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Communications to the Editor |

Lung Cancer Screening: Response to Jerome Reich, MD FREE TO VIEW

Frederic W. Grannis, Jr
Author and Funding Information

City of Hope National Medical Center, Duarte, CA

Correspondence to: Frederic W. Grannis, Jr., MD, City of Hope National Medical Center, Department of General Oncologic Surgery, 1500 E. Duarte Rd, Duarte, CA 91010; e-mail: fgrannis@coh.org



Chest. 2004;125(1):350-351. doi:10.1378/chest.125.1.350
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To the Editor:

Dr. Jerome Reich suggests that mendacity (a habit of lying) and conflict of interest (COI) taint my letter. Some background information is required to allow the reader to assess whether this is accurate. Dr. Jerome Reich and I have previously debated the issue of lung cancer screening (LCS) in CHEST.13 Reich first contacted me following publication of my article in CHEST, “The Gyanousa am Loose,” in the belief that I might have read his letter in the same issue and been “prompted” to respond.4 I assured him that I had not read his letter. He offered to send me a manuscript, which “expands the views in the letter.” I read this manuscript, and responded that I thought that there were numerous factual errors and incorrect assumptions in it.

At a later date, I was asked by the editor of CHEST to review the (unaltered) Reich manuscript. I informed the editor of my previous correspondence with Reich and suggested that this might make an editorial review by me improper. I was instructed to proceed, and wrote a formal review, highly critical of Reich’s manuscript, but suggested that the work be published to foster public debate. I hope that Dr. Reich would respond to requests to anonymously review a manuscript or grant proposal by me with the same honesty and candor. I stand by my assertion that the “postulates” or assumptions used by Reich are inaccurate and misleading.

Reich is within his rights to worry that personal financial benefit (COI) may introduce bias and mendacity into public policy on LCS. Because Dr. Reich has raised this question of me, despite my clear, prior statement that “surgeons (like myself) might benefit financially from screening,” I am informing the editors and readers of CHEST that I have been paid a salary of $225,000 by the California Cancer Specialists Medical Group/City of Hope National Medical Center for the past 6 years, and last year, for the first time, received a bonus of $7,000, unrelated in any way to screening.2 I have been a principal co-investigator in the International-Early Lung Cancer Action Project (I-ELCAP) study since 1999. In this capacity, we have received a $30,000 grant for data collection, and receive travel and accommodations to I-ELCAP meetings twice each year. My advocacy of lung cancer radiographic screening antedates these financial considerations by more than 2 decades, dating back to residency tutelage under Robert Fontana, MD, and his colleagues during the Mayo Lung Trial in the 1970s. In private practice, my medical records and lecture notes show that I have consistently advocated radiographic screening of high-risk patients since 1978.

While I agree with Reich that “integrity is the currency of scientific discourse,” his unquestioning faith that medical authors, myself excepted, are truthful and require no oversight is naïve. The pages of medical journals and newspapers report multiple recent major scandals involving individual researchers, journals, universities, managed care organizations, hospital chains, and drug and medical device manufacturers. This problem is reflected in the recent strengthening of potential COI policies by most medical journals.5 To find further examples of potential COI in LCS, Dr. Reich need go no further than authors he cites in his own references. I have reported one such example of potential COI elsewhere, and another letter has been accepted for publication in the American Journal of Pulmonary and Critical Care Medicine.6 If Reich searches for the authors named in his references among the tobacco industry documents in the University of California, San Francisco Legacy Tobacco Documents Library at http://legacy.library.ucsf.edu/, he will find many documents referring to two more of his cited authors.

I will conclude this sometimes acrimonious dialogue with Dr. Reich by reminding CHEST readers that the clinician currently has two research-based protocols in which his/her patients may participate, to help to resolve questions about the value of LCS. The National Cancer Institute prospective, randomized National Lung Screening Trial, favored by Reich, can be accessed at http://www.nci.nih.gov/NLST. The prospective, single-arm International Early Lung Cancer Action Project (I-ELCAP) study, which I believe is enhanced by carefully crafted and validated protocol guidelines for workup and treatment of screen-detected nodules, is available at http://icscreen.med.cornell.edu/. I-ELCAP has tallied > 19,000 baseline and 13,000 annual-repeat screens, and early data suggest that the screening protocol is effective and safe. Either study is an improvement over our current apathetic, nihilistic, and futile approach toward early diagnosis and treatment of lung cancer.

References

Reich, JM (2002) Improved survival and higher mortality: the conundrum of lung cancer screening.Chest122,329-337. [CrossRef] [PubMed]
 
Grannis, FW Lung cancer screening: conundrum or contumacy?Chest2002;122,1-2. [CrossRef] [PubMed]
 
Reich, JM Lung cancer screening: contumacy vs mendacity.Chest2003;123,963-964. [CrossRef] [PubMed]
 
Grannis, FW Lung cancer overdiagnosis bias: “the gyanousa am loose”Chest2001;119,322-323. [CrossRef]
 
Bland, KI Editorial comment on scientific fraud.Ann Surg Oncol2002;9,419-420. [CrossRef] [PubMed]
 
Grannis, FW Potential conflict of interest.Lung Cancer2002;38,103-104. [CrossRef] [PubMed]
 

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Tables

References

Reich, JM (2002) Improved survival and higher mortality: the conundrum of lung cancer screening.Chest122,329-337. [CrossRef] [PubMed]
 
Grannis, FW Lung cancer screening: conundrum or contumacy?Chest2002;122,1-2. [CrossRef] [PubMed]
 
Reich, JM Lung cancer screening: contumacy vs mendacity.Chest2003;123,963-964. [CrossRef] [PubMed]
 
Grannis, FW Lung cancer overdiagnosis bias: “the gyanousa am loose”Chest2001;119,322-323. [CrossRef]
 
Bland, KI Editorial comment on scientific fraud.Ann Surg Oncol2002;9,419-420. [CrossRef] [PubMed]
 
Grannis, FW Potential conflict of interest.Lung Cancer2002;38,103-104. [CrossRef] [PubMed]
 
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