekends etc. The Pharmaceuticl industry does all of this not only "to gain respecability" but to icontrol and nfluence the education and thereby the behaviour of doctors. If Dr. Smith wishes to be consistent in his response to the acceptance by Nottingham of money from tobacco then he also should take the same stand in regard to the acceptance of the billions of dollars given by the pharmaceutical industry to the medical schools and the teaching hospitals and their faculties in the U.K.
Medical student view 23 May 2001
Thirza Craze, 2nd Year Medical Student Liverpool Medical Student Send response to journal: Re: Medical student view	Sir, While my response may cause the complaint that many of the previous letters were from professors and other respected medics, I feel quite strongly that, while the vote as to whether Prof. Smith should resign was one which perhaps should not have been decided by anyone other than himself, there was an interesting slant on this - that a lot of the people who access the BMJ web site are medical students looking for information for their essays etc. If this is true than surely the people who are more likely to take part in the vote are also medical students - the Drs. of the future and those for whom the decision of Prof. Smith to resign is most important. The moral stance taken by Prof. Smith and many of the senior Drs whose replies are printed here are very important because, even though the reprehensible decision of Nottingham University to accept the money may not be reversible, it is we who will be affecting the decisions in the future and we need a strong moral example from our 'elders and betters'. This is what Prof. Smith is giving us.
Drugs and tobacco 27 May 2001
John Dowden, Medical Editor Australian Prescriber Send response to journal: Re: Drugs and tobacco	Following his widely publicized resignation, Richard Smith will have more spare time on his hands. He might use this time to consider the differences between the tobacco industry and the multinational pharmaceutical industry. Professor Bell was correct to remind us that the pharmaceutical industry makes signifcant contributions to educational institutions. It also provides large amounts of money to medical journals including the BMJ. Was it just coincidence that the banner advert accompanying Richard's resignation letter, in the eBMJ, was for a smoking cessation product or was it careful juxtaposition? I look forward to Richard reviewing the journal's policy of accepting advertising money from the pharmaceutical industry. He could start by removing the drug adverts from the eBMJ.
Tobacco villainy 27 May 2001
Mark Struthers, GP Leighton Buzzard, Bedfordshire Send response to journal: Re: Tobacco villainy	Dear Dr Smith Your resignation and stand against BAT has certainly raised awareness of the behaviour of the tobacco industry in promoting their product both in this country and abroad. At least in this respect your gesture won't be futile but it would have been more impressive if your post at Nottingham University had been something more than part time and unpaid. Not a lot of sacrifice there then? If the University were to give back the controversial £3.8m, I just wonder what BAT might do with it; perhaps indulge in more adverts aimed at young people in developing countries. Smoking can't be banned but the disgraceful advertising and promotion of tobacco could be, and it's this sort of behaviour that should be made illegal. BAT may think they are buying respectability but the University doesn't have to sell it. Better in my view for Nottingham to take the money and run. I wonder at the role in all this of Kenneth Clarke currently seeking re-election as a Nottinghamshire MP while employed as non-executive deputy chairman of BAT. As many will remember he served as both as a Tory Chancellor and amazingly as this country's Health Secretary amongst other less notable things. I can only look back in anger at what he and Margaret Thatcher did to the health service in the early 90's. With GP fundholding his pet scheme of the time, he mischievously divided the medical profession, undermined and nearly finished off the NHS. There were plenty of GPs though, with their hands on their wallets who were quick to drink with him from the poisoned chalice of fundholding. Perhaps his behaviour and that of the Conservative Party at that time would make an interesting study in corporate social responsibility for the new department in Nottingham. Now a decade later Kenneth Clarke is peddling more misery, disease and death from a company he describes "as actually one of the more advanced and responsible British companies I've come across." Sir Walter Raleigh may have been the first to bring tobacco to this country but I hardly think he was "the start of the villainy", as you suggested in your recent Guardian article. Cigarettes are here to stay whether we like it or not. The great British public want them and a tobacco industry will always be there to supply them. I have never smoked and hate smoking but many of my patients won't give up because they like it, even in the face of the obvious harm it causes to themselves and their families. They won't listen to what they don't want to hear. Nevertheless people can and do stop the habit; it really is a matter of personal choice and personal responsibility. Nobody, in this country at least, can be unaware of the harm that cigarettes do, and it will remain our job as doctors to keep people informed of the damage they cause and encourage them to stop. Tobacco is legal: imagine the outcry if there was an attempt to ban smoking. It's inconceivable; so we've got to live with it and the companies that will inevitably supply it. Better to be as sly and cunning as the tobacco industry and channel as much money as possible to more ethical uses; let some good at least come out of evil. If the tobacco shareholders don't like like it they can always invest elsewhere - perhaps in the alcohol industry.
