Thursday, April 27, 2006
Anti-Smoking Groups Widely Giving False Testimony in Support of Smoking Bans; Groups Even Being Instructed to Give Testimony that is Inaccurate
In a number of city council or state legislative hearings around the country, anti-smoking groups have claimed that 30 minutes of secondhand smoke exposure increases the risk of heart disease: coronary artery blood clots and heart attacks or hardening of the arteries.
The truth, however, is that a person cannot develop hardening of the arteries in just 30 minutes and a person without severe existing coronary artery disease is at no risk of coronary artery blood clots or a heart attack from a 30-minute exposure to secondhand smoke.
For example, according to testimony given in support of a workplace smoking ban by the New York City Department of Health and Mental Hygiene: "Just 30 minutes of exposure changes the way your blood clots and your blood vessels react in a way that increases the risk of heart disease."
According to testimony given in support of a statewide workplace smoking ban by the Tobacco Prevention and Control division of the North Dakota Department of Health: "Exposure to secondhand smoke for as little as 30 minutes can increase the formation of blood clots and restrict flow to the heart, causing a heart attack."
According to testimony given by the American Heart Association in support of a proposed smoke-free restaurant ordinance in Rochester, Minnesota: "When you leave a restaurant after dining...[tobacco smoke has] made your blood 'stickier' promoting blood clots."
The Minnesota Medical Association went so far as to include this fallacious health claim in its "Testimony Talking Points," which instructs anti-smoking advocates to testify that: "even brief exposure to secondhand smoke - just 30 minutes - increases hardening of the arteries, contributing to coronary heart disease."
The Rest of the Story
It is disturbing to me that inaccurate testimony is being given by anti-smoking groups in an effort to promote smoking bans. Although I have made it clear that I support most of these policies, I do not support the use of false scientific testimony to promote policy, even if the policy would end up having a beneficial public health effect.
The statement that 30 minutes of secondhand smoke exposure increases your risk of heart disease is false. You cannot develop atherosclerosis in just 30 minutes. And there is no evidence that a 30-minute exposure to secondhand smoke increases the risk of coronary artery clotting or heart attacks in anyone other than someone with severe existing coronary artery disease (and even in that case, the conclusion is purely speculative).
What is particularly disturbing here is that not only are anti-smoking groups widely giving false testimony to support smoking bans, but at least one group is actually instructing anti-smoking advocates to include these inaccurate health claims in their testimony in support of smoking bans.
The Minnesota Medical Association has included in its instructions to advocates that they should testify (quite fallaciously) that even 30 minutes of secondhand smoke can cause hardening of the arteries and contribute to coronary heart disease. And the Minnesota Medical Association should know better since these are physicians who presumably are aware of the fact that one cannot develop atherosclerosis in just 30 minutes.
As I am gradually revealing, the scope of this problem is much larger than I originally imagined. At first, I thought this was simply a single fanatical anti-smoking group which was spreading inaccurate information in order to scare policy makers into banning smoking outdoors. Then I thought this was simply two groups that were fighting it out to see which could come up with the more absurd claim.
Now, it is clear that there are well over 60 anti-smoking groups making these fallacious claims, that the false information is being used to promote smoking bans, that anti-smoking officials are giving false testimony at smoking ban hearings, and that at least one group is actually instructing anti-smoking advocates to present what amounts to inaccurate and misleading testimony to promote smoke-free laws.
I'm not claiming here that any anti-smoking group or groups are intentionally deceiving the public or lying, although it is getting more and more difficult for me to stand by that disclaimer. Nevertheless, what I am exposing here is not necessarily any wrongdoing on any group's part or any intentional deception. What it is, however, is a severe flaw in the tobacco control movement that must be fixed immediately.
As we stand here right now, the movement is incapable of disseminating solid science and its credibility is therefore in severe question. I'm not casting blame on any particular groups - I'm just stating that this has happened, for whatever reason. For now, the reason doesn't matter. What matters most urgently is that the problem is fixed.
Ultimately, I do think we need to get to the bottom of this and determine how such a fiasco could have occurred. The reasons for the destruction of the gatekeeping mechanism that previously guarded the scientific integrity of the movement need to be identified, so that the problem can be fixed.
But first, the anti-smoking movement needs to admit that there is a problem. So far, not a single anti-smoking group in the United States seems to care. And that doesn't bode well for the viability of the tobacco control movement in this country.
According to a press release issued this morning: "Lars Erik Rutqvist, Professor of Oncology, Senior Consultant and former Head of the Department of Oncology, Huddinge University Hospital & Karolinska Institute, Stockholm, has been appointed Vice President, Scientific Affairs within the Swedish Match Group. Lars Erik Rutqvist has a long and solid experience of both clinical and epidemiological cancer research. ... 'Cigarette smoking presents an important and growing health problem in the world. This must be met by active measures to limit unhealthy activities. In this respect, Swedish Match can make a positive contribution. It is an exciting challenge to contribute to this development. No other single effort for public health is more important than to induce people to refrain from cigarettes and I will continue to work for this, only now from a new position with a broader perspective,' says Lars Erik Rutqvist." The Rest of the Story
The rest of the story is that "Swedish Match is the largest producer and distributor of chewing tobacco in the US, with a market share of slightly more than 44 percent, according to AC Nielsen. The company´s largest brands are Red Man, Southern Pride and Granger Select. ... As the market´s leading company for chewing tobacco, Swedish Match will continue to focus on high product quality and effective market communication. The product area is expected to generate a continued strong cash flow."
The rest of the story is that this strong cash flow will come at the expense of hundreds of deaths from the use of its products each year. In the United States alone, there are approximately 28,000 cases of oral cancer each year and about 8,000 deaths. Five-year survival rates for oral cancer are only about 50%. In parts of Asia where chewing tobacco use is common, oral cancer rates are three times higher than in the U.S. And in some areas of India, oral cancer accounts for 40% of female cancer deaths.
Oral cancer is a nasty disease: without question, it is the nastiest disease that I saw as a physician. Believe me - this is one cancer you do not want to have. Complete disfigurement is all I can say. Yet it's almost entirely preventable, as 90% of these cases are attributable to alcohol and/or tobacco use.
Regardless of what Swedish Match might be doing in promoting snus use in Sweden (and regardless of whether snus is preventing smoking-related deaths by helping people quit smoking by switching to snus - a safer alternative product), the company's products are still killing hundreds of people annually due to oral cancer from its chewing tobacco, and Dr. Rutqvist is now a Vice President for this company.
I understand that someone has to serve in the role of scientific affairs within the company and I don't think that accepting this position makes the oncologist a bad or evil person in any way. However, he has no business getting up in front of the world and giving us all this crap about how Swedish Match is going to make a "positive contribution" to the public's health.
If Swedish Match really wants to make a positive contribution to the public's health, then it should simply stop selling its deadly, cancerous products to thousands of Americans and others throughout the world. That would make a positive contribution.
Understand that I'm not arguing that Swedish Match should make a positive contribution to the public's health. It's a tobacco company, not a public health organization, and its job is to sell tobacco, not to improve the public's health.
So I'm not really asking Swedish Match to make a positive contribution to the public's health. I'm simply stating that when the new Vice President of the company gets up and tells us what a positive contribution the company is going to make to the public's health, yet the company is going to continue marketing its deadly, cancer-causing products, what we are hearing is complete crap.
The oncologist is entitled to take this job and perhaps he can help develop safer smokeless tobacco alternatives. Fine. But don't get up in front of me and tell me that you are going to make a positive contribution to the public's health when your new company is killing hundreds of my brothers and sisters each year due to the terrible, disfiguring, disgusting, and devastating effects of your products.
Just do your job and let your new customers die in peace. Spare us the crap.
Here's the rest of the story - a story that is typical for many of Swedish Match's customers:
According to Kidshealth.org: "Take Bill Tuttle, for example. An outfielder for the Detroit Tigers, the Kansas City Athletics (before they moved to Oakland), and the Minnesota Twins, Tuttle chewed tobacco for most of his career. In fact, a lot of Tuttle's baseball cards over the years pictured him with a cheek bulging with chewing tobacco. Thirty-eight years after the end of his baseball career, Tuttle had a more ominous bulge in his cheek - a huge tumor that was so big that it came through his cheek and extended through his skin. Doctors removed the tumor, along with much of Tuttle's face. Chewing tobacco as a young man had cost him his jawbone, his right cheekbone, a lot of his teeth and gum line, and his taste buds. Cancer caused by his chewing habit finally claimed him in 1998, but Tuttle spent the rest of his life trying to steer young people, as well as grown athletes, away from smokeless tobacco."
