Editor—The questions raised about the validity of the data reported by Enstrom and Kabat call into question the adequacy of the peer and editorial review of the paper at the BMJ.1 Apparently no one with special expertise in research on the health effects of passive smoking was involved in the review of this paper. In an area as complex as this—to which massive reports have been devoted2,3—one or more persons with epidemiological expertise and an extensive knowledge of the literature on this subject should have been involved in the review of this paper. The obligation to find such a reviewer is heightened when one considers the authors' conflicts of interest and the fact that the paper challenges a huge body of evidence in an area of enormous public health importance.
The BMJ's press release for this paper looks as if it was written by the tobacco industry. It refers to the “already controversial debate on the health impact of passive smoking” and mostly parrots the views of Enstrom and Kabat. In its eight paragraphs, the release allocates three words to the study's limitations. The coup de grâce is that the release does not mention the authors' conflicts of interest. This problem is not unique to the BMJ. An analysis of press releases issued by seven medical journals (including the BMJ) included 23 studies that were industry funded; only 22% of the corresponding press releases revealed the source of funding.4
Competing interests: RMD has been active in tobacco research and tobacco control advocacy since 1979. From 1991 to 1998, he was editor of the journal Tobacco Control, which is published by the BMJ Publishing Group. He served as North American editor of the BMJ from 1998 to 2001. He has served as an expert witness in many tobacco related lawsuits (including two devoted to passive smoking) but has derived no personal income from such work (fees for his services have been paid to his employer, as he is a salaried employee).
References
- 1.Enstrom JE, Kabat, GC. Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98. BMJ 2003;326: 1057. (17 May.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.US Environmental Protection Agency. Respiratory health effects of passive smoking: lung cancer and other disorders. Washington, DC: EPA, 1992. (Publication EPA/600/6-90/006F.)
- 3.California Environmental Protection Agency, Office of Environmental Health Hazard Assessment. Health effects of exposure to environmental tobacco smoke. Sacramento: California Environmental Protection Agency, 1997.
- 4.Woloshin S, Schwartz LM. Press releases: translating research into news. JAMA 2002; 287: 2856-8. [DOI] [PubMed] [Google Scholar]