Tobacco companies are a source of evil, whereas pharmaceutical companies are a source of good 28 May 2001
Richard Smith, Editor BMJ Send response to journal: Re: Tobacco companies are a source of evil, whereas pharmaceutical companies are a source of good	John Dowden's rapid response that seems to see similarities between the tobacco and pharmaceutical industries makes no sense to me. They are world's apart, not least in that tobacco companies are a source of evil and pharmaceutical companies a source for good. The companies may be similar in that they tend to be large multinational companies, but so what? Hitler and John Dowden are (or were in one case) both human beings. I'm not against private industry and profit, and pharmaceutical companies are perhaps the best example of why profit matters. Well over 90% of effective drugs have been developed by the pharmaceutical industry, and even the few not discovered by the industry tend to be manufactured in a pure form by it. Yes, the industry has behaved unethically at times, but so have the Australian and British governments, the BMJ, most (probably all) medical institutions, and most human beings. John Dowden may be an exception, but I doubt it. I certainly am not. The point about the tobacco industry is that it has behaved unethically systematically and consistently. This is not true of the pharmaceutical industry, and--I think I could make the case--many examples of unethical interactions between the industry and doctors are more the fault of doctors than the industry. Those who read both the BMJ and the Student BMJ were amused that in the same week that I was on my high horse and resigning from Nottingham because it took money from the tobacco industry I was defending pharmaceutical advertising in the Student BMJ. (Rhona MacDonald argued against.) I can't unfortunately give you the URL of the article because it isn't yet posted, but I'm appending an unedited version of the article to this rapid response. Finally, it was coincidence that my resignation letter was accompanied by an advertisement for a smoking cessation product. But I'd like to see many more advertisements on bmj.com so that we can keep it free to those who access the site. Richard Smith Editor, BMJ A retired hippie (now editor of the BMJ) makes the case for drug advertising This is the piece I've dreaded writing. I grew old the day John Lennon died. Today I grow very old. I'm 49, as ancient in your minds as Winston Churchill, Spitfire planes, and spitting in the street. But if I'm old enough to preach to you about the need to include drug advertising in the BMJ I must be as old as them. I want to make my case--in part--by telling you my story. I started from where you may be now. It is the fate of revolutionaries to turn into the people they despise, and I'm the living proof--but I still think I'm right. While at school in South London I was a communist. I sometimes imagine myself explaining what that means to my grandchildren (which, as far as I know, I don't yet have). It will seem as strange as having believed in the phlogiston theory. I do have the excuse that one reason I joined the communists was to meet girls and even kiss them (that's all we did before sexual intercourse was famously invented in 1963, even later in South London). But I did care passionately about world poverty and injustice, racism, and colonialism. Like everybody else I knew, I read Regis Debray's notes on guerilla warfare, learning how to keep my gun dry in the jungle. (For the geographically challenged I should explain that South London has urban but no green jungle.) I believed that big business--as symbolised par excellence by pharmaceutical companies--were the root of most, if not all, evil. At medical school I swept into political power on a slogan that would have made Peter Mandelson envious: "Don't be thick, vote for Dick." I sat on committees with other rebellious youths like Gordon Brown, illustrating that this "growing old thing" affects the best and the brightest. I edited Synapse the medical school magazine--boldy renaming it Prolapse--and earned a tiny place in its history be being the first editor to print the word "fuck." Later at the BMJ I wrote articles on alcohol policy and asked a leader of the advertising industry to "give me one reason why all advertising shouldn't be banned." I also wrote on unemployment and health and tried my hand at some economics, assuming that the government could if it wanted fix unemployment. The point I'm making is that I understand something of the position of those who think that the Student BMJ should not carry advertising from the pharmaceutical industry. The adverts come from business monsters who are corrupt and the source of much of the injustice in the world. The advertisements cannot be believed and