Emerging tobacco hazards in China: 2. Early mortality results from a prospective study
BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7170.1423 (Published 21 November 1998) Cite this as: BMJ 1998;317:1423
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Even for a traditional medical journal as the BMJ, the Internet
allows a lively discussion and obviously attracts also readers outside the
medical community. The editorial registrar qualified the unusually harsh
electronic responses by Carol AS Thompson (1) as "a combination of
aggression, intolerance, stupidity and fanatism"(2). Furthermore, the
combination of these attributes reminded him of Nazi propaganda. As an
Austrian he has to be sensitive by nature for early signs of this
mentality.
The reaction by Carol AS Thompson may, however, also be seen from a
different perspective. Carol AS Thompson is not a physician and therefore
not used to behave properly in the framework of a highly ranked medical
journal. Nevertheless, she was brave enough to post her opinion in an
unaccustomed environment. In addition, Carol AS Thompson is supposed to be
cigarette smoking dependent and therefore her view of the real problem may
be blurred.
Nicotine dependent cigarette smokers have shown to exhibit increased
lifetime rates of major depression and anxiety disorders (3). Smokers with
more than 20 cigarettes per day were more likely to exhibit cognitive
dissonance over smoking-related health beliefs than were lighter smokers
(4).
In contrast, offensive behaviour is not due to smoking. Smoking of
nicotine containing cigarettes has been found to suppress human aggressive
behaviour (5). Nicotine, administered with experimental cigarettes also
showed to produce a dose-dependent decrease of aggressive behaviour in
humans. (6).
The burden of disease caused by smoking is too obvious to be denied
without contradiction.
Carol AS Thompson, you have demonstrated interest in this field otherwise
you would not have found this article in the Internet. You also have shown
courage to post your viewpoint in one of the most traditional medical
journals. The data on smoking related diseases are all true. Smoking is a
deadly disease. Fill up with new courage, stop smoking and throw your last
butt in a tar pit where it belongs.
References:
1. C. Thompson. Throw Peto in a tar pit. eBMJ, 13 Dec, 1998
(www.bmj.com/cgi/content/full/317/7170/1423#responses)
2 M. Muellner. Thank you Carol AS Thompson. eBMJ, 15 Dec 1998
(ww.bmj.com/cgi/content/317/7170/1423#responses)
3. N. Breslau, M. M. Kilbey, and P. Andreski. Vulnerability to
psychopathology in nicotine-dependent smokers: an epidemiologic study of
young adults. Am.J.Psychiatry 150 (6):941-946, 1993.
4. M. T. Halpern. Effect of smoking characteristics on cognitive
dissonance in current and former smokers. Addict.Behav. 19 (2):209-217,
1994.
5. D. R. Cherek. Effects of cigarette smoking on human aggressive
behavior. Prog.Clin.Biol.Res. 169:333-344, 1984.
6. D. R. Cherek. Effects of cigarette smoking of nicotine on human
aggressive behaviour Psychopharmacology. 75(4):339-345, 1981.
Michael Binder, MD
Decision Systems Group
Brigham and Woman´s Hospital
Boston, MA 02115
mbinder@dsg.harvard.edu
Competing interests: No competing interests
Electronic letters submitted to the BMJ are usually read by at least
one member of the editorial team before they are posted on the web. This
is done for various reasons, the most important being the assurance of a
minimum standard. Even though space on the web is virtually unlimited, our
readers do not possess unlimited patience and so we try to publish
substantiated opinions which contribute significantly to the related
subject. Our readers may not realise that a letter published in the eBMJ
is also eligible to be published in the paper version of the BMJ.
Yesterday, when I was scanning the electronic letters submitted to
the eBMJ two letters (1,2) immediately captured my attention, both written
by the same person: Carol AS Thompson, a machine operator at Falmbeau
Micro Plastics Factory, and definitely a hater of anti-smokers. I suppose
she is also a heavy smoker, obviously afraid of a smoke free environment.
My first reaction was to delete them, as this opinion is not substantiated
(at least not in the way it is presented), and nor does it contribute to
the related subject in a meaningful way. So, why should it be on the web?
However, there are reasons to present letters like these at times: the BMJ
respects freedom of speech, as well as each person's right to make a fool
of himself / herself. This is my response as a member of the editorial
team.
