Wetenschap wordt het zwijgen opgelegd

This investigation of the career of the smoking article was somewhat serendipitous. What was to be an examination of rapid responses led us to the media and tobacco industry coverage of the smoking article, as partisans worried that the results would be used to stymie public health efforts. The relative paucity and strong imbalance of the coverage of the smoking article led us to examine the media discourse on smoking in general. From the present perspective, our narrative has been developed backwards.

A realistic starting point is the cascading moral crusade to protect public health by policing smoking. Smokers, as ever-present persons who are killing themselves and killing or harming others, present an ideal moral and political target. The threat posed by these folk devils is understandable, visible and bothersome, fear inspiring, and, unlike many other threats, readily subject to social controls. Partisans are engaged in loosely connected rolling crusades, local skirmishes that can go regional or even national, as well as in international movements that continually ratchet up both anxieties and efforts at social control.

Partisans are allies of science, but only in so far as it furthers their crusades. Moral concerns—we are speaking of the deaths of innocent victims here—trump scientific truth seeking and partisans have no use or tolerance for conflicting results or scientific doubts.

Their TRUTH has been proved beyond any possible doubt, and any revisionism is clearly in error and cannot be tolerated since it might impede their life-saving campaigns. This moral imperative appears to have generalized to public arenas, particularly the media, where the harm attributed to smoking is simply a given that authorizes efforts to police it. Hence discourse can deal with the mechanisms or means of protecting people from side-stream smoke; but the prior question of the need to do so is hardly intelligible.

Then the BMJ, in pursuit of good science, published the smoking article. But an inflammatory headline by this high status journal, coupled with the historic significance of this long-term study commenced by the American Cancer Society, led partisans to vent their wrath on the relatively obscure BMJ Web site. In this regard, it is significant that no newspaper story covered the rapid responses themselves (they make a remarkable read), again suggesting self-silencing about a skirmish replete with personalized and readily balanced conflict. In the same vein, partisan fears of media coverage were clearly exaggerated. It is surprising, and an open question as to why the partisans attacking the BMJ did not appreciate the extent to which media self-silencing prevails around the issue of secondhand smoke. A further question that our data do not address is whether the rapid attack on the journal and editor will render editors more circumspect in the future.

For partisans, self-silencing, with its small footprint, is obviously more desirable than public silencing skirmishes. Drug companies, claiming proprietary rights over their research, have also been found to withhold or provide minimal publicity to negative findings. But rebellious scientists, journals, and regulatory agencies seek to pry open the research record, creating the possibility of public skirmishes that often end up in the courts. Overall, there are a number of reasons to expect that silencing skirmishes will become more frequent and extreme.

The growth of big science, with the increasing funding of research by interested organizations, exacerbates conflicting interests and the scope of scientific controversies. If partisans don’t like the findings—or, more to the point, regard them as unthinkable and intolerable—they can try to pry open the biases of the funding agencies or the researchers.

Big science is also increasingly tied to social policy and risk decisions, rendering its findings of great concern to a wide range of interested parties. Effectively, different groups are seeking to claim ownership over particular Truths, and science is now a central factor in sustaining their versions of reality. Underwritten by strong moral concerns, these white knights tilt at windmills of “error.” Silencing skirmishes—partisans trying to mute certain results and others trying to pry them open—are likely to increase in frequency and intensity.

As this is being written, the FDA decision to bar its top expert from testifying about antidepressants and childhood suicides has already had a series of implications. Specifically, the New York State attorney general has brought a civil law suit again GlaxoSmithKline for concealing negative information about the effects of its antidepressant medicine Paxil on adolescents. In response, the company is posting the unpublished test data on its Web site.

At the same time, the FDA has commissioned a review of the effects of antidepressants, while the International Committee of Medical Journal Editors is considering a proposal that would require drug makers to register clinical trials at their start in a public database (Harris, 2004b; Meier, 2004). The dynamics of these skirmishes form a fascinating and significant research topic.