As Joe Garagiola said (see the Mayo Clinic website): "I chewed tobacco because it seemed to be the thing to do if you were playing baseball. You won't die of gum disease or yellow teeth, but develop oral cancer and it's a terrible way to go. Here you are with oral cancer from using spit tobacco, your jaw has been removed and you have to eat through a tube. You die one piece at a time. Spit tobacco is a horrible, horrible thing. I just wish I could get this message across to everyone."
It doesn't look like Joe will be getting any help any more from Dr. Rutqvist. Instead, the oncologist will be working for a company that promotes chewing tobacco use and whose products contribute to hundreds of oral cancer deaths each year.
Again, that's his business and I'm not criticizing him for taking the job. But no one is going to get up in front of me and do a song and dance about how his tobacco company is going to make a positive contribution to the public's health and how no other single effort in public health is more important than what he will be doing for the company, and how he will be able to continue what he was doing as an oncologist by working for a tobacco company.
That's a load of crap. And I'm not going to take that. It's like spitting chewing tobacco in the faces of oral cancer victims - former patients of mine - all over the country.
NOTE: This post is dedicated to Nikki, the first oral cancer patient who I ever treated.
Wednesday, April 26, 2006
Harvard Law School Professor Takes Issue With Being Listed as an Example of a "Junk Scientist" by Anti-Smoking Group
In the original article, Dr. Viscusi's research was cast as being "junk science." In a section entitled "The Tobacco Industry's Own Use of Junk Science," Dr. Viscusi's work is provided as one of four examples. He is referred to as a "professional witness" and a statement is made to the effect that a professional witness "spends more time in the courtroom than in the laboratory."
The evidence of the potential inappropriateness of allowing Viscusi to testify is that he was alleged to have conducted research that was commissioned by the law firm representing R.J. Reynolds specifically for the purposes of its defense at the trial. Apparently, Dr. Viscusi was not allowed to testify in Minnesota; according to the article, the reason was that his "testimony was based on surveys done in anticipation of litigation (a reason to exclude such testimony under Daubert II), commissioned by Jones Day Reavis and Pogue, the law firm representing RJ Reynolds Tobacco Company."
In responding to the characterization of his research as being junk science, Viscusi notes that: "the studies I have relied upon in my expert testimony in tobacco cases have been published by the leading peer-reviewed university presses, such as Oxford University Press and University of Chicago Press, and by some of the most distinguished peer-reviewed economics journals, such as the Review of Economics and Statistics and the Journal of Political Economy. To suggest that these groups, considered preeminent in their field, would publish work based on 'tainted surveys' and 'junk science' defies reason and experience. This research and my other work on decisions involving health and safety risks are among the most widely cited publications in the economics field."
The Rest of the Story
I am familiar with Dr. Viscusi's work, and I find it unfair, inappropriate, and inaccurate to suggest that his research represents junk science.
I think what is going on here is that three very different issues are being somewhat conflated, leading to a presentation that attempts to present the facts in a simple way, but which perhaps becomes misleading because the issues are more complex.
There are three very different issues at work here.
First is the issue of junk science, which is "faulty scientific data and analysis used to promote special agendas." The key here is that the science is faulty - there is something terribly wrong with it. It is not valid science.
The second issue is bias in research. This bias could be created because someone is being paid to testify, because research was commissioned by the law firm representing a client, and/or because the research was conducted for the specific purpose of producing data that could be used at trial. The key here is that it does not necessarily mean that the science is invalid; there just may be bias present that needs to be disclosed and accounted for.
The third issue is the legal issue of what constitutes permissible expert testimony. This is where Daubert comes in. Each of the first two issues comes in to play here, as a judge must consider whether research is faulty and whether there is an inherent bias that would preclude the testimony from being admissible.
The most important point I want to make is that just because there is an inherent bias in a piece of research and even allowing that a judge makes a decision to bar testimony under Daubert, this does not necessarily mean that the research represents junk science. It is possible, for example, that the judge ruled that the inherent bias (such as the preparation of the research specifically for trial) was enough to preclude it under Daubert.
The reason why I think Dr. Viscusi has a legitimate grievance with the way his work was portrayed in the AJPH article is that the article casts his research as being "junk science," not simply as being research that was ruled inadmissible in court because of the nature of its preparation (i.e., the alleged fact that some of the relevant research was "commissioned" by the law firm representing R.J. Reynolds and that it was allegedly disallowed under Daubert). Note, by the way, that Dr. Viscusi's letter takes issue with the contention that his testimony was actually disallowed under Daubert).
The same arguments being used by the authors to discredit Dr. Viscusi's work and cast it off as "junk science" could be used to cast off my own research or that of innumerable witnesses against the tobacco companies.
It is common practice for "anti-tobacco" witnesses to prepare specific research at the request of plaintiff's attorneys. In my case, the California Attorney General's office supported research I conducted into the exposure of youths to cigarette advertising in magazines (the state provided the data for my analyses). This research was partially the basis for my testimony in California's lawsuit against R.J. Reynolds for allegedly violating the Master Settlement Agreement by targeting youths in its magazine advertising. This work was not commissioned, since I would have done this research anyway, but it was supported by the state of California, which ended up being the plaintiff in the lawsuit in which I testified.
In its defense at trial, R.J. Reynolds did indeed attempt, unsuccessfully, to use this information to disallow my testimony, but the company's attorneys showed me the respect of not suggesting that my work was complete junk, a courtesy apparently not afforded to Dr. Viscusi here.
It seems to me that an assumption is being made that research used to support the tobacco industry's defense at trial is junk, while research conducted under quite similar conditions but used to support the plaintiffs, is automatically valid.
Even the argument about Dr. Viscusi being a "professional witness" doesn't necessarily hold water. Without even getting into whether the characterization is accurate or not, the same thing could be said about me or a number of other tobacco control practitioners who have testified in a large number of tobacco cases. I think I'm up to about 10 different depositions or testimonies at trial now. Does that mean that I'm a "professional witness" and that my research is "junk?" (My research may be junk, but I assure you that's not the reason!)
I think we have to be careful here, because some of the same arguments that we appear to be using against tobacco industry witnesses could easily be used against us.
For example, the critical (and only) research that I am aware of that supports the key contention, made at trial in the DOJ tobacco lawsuit, that the American Legacy Foundation's "truth" campaign is extremely effective in reducing youth smoking, is a paper that was authored by the American Legacy Foundation. You can bet that if Philip Morris wanted to present research at trial on the effectiveness of its youth smoking prevention programs and that work turned out to be written by Philip Morris, we would be demanding that the research be thrown out. We would probably be calling it "junk science." And maybe it would be. But the knife cuts both ways.
Let me say, however, that the biggest reason why I believe it is unfair, inappropriate, and inaccurate to suggest that Dr. Viscusi's research represents junk science is that it is clearly not. Dr. Viscusi's work on risk perception represents seminal work and is highly regarded in prestigious academic journals. The research is valid and reputable and provides important insights that could actually help inform tobacco control interventions if we paid some heed to it rather than ignore it and immediately cast it off as junk science.
Now understand that I am saying this as someone who has directly confronted some of Dr. Viscusi's work in the courtroom and who has been in a position of arguing that smokers do not have an accurate perception of their risks despite Dr. Viscusi's finding that smokers tend to actually overestimate the absolute risk of disease. The fact that I may disagree with some of the interpretation of these findings and with the ultimate conclusion regarding whether smoking is a behavior that is done with a fully-informed understanding of risk does not mean that the research itself is not reasonably valid.
I see no scientific reason why tobacco companies should not be allowed to let Dr. Viscusi present his research in the courtroom and allow the jury to consider his work as well as that of scientists who have reached different conclusions. Let the jury see all the data, let them hear the differing interpretation of the data, and then let them make their decision. Isn't that what trial by jury is supposed to be about?
I would hasten to add here that I think Dr. Viscusi's characterization of the state litigation against the tobacco companies which resulted in the Master Settlement Agreement is dead on -his description of the MSA being about money rather than public health accords with dozens of posts I have written over the past months.
