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Communications to the Editor |

Re: Contumacy vs Mendacity Revisited; Response to Dr. Grannis’ Letter FREE TO VIEW

Jerome Reich
Author and Funding Information

Portland, OR

Correspondence to: Jerome Reich, MD, FCCP, 7400 SW Barnes Rd, A622, Portland, OR 97225; e-mail: Reichje@dnamail.com



Chest. 2004;125(1):351-352. doi:10.1378/chest.125.1.351
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Published online

To the Editor:

Thank you for giving me this opportunity to respond the four issues raised by Dr. Grannis in his letter.

The American Heritage Dictionary (3rd ed.) offers the following definitions of the word: “1. The condition of being mendacious; untruthfulness. 2. A lie; a falsehood.” In his editorial response1 to my article,2 Dr. Grannis stated that “Reich goes on to postulate that not only are 33% of LCs [lung cancers] ‘pseudodisease’(ie, nonlethal if untreated), but that another 33% are ‘nonaggressive’ in their behavior. This is at variance with the data from thousands of clinical series examining this disease.” And, “He postulates that death occurs when FEV1 falls to 1 L” [italics added]. In the section dealing with the long-term sequelae of lobectomy,,2 I prefaced the notional figures supplied in this model, whose purpose was to account for the seeming paradox of higher survival and increased mortality in the screened cohorts vs controls, with “Consider the following hypothetical scenario.” In this hypothetical scenario involving two 3,000-sized cohorts, I assumed that LC developed in 10%, divided equally into aggressive, indolent, or overdiagnosed phenotypes, all in the first year, all in the left upper lobe, and that all were treated with lobectomy. I wrote, “Assume further that… excess deaths from respiratory failure, pneumonia, or coronary disease occur when the mean FEV1 falls to 1 L… ” To postulate is “to assume or assert the truth, reality, or necessity of, especially as a basis for an argument” (American Heritage Dictionary, 3rd ed.). In my correspondence with Dr. Grannis, in response to his initial comments in the capacity of an outside reviewer, I pointed out that this was a hypothetical scenario and not, as he stated, a postulated phenotypical (and actuarial) distribution. I no more believe, postulate, or promote the idea that LCs are equally divided into these phenotypes than I believe that all LCs occur within the first year of screening, all within the left upper lobe, or that all individuals die when their FEV1 falls to 1 L. The reader should judge whether his choice of the term postulate was intended to discredit the article by willfully and with foreknowledge distorting what I wrote and, if so, whether this constitutes untruthfulness.

In his editorial,1 Dr. Grannis stated “… managed care organizations (like Kaiser) would be forced to absorb the costs [of population screening],” implying that my analysis had been influenced by my association with Kaiser. I pointed out in my response3 that I had no affiliation with that organization, having retired from it in 1995. Dr. Grannis reports an income of $1,357,000 from the California Cancer Specialists Medical Group within the past 6 years. He further notes that he has been involved in LC screening since the 1970s. His income is therefore dependent, in part, on screening, which generates opportunities for surgical intervention. His institution receives a portion of its funding for research in LC screening from the International-Early Lung Cancer Action Project. The reader should judge whether a conflict of interest exists and, if so, on whose part.

Dr. Grannis states in his letter and e-mail correspondence to me that three authors, whose articles I cited in my article,2 had “major potential conflict of interest,” reflecting their association with or funding by the tobacco industry, the implication of which is that they falsified their reported data. I requested Dr. Grannis to furnish material that would support this claim, which he has not done; instead, he referred me to a lengthy database. If Dr. Grannis has persuasive evidence that these investigators engaged in scientific misconduct, the customary course is to bring it to the attention of the institutional review boards or the editorial offices of the affected journals. I did not adjudicate the veracity of the authors of the articles I cited, and it is not my responsibility to exonerate them. For scientific investigators, nothing is more precious and irrevocably lost than a reputation for scientific integrity. Not wishing to participate in a defamatory effort, I decline to cite the three names he furnished. The reader should judge whether Dr. Grannis has made a persuasive case for dismissing the unspecified findings of authors that contravene the doctrine that low-dose CT (LDCT) is necessarily efficacious.

My article2 addressed this issue and discouraged it, deferring to the results of the ongoing, national, prospective controlled trial undertaken by the National Cancer Institute. The Society of Surgical Oncology, Harvard Community Health Plan, American Cancer Society, National Cancer Institute, United States Preventive Services Task Force, Society of Thoracic Radiology, and National Cancer Guidance Group have each, after a careful review by experts, recommended against mass population screening of smokers, as has the American College of Chest Physicians, who add that “LDCT may result in aggregate harm to screened individuals,”4 a conclusion identical to that I proffered in my article. Dr. Grannis adheres to the doctrine that LDCT is necessarily efficacious because it identifies a high proportion of resectable LCs. Were doctrine to take precedence over experience, all evidence to the contrary being dismissed as attributable to flaws in methodology or analysis (or to fraudulent data), we would, like the alchemists, still be attempting to transmute baser metals into gold. The reader will make his own decision.

Grannis, FW (2002) Lung cancer screening: conundrum or contumacy.Chest122,1-2. [CrossRef] [PubMed]
 
Reich, JM Improved survival and higher mortality: the conundrum of lung cancer screening.Chest2002;122,329-337. [CrossRef] [PubMed]
 
Reich, JM Lung cancer screening: contumacy vs mendacity [letter].Chest2003;123,963-964. [CrossRef] [PubMed]
 
Bach, PB, Kelley, MJ, Ramsey, CT, et al Screening for lung cancer: a review of current literature.Chest2003;123,72S-82S. [CrossRef] [PubMed]
 

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References

Grannis, FW (2002) Lung cancer screening: conundrum or contumacy.Chest122,1-2. [CrossRef] [PubMed]
 
Reich, JM Improved survival and higher mortality: the conundrum of lung cancer screening.Chest2002;122,329-337. [CrossRef] [PubMed]
 
Reich, JM Lung cancer screening: contumacy vs mendacity [letter].Chest2003;123,963-964. [CrossRef] [PubMed]
 
Bach, PB, Kelley, MJ, Ramsey, CT, et al Screening for lung cancer: a review of current literature.Chest2003;123,72S-82S. [CrossRef] [PubMed]
 
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