Thursday, March 09, 2006

Attorneys General Take Credit for Declines in Cigarette Consumption

The National Association of Attorneys General (NAAG) and the American Legacy Foundation announced yesterday that cigarette consumption has dropped to a 54-year low, as Americans smoked fewer cigarettes last year than at any time since 1951.

According to an article in the Washington Post: "Americans smoked fewer cigarettes last year than at any time since 1951, and the nation's per capita consumption of tobacco fell to levels not seen since the early 1930s, the association of state attorneys general reported yesterday. Using data the federal government gathers when it collects taxes on cigarette sales, the group found a 4.2 percent decline in 2005 alone and an overall drop of more than 20 percent since tobacco companies reached a legal settlement with the states in 1998."

The cause of the decline?

According to the National Association of Attorneys General and the American Legacy Foundation, credit for the decline in cigarette consumption goes to the National Association of Attorneys General and the American Legacy Foundation:

The press release issued by NAAG boasted that: “’The work of the Attorneys General in negotiating the tobacco MSA focused attention on the conduct of the tobacco companies and the dangers of cigarette smoking,’ said Iowa Attorney General Tom Miller, co-chairman of the National Association of Attorneys General Tobacco Committee. ‘The continued enforcement efforts of the MSA’s provisions by Attorneys General, along with other health advocates, have made a marked difference in the number of smokers across the country, particularly among youth.’”

And according to the Washington Post article: "Association leaders and other tobacco-control advocates hailed the decline as a sign that sometimes-controversial developments triggered by the $246 billion settlement have been effective. The drop was a result, they said, of factors that include the sharply higher cost of cigarettes, restrictions on cigarette advertising and a shift in public perceptions as the dangers of smoking are more aggressively and widely publicized."

"'I think we're reaching a tipping point, where the image of tobacco is that it's unhealthy and dangerous, and not glamorous like years ago or neutral like the cigarette companies say now,' said Tom Miller, Iowa's attorney general and co-chairman of the National Association of Attorneys General's tobacco committee."

"Cheryl Healton, president of the American Legacy Foundation, a tobacco-control group initially funded by the legal settlement, said the continuing decline suggests that the national health goal of reducing smoking rates even further by 2010 is within reach. 'We're on target to exceed the national goal' of having no more than 15 percent of youths and 12 percent of adults smoking, Healton said. Few of the other national health goals adopted in 2000 appear to be achievable, she said, 'but this is one battle we're winning.'"

Iowa's Attorney General, Tom Miller, said that the declines in cigarette consumption were welcome by the states, even though they will result in reduced payments to the state under the Master Settlement Agreement: "'We knew from the beginning that if we succeeded in changing the cigarette culture, that sales would drop and so would our payments,' he said. 'But states deal with rising and declining revenues all the time, and this is one decline we're quite happy to see.'"

The Rest of the Story

I can’t say that I’ve ever seen such a display of self-congratulatory, flamboyant, and bogus hot air since the last Albuquerque hot air balloon contest.

The rest of the story, to start, is that cigarette consumption in the United States has dropped every year since 1980. And per capita cigarette consumption has dropped every year since 1975.

So the announcement that cigarette consumption in the U.S. declined sharply last year means very little. You could have said that every year for the past quarter century. If cigarette consumption had increased it would have been an earth-shattering announcement. So to stand up in front of microphones and take credit for cigarette consumption declining seems just slightly disingenuous to me.

And boasting about the fact that cigarette consumption has fallen to levels not seen since 1951 is even more disingenuous. Because every year for the past 30 you could have said that cigarette consumption has fallen to levels not seen since some year back in the early or middle part of the 20th century.

In 1990, for example (far before the Master Settlement Agreement existed), one could have boasted that cigarette consumption had fallen to levels not seen since a quarter century earlier (in 1965).

And in 1995, again before the MSA, one could have bragged that cigarette consumption fell to levels not since since 1960, the lowest levels ever seen since I was born!

While NAAG titled its press release “Cigarettes Sales in U.S. Reach Historic 55 Year Low,” one could title the press release with a similar claim every year. In fact, even if the Attorneys General were to completely abandon all their tobacco-related activities and the Legacy Foundation were to cease its actions, we could soon say that cigarette consumption has fallen to reach a historic 56 year low. And so on.

The second part of the rest of the story is that the same Attorney General who is boasting about how much he cares about declining cigarette consumption and about how much he is willing to sacrifice state fiscal resources (from cigarettes sales) to save lives intervened in an Illinois tobacco court case, submitting an amicus brief to a trial court judge urging him to reduce the $12 billion appeal bond he had ordered Philip Morris to pay, as specified by Illinois law, after the company was found guilty in a class-action lawsuit.

In intervening to protect the financial well-being of Philip Morris, Miller and 36 other Attorneys General wrote: "Defendant Philip Morris has informed the States that the $12 billion appeal bond required in this Court's March 21, 2003 Judgment may prevent it from making the $2.6 billion payment to the States that the MSA requires it to make on April 15, 2003. The States submit this brief to advise the Court that many State programs, including vital public health programs, depend on MSA payments for their support and to urge this Court, after a full assessment of Defendant's financial condition, to exercise its discretion to set an appeal bond that does not interfere with the States' vital interests. ... The States have a strong interest in preserving the value of the settlements they fought for and won, and the results in this lawsuit should not prejudice those settlements."

