Rest of the Story Author Thrown Off of List-Serve; Censorship Alive in Anti-Smoking Movement, But Little Room for the Truth

In a startling turn of events, a 21-year veteran of the tobacco wars, who has published more than 50 peer-reviewed articles in leading scientific journals on tobacco science and policy issues, testified more than 10 times in tobacco cases, serves as a statistical editor for one of the leading tobacco control journals, and who has testified in more than 100 hearings for smoke-free workplace laws, was thrown off the largest and most prominent international tobacco control list-serve for calling on anti-smoking organizations to be truthful in their communications to the public of scientific issues regarding secondhand smoke.

After posting a note to the list-serve in which I suggested that anti-smoking organizations were making junk science claims by widely disseminating to the public the claim that 30 minutes of secondhand smoke exposure causes atherosclerosis in nonsmokers and that we need to rectify the problem to protect our credibility, I was thrown off of the list-serve.

Interestingly, I was not told I was being kicked off the list-serve. I found out because I was no longer able to access the list-serve, post messages, or receive or view messages. After confirming with many other list-serve members that they were having no technical problems with access and after waiting a week with no resolution to the problem of my access to the list-serve, it became clear that I was indeed off the list-serve. I also received definitive internal confirmation that the list-serve management team did in fact meet (via email) to take actions to censor the expression of my opinions on the list-serve.

My final post on the list-serve, which apparently was just too much for the anti-smoking groups to take, stated the following:

"For many years, tobacco companies and many other opponents of tobacco control policies have accused the tobacco control movement of engaging in junk science, especially regarding the health effects of secondhand smoke.

For example, we have been accused of cherry-picking the science on secondhand smoke, making up the science, and spreading scientific claims that are implausible, and therefore junk.

But recently, I believe that junk science has actually entered the anti-smoking movement.

The greatest example is the claim we are making that 30 minutes of secondhand smoke exposure can cause hardening of the arteries. Apparently, this claim stems from a study published in the Journal of the American Medical Association which showed that a 30-minute tobacco smoke exposure causes endothelial dysfunction (damage to the function of the cells lining the coronary arteries) in nonsmokers. Endothelial dysfunction is a marker of the earliest stage of atherosclerosis.

The significance of this study is that it demonstrates a plausible biologic mechanism by which chronic exposure to secondhand smoke can cause heart disease: repeated damage to the endothelial lining of the coronary arteries could result in a process of atherosclerosis, over a period of many years.

But instead of representing the study for what the science actually showed, we are distorting the scientific findings and using them to claim that a single 30-minute exposure to secondhand smoke is enough to cause atherosclerosis, forgetting to tell the public about the chronic (repeated) exposure part.

Moreover, a group of major anti-smoking organizations prepared a strategy document urging all of us in the movement to make this claim publicly in order to promote smoking bans. By making the damage from secondhand smoke seem immediate and severe, it was suggested, we could help break down barriers to the adoption of these smoking bans because our statements would have more of an emotional effect.

But by forgetting this key component of the scientific evidence - that it documented only a transient effect that represented the very earliest stage of atherosclerosis and did not imply that a single exposure could cause irreversible effects that would go on to result in heart disease - we turned what was otherwise good science into junk science claims.

And in doing so, we are doing everything that we had been accused of doing:

First, we are cherry-picking the evidence. For example, we are reporting the part of the study that showed that coronary blood flow under the artificial and strictly experimental conditions of hyperemia was impaired, but ignoring the part of the study which documented that there was no change in coronary blood flow in subjects exposed to secondhand smoke for 30 minutes. This is resulting in widespread claims by our organizations that 30 minutes of tobacco smoke exposure causes decreased coronary blood flow, which is a highly misleading, if not fallacious claim.

