What I've learned is that for the most part, the anti-smoking movement is driven by an agenda - an agenda that will not allow science, sound policy analysis, the law, or ethics to get in its way.
It is an agenda that if challenged causes anti-smoking groups to scramble to try to justify their actions - and they come up with new ways of defending their actions, resorting to weaker and weaker arguments to do so.
And instead of merely presenting arguments to justify their actions, they resort to attacking the individual who questions the justification for their actions, in part, in order to quell any dissent from the established dogma of the movement.
Instead of the science driving the agenda, it appears that the agenda drives the interpretation of the science.
Instead of sound policy analysis driving the agenda, it appears that the agenda gets in the way of sound policy analysis.
Instead of an informed consideration of legal issues driving the agenda, it appears that the need to defend the agenda blinds many advocates from being interested in understanding the legal framework that actually justifies their actions.
And instead of a concern for ethical principles providing the boundaries in which the agenda is pursued, it appears that the promotion of the agenda defines the boundaries of what is considered ethical.
A few examples in each of these areas will hopefully be sufficient to demonstrate my arguments.
The Rest of the Story
Let's start with the ad hominem attacks, since those are perhaps the most troublesome to me (probably because I'm the one at the receiving end).
In response to the suggestions that although smokers do not have any absolute right to smoke, they nonetheless do have a right to engage in legal behavior if it is not infringing upon the health of others, and that there is not sufficient scientific evidence to justify government intervention to ban smoking in open, outdoor spaces, I was called:
- a "holier-than-thou civil libertarian manqué"; and
- a "naysayer".
But I find it problematic to be called a naysayer. Because it implies, I believe, that saying anything that goes against the mentality of the movement is simply not acceptable. By framing my differing science-based opinion in a pejorative way, rather than as an appropriate scientific-based opinion with which others may disagree, it is really an attempt to censor dissenting opinion. If you disagree with the dogma of the movement, you must automatically be a cynic or a skeptic, rather than have a legitimate opinion.
I have to admit that although I have come to expect to be attacked, I am surprised at the relatively benign comments that prompted this particular attack - an opinion that smokers have the right to smoke (i.e., to engage in a legal behavior) as long as they are not infringing upon the health of others; and my opinion that there is not sufficient scientific evidence to justify government intervention to ban smoking in open, outdoor spaces.
As far as the first opinion goes, it seems perfectly reasonable to me - I honestly don't see what the controversy is or why that opinion would so deeply offend an anti-smoking advocate.
As far as the second opinion goes, people can certainly disagree with me if they want, but the only scientific "evidence" that was provided to me to justify outdoor smoking bans was a single study that did not document any health problems due to sustained exposure to tobacco smoke originating from the outdoors.
It hardly seems to warrant calling me a "naysayer." It hardly seems like I am a cynic or a skeptic to suggest that perhaps more than a single study would be necessary to justify such drastic government intervention and that perhaps that study should actually document sustained, not temporary levels of high exposure to secondhand smoke in places that people are unable to avoid.
Next, I'll address the scrambling justification for the anti-smoking agenda, with weaker and weaker arguments.
Perhaps the best example is the response I received about my post challenging the scientific justification for outdoor smoking bans. Instead of arguing the point with me and suggesting that there is evidence justifying the drastic action of banning smoking outdoors, most of the responses provided new and different justifications for such laws.
One new justification was that these laws are justified because they will deter smoking by de-normalizing the behavior. That justification doesn't hold, I think, because by the same reasoning, we should ban alcohol use in public, fast food use in public, and sitting in a sedentary way on a bench in public, since all of these will help to normalize unhealthy behaviors.
Another new justification was that these laws will improve the quality of life by eliminating a major nuisance. A nuisance? I can tell you right now that I am not in public health because I want to try to eliminate all the nuisances out there. I'm in public health because I want to prevent death, disease, disability, and suffering, not to prevent nuisances.
Yet another new justification was that banning smoking outdoors is justified because cigarette butts are a major litter problem. That may be the case, but that makes it a problem that should be addressed by litter control practitioners, not tobacco control practitioners. I'm not in tobacco control because I want to control litter, no matter how worthy an endeavor that may be.
And yet another justification was that the public supports broad outdoor smoking bans. Unfortunately, that's not a sufficient justification to me. If the policy isn't justified, then it's not justified, regardless of what the results of public opinion polls may show. After all, the majority of citizens in a number of states may oppose abortion, but I don't think that justifies public health advocates supporting laws that restrict women's abortion rights. Even here in Massachusetts, the majority of the public opposes gay marriage, but you won't find me supporting a ban on gay marriage anytime soon.