distort knowledge and prescribing patters--and they simply aren't necessary. So ban them. The most dramatic moment in my transition to a different way of thinking about business and economics came in November 1989. I was doing the Sloan programme ("an MBA for the middle-aged") at the Stanford Graduate School of Business in California. I was upstairs in our student house doing my homework on microeconomics when my wife called me. I went downstairs to see television pictures of the Berlin Wall being pulled down. I learnt in economics that there are two broad options for economies--planned and market. The collapse of the planned economies of eastern Europe ended any serious belief in planned economies. Markets must be regulated and create their own problems, but they are essentially the only option for running economies. The "third way" is nothing qualitatively different: it's simply a form of a regulated market economy. Pharmaceutical companies illustrate the power of market economies. It's virtually impossible to think of an important drug that wasn't developed by the industry, and even those that go back a long way--such as digitalis---are manufactured by the industry in a pure form so that they can be used therapeutically. The profit motive has given doctors an array of effective interventions that hardly existed before the 1950s. And advertising is an important part of a market economy. It is needed to promote competition and is essential for allowing new and superior products to come through. It must be regulated, and it is--by British and European legislation, by a code of practice committee, and by the Advertising Standards Authority. It's true that advertising tells only part of the story, but so do most articles in newspapers and--it must be said--the BMJ. We might aspire to complete objectivity but we never reach it. The beauty of advertising is that everybody knows it's biased. My 10 year old daughter knows that, and so do medical students. They have been bombarded by advertising all their lives and will continue to be. They need to learn to interpret it, and where better to learn than the Student BMJ? The websites of the BMJ and Student BMJ contain many pieces on problems with advertising and advice on how to deal with promotions from pharmaceutical companies. So there could be a case for including advertising in the Student BMJ even if we weren't paid for it--but of course we are. We can use that money to underwrite some of the high costs of the journal and importantly buy our editorial independence. Making a profit is the biggest single guaranteee of editorial independence. Perhaps the clinching argument for advertising comes courtesy of the web. It has allowed publications to give readers the choice of receiving material free with advertising or paying for it without advertising. Surprise, surprise almost nobody pays.
The other side of the story 30 May 2001
Rhona MacDonald, assistant editor BMJ, editor student BMJ BMJ Send response to journal: Re: The other side of the story	Thank you, Richard. Below is my side of the debate on whether we should have drug advertising in the studentBMJ, but you can read the whole debate yourself if you go to: www.studentbmj.com/03.html Should there be drug advertising? A human rights campaigner, Rhona MacDonald (editor of the studentBMJ), makes a case against Perhaps it is just that I am not as old as Richard Smith and have not yet had time to be corrupted by market economies, but I still care passionately about world poverty, injustice, racism, and colonialism. To me drug companies are still the "root of most evil." Am I just being naive and idealistic? I don't think so. I worked in Bangladesh for a while. What I saw there broke my heart and I vowed that I would make it my life's mission to contribute something to help combat world poverty. Engraved in my memory is something I witnessed there that was totally perverse. Sugar coated vitamin pills were being promoted by drug companies in a way which made some of the poorest people in the world think that they were not doing the best for their children. So they exchanged a day's wages for a useless piece of trash which would not be allowed to go on sale in Britain. I also worked in an orphanage in Romania for four consecutive "holidays." The drug companies' donations of antibiotics and vitamins were all out of date. As a hospital doctor, I never went to any of the drug companies' nights out. It was standard practice where I worked that if you wanted a night out, you just found a drug rep who could take you so you didn't need to pay. Because the drug companies saved money by not taking me, I asked them to give the money to charity instead. They never did. I never ate the drug companies' sandwich lunches even though I had to go to their educational talks