Thursday, December 22, 2005

Final Thoughts Before the Holidays: On Pueblo, Parks, and People

It has been 9 months since I started The Rest of the Story. Tens of thousands of visits and 280 blog posts later, a lot has happened and I have learned quite a bit, not only about the anti-smoking movement, but about many of the people who I think we should be trying to serve. Thinking back over the past months, I think 3 things stand out.

Here they are, prior to my taking a break for the holiday (and I will be back in action on Tuesday, January 3).

The Rest of the Story

PUEBLO

I think the biggest surprise to me has to be the reaction to my commentary on the Pueblo study, unpublished research which was highly publicized in press releases and by anti-smoking groups in their advocacy efforts. This was a study which essentially compared two data points - the rate of heart attacks during the 18 months before and after a smoking ban in Pueblo, Colorado, which found that the 2nd data point was 27% lower than the first, and which then was reported as validating "previous scientific evidence that indoor smoke-free laws can dramatically reduce heart attacks" and as confirming that "smoke-free laws reduce heart attacks."

There is simply nobody I have talked to outside of tobacco control circles who sees this study design as yielding any conclusive information about the impact of the Pueblo smoking ban on heart attack rates. And taking a step back and thinking about this again, it is simply hard to believe that anyone could take this observed variation in heart attacks between two short periods and draw a conclusion that the variation was attributable to the smoking ban, especially when the underlying variation over time in heart attack rates in a small city like Pueblo is considerable, and when the study only went back 18 months, a period completely insufficient to establish what the baseline variability in heart attack rates in Pueblo is in the first place.

To be honest, this is precisely the kind of shoddy science that I have criticized the tobacco companies for using in the past to try to convince the public that smoking bans cause drastic reductions in restaurant sales.

That it was essentially expressing my professional scientific opinion about this research (or more accurately, about the exaggerated claims being made to the public based on this unpublished research) that led to censorship of my opinions by the tobacco control community (through being expelled from a tobacco policy list-serve) is still shocking to me.

And I would note that I really was quite conservative in my expression of opinion about the research and the conclusions that were being drawn from it. I made it clear that I was not stating that the research didn't provide a suggestion of a significant effect of smoking bans on heart attacks. I only pointed out that given the short time period of the study and the two data points, it would be almost impossible to determine whether the observed 27% change in heart attack admissions was due to random variation or to the smoking ban (or some other factor), and therefore, that it was far too premature to be drawing definitive causal conclusions.

For this, I was blacklisted from an important tobacco policy discussion group that I have been a frequently contributing member of for nearly the past decade.

This all made a substantial impression on me because it demonstrated to me: (1) that there was a significant element of the tobacco control movement that is not truly interested in the science or in good science and which instead is driven by the pre-ordained agenda; and (2) that there is a tinge of McCarthyism in the tobacco control movement: dissent is met not by discussion of the relevant issues, but by attacking, discrediting, and censoring the messenger.

PARKS

I think the second most prominent thing that stands out in my mind is the reaction to my commentaries suggesting that perhaps outdoor smoking bans in nonenclosed, wide open outdoor areas (such as parks) where people are free to move about is going too far (because the scientific evidence of substantial harm being caused by this problem does not seem to outweigh the intrusion into liberty that this intervention would represent).

The reaction had a huge impression on me not because there was disagreement with my views - I obviously realized that I was going against the grain of popular opinion in the movement. But the reaction I received was not disagreement. Instead, it was a combination of: (1) being personally attacked; (2) being told that there were far more important things to be doing than discussing the justification behind tobacco control policies; and (3) realizing that by pointing out that the science probably did not support many of these outdoor smoking bans, I had stimulated the introduction of a host of new "explanations" for what we were doing, ranging from social engineering to cleaning up litter to merely getting rid of a nuisance.

It was then that I came to the realization that to a large segment of the movement, the science really doesn't matter. The agenda is sacred, and it simply cannot be challenged. A variety of approaches is available to protect the agenda, including attacking anyone who dissents. In addition, while we always "pretend" that it is the science of the health effects of tobacco smoke that is motivating our actions, it became clear that evidence for those health effects doesn't really seem to be required. There will always, it appears, be a justification for the agenda, when it really comes down to it.