Still I felt inclined to comment as a reader, as well. I do not want
to defend the scientific value of these two papers and an editorial
(3,4,5), which caused this eruption of emotions. There may be enough room
for criticism, but unfortunately Carol Thompson was not able to develop
her arguments. I also do not wish to criticise her poor language skills,
as mine are not brilliant either. Nor do I want to go into detail
concerning the pseudoscientific statements by Carol Thompson, that smoking
related diseases are "actually caused by viruses and bacteria". I do want
to address the tone of these letters briefly. Apart from the topic, they
read almost like Nazi propaganda: a combination of aggression,
intolerance, stupidity and fanatism. When reading these letters, I hardly
could avoid thinking of all the destruction and grief that was caused by
these obviously very human attributes. We don't have to go far back into
history, or far away (geographically) to see appalling examples of
fanatism and its sequels: unspeakable (often even unthinkable) things
happened before, they happen now, and, unfortunately, will happen again
and again; it is just a question of the scale. Are there any means to
prevent this, like population based interventions to increase tolerance
and open-mindedness? Maybe these letters of Carol Thompson serve as a good
aid to bear these aims in mind too.
Finally, two questions from a reader to Carol Thompson:
1) Why did you bother to write two almost identical letters? The
power of your arguments does not increase, nor do the arguments become
more reasonable when you add them up. Or was your intention to undermine
this hypocritical and deliberately fraudulent system by trying to waste
the readers time?
2) Did you ever consider that science is more than results presented
in a journal or a newspaper? Use your brain for more than just basal
functions. Try to think and reflect, it's fun!
Yours sincerely
Marcus Müllner, BMJ Editorial Registrar
Conflicts of interest: many. I work for the BMJ, I am a physician
(during my training in Internal Medicine in Austria I saw many people
suffering and dying from smoking related diseases), I am a smoker who
tries hard (and relatively successful) not to smoke because it really is
dangerous (for me and my environment).
References:
1) Carol AS Thompson. Throw Peto in a tar pit eBMJ, 13 Dec 1998
(www.bmj.com/cgi/content/full/317/7170/1423#responses)
2) Carol AS Thompson. Anti-smokers lie about health risks of smoking,
eBMJ, 13 Dec 1998 (www.bmj.com/cgi/eletters/317/7170/1399#EL2?)
3) Shi-Ru Niu, Gong-Huang Yang, Zheng-Ming Chen, Jun-Ling Wang, Gong-
Hao Wang, Xing-Zhou He, Helen Schoepff, Jillian Boreham, Hong-Chao Pan,
and Richard Peto. Emerging tobacco hazards in China: 2. Early mortality
results from a prospective Study. BMJ 1998; 317: 1423-1424
4) Shi-Ru Niu, Gong-Huang Yang, Zheng-Ming Chen, Jun-Ling Wang, Gong-
Hao Wang, Xing-Zhou He, Helen Schoepff, Jillian Boreham, Hong-Chao Pan,
and Richard Peto. Emerging tobacco hazards in China: 2. Early mortality
results from a prospective study. BMJ 1998 317: 1423-1424
5) Lopez AD. Counting the dead in China: Measuring tobacco's impact
in the developing world BMJ 1998;317:1399-1400
Competing interests: No competing interests
Studies which merely compare the death rates of smokers versus non-
smokers are nothing less than deliberate scientific fraud. These studies
purposely exploit the defect of confounding, to falsely blame smoking for
diseases that it does not cause.
We now know that most of the supposed "smoking related diseases" are
actually caused by viruses and bacteria. The anti-smokers falsely blamed
smoking for stomach cancer and ulcers caused by Helicobacter pylori; for
cervical cancer, esophageal cancer, and bladder cancer actually caused by
human papillomavirus; for asthma actually caused by Chlamydia trachomatis;
and for heart disease actually caused by Chlamydia pneumoniae and other
infection.
For some of these diseases, notably ulcers, stomach cancer, and
cervical cancer, the supposed association with smoking, which was
proclaimed to us to be "causal," was entirely due to confounding. For the
other diseases, "the evidence is mounting," to steal a phrase from the
anti-smokers, and the anti-smokers' "mountain of evidence" is washing away
like sand.
But it seems that there are certain old dinosaurs who want to freeze
science in the golden age of ignorance of the 1980s, namely Richard Peto
and his ilk. Throw this old relic in a tar pit where he belongs!
Competing interests: No competing interests
Kudos
<P> I was delighted to see these publications and commend the
authors for
an excellent piece of work. As appalling and disturbing as are the facts
presented in the articles, ignoring them will not serve humanity.
Pretending that the data are otherwise is tantamount to subscribing to the
flat earth theory. The only way this current epidemic of smoking related
deaths will abate is when everyone, everywhere understands the facts and
implications put forth in these articles. Otherwise I fear that the
situation will be even worse than predicted.
<P> Thank you for forcing the world to look at a truly
frightening scenario. I look forward
to perusing all of your future work.
<P> Sincerely,
<P> Ari Ma'ayan
BioModa, Inc.
www.biomoda.com
Competing interests: No competing interests