as part of my continuing professional development. I didn't have time to go to the canteen, which meant I had to starve all day. Why was I so against even eating an innocent sandwich, which had been tainted by a drug company? Because this is the start of the slippery slope. Drug companies will do anything to hook doctors and then pull them in. They even try hard to give the illusion that the actually care about people in the Third World. Do not be fooled. Profit motivates everything that drug companies do. For example, the drug company Roche funds Sight and Life, a humanitarian initiative to combat vitamin A deficiency. However, Roche was recently discovered to be the leader of a conspiracy to set vitamin prices and, along with three other drug companies, had to pay nearly $1bn (£714m) in criminal fines. A Roche executive was sentenced to five months in jail. Drug companies exploit people in developing countries. Firstly, they test drugs on poor people who will never benefit from them. Secondly, they refuse to market products that would save lives but would not rake in profits. For example, eflornithine is the only agent effective against African sleeping sickness, which claims thousands of lives a year. However, for profit reasons, Hoechst Marion Roussel stopped its production. It recently found that it could slow the production of unwanted facial hair in women, so suddenly the drug is commercially viable again. Finally, drug companies refuse to allow poor countries to make cheap generic versions of essential medicines. The industry fiercely guards its patents and has the support of the World Trade Organisation's agreements on intellectual property rights. Like many campaigners for human rights, I was delighted at last month's historic decision to drop all charges against the South African government for breaking these patency agreements. Drug companies say that they would not be able to develop new drugs to help patients in the West if poor countries could make cheaper equivalents. What is the morality behind saving a few lives against saving the lives of thousands? At the end of the day it all comes down to money, and who can afford to pay for treatment. I have a rare, progressive illness for which there is no cure. I would much rather drug companies spent money developing drugs which will save the lives of millions in developing countries than a drug that may help to save my own life. The money saved by stopping the bribing of doctors and the placing of drug advertismentsin medical journals could easily be used for developing drugs for use in developing countries. I recently accepted an invitation for selected journalists to lunch with the Association of the British Pharmaceutical Industry. Don't worry, I wasn't going to eat their food, but it was just after the South African decision and I did want to hear what the association had to say. It was in one of London's poshest hotels (I didn't realise this and turned up in my jeans!), and everyone except me was tucking into a three course meal. The association will not allow me to quote what was said, but I was alone in my disapproval of the patency agreement, the bribing of doctors, and the way in which those present were talking about the African people (in between mouthfuls of salmon). The cost of the lunch would probably have been enough to supply antibiotics to South Africa for a whole month. As I left the dining room, a Brazilian waiter came running after me to thank me for what I had said. So, should the studentBMJ carry drug advertisements? Definitely not, if the decision was mine to make. I have come to accept that the BMJ needs drug advertisements to be independent. However, the studentBMJ is never likely to be independent as your BMA subscription does not fund the studentBMJ. We rely on the BMJ to keep us going. Since the BMJ has drug advertisements, I do not see why the studentBMJ should be tainted as well. Rhona MacDonald editor, studentBMJ rmacdonald@bmj.com Do you think we should have drug advertisements in the studentBMJ? Go to www.studentbmj.com to cast your vote.
Well Done 31 May 2001
B C Rao, General Practitioner Apoorva diagnostic and day care centre, Indiranagar, Bangalore, India Send response to journal: Re: Well Done	The resignation of Prof Smith was timely and will hopefully send the necessary message to the strong and world wide tobacco lobby. This is also relevent to the situation in India where I feel they are targetting young people to use tobacco.Tobacco related problems are a major drain on our fragile economy, apart from the immense misery that its use causes. Utterly stupid to grow this weed and encourage its use and spend money treating the various cancers it causes! Will the users and makers of tobacco products please listen to sane voices like that of Prof Smith?