Obviously, there are some elements of Dr. Viscusi's opinions that I don't agree with, but there's no question that his research is not junk science, and that characterizing it as such is unfair as well as inaccurate and inappropriate.
I understand that the legal battle between the plaintiffs attorneys and the tobacco companies is a fierce one and both sides are going to do everything they can to win, but it would be a shame if individual researchers ended up taking unfair hits to their character and the quality of their research because of it. It appears to me that this is what has happened to Dr. Viscusi (not to mention a few other researchers on the anti-tobacco side who I will not mention here).
The rest of the story is that Dr. Viscusi's research has been inaccurately and unfairly cast as being junk science. The issues of potential bias in research and the utter faultiness of research appear to have been conflated, resulting in an unfair attack on the character and research quality of an individual.
We don't need to do this. We can win in the courtroom, and we can win with a little more courtesy and dignity than attacking individuals and their character and reputations based not on the actual quality of their work, but on the side that they take in the Tobacco Wars.
The bill, sponsored by Representative Bob Mathis, sailed through the legislature in two days with overwhelming legislative support and little discussion, at the same time as a bill to ban smoking in restaurants (but not bars) was hotly debated, but eventually enacted.
Similar legislation is apparently being considered in Utah, as well as in New South Wales.
The Rest of the Story
The first part of the rest of the story is that Representative Mathis, who championed the smoking ban in cars, was actually opposed to the smoking ban in restaurants. He is apparently so concerned about health that he wants to intrude into the privacy of one's behavior in one's own car to tell people what they can and cannot do, but he isn't so concerned about health that he wants to regulate smoking in people's workplaces. He is apparently so protective of individual rights that he defends a business' right to make its own decisions about allowing smoking, but not the right of an individual to make their own decision about smoking in their own car.
The second part of the rest of the story is that the Arkansas legislature seems quite hypocritical for banning smoking in cars, but allowing smoking in bars. If it's not a health hazard in bars, then it's not a health hazard in cars, and if anything, the degree of government intrusion inherent in regulating smoking in cars is greater than that inherent in regulating smoking in bars.
In other words, this is public health hypocrisy near its worst. I would argue that banning smoking in cars puts Arkansas into the category of being rabidly anti-smoking. It has become the first and only state to intrude into privacy rights in a person's own car to regulate smoking. Yet the state is so weak on the issue that it isn't willing to touch bars. This makes no sense to me, other than to suggest that the Arkansas legislature has no moral backbone or principles. I think the state legislators, especially Representative Mathis, needs a quick intravenous infusion of chondroitin sulfate.
But the worst part of the story is the law itself and what it reveals about the apparent motivations of the Arkansas legislature and the groups which supported this bill.
Importantly, it's acceptable to do damage to your children's health as long as you enroll in a smoking cessation program. Doing so waives the fine.
If it were really the health damage to the kids that was at issue here, then it shouldn't matter whether the violator enters a smoking cessation program, which has a dismal success rate in terms of actual cessation. The punishment is designed for the crime. And here the crime doesn't seem to be exposing children to secondhand smoke, it seems to be not wanting to quit smoking.
According to this law, as long as you desire to quit smoking and are willing to enter a smoking cessation program to demonstrate that, you are off the hook. You can smoke in your car as much as your heart desires. You're pretty much off scot free, even for multiple violations, as long as you can prove that you're attending a smoking cessation program. But if you don't want to quit smoking or even if you do but you don't feel that a smoking cessation program would be the best way to do so (and it isn't for most people), one offense and you're fined.
It certainly looks to me like what Arkansas is doing is turning the police into lifestyle police. And I mean that quite literally. The police in Arkansas are now being told to turn their attention to the effort to ensure that smokers with young children want to quit smoking. The violation, the police are instructed, is not smoking in a car with kids, but failing to want to quit.
In other words, this bill is really more about trying to alter lifestyle than it is about actually protecting the public's health.
Now I'll spend the rest of this post commenting on the policy itself - is banning smoking in cars justified as a public health policy?
I have to admit that this is a very difficult issue for me, because children are truly captive in their parents' cars, and the acute effects of secondhand smoke can be substantial for young children, especially infants.
Ultimately, however, I do not support legislation that bans smoking in one's own car. And here's the reason:
I do not see any real difference between one's own car and one's own home when it comes to regulating smoking to protect the health of children. If anything, I would argue that the threat to children from smoking in the home far outweighs the threat from smoking in cars, because although the concentration of secondhand smoke in cars is likely to be higher, the length of exposure in homes is likely to be substantially higher. Moreover, both the overall prevalence and overall time of exposure for children is almost certainly higher in the home than in cars. Many families do not even own a car, but nearly every family lives in some sort of home.
In other words, secondhand smoke exposure in the home is almost certainly a greater public health hazard for young children than secondhand smoke exposure in cars.
So if one is going to support legislation to ban smoking in cars with children, I simply do not see how one cannot also support legislation to ban smoking in homes with children. There is no qualitative difference that I can see between the two, and the quantitative difference would argue for a greater priority on the problem of exposure to secondhand smoke in the home.
Both are examples of the government intervening to protect children from risk of illness or disease due to lawful behaviors of their parents in the privacy of property that they personally own and are not used for business or commercial or any public purposes.
Both involve infringing upon parents' authority to make their own decisions about behaviors that potentially affect the health of their children.
As much as I hate to see children exposed to secondhand smoke in the home because of the potential health hazards, I simply believe that the privacy rights in the home outweigh the government's interest in regulating a lawful behavior that is merely a potential threat
Regulating smoking in the home would open the door to a wide range of intrusions into personal privacy that people would, I think, find highly objectionable. I don't think we want to see regulations that require what parents must or must not feed their kids, how much physical activity their children must have, what their kids can or cannot watch on television, what movies children can watch, or whether or not parents are required to put sunscreen on their children when they go outside to play for an hour.
I therefore view regulation of smoking in cars similarly. I think the intrusion into individual privacy of behavior on their own property outweighs the government's interest in protecting the health of children from this potential health hazard.
Undocumented Accusations of Wrongdoing Bring Down Ambassadorial Nominee; Anti-Smoking Groups Joined in Making These Claims
As I reported here last week, Senator Dick Durbin (D-IL) held up the nomination of Associate Attorney General Robert McCallum to become ambassador to Australia over a claim that he acted improperly in changing the government's requested smoking cessation remedy in its RICO-based Department of Justice (DOJ) lawsuit from a $130 billion backwards-looking program to a $10 billion forwards-looking one.
Now, that effort to derail McCallum's nomination, which comes without any documented evidence that he did anything wrong, has been successful.
The Rest of the Story
This is precisely why, as early as July of last year, I spoke out against the unwarranted and undocumented political attack that anti-smoking groups, led by Americans for Nonsmokers' Rights (ANR), waged against Associate Attorney General McCallum.
I argued that it was simply inappropriate for a public health group to be making a political attack without sufficient evidence of wrongdoing. In this case, there was actually no evidence that McCallum did anything wrong.
This, however, didn't stop ANR from falsely claiming to the public that McCallum was a "former tobacco industry lawyer" and implying that it was therefore an ethical violation for him to be involved in a lawsuit against the tobacco companies who he formerly represented.
In its political attack, ANR went so far as publicly stating that there was "a cancer" on the Justice Department.
In addition, ANR stated that there was sufficient evidence to warrant "an ethics complaint to be filed with the Federal Bar."
All this despite the fact that ANR itself admits that federal policy allows an "employee to participate in a matter about which he has an apparent conflict if he is authorized by an appropriate agency designee" and that "Mr. McCallum apparently was so authorized."
The truth is that McCallum never represented any tobacco company and therefore he is not a former tobacco industry lawyer as ANR claims.
The truth is that McCallum did appropriately request clearance from the DOJ Ethics Office to participate in the DOJ tobacco case because he had been a partner at a law firm that represented R.J. Reynolds. Clearance was granted.
The truth is that the conflict of interest is one which would provide R.J. Reynolds with a potential grievance, not the U.S. government.
The truth is that the request to reduce the proposed smoking cessation remedy in the DOJ case from a $130 billion backwards-looking program to a $10 billion forwards-looking one was legally necessary in order to comply with the D.C. Court of Appeals ruling that precluded backwards-looking remedies. Had McCallum not intervened in the lawsuit to more narrowly tailor this remedy, it would have been a complete embarrassment to the Department of Justice (as such, it is only a partial embarrassment, because at least it looks like DOJ is aware of the appellate court decision, though not being particularly compliant with it).
