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What Chest & ACCP should do about the Ohar, et al article

Lawrence Martin, M.D., FCCP

First, let me state what Chest and ACCP should not do. They should not 'do nothing.' Interested parties will sooner or later find their way to this web site, and wonder. And not just people with an interest in asbestos diseases, but also people interested in medical journal integrity, or in junk science, or in conflict-of-interest issues. If Chest and ACCP do nothing, then their silence in the face of solid evidence about the article will create an unhealthy undercurrent for an otherwise prestigious medical journal. Like it or not, Chest and ACCP have stamped their imprimatur on an article that gives false credibility to a well recognized scam. It is not too late to correct that mistake.

Medical journals, like any institution, are run by fallible people, and mistakes are made all the time -- there's nothing inherently wrong in that. New England Journal of Medicine, JAMA, and other prestigious journals have all published regettable articles (junk science, bogus research, author conflict of interest), and owned up to it in later issues, either by publishing critical letters from readers, or in their own editorial comments.

Furthermore, by doing nothing, Chest and ACCP deprive the authors of a chance to respond to my allegations, to rebut what I've written (or, perhaps, even to gracefully retract their work).

Lastly, by doing nothing Chest and ACCP will deprive their readers -- about whom they should be most concerned -- of access to honest scientific discourse. Doing nothing will seem the easiest option, but in the long run it is not in their best interest.

Chest and ACCP should also not attack the messenger. They should not file suit to have my web pages removed, or try to kick me out of ACCP. I state this pre-emptively, and believe none of these actions is likely, but they have crossed my mind. Asbestos plaintiff attorneys have unlimited funds and enormous political power; they could conceivably team up with ACCP in an attempt to squelch this web site or 'discredit the expert' (a favorite legal tactic when your case has no merit). I am counting on the U.S. Constitution, ACCP's integrity as a scientific organization, and the power of the internet to keep that from happening.

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Before I recommend what Chest should do, I will point out one irony of this affair. I had no trouble publishing an e-letter on Chest's web site. In this letter, which I titled Asbestos Literature Does Not Support Study Conclusions, I provide 14 references that refute the Ohar et al article; with the exception of one reference that came out after the Ohar et al article, they are the same as in the original letter. The big difference between my e-letter and the original letter is that the former omits the legal references, and I say nothing specifically derogatory about the current state of asbestos screening. Otherwise the letters contain the same basic information. It remains a mystery why Chest did not ask me to revise my original letter, or explain what, exactly, offended the editors or reviewers.

Unfortunately, e-letters are not read unless someone is specifically looking for a response to a specific article on-line, and e-letters don't end up in Medline data bases. The e-letter is not even sent to the original authors for a response. The e-letter is perhaps better than nothing, but not the same as getting a printed rebuttal into the pages of Chest.

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Now, as to what Chest & ACCP should do, I recommend one of the following:

1) Retract the article. State that, since it was based on x-ray reports solicted by plaintiff attorneys, the sole purpose of which is to generate lawsuits, and that the reports were never objectively validated, that the article raises serious medical-legal and ethical questions. Explain that an article based on such biased data does not conform to Chest's role as a scientific journal, and must be retracted. Ideally, such retraction should be agreed to by the authors.

2) Realistically, a retraction is highly unlikely. Option #2 is to print my original letter, and invite response from the article's authors, plus responses from other physicians whose work I've cited. Chest can publish all these responses as a one time 'Symposium', stating that the issue is very controversial, that Dr. Martin has raised some important questions, and that no more will be printed about this controversy henceforth. At least that way, any future reference to the Ohar et al article will also have to mention the follow-up Symposium, and allow readers to see both sides of the issue. That would be a reasonable approach for a reputable medical journal.

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