BAT Funding - A paediatrician's perspective 20 June 2001
Sue Franklin, Research Secretary University of Nottingham Send response to journal: Re: BAT Funding - A paediatrician's perspective	Professor Sir Colin Campbell Vice Chancellor University of Nottingham Dear Sir Colin British American Tobacco Funding for a Department of International Corporate Social Responsibility at the University of Nottingham: A Paediatrician's Perspective As clinical and academic paediatricians we have been disappointed by the decision taken by yourself and the University's Senate to accept the £3.8m from British American Tobacco, in order to part-fund a new department of International Corporate Social Responsibility. We note the report of the Faculty debate in the BMJ where Richard Smith eloquently outlined a very strong case for the University of Nottingham to reject money from this source. You attempted to defend the University's position but acknowledged at the outset that you were unlikely to be successful with a medical audience. A poll was recently conducted on the BMJ web site which overwhelmingly supported the view that the money should be returned and marginally supported the view that Richard Smith should resign in protest from his Chair (see www.bmj.com). As you know, Richard Smith has resigned. At first look, the issues surrounding this controversy may not seem directly concerned with clinical or academic paediatrics. However, we feel strong professional concern about the impact of this decision upon the future health of children and young people world-wide. Although childhood smoking is not a major cause of ill health in the first 18 years of life, population studies show a consistently strong association between parental (passive) smoking and the severity of respiratory diseases in children, as well as the risks of developing cancer in childhood. As paediatricians we are all aware that children are the most vulnerable group of every society, being at risk of death, injury, abuse or exploitation by adults. The Children Act responded to this vulnerability in the UK law as recently as 1989. A major criticism of BAT's commercial strategy has been its drive to recruit new smokers in childhood and adolescence in developing countries. This strategy cynically seeks to exploit young people's future health in the pursuit of company profit and is out of step, in our view, with modern day attitudes to the protection of children and young people. You stated during the debate that you do not wish to get between "the man in the street" and "his pleasure". In our view this is not an acceptable stance as the majority of smokers spend their lives trying to shrug off their "pleasure" in order to escape the tyranny of tobacco addiction. Perhaps your view may have been different if it were your own children who were being plied with "free fags" on their way home from school. BAT's offer to invest in a Department of International Corporate Social Responsibility is seen by many to be a strategy to limit the damage of the exposure of this marketing strategy, not to mention the legacy of the tobacco industry's prolonged denial of the health risks of smoking. Your defence has focussed upon the legality of the University's position and the compliance with the CRC tobacco funding accord. You stressed that the University is a liberal institution, which embraces pluralist policies. In our view this may be appropriate when it comes to student admissions, employment law and academic freedom. However, we feel it cannot be applied in a political vacuum when it comes to funding arrangements for an international department of business studies in an international university. There is no dispute that countries world-wide suffer the staggering financial and health consequences of their populations' smoking habits, which have been outlined so effectively by Professor Smith. We share in the responsibility of the Faculty of Medicine and Health Sciences to train health professionals in health education, a major component of which is concerned with adverse effects of smoking. Arguably this education is best delivered during the childhood and adolescent years. Furthermore, the Faculty must be able to pursue research into the health consequences of smoking and communicate this information to the public domain. The consequences of the University's actions are already being encountered. Professor Smith and Professor Thurston's resignations from the University are the first steps on a road to ostracisation of the University in the field of cancer research. The Cancer Research Campaign has removed their political support for the University. They have instructed their employees to have no formal links with the University. This attitude is predicted to translate into unfavourable outcomes for future research applications from cancer research groups. The recent decision by the CRC and the Imperial Cancer Research Fund (ICRF) to merge all their activities raises the possibility that the two biggest cancer research charities in the UK may, in the future, share the view that Nottingham University cancer research is blighted by the University's complicity with tobacco companies' corporate objectives. Such a situation, developing at a time when only one in seven research grant applications are successful, runs the risk of causing a major downturn in cancer research in Nottingham. Nowhere will this be more disappointing than for the research programme that has been initiated by public donations to the Children's Brain Tumour Research Fund. Over £500,000 has been donated since 1998 by local donors. This money is being used to pump prime