Back on July 21, I noted that ANR's political campaign to denigrate Robert McCallum was working. The public seemed to be buying the "fact," false as it was, that McCallum had previously represented R.J. Reynolds.
I wrote on July 21: "I think we need to wait until the investigation has been completed to cast judgment on him [McCallum] and his role in the case. But what I do think is indisputable is that he deserves to be judged based on the facts. And in this case, the fact is that he never represented R.J. Reynolds in litigation. But in my opinion, the majority of the public who is familiar with this story believes that he has. I do not think that is just. And I do not, therefore, find it acceptable that anti-smoking groups may have contributed to the public's misperception in a way that may inappropriately denigrate the reputation and character of an individual."
Apparently, the denigration of McCallum's character was successful, because public opinion was judged to be sufficiently negative against McCallum to support a single Senator successfully blocking this nomination.
Don't get me wrong. I'm not suggesting that ANR was responsible for blocking the nomination. That was clearly Durbin's doing. I'm only pointing out the kind of damage that can be done when anti-smoking groups make undocumented and unwarranted political attacks. And I'm pointing out the damage that was apparently done by ANR's unwarranted and premature attack.
The rest of the story is that there simply is no actual evidence that Associate Attorney General Robert McCallum did anything wrong by seeking clearance to be involved in his Department's tobacco case, being cleared by the Ethics Office, and participating in the case. Nor is there any evidence that he did anything wrong by demanding that a more narrowly tailored and forwards-looking smoking cessation remedy be substituted for one which was clearly not consistent with statute as interpreted by the governing court in the case.
My impression is that ANR and other anti-smoking groups are so anxious to jump into the attack of anyone who can in any way be construed as opposing our side that they jumped the gun and attacked without the evidence.
Unfortunately, this is not an isolated occurrence, but seems to be becoming a common theme in the anti-smoking movement: attack first, ask questions later.
This is not the way to practice public health.
Tuesday, April 25, 2006
New Ad Reveals that American Legacy Foundation Partner has Delivered 10 Billion Tobacco Impressions to U.S. Theater Audiences
The ad series, being run by the SmokeFreeMovies campaign, aims to eliminate the portrayal of smoking in movies seen primarily by youths (specifically, those with a G, PG, or PG-13 rating).
The culprit, according to the ad? Time Warner, whose CEO - Richard Parsons - "sat on Philip Morris' Board for ten years."
The SmokeFreeMovies policy proposals are endorsed by the American Legacy Foundation.
The Rest of the Story
I'm sorry, but it's hard to have any credibility as a national anti-smoking organization if your chief partner is a corporation that has "delivered an estimated 10 billion tobacco impressions to U.S. theater audiences alone."
And it's difficult not to come across as complete hypocrites when you endorse the SmokeFreeMovies policy goals on the one hand, and then you partner with the chief culprit of the problem on the other.
This action by the American Legacy Foundation is a complete joke. And frankly, it's an embarrassment to the entire tobacco control movement.
There are a large number of tobacco control advocates and organizations which have been working for years to address the problem of youth exposure to smoking advertisements and glamorous smoking portrayals in magazines and movies. With its completely unprincipled action of partnering with the chief culprit, which has apparently delivered 10 billion of these tobacco impressions to the nation's youths, the American Legacy Foundation has totally undermined all of the hard work of these dedicated advocates and organizations.
And apparently, it's all for financial and/or organizational gain. It appears that Time Warner is providing a platform for Legacy to get across its messages. Possibly, Legacy is receiving in-kind or monetary support from Time Warner in return for what amounts to an endorsement of the company by one of the nation's "leading" anti-smoking groups. I can think of no other plausible explanation for why Legacy would partner with the chief culprit of the problem that the SmokeFreeMovies campaign seeks to solve.
I guess when it comes to money and/or power, the lines between right and wrong get obscured. Apparently, money and/or power justify hypocritical actions like blasting companies for delivering youths to the tobacco industry on the one hand and partnering with those very companies on the other hand.
I think it's the loss of principle that disturbs me the most. I think it's time that we as a movement stand for something. It's almost getting to the point where I don't care what we stand for. Let's just stand for something and stick with it.
We can't attack corporations for delivering kids to Big Tobacco at the same time as we partner with those corporations. We can't attack Big Tobacco for contributing money to Congress to lobby for federal legislation at the same time as we join them in lobbying for that very same legislation. We can't attack the tobacco companies for their misleading and inaccurate communications to the public, while at the same time we are running a widespread public information campaign that is based on completely fallacious scientific claims.
I don't think we can have it both ways. We can't attack companies for doing things and then turn around and do those very same things. We can't attack companies publicly for addicting and ultimately killing kids and then turn around and privately forge deals with those companies for mutual benefit.
It's not only hypocritical, but it also undermines the effectiveness of the movement and seriously threatens our credibility.
I think it's time for the American Legacy Foundation to make a decision. Does it really want to put pressure on Time Warner to reduce its delivery of smoking images to children or does it not? If it does, then it needs to immediately dissolve its partnership with Time Warner. If it doesn't then it needs to immediately end its partnership with the SmokeFreeMovies campaign.
I think Legacy needs to make up its mind. Which side is it on? If it's on the side of SmokeFreeMovies, then that's fine. But call Time Warner and tell them that the partnership is over. If it's on the side of Time Warner, then that's fine too. But call SmokeFreeMovies and tell them that the partnership is over.
What Legacy is doing seems kind of like having two spouses. It's Legacy's prerogative to choose the entity to which they wish to be married. But you have to make up your mind, one way or the other.
Monday, April 24, 2006
According to the article, the director of a New York anti-smoking group stated: "A burning cigarette is more toxic to the people around it than it is to the person smoking it."
The Rest of the Story
I am not aware of any evidence that tobacco smoke poses more risks for people exposed passively than to active smokers themselves. So I don't particularly see any accuracy in this statement.
In fact, it is impossible for this statement to be true, because while the people around the smoker inhale only the diluted sidestream smoke from the cigarette, the person smoking inhales both the less diluted sidestream smoke and the mainstream smoke. So how could sidestream smoke plus mainstream smoke be less toxic than just the sidestream smoke? This makes absolutely no sense.
But more importantly, I think this type of communication is likely to undermine our efforts to convince smokers of the dangers of active smoking. If smokers are led to believe that the risks of active smoking are no worse than being exposed to drifting tobacco smoke, then why should they be particularly concerned about their health? Why should they quit smoking?
Why would an anti-smoking group make such a false claim? Presumably, because they are trying to promote smoking bans and want to try to sensationalize the effects of secondhand smoke as much as they can.
But in the process, what they have done is to seriously downplay the risks of active smoking.
I am all for making people aware of the hazards of secondhand smoke, but not at the expense of undermining the public's appreciation of the hazards of active smoking.
And not at the expense of scientific accuracy and honesty.
This example of yet another fallacious claim being made by an anti-smoking group suggests that these claims may well represent more than simply innocent mistakes. It seems that there is some sort of concerted effort to try to sensationalize the effects of secondhand smoke in order to affect public policy.
Here, a claim which cannot possibly be true is being advanced to try to scare people into thinking that a burning cigarette poses a greater health threat to exposed nonsmokers than to the smoker. In other words, a fallacious claim is being made in order to try to scare people into supporting smoking bans.
Make no mistake - I support smoking bans and have let my opinions be known repeatedly. But I don't support making fallacious claims to advance a policy that I support.
I don't think it's a particularly good idea, even from a strategic perspective, to make a claim that cannot possibly be true. In an apparent effort to try to generate more support for a smoking ban, these types of claims are going to do little more than expose the lack of scientific integrity of the present anti-smoking movement and threaten the credibility of the entire movement.
Why can't the truth stand on its own? I simply don't understand what is so threatening about the scientific truth that we can't represent the science as it is, rather than distort it beyond all reason.
Here, I will relate two examples of false scientific claims being made by anti-smoking groups to policy makers.