Second, we are making up the science. One of our major groups is claiming that a 30-minute exposure to secondhand smoke increased the risk of a fatal heart attack among nonsmokers to the same level as that of smokers. This is a "made up" claim, because there isn't a shred of evidence that this is the case. In fact, the claim is so preposterous that it fails, on its face, without even a need to conduct any scientific study. It simply can't be the case that a person exposed to just 30 minutes is at the same risk of a fatal heart attack as someone exposed for a lifetime to actively smoking 2-3 packs of cigarettes per day.

Third, we are making scientific claims that are completely implausible. You can't develop hardening of the arteries in just 30 minutes. It takes years.

The bottom line is that by turning otherwise good science into junk science, I believe that we as a movement are legitimizing the claims of groups (including the tobacco companies) that have wrongly (in the past) accused us of disseminating junk science claims. Now, I would have to agree with them. There is junk science in the anti-smoking movement.

The real problem is that the public cannot necessarily discriminate between good science and junk science. If some of the claims we are making are based on junk science, then what's to tell the public that all of our claims are not junk science claims. We are risking having the media, the public, and policy makers reject everything we are saying, because some of what we are saying is based on shoddy science or is completely untrue.

As I've stated before, the science is good enough. We don't need to distort it. We don't need to make it up. We don't need to cherry-pick. We don't need to make implausible claims. The truth is good enough.

By not being satisfied with letting the science speak for itself, by transforming good science into junk science in order to scare people into thinking that secondhand smoke is more severe of an acute hazard than it really is in order to support our agenda, I believe that we are in danger of losing our most prized possession - our reputation and credibility."

After this post, there were calls for my expulsion from the list-serve by a number of advocates, with personal insults and attacks hurled publicly at me, and the demand for banning me from expressing my opinions on the list-serve was apparently heeded.

The Rest of the Story

Censorship is alive and well in the anti-smoking movement. It is quite clear that there is simply no room for dissenting opinions, and if you express such an opinion, you will likely be censored.

You have to conform to the established dogma and prevailing wisdom of the movement, no matter how outrageous are the actions being taken by, and claims being made by anti-smoking groups. You absolutely cannot criticize; if you do, you risk being expelled from the movement, at least in terms of your ability to express your opinion in any tobacco control discussion forum. This is now the second list-serve from which I have been expelled for expressing my opinions and interfering with the "quality" of the list-serve discussions.

It has become apparent to me that these list-serve "discussions" are not really "discussions" at all. Instead, they amount to little more than a system of forced indoctrination of prevailing views onto anti-smoking advocates. You either have to conform to the dictates of the movement, or you're out of there, at least if you let it be known that you do not conform. I'm sure there are many others who, like myself, find a lot of the health claims being spewed out by anti-smoking groups to be exaggerated, if not inaccurate, but who are afraid to express their opinions because the lack of conformity to the doctrines of the movement will result in negative repercussions for their own careers. And seeing what has happened to me, I understand why they feel that way. They are correct - if they do express their opinions, they will be placing their careers in jeopardy.

Now I see how it is that the anti-smoking movement has been able to get away with making such completely implausible and absurd claims as they have been (like the 40% decline in heart attacks due to a smoking ban in Helena or the 30 minutes of secondhand smoke exposure causing hardening of the arteries). It isn't necessarily that everyone in the movement believes this crap. It's that those who don't believe it are afraid to speak out publicly because they would be risking serious repercussions, including potentially being censored, expelled from discussion groups, or most importantly, having their funding and reputations threatened.

The rest of the story is that there simply is not room for the truth in the anti-smoking movement. The perceived success of the movement is falsely believed to rely on the ability to say, do, and claim anything, as long as it advances the anti-smoking cause. And anything or anyone who attempts to hold the movement to scientific accuracy and truth is therefore perceived as a serious threat to the movement - a threat which must be removed. The call for the whole truth, and nothing but the truth, cannot be tolerated. There just isn't room for that in the movement's current group-think mentality.

I of course find this mildly ironic - a little too ironic, don't you think: that a movement that is essentially founded upon the idea that the tobacco industry has been lying to the public for decades and that we are the ones who will tell the public the truth cannot actually tolerate the truth in our own movement.