This was truly a wake-up call for me because for at least 20 years, my opinion and expertise as a scientific researcher on the health effects of secondhand smoke and the justification for smoke-free policies seemed to have been well-respected by the tobacco control movement. But when the same scientist, using the same type of scientific evidence and the same reasoning came to a different conclusion about the appropriate policy, all of the sudden I was no longer a credible scientist; instead, I was a "naysayer," I was a civil libertarian manque. I came to realize that much of what I was apparently valued for was not the quality of my science, but the fact that I came up with conclusions that supported the prevailing agenda of the movement.

Many of the same people who had previously praised me and the quality of my work and highly publicized my research and my opinions were now publicly insulting me, telling others to ignore me, and attacking me as being a completely unreliable and incompetent scientist and tobacco control policy analyst.

But remember that the economist John Maynard Keynes once said: "Sir, when the facts change, I change my mind. What do you do?"

I've been in the tobacco control movement for 21 years and I have extensive experience in the field at the national, state, and local levels. I have over 60 peer-reviewed publications in tobacco control and have testified as an expert witness in at least 7 tobacco trials. What has guided me throughout my career is an attempt to bring sound scientific and sound policy analysis to the problem of tobacco use. And I'm not going to stop doing that now.

When the facts change, I change my mind. What does the tobacco control movement do? It's clear: censor the individual so that the movement does not become aware that the facts may have changed. There is no room to challenge the received wisdom and canons of tobacco control.

To borrow a few words and wisdom from a dear colleague of mine, I think there is a need for, and a value to provocation, challenge, and scrutiny of long-held assumptions. This is the motor of progress and renewal. And what is its opposite?

PEOPLE

I think what stands out most in my mind, however, thinking back over the past 9 months, is the people who I have met, conversed with, discussed issues with, provided some education to, learned from, and even debated heatedly.

I had been indoctrinated with the idea that anyone who disagreed with the prevailing tobacco control movement views must automatically be a tobacco industry front, not to be trusted, respected, or even acknowledged as a valuable human being with legitimate and potentially important opinions, views, and perspectives.

I think, more than anything, it is the "attempt" to proceed with this indoctrination that led to my "awakening," because it is simply not in my nature to think in this way. When Americans for Nonsmokers' Rights (ANR) suggested to me, back in 1999, that one could not say anything that could remotely be construed as being anything but derogatory about an individual on the other side of the issue from "us" is when I really woke up. In many ways, my resignation from ANR was my official awakening.

One of the most remarkable things that has happened over the past 9 months is the incredible diversity of people who have read this blog. There are few tobacco control blogs to begin with, but I doubt that any have the diversity of readership as seen here. There are a large number of smokers' rights blogs, and while I know a few anti-smoking advocates who frequent these blogs (most often to harass the smokers), there is not a lot of diversity in the readership.

But here, we have a large number of readers who range all over the spectrum on the issues discussed. We have everyone from the most zealous anti-smoking advocates to the most dedicated smokers' rights advocates, from the most prominent organizations that are fighting the tobacco companies to the tobacco companies themselves, from attorneys representing the smokers to those defending the tobacco companies, and a large number of readers who are not really on either side of the issue, but are truly interested in the issues being discussed.

I think that bringing together this breadth and diversity of interests may be the most important contribution of this blog so far, and perhaps the one that stands out most to me as we enter the holiday break.

I also see this occurrence as a unique opportunity to advance the quality of discussion, dialogue, and discourse on tobacco policy issues, and I hope that this will continue in 2006 to serve as a forum to learn more about the issues and more about each other and what motivates and concerns all those who are passionate about these important issues.

If anything has become clear, I hope it is that I am attempting to present a well-reasoned, well-documented, and passionate, yet as unbiased as possible (for a tobacco control practitioner) analysis and commentary on what I see as the most important issues facing the tobacco control movement each day.

With that, I wish all my readers a happy holiday season, and a peaceful and fulfilling New Year.

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