The First Story
According to the minutes of a March 24, 2005 meeting of the Children's Health and Environment Committee of the Indianapolis City Council, which was conducting a public hearing of a proposed workplace smoking ordinance, the American Heart Association (Indianapolis Metropolitan Region) testified that:
"Twenty minutes of exposure to secondhand smoke is equal to smoking one pack of cigarettes and results in sticky blood platelets which again increases the chance for heart attack. Thirty minutes of exposure has the same effect on the coronary arteries as a regular smoker, which affects the ability of the artery to open or dilate during times when a person needs more or less blood supply to the heart muscle. Two hours of exposure to secondhand smoke can cause irregular heartbeats, which can lead to an arrhythmia or a heart attack."
The questioning of the American Heart Association speaker revealed considerable confusion about the claim being made:
"Councillor Bradford asked how long it takes to smoke a cigarette. He asked if it only takes 10 minutes to smoke one cigarette, how can 20 minutes of exposure to secondhand smoke be like smoking a pack of cigarettes? Ms. Rench said that the 20 minutes of exposure to secondhand smoke relates to the equivalent effect of a pack-a-day smoker. Councillor Bradford asked if this secondhand exposure refers to one smoker in the room or more than one smoker. Ms. Rench said that she does not have exact statistics on the number of smokers. Councillor Bradford said that if it only takes 10 minutes to smoke a cigarette, does it not make sense that 20 minutes of exposure to secondhand smoke would be more like smoking two cigarettes. Ms. Rench said that the effects on a first-hand active smoker are different from those produced by secondhand smoke. Councillor Talley said that he smoked briefly in the Marine Corps and could smoke a cigarette in a minute and a half, so this time correlation may not be accurate. Ms. Rench said that this comparison is simply saying that if you are a nonsmoker who is exposed to 20 minutes of secondhand smoke every day, it is comparable to the health effects on a pack-a-day smoker. Councillor Keller said that spending 20 minutes in an establishment with heavy smoke, such as a bar, would be the equivalent effects as a person smoking 20 cigarettes throughout the day."
The Rest of the First Story
It is terribly misleading, I believe, to suggest that "Twenty minutes of exposure to secondhand smoke is equal to smoking one pack of cigarettes." If this were true, then people who experienced regular but transient exposures to secondhand smoke would suffer the same health consequences as pack-a-day active smokers. We know that this is not the case. For one thing, lung cancer risk is overwhelming higher in an active smoker than a transiently exposed nonsmoker. For another thing, chronic obstructive lung disease (such as emphysema) is a serious risk among an active smoker, but does not occur among passive smokers. So I simply don't see how one can suggest to policy makers that twenty minutes of secondhand smoke exposure is equal to actively smoking one pack of cigarettes.
It is also quite misleading, I believe, to suggest that 30 minutes of secondhand smoke exposure "results in sticky blood platelets which again increases the chance for heart attack." Sure, 30 minutes of exposure does increase platelet stickiness, but there is no evidence that this is of any clinical significance for nonsmokers. Perhaps for someone with severe existing coronary artery disease this could be a possible danger, but it is certainly not accurate to suggest that as a general matter, 30 minutes of exposure increases the chance for a heart attack.
It is also quite misleading, I believe, to suggest that "Thirty minutes of exposure has the same effect on the coronary arteries as a regular smoker, which affects the ability of the artery to open or dilate during times when a person needs more or less blood supply to the heart muscle." Thirty minutes of exposure clearly doesn't have the same effect on the coronary arteries as being a regular smoker. For starters, the effect of 30 minutes of exposure is transient and reversible and for all intents and purposes, clinically meaningless for most nonsmokers. In a healthy nonsmoker, there is no evidence that the temporary endothelial dysfunction caused by transient secondhand smoke exposure has any clinically meaningful effect on coronary artery blood flow. In fact, there is documentation that baseline coronary artery blood flow is not affected and in that there is little if any effect even for someone running on a treadmill. But active smoking can cause narrowing of the coronary arteries leading to myocardial infarction and death. I don't see how these two disparate levels of health effects are in any way comparable.
Perhaps the most misleading statement of all is the claim that "Two hours of exposure to secondhand smoke can cause irregular heartbeats, which can lead to an arrhythmia or a heart attack." Actually, calling this misleading is being quite generous. It's actually a false statement in my view. Two hours of exposure does not cause irregular heartbeats and it certainly does not lead to a serious arrhythmia or heart attack. What it does is decrease heart rate variability, which is simply a measure of cardiac autonomic function. There could be consequences, perhaps, for a person with severe coronary artery disease, but for most nonsmokers, a single two-hour exposure poses no known risk of an arrhythmia or heart attack.
But the story here is not just that the testimony was highly misleading and in some cases inaccurate (and therefore I would say somewhat irresponsible). The story is also that the council was clearly misled by the testimony. When questioned about the obviously false statement that 30 minutes of exposure to secondhand smoke is equal to the effects of actively smoking one pack of cigarettes a day, the American Heart Association spokesperson apparently started grasping at straws and revealed that she actually didn't understand what she was talking about. Quite clearly, she was just repeating dogma that she had seen or heard but didn't really have any depth of scientific understanding of what she was talking about.
The Second Story
According to the minutes of the June 12, 2003 meeting of the Laredo (Texas) City Council on a proposed smoking ban, the city health director apparently provided testimony in which he claimed that:
"Thirty minutes of breathing secondhand smoke compromises the ability of the blood to manage LDL 'bad' cholesterol by depressing anti-oxidant defenses - the effect persists for several hours after exposure ends. The arteries' ability to dilate is also reduced, diminishing the flow of blood to the heart. After 120 minutes of breathing secondhand smoke, the risk of an irregular heartbeat (arrhythmia) that can itself be fatal or trigger a heart attack increases."
The Rest of the Second Story
I find it inaccurate to claim that 30 minutes of exposure to secondhand smoke diminishes "the flow of blood to the heart." Sure, it does reduce coronary flow reserve velocity, but this is of no consequence in an otherwise healthy person, and it does not translate into diminished blood flow to the heart. In fact, the study from which these data are derived demonstrated that there was no change in coronary blood flow after 30 minutes of secondhand smoke exposure.
I also find it inaccurate to claim that "After 120 minutes of breathing secondhand smoke, the risk of an irregular heartbeat (arrhythmia) that can itself be fatal or trigger a heart attack increases." There is no evidence that such an exposure has any effect on the risk of a catastrophic or fatal cardiac arrhythmia.
What these examples demonstrate (and I'm sure there are many more) is that the fallacious claims being made by anti-smoking groups to support smoking bans are not simply innocent mistakes that are of no significant consequence. In fact, these claims are being used inappropriately to advance public policies and it appears that they are significantly misleading or deceiving public policy makers about the acute health effects of secondhand smoke.
I've stated clearly many times that I support workplace smoking bans and so I am not writing because I want to try to derail efforts to promote these policies. I am writing because as much as I support these policies, I do not believe it is right to use fallacious claims to support the policies, and I think it is unfortunate that policy makers are being misled in the name of promoting the public's health.
Harford County (Maryland) Cancer & Tobacco Community Coalition: "30 minutes and your coronary arteries show the same damage as a smoker."
University of Kentucky Tobacco Policy Research Program: "20 minutes of exposure causes excess blood clotting, increasing the risk of heart attack and stroke. 30 minutes of exposure increases the build up of fat deposits in blood vessels, increasing the risk of heart attack and stroke. 2 hours of exposure increases the chance of irregular heart beat that can be fatal or trigger a heart attack."
Inter-Tribal Council of Michigan: "30 minutes of secondhand smoke compromises a nonsmoker's coronary arteries to the same extent as in smokers."
Blue Cross of Northeast Pennsylvania: "The effects of the secondhand smoke can be seen within five minutes of inhaling the chemicals from tobacco. ... Exposure to secondhand smoke can cause changes in cholesterol chemistry in 20 minutes, and in two hours changes occur in the heart's rate of contraction. All of these changes can cause an increased risk for a heart attack or long-term development of atherosclerosis."
Leeds, Grenville, and Lanark Health Unit: "within 30 minutes, blood platelets are activated, which makes the blood 'stickier' and damages artery linings which can lead to a heart attack."
City of Laredo (testimony before City Council): "After 120 minutes of breathing secondhand smoke, the risk of an irregular heartbeat (arrhythmia) that can itself be fatal or trigger a heart attack increases."
American Heart Association, Indianapolis Metropolitan Region: "Two hours of exposure to secondhand smoke can cause irregular heartbeats, which can lead to an arrhythmia or a heart attack."
County Durham and Darlington National Health Service (UK): "Within 20 minutes, passive smoking activates platelets causing them to stick together forming blood clots."