projects with a view to winning high quality research funding from the CRC, ICRF or MRC. The first Scientific Fellowship for this group has been advertised by the University this month, in Nature. We do not dispute that the University has accepted BAT's money legally and in accordance with CRC tobacco money agreement. We recognise that the Cancer Research Campaign's threats of political and research isolation for the University's research groups may be empty and unsustainable. We question whether the judgement of the University has been appropriate for an international institution concerned with education and research. Medicine and Health Sciences is the largest University Faculty. It is integrated with the Nottingham and the East Midlands health services. Is it justifiable for the University to have risked the reputation of the Faculty and the integrity of the East Midland's cancer research and clinical services just for a modest capital donation? We appreciate that this may seem an issue of little importance, as the decision has been made and we are, in general, powerless to influence University policies of this sort. However, there are times when paediatric concerns for the maintenance of health of young people justify extraordinary actions. We wonder if this situation is one where we can bring pressure to bear within our own system on behalf of the future health of children and young people, world-wide. Through this letter we ask the University to give the £3.8m back to British American Tobacco. We will publish this letter in the BMJ website and circulate it to local and national press. We call upon other academics concerned with ethics, health care and other scientific research to protest within the University. Yours sincerely (See attached signatures) The undersigned agree with the views expressed in this letter and request that the University of Nottingham gives the £3.8m back to British American Tobacco in the interests of the future health of children and young people world-wide: Name Title Address David Walker Paediatric Oncologist UHN Jonathan Punt Paediatric Neurosurgeon UHN Derek Johnston Paediatrician UHN Martin Hewitt Paediatrician UHN Prof Leon PolnayCommunity Paediatrician UHN Dr D Wood Paediatric SpR City Prof Imti Choonara Professor in Child Health Derby City Prof Terence Stephenson Professor in Child Health UHN Prof Nick Rutter Professor in Paediatric Medicine UHN Prof Neil Marlow Professor in Neonatal Medicine UHN William Whitehouse Paediatric Neurologist UHN John McIntyre Senior Lecturer in Child Health Derby City Richard Horton Paediatrician Derbyshire Children's Hosp Gillian Small Paediatric SpR City David Bond Paediatrician King's Mill Charlie Charlton Paediatric Gastroenterologist UHN Dr V Noble Paediatrician King's Mill Dr S Ko Paediatric SHO City Alan Smyth Paediatrician City Jonathan Evans Paediatric Nephrologist City Anna Gregory Paediatric SpR E38, UHN Judith Grant Neonatologist UHN Yin Ng Community Paediatrician Beeston Clinic Harish Vyas Consultant Intensive Care UHN Dr J Dilks Paediatric SHO City Jennifer Evennett Paediatric SpR PICU, UHN Jacqueline Nicholson Community Paediatrician Derby Adrian Worsley Paediatrician King's Mill Adam Connor Paediatric SHO Papplewick Ward, City Alan Watson Paediatric Nephrologist City Mary Lambert Community Paediatric SpR Strelley Health Centre Sara Watkin Neonatologist City Liz Marder Paediatrician Children's Centre, City Liz Adamson Community Paediatrician Derby Jane Tresidder Community Paediatrician Derby David Curnock Paediatrician City Dr R Harris Paediatrician King's Mill Lesley Hyde Community Paediatrician Ripley Hospital, Derby Christopher Rance Paediatric Surgeon UHN Dr D Foster Community Paediatrician Mansfield Community Hospital Mr G Croaker Paediatric Surgeon UHN Lizzie Didcock Paediatrican Child Protection Office Ian Lewins Paediatric SHO E38, UHN Jane Williams Community Paediatrician Carlton Clinic Kate Forman Paediatric Haematologist UHN Keith Dodd Paediatrician Derbyshire Children's Hospital Helen Boyer Sister - Paediatric Oncology E38, UHN Suzy Heafield Paediatric Oncology Pharmacist UHN Margaret Parr Oncology Nurse Specialist E38, UHN Edwina Dobson Senior Staff Nurse E38, UHN Frances Northeast Neuro-oncology Liaison Nurse Day Care Unit, UHN Elizabeth Whiles Oncology Liaison Nurse Day Care Unit, UHN Julie Evans Research Nurse UHN Sally Robbins Paediatric Macmillan Nurse UHN Sally Clark Paediatric Dietitian UHN Deborah Rose Staff Nurse E38, UHN
Response to Quinn 7 November 2001
Simon Chapman, Editor, Tobacco Control Send response to journal: Re: Response to Quinn	My attention has recently been drawn to a rapid response posted on May 11 2001 by a Florida resident, Mr Quinn, who without extending me the courtesy of copying his public response, divulges details of his private correspondence with me concerning Richard Smith's decision to resign from Nottingham University. Dr Quinn reproduces a note he sent to Tobacco Control, but fails to include the response I posted to that note on the Tobacco Control site. For the record, I reproduce it here. **** Thank you Dr Quinn for the obvious trouble you went to in replying. I have some further bad news for you about the lack of objectivity in medical publishing. There are so-called scholarly "journals" with names like Preventive Medicine and Injury Prevention, which, like Tobacco Control, have taken up the radical position that reducing preventable disease and injury is a good thing and that there is little point in feigning some sort of "objectivity" that we might not want to control AIDS, malaria, motor vehicle deaths or those caused by smoking, to