Failing to bark and barking

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7394.882/a (Published 19 April 2003) Cite this as: BMJ 2003;326:882
  1. Hugh Tunstall-Pedoe, professor of cardiovascular epidemiology (h.tunstallpedoe{at}dundee.ac.uk)
  1. Cardiovascular Epidemiology Unit, University of Dundee, Ninewells Hospital, Dundee DD1 9SY

    EDITOR—Le Fanu's Sherlock Holmes style case of the missing data and dog that failed to bark had amusing elements but also misunderstandings, errors, and accusations of concealment, implying bad faith.1

    • Twenty one countries took part in the World Health Organization's monitoring trends and determinants in cardiovascular disease (MONICA) project, not 27.

    • MONICA had set out to validate and explain such trends. Our 1999 paper on trend results was big news internationally, including the BMJ,2 but apparently Le Fanu missed it.

    • Mortality data are freely downloadable from the World Health Organization. The dearth of publications on mortality trends in scientific journals is not from conspiracy. Any novice can have a go, so editors and reviewers are overburdened with enthusiasts trying to prove things badly. Works of scholarship may have an uphill fight for publication because routine mortality statistics are considered trivial and unscientific compared with laboratory studies.

    • Americans did not study immigrants just from Japan. Studies go back 55 years, classically contrasting New York's Italians with its Jews, and Irish and Norwegians in the United States with brothers in the home country, more recently focusing on Hispanics and newer ethnic groups. Disease rates are easier to study with first generation migrants, place of birth providing a census denominator, than later on.

    • Smoking shows all or none differences in one population, where diet has historically been more uniform. Diet differs greatly between populations, thereby determining a population's susceptibility to cardiovascular disease and also to specific cancers. The cholesterol story is well established, but diet is now known to contain more varied contributors to coronary risk than dairy fats alone.

    • Le Fanu's unoriginal suggestion that coronary disease has an infective origin would not in itself explain why it took 10 years to cross the Atlantic as an epidemic, and half a century to reach eastern Europe. Lifestyle fits better. Existing explanations for disease trends must give way to better ones, but they must be more specific than that.

    Le Fanu claimed in the Sunday Telegraph Magazine in 2000 that I published research that I knew to be false, that was nonsense and quackery, and that I was a danger to the public.3 Although now apparently running with the fox as well as hunting with the hounds, by characterising MONICA collaborators as not barking he claims the opposite role for himself.


    • Competing interests HT-P was a project author and principal investigator in the WHO MONICA project.

    • A longer version of this letter complete with references is available at bmj.com/cgi/eletters/325/7378/1490#30160


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