But forgetting my own careful and thorough documentation of exactly why many of the claims being made by anti-smoking groups are inaccurate (it should be clear to regular readers of this blog that I'm not simply throwing my opinions out there - I've attempted to provide clear, well-documented, and compelling explanations for them), it has become clear to me that there is no room in the anti-smoking movement for even expressing one's opinion of what the truth is.

In other words, it wouldn't matter if I was right or wrong in my interpretation of the scientific data and in my opinion of whether the claims being made by anti-smoking groups are fallacious or not. Clearly, that is not the relevant issue. In fact, on the list-serve there has been absolutely zero discussion of the scientific issues and no arguments provided to refute or even challenge my opinion.

Instead, it is the opinion itself, and the expression of the opinion itself, that is the problem. It doesn't matter how well-documented your arguments are; what matters is what side you are arguing. If it is construed as being against what anti-smoking groups are doing or saying, then you are a threat and your opinions can therefore not be tolerated.

It's sad to me that a movement which features the "truth" campaign as its sentinel public health intervention is unable to tolerate the "truth" in its own discourse. You would think that the movement would pride itself on the truth, not avoid the truth at all costs.

And if what I'm arguing is not the truth - if I'm wrong in suggesting that atherosclerosis takes years to develop - then there should be a sound and rigorous refutation of my opinion and a presentation of the scientific evidence that supports this claim. I'm not asking anyone to blindly accept my opinions, but I do expect that those who are making the claims I'm challenging should be able to provide scientific evidence to support these claims.

So far, there hasn't been a single study advanced to support the contention, widely being disseminated by anti-smoking groups, that a single, acute exposure to secondhand smoke can cause hardening of the arteries in exposed nonsmokers or that it poses any risk of a catastrophic or fatal coronary event in anyone other than individuals with severe existing coronary artery disease.

Obviously, I don't think that I'm wrong in challenging the claims that are being made which I think are fallacious. But what I'm trying to say is that if for some reason I am wrong, then I need to be told why. Simply throwing me off list-serves so that I don't interfere with the "discussion" (more accurately - "indoctrination") does not make the problem go away.

Sure - it does get rid of me; it stops me from expressing my opinions and taking part in the internal discussions in the tobacco control movement. But it doesn't solve the real problem, which is the serious threat to the credibility of the anti-smoking movement that is posed by the ridiculous claims that we are making.

And now we have an even bigger problem. Because now the public is aware of the rest of the story - they are aware of how we treat colleagues within our movement who demand that we speak the truth and stick to it in our public communications. Now they are aware of the tremendous double standard that characterizes us. The tobacco companies must tell the truth. But it's OK for us to distort the truth. After all, they're killing people and we're trying to save lives. What does it matter if we are untruthful in our communications if we are helping to save the children?

The problem of maintaining our scientific credibility in the face of increasingly absurd claims being made by anti-smoking organizations is a huge one. But it's nothing compared to the damage that we are doing to our own reputation by revealing that there is no room for the truth in our movement and that we will censor the expression of the opinions of those who try to speak it.

Anti-Smoking Group Quoted as Saying that Secondhand Smoke is as Hazardous as Smoking

In an article on the Channel 6 - Knoxville (WATE) television station's web site, the American Cancer Society was quoted as stating that secondhand smoke exposure is as hazardous as active smoking and implying that the lung cancer risk among passive smokers is the same as it is among active smokers.

Here's the quote from the American Cancer Society spokesperson, who was lamenting the lack of tobacco settlement funds being allocated to smoking prevention: "We're basically passing on to the next generation the habit of smoking. We know that smoking causes lung cancer, that for non-smokers the risk from second hand smoke is just as big. So lives are still at stake and right now we're not doing a whole lot about it."

The Rest of the Story

The junk science claims are just getting worse and worse. Now, we are being quoted as claiming that secondhand smoke poses the same lung cancer risk as active smoking.

Before commenting on the implications of this story, let me first explain why the health claim attributed to the American Cancer Society is fallacious.