Heart Foundation South Africa: "Only 30 minutes of exposure can damage a non-smoker's heart and increase the risk of heart disease by 30%."
American Cancer Society: "30 minutes of breathing secondhand smoke makes blood platelets get as activated as in habitual pack-a-day smokers. These activated platelets damage the lining of arteries, which leads to heart disease. If they form a blood clot that lodges in a coronary artery, we call that a heart attack. If it lodges in the brain, we call it a stroke."
New Jersey GASP: "Healthy nonsmokers who enter a smoke-filled room show almost immediate changes in their blood, changes that can result in heart disease and stroke."
Coalition for a Tobacco-Free Vermont (cached - no longer on the web page): "Just 30 minutes of exposure to second-hand smoke changes blood chemistry and increases the risk of heart disease in non-smokers."
University of Missouri - St. Louis Wellness Resource Center: "Even 30 minutes of exposure to secondhand smoke can cause heart damage similar to that of an everyday smoker."
American Heart Association, Heritage Affiliate: "Even 30 minutes of exposure to secondhand smoke reduces blood circulation and increases your risk for a heart attack."
Swindon Primary Care Trust (UK): "Just 30 minutes in a smoky room can thicken the blood and reduce the oxygen needed for red-blooded passion."
SmokeLess States: "After only 30 minutes, secondhand smoke starts to affect blood vessels in ways that can lead to heart disease and stroke."
Smoke Free Berkshire: "Many people believe the negative health effects of secondhand smoke are only caused over a long period of time but did you know that being in a smoke-filled room for only 30 minutes is enough to thicken the blood and make it 'sticky' which increases the risk of heart attacks and strokes."
Tobacco Control Strategy Planning Guide: "30 minutes of breathing secondhand smoke makes blood platelets get as activated as in habitual pack-a-day smokers. These activated platelets damage the lining of arteries, which leads to heart disease."
Canadian Lung Association: "Just 30 minutes' exposure to second-hand smoke hardens your arteries."
Web MD: "As little as 30 minutes of secondhand smoke can lead to hardening of the arteries in nonsmokers."
SmokeFreeColorado: "Only 30 minutes of exposure to secondhand smoke reduces blood flow to the heart, significantly increasing a nonsmoker's chances of heart attack and stroke."
The Rest of the Story
By my count, this now brings to at least 65 the number of anti-smoking and health groups that are making or have made completely fallacious scientific claims about the acute cardiovascular effects of secondhand smoke exposure.
The penetration of these fallacious claims is impressive and the extent to which these claims seem to have been (and are currently being) disseminated to the media, the public, and policy makers is immense.
I think this is truly a crisis for the anti-smoking movement. It is just too large a problem to ignore. Our credibility as a movement is truly at stake.
Sunday, April 23, 2006
According to an article in the Star Phoenix: "Public health authorities are crediting Saskatoon's smoking ban with a reduction in the number of heart attacks. ... In the first year of the smoking ban in Saskatoon, the heart attack rate dropped by 10 per cent compared with the previous five years, to 148.2 cases per 100,000 from 165.4 cases for every 100,000 people. That translates into 32 fewer heart attacks in one year, says a report that was received at the authority's meeting."
The Saskatoon smoking ban, which covers all public places, went into effect on July 1, 2004.
The Rest of the Story
Although public health authorities in Saskatoon are bold enough to be making such an assertion that they can directly attribute the 32 fewer heart attacks observed in the city between July 2004 and July 2005 to the smoking ban, they are apparently not so bold as to make the data available for review, which would allow the public to evaluate the validity of the claim and the science upon which the claim is made. While the public health authorities apparently reported their conclusion to the press (a conclusion that is now being rapidly disseminated throughout the world), I can find no evidence that they made the actual data available: the SHR website does not appear to contain a copy of the report so that it can be critically evaluated.
All we know is that there was a 10% reduction in the heart attack rate in Saskatoon from the five years prior to the smoking ban to the year following the ban. That's hardly enough information to be able to draw a causal conclusion about the impact of the smoking ban on the heart attack rate.
For starters, one needs to know the baseline secular trend in heart attacks in Saskatoon. Based on secular trends in heart attacks observed elsewhere, and on the drastic declines in smoking observed in Canada during the late 1990s and early part of the present decade, one would expect that heart attack rates in Saskatoon might have already been on the decline, prior to the implementation of the July 1, 2004 smoking ban. If that's the case, then the 10% decline in heart attacks, or some part of it, might have simply been a reflection of underlying secular trends.
Second, one needs to know the baseline level of variation in heart attacks in Saskatoon from year to year. It's quite possible that an annual variation in heart attacks of about 10% is not unusual for Saskatoon. It's possible that such a change is consistent with normal year-to-year variability in heart attacks in the city.
Third, it's not clear whether there was any comparison group, in which there was not a decline in heart attacks during the same time period, that would provide evidence that might help one to conclude that the observed decline in heart attacks in Saskatoon was attributable to the smoking ban, rather than to secular changes in heart attack incidence, which we know is declining in many large cities.
There has apparently been a significant decline in smoking prevalence in Saskatoon since the implementation of the smoking ban (from 24.1% to 19.4%) and there is apparently survey evidence that this decline is at least partly attributable to the smoking ban. It would not be unreasonable to conclude that the smoking ban affected smoking prevalence in Saskatoon, a finding that would be consistent with extensive published literature on this topic.
However, to make the leap to attributing any changes in heart attack rates to the smoking ban is simply unwarranted unless some rigorous scientific analyses are conducted.
I don't know exactly what scientific analyses have been conducted, because that information was apparently not made available. However, from the limited information that was released to the public, the data are clearly not sufficient to draw a conclusion that the observed decline in heart attacks in Saskatoon was due to the smoking ban. It's not implausible that this is the case (unlike the situation in Helena), especially given the large decline in smoking prevalence; however, the data that are presently available to us are not sufficient to support such a conclusion.
What appears to be happening here is that anti-smoking advocates are so eager to demonstrate an impact of their policies on disease rates that they are jumping the gun in concluding that any changes in disease rates are due to their policies. This is understandable since as public health practitioners, we would all love to see these changes and to believe that they are due to our efforts. However, sometimes we need to hold our eagerness in check in order to ensure that we are relying upon sound science before reporting such conclusions widely to the public.
In Saskatoon, as in Helena and Pueblo, relying upon sound science does not seem to be the priority. The priority appears to be crediting our efforts with any observed changes in disease rates to further support these policies. Unfortunately, while these claims may give a short-term boost to our anti-smoking efforts, in the long run they are going to hurt. Because they are sacrificing the long-term scientific integrity of our movement for short-term political gain. And in the long run, the decline in scientific credibility of our movement is going to hurt a lot more than the fleeting gains from the newspaper coverage of the Saskatoon health officials' claims.
Saturday, April 22, 2006
In the commentary, entitled "The Intolerance and Arrogance of the Modern-Day Anti-Smoking Movement," Dr. Whelan suggests that the anti-smoking movement has become "increasingly unscientific, arrogant, absolutist, and intolerant of dissenting views."
According to the commentary: "Cigarette smoking is the leading preventable cause of premature death, accounting for approximately 400,000 deaths annually in the U.S. -- nearly one in every four deaths, and one in every two premature deaths each year. But we at ACSH hold to the belief that the best way to lose an argument is to overstate it. And overstatement is exactly what a growing number of members of the anti-smoking community are doing. Indeed, anti-smokers are becoming increasingly unscientific, arrogant, absolutist, and intolerant of dissenting views."
Two examples are cited to support this contention. First is the way that the movement has treated dissent to the dogma that we cannot suggest that smokeless tobacco is less hazardous than cigarette smoking. Apparently, ACSH hosted a conference on harm reduction strategies and "Despite ACSH's attempt at balance, veteran members of the anti-smoking community were irate that ACSH was hosting such a meeting, and one anti-smoking leader called ACSH to announce that I would be 'excommunicated' from the anti-smoking movement if I moved forward with this event. (ACSH did move forward, so I guess I am out.)"
