In a self-congratulatory statement full of undocumented and exaggerated claims, the American Legacy Foundation yesterday praised itself for a campaign that will save "hundreds of thousands of lives." The statement comes as a response to yesterday's Delaware Chancery Court decision that the Legacy Foundation's "truth" campaign does not violate the "anti-vilification" clause of the Master Settlement Agreement."
According to the Foundation: “Vice Chancellor Stephen Lamb has reasonably defined vilification and personal attack in a way that will allow our foundation to continue to tell American youth the facts about tobacco and the industry that markets its products to them. This decision will save hundreds of thousands of lives and we are grateful for it. ... The truth® campaign will one day go down in the annals of public health history for saving millions of young lives from tobacco addiction and premature death."
To support its far-reaching claims, Legacy cited a single study - a March 2005 AJPH study that it alleges proves that the "truth" campaign resulted in a 22% reduction in smoking among teens during its first two years: "The American Journal of Public Health published findings in March 2005 crediting truth® with accelerating the overall decline in youth smoking by 22 percent in the campaign’s first two years, 2000-2002. This translates to 300,000 fewer youth smokers in 2002 due to the truth® campaign."
In addition, Legacy claims that an independent group of public health leaders rallied to help save the "truth" campaign: "Former Health, Education and Welfare Secretary Joseph Califano, who himself had declared tobacco as 'Enemy #1' during his tenure, rallied a prestigious group of the nation’s public health leaders, The Citizens’ Commission to Protect the Truth."
The Rest of the Story
The real truth, as I see it, is that the AJPH article in question actually showed that the "truth" campaign was not effective in reducing youth smoking. It demonstrated that at the highest levels of exposure -- those that would be most likely to affect smoking behavior if such an effect were real -- there was no effect on youth smoking, or in some cases, actually an increase in smoking rates.
The paper inadvertently cut off Figure 2 at a moderate exposure level of 15,000 GRPs, which left out a large part of the sample. Had the figure been extended to show the results for the full range of exposure, it would have become apparent that there was no campaign effect detected for youths with very high campaign exposure. It would have become clear that the pattern was not consistent with a hypothesis of diminishing campaign effects, but rather, consistent with the absence of an effect of the campaign on youth smoking prevalence.
Overall, I do not think this paper provides strong evidence, or actually any evidence, that the "truth" anti-smoking media campaign was responsible for a reduction in youth smoking between 2000 and 2002. It certainly does not provide evidence upon which one could credibly state that the "truth" campaign was responsible for a 22% reduction in youth smoking during that time period. It certainly does not provide evidence upon which one could reasonably conclude that the effects of the "truth" campaign have continued since 2002, and it does not provide evidence to back up a claim that the "truth" campaign will, in the future, "continue" to have dramatic effects on youth smoking.
In short, I think the American Legacy Foundation is making greatly exaggerated claims about the effects of its campaign that are not documented by, or even consistent with, the existing scientific evidence.
To claim that the campaign will save "hundreds of thousands of lives" or less modestly, "millions of young lives" is, I believe, not a credible or responsible claim based on the actual evidence that is available.
Clearly, more work needs to be done to determine the effect, if any, of the "truth" campaign on adolescent smoking rates. And as I stated earlier, there are plenty of reasons to support and continue funding anti-smoking media campaigns such as the "truth" campaign; however, I do not see the results of the AJPH study that Legacy cites as being one of them.
But beyond the lack of scientific integrity that I see here are two probably more important problems. First is the fact that the study which Legacy cites is its own study, funded by itself, and whose senior author is in fact the President and CEO of the Legacy Foundation.
While this fact is appropriately disclosed in the article itself, it is not revealed to the public in Legacy's press release. The press release tries to (in my opinion deliberately) pull the wool over the public's eyes by making them think that this was an independent study.
The release states that: The American Journal of Public Health published findings in March 2005...", making it sound like the Journal published an independent evaluation of the "truth" campaign. What really happened is that "The American Legacy Foundation published findings in March 2005...".
Since the president and CEO of Legacy was in fact the senior author on this paper, it is clearly a conflict of interest for her to be involved in this research, and such a conflict should be disclosed not only in the paper itself, but any time these results are presented publicly by Legacy.
So we now have a lack of ethical integrity on top of the lack of scientific integrity.
But perhaps the most disturbing aspect of the story is how Legacy makes it appear as if former HEW Secretary Califano and his Citizens' Commission to Protect the Truth independently came to the aid of Legacy. The real truth is that Califano and his Citizens' Commission were paid by Legacy to come to the aid of Legacy. They were paid to the tune of $1.5 million.
The rest of the story reveals that the American Legacy Foundation, in praising itself and making claims that it is going to save millions of lives, is making completely unsubstantiated and unfounded claims based on a single paper which they themselves authored and that they have failed to disclose in their public statement that the paper was actually authored by themselves, or that the group that has supposedly come forward independently to support its funding is actually being paid by Legacy to come forward to support Legacy.
If this is the kind of scientific and ethical integrity that characterizes the anti-smoking movment, I'm not sure I want to continue to be a part of it.