In other words, Miller and most of the other Attorneys General were arguing that because the legal remedy awarded to plaintiffs in Illinois - under the judicial system and laws of Illinois and under the United States Constitution - affected financial payments to their states, the judge should alter the application of Illinois law to protect their state's financial interests, and that concern should override the pursuit of justice by these citizens under the laws of Illinois.

The rest of the story, in fact, is that Miller did not put the public’s health above financial payments to the states! In fact, he intervened to ensure that justice would not be served, that the public’s health would not be protected, and that cigarette companies’ financial well-being would not be hurt, solely to protect his state’s and other states’ financial interests.

So much for the interest in reducing tobacco use outweighing the financial interests of the states in protecting the financial conditions of the cigarette companies!

The insincerity of Attorney General Miller and the National Association of Attorney Generals is simply overflowing in their press release. How can they seriously attempt to convince us that fighting the tobacco companies and protecting the public's health is their primary concern when they went to bat for Philip Morris, intervening and interfering in the pursuit of justice by a class of citizens in another state, all in an effort to protect the financial welfare of the nation's leading tobacco company (so that their own states' financial status would not be affected)?

The third aspect of the rest of the story I would like to point out is that once again, this is really shoddy science rearing its ugly face. You simply can’t look at overall trends in cigarette consumption and credibly make claims about specific factors that are affecting the changes in consumption without doing a careful, rigorous analysis that attempts to account for a large number of factors that influence cigarette consumption.

I myself have conducted such research and I have reviewed such research, and I can tell you that the claims that NAAG and Legacy are making based on a simple ecological comparison of cigarette consumption trends and the timing of the MSA simply do not hold water.

It is simply too difficult to know what would have happened to cigarette consumption had the MSA not been signed.

I will go out on a limb here. I am going to offer my expert opinion that I believe we would have seen a much greater decline in cigarette consumption from 1998 to 2005 had the 46 states continued pursuing their individual lawsuits against the tobacco companies, rather than signed the MSA, which I argued just yesterday is the worst public health blunder of my lifetime.

The public education, the successful and effective framing of the issue of the tobacco problem, and the policy gains resulting from the 46 separate lawsuits, if allowed to go to completion, would have, without any doubt in my mind, resulted in a far better outcome for the public’s health than the disaster that is the MSA.

I can’t prove it – but you know what? Neither can NAAG and Legacy prove that I’m wrong. And until they present some credible analysis of what would have occurred in the absence of the MSA (which means in the presence of 46 individual lawsuits against the tobacco companies), and present a rigorous analysis that controls for the myriad of factors that affect cigarette consumption, their claim that the MSA resulted in significant declines in tobacco use is what I consider to be very shoddy science, something for which I would without hesitation fail one of my graduate students (and I’m known as somewhat of an easy grader).

In fact, if you use the reasoning that NAAG is using, one could just as easily conclude that the severe cut in funding to the Legacy Foundation’s “truth” campaign is the reason for the unprecedented decline in cigarette consumption in 2005. After all, this unprecedented decline in cigarette consumption coincides perfectly with the reduced funding of, and reduced intensity of the “truth” campaign. Based on the observed trends, we should eliminate the “truth” campaign completely in order to see even more unprecedented declines in cigarette consumption in 2006.

By the way, I don’t doubt that increased cigarette prices as a result of the MSA contributed to the decline in cigarette consumption. But a major part of the decline probably had something to do with the spread of smoke-free workplace laws throughout the country, something for which NAAG and Legacy cannot take credit. Nevertheless, my contention is that prices of cigarettes would be even higher today had the MSA not been signed. I have little doubt that the lack of financial predictability of the outcomes of 46 separate state lawsuits, the almost sure victories in at least a few states, the more favorable settlements that would have been achieved, and if nothing else, the $12 punitive damages bond that Philip Morris would have been required to pay, would have all added up to a much bigger acute cigarette price increase than occurred.

Plus, I have little doubt that there would have been more success in substantially raising cigarette taxes over the past seven years had the states not become tobacco industry partners due to the MSA. Again, I can’t prove it. But neither can NAAG prove that I’m wrong and therefore credibly take credit for some sort of public health victory.

Finally, I must say that the Legacy Foundation’s prediction that we are on target and will reach the goal of reducing adult smoking prevalence to 12% by 2010 is wrong. Based on what I see happening in the tobacco control movement right now, I don’t see any chance that we’re going to reduce smoking prevalence to 12% within the next 4 years. I think that’s little more than a sales pitch to make it seem like we’re doing so great thanks to the efforts of the American Legacy Foundation, whose own data, I must say, have convinced me that there is no evidence that its “truth” campaign has had any effect on youth smoking.

There was a day when tobacco control groups looked objectively at cigarette consumption data, did rigorous analyses, and drew careful and scientifically-grounded conclusions, instead of jumping in front of microphones and television cameras and congratulating themselves for work done largely by others. And we did it all without talking out of both sides of our mouths. I was a part of that and I look back fondly on those days. It’s just sad to see what things have come to.

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