The second example is the exaggerated claims being made about the acute cardiovascular effects of secondhand smoke:
"A few egregious examples: a leading tobacco researcher made the improbable claim that the smoking ban in Helena, Montana resulted in a 40% decline in heart attack admissions in a six-month period after the ban. 'We used to think that heart disease came after years of exposure' said Dr. Richard Sargent, an anti-smoking Montana physician, who then went on to argue that even short-term exposure to exhaled smoke can damage the heart: 'if you go into a restaurant for a sandwich, if you go into a bar for a beer, and you get exposed to a heavy amount of secondhand smoke, you're just as at risk for a heart attack as a smoker.'"
Finally, Dr. Whelan points out how the anti-smoking movement treats any dissent to its established dogma, even when that dogma flies in the face of common sense and scientific fact: "Funny thing about communication in science and medicine. When a politically correct theory or claim takes hold and is loudly trumpeted (as in 'secondhand smoke, even in trace amounts, kills'), dissenters are terrified to step forward and challenge that theory lest (a) they be called apologists for, in this case, the cigarette industry or (b) they be accused of not getting on the bandwagon of what is an inherently good public health cause."
The Rest of the Story
I think that Dr. Whelan and ACSH are to be congratulated for coming forward and having the courage to tell it like it is, even though the anti-smoking movement will likely respond to this dissent by attacking the organization and accusing it of being cigarette industry apologists.
The last laugh will be ACSH's however, as the organization is, and has been, one of the strongest and most consistent voices speaking out against the tobacco industry.
At a time when many of the national tobacco control organizations - including the Campaign for Tobacco-Free Kids, American Cancer Society, and American Heart Association - attempted to bail out Big Tobacco from its legal woes by providing it with immunity for its wrongdoing, in exchange for billion of dollars, ACSH refused to be enticed by this buy-out offer and remained steadfast in its principles, publicly opposing the global tobacco settlement (or "global tobacco bailout" as some have called it).
In this battle between public health versus politics and money, our Campaign for Tobacco-Free Kids chose politics and money, while it was ACSH that stood up for the rights of American citizens and chose the side of public health.
At a time when nearly the rest of the anti-smoking movement was silent in the face of the American Legacy Foundation's stupid and harmful decision to honor the nation's leading publisher of cigarette advertisements seen by children, ACSH had the courage to criticize this action, even though the organization itself had a grant from Legacy. In contrast, nearly every other anti-smoking group was silent, most likely because of the fear that they might jeopardize their own funding if they criticized Legacy.
At a time when the Campaign for Tobacco-Free Kids supported the Master Settlement Agreement, which I view as the worst public health blunder of my lifetime, ACSH was again one of the few anti-smoking organizations to oppose this purely politically- and financially-motivated deal.
And now, when the Campaign for Tobacco-Free Kids and a host of other public health organizations are supporting FDA tobacco legislation that would provide Big Tobacco with virtual immunity in return for regulation of tobacco products in name-only (but not in a way that would produce any real public health benefit), ACSH stands nearly alone in the tobacco control movement in opposing this proposed policy.
So while ACSH might predictably take some hits from within the tobacco control community for suggesting that the movement is increasingly unscientific and intolerant (in other words, for calling a spade a spade), the ultimate irony is that ACSH has been a far more principled supporter of effective tobacco control policy than the Campaign for Tobacco-Free Kids, American Cancer Society, American Heart Association, American Lung Association, and American Legacy Foundation.
It is also interesting to note that the response I have received from the anti-smoking movement to expressing an opinion that differs from the established dogma is not unique. I am not the only one who has apparently been "ex-communicated" from the movement for expressing dissent. Perhaps we are on our way to establishing an "ex-communicated tobacco control movement."
The example that Dr. Whelan provides of the overstating the acute cardiovascular effects of secondhand smoke is particularly compelling. How could someone without severe existing heart disease be at the same risk of a heart attack as a smoker from having a sandwich in a smoky restaurant? How could the person be at any risk of a heart attack if they don't have pre-existing coronary artery disease? It's medically impossible for an acute exposure to secondhand smoke to cause a heart attack in a healthy person unless it causes coronary spasm, and there's no evidence for that.
The rest of the story is that ACSH is one of the only national tobacco control organizations I am aware of in the United States which is willing to publicly stand up for basic principles of public health practice in tobacco control. And here, ACSH has told it like it is: the anti-smoking movement is becoming increasingly unscientific, absolutist, and intolerant of dissenting views.
Thursday, April 20, 2006
Tobacco Control Practitioner Supports WHO's Decision Not to Hire Smokers; Bigotry Alive and Well in Anti-Smoking Movement
In the editorial, she argues that: "Health professionals have for years been enjoined not to smoke as part of their professional responsibilities. And now, many health organisations see the need for coherence in their staffing requirements. In my view, the WHO has taken a decision that is a timely next step in our changing perception of tobacco use."
In trying to explain why there is what she calls a "schism" in the tobacco control movement on this issue, she suggests that the reason why some in tobacco control have denounced these policies is that they are afraid of being accused of "telling other people how to run their lives" and of being cast in the dark cloud of "moralizing," and therefore are reluctant to support the WHO's policy. She seems to be suggesting that those in tobacco control who oppose this policy are doing so only because they are afraid of what others might think if they expressed support for it, but that deep down, they actually do support the idea.
In her words: "such comments [that we in tobacco control are moralizing] make us a bit edgy, and we leap to deny any accusation that we are telling people how to live their lives. The blatant deception, chicanery and exploitation the tobacco companies have been shown to extend to their customers have had the secondary effect of taking away some of the 'moralising' cloud over tobacco control, but many are nevertheless working in this shadow. Hence the reticence to support the WHO's new hiring requirement."
The Rest of the Story
Bigotry is defined as utter intolerance of any creed, belief, or opinion other than one's own. The author of this editorial apparently feels that smokers have no place in the workplace, or at least in workplaces that involve the practice of public health. She is certainly entitled to her opinion, and should she wish to implement such a policy in her own workplace, that is her prerogative as an employer, as long as she is not breaking any anti-discrimination laws in her country (and I have no knowledge of employment discrimination law in France).
But to suggest that her opinion on the inappropriateness of smokers in the public health workforce should be institutionalized in the form of policy, at the expense of an entire segment of the population who are largely addicted to a product which they are unable to easily stop using due to the addiction, is intolerance on a grand scale.
It is intolerance of the lawful behavior choices of an entire population of people, choices which do not directly affect their ability to perform the duties of a public health job and which do not conflict in any way with the practice of public health.
The argument that this tobacco control practitioner is making is, I think, an extremely dangerous one. Because she seems to be suggesting that hiring smokers represents incoherence with the appropriate staffing policies of a public health organization.
Well let's go with that for a while. Let's accept her contention that smoking is incoherent with the job of being a public health professional. Let's give her the complete benefit of the doubt here.
What I would then ask us to consider is whether being fat is also incoherent with the job of being a public health practitioner. Clearly, according to the same reasoning, it is. Obesity is arguably the number two public health problem, right behind smoking. So if it is inappropriate for someone who chooses to smoke to practice public health, then it is also inappropriate for someone who chooses to not exercise and not control their food intake to be a public health practitioner.
And then we can go right down the line. It would also be an incoherent staffing policy for a public health organization to hire someone who does not adequately control their blood pressure. The same goes for inadequate control of their cholesterol level, blood sugar level (especially in diabetics), and excessive fat intake (as these are three of the most important factors in the development of heart disease, the #1 cause of preventable death).
So according to this reasoning, the only people who should be employed by public health organizations are thin, physically active, normotensive, normocholesterolemic, non-diabetic (or diabetic with good blood sugar control) people who don't smoke and don't eat too much fat. The "coherent staffing policies' that are being called for here are really a call for an "Aryan race" of public health practitioners who meet all of these lifestyle and behavioral requirements.
This kind of thinking is bigoted. It is completely intolerant of behavior that differs from one's own. And for no reason that has anything reasonably to do with the requirements to perform a job.
I'll tell you one thing I can say for sure. If we disallowed smokers to enter the nursing field, patient care in this country would suffer significantly. Many of the absolute best nurses I have had the good fortune to work with happened to be smokers. It would have been not only ludicrous, but also would have diminished the quality of patient care to deny these talented and well-qualified individuals employment in the health care profession because they happened to smoke when they were off-the-job on their own time.
I certainly think that programs to try to encourage health care professionals to quit smoking are reasonable, but I think worksite wellness programs and incentives are the appropriate way to deal with this issue - not banning smokers from the public health workforce.
Now to the insulting part of the editorial.