Interestingly, I have never heard any of these same justifications used for indoor smoking bans. The reason, I think, is that they are not needed to support indoor bans. After all, we have the scientific evidence on our side for those. But now that the scientific evidence appears to be shaky, advocates are all of the sudden drawing upon a whole new set of justifications.
Now to the big four:
1. Instead of the science driving the agenda, it appears that the agenda drives the interpretation of the science.
I found it interesting that the one study that was touted as justifying outdoor smoking bans failed to demonstrate that smoke entering a building from the outside poses a serious and sustained threat to the health of those working in the building or that smoking in open, outdoor areas poses any significant health threat. Nevertheless, the study was cited as completely refuting my argument.
In fact, one response suggested that I was not "up to speed on the facts" and that if I read this study, I would see the error of my opinion. Of course, I was up to speed on the facts before I wrote about this issue (a lot of research goes into almost all of my posts), but it is quite clear to me that the science in this case simply does not support the need for government intervention to ban smoking in most outdoor areas (as I have stated clearly and repeatedly, I make exceptions for enclosed areas or places with fixed seating - like stadiums - where people cannot easily move away from the smoke).
But perhaps the best example of the agenda driving the interpretation of the science is the article from yesterday's release of the journal Pediatrics. I won't repeat the details here, but yesterday's post explains why I think the conclusion that 38% of kids who smoke do so because they saw people smoking in movies is not warranted.
2. Instead of sound policy analysis driving the agenda, it appears that the agenda gets in the way of sound policy analysis.
The agenda, I believe, is clearly to ban smoking in all public places - even outdoors. While a sound policy analysis demonstrating that outdoor smoking bans are necessary to protect the public from a serious health threat would convince me to change my opinion, I am instead bombarded with arguments that this is a serious nuisance, a huge litter problem, something that should be de-normalized in spite of the lack of evidence, and a host of other arguments that in my mind, do not constitute sound policy analysis. But they are thrown forth in the name of being sound analysis. It is pretty clear to me that sound policy analysis is not driving this agenda, but it does appear that the agenda is getting in the way of sound policy analysis.
3. Instead of an informed consideration of legal issues driving the agenda, it appears that the need to defend the agenda blinds many advocates from being interested in understanding the legal framework that actually justifies their actions.
In responding to my argument that there is, indeed, a legal right to engage in lawful behaviors if they are not infringing upon the rights of others, one argument that was put forward was that since smoking is not specifically mentioned in the U.S. Constitution, there is no right to smoke.
Well, it's also true that breathing clean air is not mentioned in the Constitution, nor is the right to a safe workplace reasonably free of recognized and preventable hazards. Does that mean there is no right to a safe workplace? Of course not.
I clearly articulated my position that there is no absolute right to smoke and that the right to engage in this legal behavior can certainly be infringed upon if necessary to protect the public's health. But that's the key phrase - if necessary. It is simply upon those two words that my opinions are based.
By far, the best example of the anti-smoking agenda getting in the way of the legal justification for that agenda is the attempts by anti-smoking groups - -most notably the Campaign for Tobacco-Free Kids, Americans for Nonsmokers' Rights, ALA, AHA, and ACS - to try to convince a federal judge to misapply the law in order to extract billions of dollars from the tobacco companies that could be used for anti-smoking programs.
4. Instead of a concern for ethical principles providing the boundaries in which the agenda is pursued, it appears that the promotion of the agenda defines the boundaries of what is considered ethical.
In many ways, the bulk of this blog deals with this very issue. Probably the majority of my posts relate to what I see as the use of unethical means to achieve desired (and appropriate) ends. But to pick just one example, I think the personal attacks on my friend, Martha Perske, are a perfect example of letting the agenda define the boundaries of what is considered ethical and therefore, acceptable.
The rest of the story is that I have become convinced that the agenda of the anti-smoking movement has taken on a life of its own. Anything that gets in the way of that agenda - whether it be the science, sound policy analysis, the law, ethics, or me - must be dismissed (in my case, by taking a 1-month vacation).
While I would be happy to take a 1-month vacation (especially if it's during Boston's harsh winter), I unfortunately don't think that we as public health practitioners should ever take a vacation from science, sound policy analysis, the law, and ethics. And I hope that this blog plays some small part in making sure that we never do.