ASH in de verdediging na kritiek op onderzoeken

De ontzenuwing van de fabel dat rookverboden het aantal opnames voor hartaanvallen snel doen dalen (ook nog steeds geroepen door Ab Klink) heeft de Engelse anti-rokenorganisatie ASH er toe gezet om wild om zich heen te slaan. Wie nou zou denken dat ze met goed wetenschappelijk weerwoord zijn gekomen, kent de anti-rokenbeweging nog niet. Nee, in een artikel in het blad Expert Review of Pharmacoeconomics and Outcomes Research worden in twee verschillende artikelen de boodschappers van deze kritiek vergeleken met degenen die beweren dat HIV en AIDS niets met elkaar te maken hebben. Het tweede artikel maakt een nóg heftiger vergelijking: degenen die wetenschappelijk gefundeerde kritiek hebben laten horen zijn holocaust-ontkenners.

Op de man spelen en niet op de bal is regel nummer 1 voor gepaste kritiek tegen dissidenten in de anti-rokershandleiding die elke beginnende anti-roker als het rooie boekje dient door te spitten alvorens hij mee mag gaan roepen.

Dr. Michael Siegel van de Universiteit van Boston, zélf dissident, heeft dat rode boekje al eens samengevat op zijn blog. Deze keer gaat hij in het blad MediLexicon in op de artikelen van de ASH-medewerkers.

This article demonstrates the religious-like and McCarthyist-like nature of the modern-day anti-smoking movement. If you do not subscribe to the accepted dogma of the movement, even when there is legitimate scientific evidence that brings that dogma into question, you are a dissident and a denialist — on no firmer ground than those who deny that AIDS is caused by the HIV virus. Moreover, you are not expressing a sincere opinion, but are in the pocket of the tobacco industry, part of an orchestrated industry campaign.

The absurdity of the article is evident in its implication that I – a strong anti-smoking advocate – am a denialist who is being orchestrated by the tobacco companies to disseminate conspiracy theories – since I myself have been a vocal critic of the conclusions of these heart attack/smoking ban studies.

Someone who has argued that secondhand smoke kills over 50,000 Americans each year and whose testimony about the tobacco industry’s deception of the public contributed towards a $145 billion verdict against the companies is hardly someone who fits the description of being a denialist who is waving around conspiracy theories under orchestration by Big Tobacco.

To be sure, historically the tobacco industry has orchestrated campaigns to undermine the public’s appreciation of the recognized hazards of active smoking and secondhand smoke exposure. If you want to read about that history, you need go only so far as to read my testimony in the Engle tobacco case, which initially resulted in a $145 billion verdict against the tobacco companies. It is also true that a number of supposedly independent scientists who have challenged the link between smoking or secondhand smoke and disease have been funded by the industry and have been part of a campaign orchestrated by the industry.

However, the criticism of the research linking smoking bans with a causal effect on acute cardiac events is largely a different story. First, the nature of the evidence is very different. While there is abundant evidence linking smoking and disease and one would have to be a denialist to argue that smoking is not harmful, the research being used to conclude that smoking bans result in huge, immediate declines in heart attacks is very weak. These conclusions are based on time trend analyses, often without a control group, they cannot adequately determine whether observed changes reflect random variation, secular trends, or a real effect of the smoking ban, and thus causal conclusions from these studies are very shaky.

I will not take the time here to explain all the methodologic weaknesses of these studies, but interested readers will find an extensive set of commentaries on my blog which critique this literature.