The author of this piece suggests that the reason why some of us in tobacco control who oppose the WHO's policy do so is that we are afraid of being accused of moralizing and telling people how to live their lives. Somehow, our concerns are not legitimate ones - we are just cowards, too "edgy," or are just protecting our movement from criticism.
I can't speak for anyone else, but I can assure the author of this piece that I oppose the WHO's discriminatory and bigoted hiring policy not because I'm afraid that supporting the policy would open the door to criticism of our movement, but because I think it's a discriminatory and bigoted policy.
I don't oppose the WHO's policy because I'm afraid of being accused of moralizing and telling people how to live their lives. I oppose it because I don't believe that we should moralize or tell people how to live their lives. We certainly shouldn't cast judgment on people who engage in unhealthy, lawful behaviors. And we most certainly shouldn't preclude them from the workforce, our own (the public health workforce) or anybody else's.
It seems to me that this editorial is just another example of how the tobacco control movement allows no room for dissent with its established dogma. Anyone within the movement who criticizes this policy is being cast not as having any legitimate opinion, but of simply acting insincerely out of fear or purely strategic concerns. Our opinions critical of the direction the movement is going cannot possibly be heartfelt, legitimate, well-reasoned concerns. It can't be how we "really" feel. After all, we're tobacco control practitioners. There must be some other motivation driving us to this dissent.
I agree with the author of this editorial on only one thing. The World Health Organization's decision is a "timely next step." It is a timely next step towards taking the tobacco control movement completely out of the realm of public health and turning it into little more than a fanatical, overzealous, and bigoted crusade against a good 20% of the population.
Minnesota Anti-Smoking and Health Groups Call for Balancing State Budget on Backs of Smokers, But Not for Restoration of Tobacco Control Programs
According to the press release: "Several of the state's leading health advocacy organizations today launched a statewide advertising campaign to emphasize the health benefits of the 75-cent tobacco price increase. The radio and newspaper ads highlight the impact that higher tobacco prices have on preventing kids from smoking and helping more people quit smoking. The advertisements are sponsored by Blue Cross and Blue Shield of Minnesota, the American Cancer Society, American Lung Association of Minnesota, American Heart Association, Minnesota Medical Association, AARP, Campaign for Tobacco-Free Kids and the Minnesota Smoke Free Coalition."
The Minnesota legislature is currently considering how to handle a significant budget crisis. Last July, the legislature enacted a 75 cent per pack "health impact fee" on cigarettes, which was intended to "recover for the state health costs related to or caused by tobacco use." The "fee" was not considered to be a "tax" because the Governor had pledged not to raise any taxes. In order to make the measure politically palatable given his pledge, the measure was framed as an impact fee designed simply to recover health care expenditures caused by smoking.
However, in December, a Ramsey County judge struck down the health impact fee as being a violation of the state's settlement of its litigation against the tobacco companies, which "barred the state from seeking additional money from the firms to pay for health care costs related to smoking."
Although the state has appealed this decision to the state Supreme Court, the legislature is right now considering whether to simply enact the 75 cent per pack "fee" as a plain old cigarette tax instead, which would easily pass legal muster, as the tobacco settlement does not dictate how the state can set its taxes. The advertisements by the health groups are apparently timed to coincide with the legislature's consideration of this possible cigarette tax increase.
Without the cigarette tax, the state is poised to lose $185 million in annual revenue, necessary to balance its budget and provide necessary state services and programs. The "health impact fee" was enacted by the legislature specifically to balance the budget and avoid a government shutdown.
Ironically, the Governor, who was the chief impetus behind the "health impact fee," now opposes the cigarette tax proposal.
The Rest of the Story
It is quite clear that the purpose of the cigarette health impact fee or tax or whatever you want to call it is not to reduce cigarette smoking and improve the public's health. The expressed purpose of the tax is to balance the state's budget and avert what would otherwise be a budget crisis.
The fee/tax is about one thing - money. It is about finding a way to reap in $185 million in additional revenues so that the state does not have to take any politically less popular measures to finance its budget (such as raising taxes on the wealthiest of citizens and corporations, rather than the poorest residents).
The rest of the story is that the very same legislature which is now asking smokers to pay for the necessary state services that no politician wants to cut or to ask the wealthy to finance two years ago decimated the state's services for those very smokers, destroying a program dedicated to preventing youth smoking and encouraging smokers to quit.
But instead of suggesting that the cigarette tax be increased to restore these services which would directly benefit smokers and improve the public's health, the anti-smoking and health groups simply want to raise the cigarette tax, regardless of whether the money is used to provide any services, treatment, or other programs for those who will shoulder the burden of this regressive tax.
Rather than trying to restore the tobacco prevention and cessation services, the health groups are essentially acting as accomplices in the decimation of what had been an effective tobacco control and public health program by accepting its demise and not calling for the massive proposed cigarette tax increase to be used, at least in part, to restore the program and services.
And this opportunity will not arise again any time soon. You don't have too many opportunities to raise taxes these days, so if you are going to do it, you ought to be pretty darn careful about how you choose to allocate the revenues. If you aren't spending the money, at least in part, to benefit those who are shouldering the burden of the payments, then the tax is truly regressive and discriminatory.
As Dr. Richard Wagner stated in his report critical of the use of tobacco taxes to fund state budget shortfalls: "Tobacco taxation is a severe form of tax discrimination whose victims reside primarily among the working classes and not professional people. It is tax discrimination against people of modest means for the benefit of the well-to-do."
I think this discriminatory effect can be mitigated by allocating the revenues from the tax to benefit those who are paying the tax (such as providing for cessation services, tobacco prevention programs, smoking education, medical treatment for smoking-related diseases, and increased research on treatments for the diseases which we are so dismal in treating). However, this is not what the health groups are calling for. Instead, they seem content to have the money used simply to balance the budget, and to allow the decimated state tobacco control program to remain in shambles.
It is not as simple as the health groups are making the issue out to be. In the press release, the Blue Cross spokesperson stated: "It's good health policy to have higher cigarette prices. It prevents kids from starting to smoke and it encourages adults to quit."
I view that as a very narrow perspective on the complex policy issues involved. First of all, it ignores the purpose of the increased cigarette tax. Second, it ignores the possibly regressive and discriminatory nature of the tax. But perhaps most importantly, it ignores the potentially destructive public health consequences of making the state dependent upon cigarette consumption to fund vital state programs and services.
This policy would make the state dependent on cigarette consumption for the most vital resources of the state: those necessary to balance the budget. It would completely take away any legislative incentive to promote any kind of vigorous smoking cessation or smoking prevention program. You might as well kiss the restoration of the tobacco control program goodbye for the near future. And more importantly, there will be no further incentive for the legislature to do anything that would seriously affect tobacco consumption. Doing so would threaten the state's budget and therefore, with this proposal, becomes politically untenable instantaneously.
In other words, what the anti-smoking and health groups are pushing for is a proposal that would stymie any effective tobacco control policymaking in the state. I don't see that as good public health policy.
I see this basically as a way to balance the budget in the most politically palatable way possible: do it on the backs of smokers, a group which tends to be less economically advantaged and easier to take advantage of. Don't ask the wealthiest citizens and corporations to balance the budget - after all, they represent a much stronger voting bloc and such an action could harm the re-election chances of politicians, and possibly even donations to the non-profit health groups. But putting the burden on the smokers is the easy solution and it won't hurt the politicians or the health groups politically or financially.
The rest of the story is that the health policy which anti-smoking and health groups in Minnesota are lobbying for is little more than a discriminatory, regressive tax on the poorest state citizens designed to balance the budget on their backs rather than have the courage to ask the wealthiest citizens and corporations, who could easily afford $185 million per year, to do so. It makes the state dependent on cigarette consumption for its financial stability, takes away any incentive to pass effective tobacco control policies that might significantly reduce cigarette consumption and threaten the state budget, destroys the chances of restoring the state's effective tobacco control program, and squanders an opportunity to provide services for smokers and research and treatment for the diseases that are affecting them.
This is hardly what I would call a "win, win, win" situation, as the Campaign for Tobacco-Free Kids has called it. At least not if you have a little broader view of public health policy than simply wanting to raise cigarette taxes as the be-all and end-all of your strategy to improve the public's health and instead have some desire to build a lasting public health and tobacco control infrastructure that can and will remain effective, fair, and unencumbered by irreconcilable adverse political constraints.