Thursday, 28 May 2015

BMJ What's your weakness?

Editor's Choice

What’s your weakness?

BMJ 2015; 350 doi: (Published 21 May 2015) Cite this as: BMJ 2015;350:h2742
  1. Kamran Abbasi, international editor, The BMJ
We all have weaknesses. Tickets to the Chelsea flower show, a test match at the Oval, La Traviata at Glyndebourne, or a Paul McCartney concert at the O2 arena. What tempts you most? One of these five star events, with hospitality thrown in, surely will? We all have weaknesses, and companies know it. The world of corporate hospitality depends on it. Shouldn’t we expect politicians, of all people, to understand that there are no free lunches? The payer wants something from you. It might be something trivial, like your heart, but it might also be your integrity. What if those free tickets were offered by a tobacco company? What’s in danger, your heart or your integrity?
Jonathan Gornall’s inquiry into the influence of the tobacco industry on UK parliamentarians reveals that 38 members of parliament have accepted hospitality from the tobacco industry on 55 occasions since 2010 (doi:10.1136/bmj.h2509). Nine peers own shares in tobacco companies. In 2013 one of those companies, Japan Tobacco International, made an operating profit of £3bn. Japan Tobacco International is usually shortened to JTI, so the nature of the company may not be immediately obvious when scouring parliament’s register of members’ interests. Importantly, 20 of those 38 MPs voted against plain packaging on tobacco products earlier this year. The MPs will argue that they were not persuaded by hospitality, but it is clear from Gornall’s report that the tobacco industry sees hospitality as a way of exerting its influence to ensure “some balance remains in the debate.”
In certain circumstances our tolerance of tobacco is now casual. Waterpipe smoking, better known as shisha or hookah, was once a social pastime in decline. Now it is a youth phenomenon and a global public health epidemic. It is made palatable by flavoured, sweetened tobacco (maasel); made fashionable and feasible by sharing information on the internet and social media. The hazards of waterpipe smoking are quickly emerging (doi:10.1136/bmj.h1991). Wasim Maziak explains that there is an expected association with known risks of tobacco smoking, such as lung cancer and cardiovascular disease. But waterpipe smoking also brings unique health problems. Several cases of carbon monoxide poisoning are reported, with a particular concern about the popularity of waterpipe smoking among women and its effects on pregnancy. Crucially, waterpipe smoking thwarts smoking cessation initiatives, initiates cigarette smoking, and harms non-smokers. Despite the growing evidence base, waterpipe smoking remains under the radar of most tobacco control policies. We need a clear and comprehensive regulatory approach.
Being guided by the evidence mattered to David Sackett. He invented clinical epidemiology and coined the phrase “critical appraisal.” He was widely recognised, says Richard Smith in an obituary of Sackett, as “the father of evidence based medicine” (doi:10.1136/bmj.h2639). Sackett was against the concept of “experts” and argued that after 10 years of being an expert you should stop. True to his word, he delivered his last lecture on evidence based medicine in 1999. Evidence based medicine has advanced several steps since, including with the movement to make anonymised patient level data from clinical trials widely accessible. The BMJ is intimately associated with the evidence based medicine movement and the push for data sharing ( From July our data sharing policy will be extended from trials of drugs and devices to all clinical trials (doi:10.1136/bmj.h2373). Companies have their weaknesses but, as Sackett acknowledged with his 10 year rule, so do academics.


Cite this as: BMJ 2015;350:h2742