The fatal flaws in the paper by Enstrom and Kabat (BMJ 2003;326:1057-
0) are evident in the title of the article and in the Objective statement.
The title claims the study is "a prospective study." It is not by any
contemporary definition of the term. The failure to apply the same
measures and definitions of exposure to ETS over the duration of the study
is just one of several egregious deviatons from a credible prospective
research design.
The study Objective: "measure the relation between ETS as determied
by smoking in spouses and long-term mortality from tobacco related
disease," is bizarre and misleading. How can one possibly expect to
determine the relationship between ETS and tobacco-related mortality by
defining ETS as "spousal smoking" alone. The authors apparently elected to
discount the obvious fact that during the first two decades of the study
period the public was awash in ETS, at home, in the workplace and in
social gatherings. This problem and the failure to use consistent measures
of ETS exposure throughout the study make any interpretation of study
findings an excercise in futility.
Competing interests:
None declared
Competing interests:
No competing interests
17 May 2003
Stephen J. Jay
Professor of Medicine and Public Health
Indiana University School of Medicine, 1050 Wishard Blvd. RG 4175, Indianapolis, IN. 46202
Rapid Response:
Study Objective Flawed--Fatally
The fatal flaws in the paper by Enstrom and Kabat (BMJ 2003;326:1057-
0) are evident in the title of the article and in the Objective statement.
The title claims the study is "a prospective study." It is not by any
contemporary definition of the term. The failure to apply the same
measures and definitions of exposure to ETS over the duration of the study
is just one of several egregious deviatons from a credible prospective
research design.
The study Objective: "measure the relation between ETS as determied
by smoking in spouses and long-term mortality from tobacco related
disease," is bizarre and misleading. How can one possibly expect to
determine the relationship between ETS and tobacco-related mortality by
defining ETS as "spousal smoking" alone. The authors apparently elected to
discount the obvious fact that during the first two decades of the study
period the public was awash in ETS, at home, in the workplace and in
social gatherings. This problem and the failure to use consistent measures
of ETS exposure throughout the study make any interpretation of study
findings an excercise in futility.
Competing interests:
None declared
Competing interests: No competing interests