name a few. Turning to his pecific accusations: 1. We want to tax tobacco. Guilty! It is a very effective way of reducing tobacco use. 2. We want to "prohibit tobacco altogether". Can he point to even one sentence published in any part of Tobacco Control since it began over 10 years ago, that shows prohibition of tobacco use by adults being advocated by any author or editorially endorsed? Indeed, I recently contributed to a debate in the journal (Banning smoking outdoors is seldom ethically justifiable 2000;9:95-7) where I explicitly argued against prohibitionism. Only yesterday I wrote an article for the Sydney Morning Herald advocating dedicated smoking rooms in hotels (http://www.smh.com.au/news/0105/11/features/features5.html) 3. We do not deal objectively with ETS: Could Dr Quinn name one review of the evidence on ETS not commissioned by the tobacco industry which does not conclude that ETS causes disease and should be controlled through public policy? 4. Our Top 10 Online articles for March are stacked with members of the editorial board ... we therefore "thrive on self-referential publication". "Ten of the authors are members of the editorial board". Sorry, Dr Quinn, but Sargent Gilpin, Choi, Jacobson and Davis (5/10 of the people you named) are not members of the journal's editorial board. That's not a very good "objective" start to your criticism. And, as stated plainly on the page, the Top 10 Online refers to those papers that have had most "hits" from online readers. It has nothing to do with "self-referential publicaton" Again, your case is looking decidedly threadbare. 5. Dr Quinn cites a newspaper article from 1997 that he believes shows evidence that I was party to a process that eliminated unfavourable evidence from an Australian government report on ETS. The remarks I made in the letter he cites concerned suggestions I made to the committee about ways of expressing data that would make them more understandable. A table in a draft report of a working party of which I was a member showed estimates of annual ETS caused lung cancer deaths in Australia, broken down by age and sex. As Australia has a relatively small population, this resulted in some cells having "fractional" annual death rates. I warned my colleagues that journalists would have no idea what a "fractional death" meant and may question that the report's estimate of annual lung cancer deaths from passive smoking in Australia consisted of adding up "fractions" of deaths. However, an annual fraction such as 0.5 simply means we can expect one death every two years from a cause. If we were to construct tables of deaths broken down by age groups and sex for deaths in Australia from a huge number of relatively uncommon deaths, the same concern would have it that there were "no deaths" in Australia in the average year from measles, whooping cough or lightening strikes to name three because for most age groups, only annual "fractional" deaths occur. My crime here, was to advise my colleagues that it would be sensible to express the estimated number of deaths from ETS in a way that would be more intelligible to the ordinary reader. The final report did that, but did not somehow "alter" the original estimate as Dr Quinn's offensive comments imply. 6. Dr Quinn's final effort at implying I accept support from the pharmaceutical industry and do not acknowledge it is also incorrect. The newspaper report to which he refers arose when a report I authored on trends and influences on smoking cessation in Australia was faxed to a journalist. Acknowledgement of SmithKlineBeecham sponsorship of the report was clearly printed on the report. The colour contrast of the lettering of the acknowledgement with the colour of the page on which it appeared did not carry when it was faxed. The journalist called me asking why there was no acknowledgement. I explained that there indeed was; and that the contrast problem was probably responsible for this misperception. A copy was immediately couriered to the journalist, who nonethless ran her muck raking story as planned, gathering condemning quotes from people who had not been told that acknowledgement indeed had been given. A formal complaint about this incident was lodged with the editor of the newspaper. 7. Tobacco Control has a "cozy" relationship with the BMJ. In fact the BMJ publishes Tobacco Control. Your point? 8. Our contributors are "warriors on the front lines of the war on smokers". The war is on smoking, not on smokers.
ethics and tobacco 1 November 2002
susanne stevens, researcher cf24 3pf2 Pen y lan road Send response to journal: Re: ethics and tobacco	richard smith did the right thing. Pity others did not. I wrote to several government ministers, the Health ministers of all parties, the BMA, the GMC - nobody wanted to take action including ASH regarding the use of BAT funding by Prof Gray of the Institute of Psychiatry to carry out research on brain disorders, he especially mentioned alzeimers in his response to me by letter. In this letter he stated that he is not uncomfortable about his decision to use tobacco money as it was for the greater good. On wards in other parts of the Institute people with mental health problems have these exacerbated by high use of tobacco to deal with stress. Some time later a government minister was swaning about Asia promoting sales of tobacco tas a representative of BAT. The appalling medical services in these countries mean many will die a horrible early death leaving relatives in lifelong misery.There can be no trade of lives , Prof Gray's research should ever have been funded by BAT. Competing interests:   None declared