The relative risk for lung cancer associated with active smoking is about 17. This means that smokers are about 17 times more likely to develop lung cancer as nonsmokers.

The relative risk for lung cancer associated with secondhand smoke is about 1.3. This means that passive smokers are about 1.3 times more likely to develop lung cancer as non-exposed nonsmokers.

This means that the risk of lung cancer from secondhand smoke is 17/1.3, or 13 times lower in nonsmokers than in active smokers.

So it is not accurate to say that we know smoking causes lung cancer and that the risk from secondhand smoke is just as big. The truth is that the risk is about 13 times less.

Now I understand that it is possible that the reporter got the quote wrong. It wouldn't be the first time that happened. So I'm not necessarily casting blame on the American Cancer Society or its spokesperson here. But the point of this post is simply that the resulting communication to the public was inaccurate. And it was attributed to the Cancer Society. And something must have gone wrong in the interview to result in this misunderstanding by the reporter (even if it was a misunderstanding rather than an accurate representation of the actual quote).

The point is that the end result - regardless of whether it was the fault of the Cancer Society or of the reporter - is yet another false and misleading public claim that is being communicated to the public on behalf of the anti-smoking movement.

And there are really three things at stake here.

First is the credibility of the anti-smoking movement. The junk science claims are becoming so rampant and so ridiculous that we are seriously risking all of our credibility. Much of what we say about the hazards of secondhand smoke is truthful, but if we are inaccurate about some of our claims, what is to stop the public from simply dismissing all of our claims?

Second is the integrity of our movement and the value of truth and scientific accuracy. Regardless of whether these false statements have any negative repercussions or not, it is wrong simply because scientific accuracy, truthfulness, and transparency are three very important ethical values that should form the basis for our actions as public health and tobacco control practitioners.

Third is the undermining of the public's knowledge of the health hazards associated with active smoking. What the American Cancer Society is actually being quoted as saying here is that active smoking is no worse than secondhand smoke exposure. And since people (accurately) understand that the risks of secondhand smoke are much lower than those of smoking, such a false belief would lead people to drastically underestimate the true effects of active smoking.

I view this statement attributed to an anti-smoking group as a very damaging one, because it is going to undermine the public's understanding of the serious health hazards associated with smoking. In fact, since there are many who don't really think that secondhand smoke is particularly dangerous, the ACS-attributed quote could mislead these members of the public into thinking that active smoking is also not particularly dangerous. I doubt that will happen because the dangers of smoking are widely known; however, this type of media coverage could easily be expected to undermine the public's appreciation of the degree of danger of active smoking.

The rest of the story is that yet another fallacious, junk science health claim attributed to an anti-smoking group is being spread to the public. The communication of these untruthful claims is threatening the credibility of our movement, violating basic ethical principles of public health conduct, and undermining the public's appreciation of the hazards of smoking.

But worse, no group (within the movement) seems to care. If we save just one life, what does it matter if we are lying to the public?

New Study Shows that Helena Conclusions About Effects of Smoking Ban on Heart Attacks are Scientifically Implausible

A new study published in the current issue of the journal Tobacco Control estimates the percentage of heart disease deaths that are attributable to smoking in 38 countries in the World Health Organization's Western Pacific and South East Asian regions (see: Martiniuk ALC, Lee CMY, Lam TH, Huxley R, Suh I, Jamrozik K, Gu DF, Woodward M. The fraction of ischaemic heart disease and stroke attributable to smoking in the WHO Western Pacific and South-East Asian regions. Tobacco Control 2006; 15:181-188).

For males, the estimated proportion of heart disease deaths attributable to smoking among males ranged from 13-33% and in females, it ranged from 1-28%.

The Rest of the Story

The overall prevalence of male smoking in these countries is substantially higher than it is in the U.S., and the overall prevalence of female smoking in these countries is considerably lower. Thus, the proportion of heart disease deaths in the U.S. is almost certainly lower for males and higher for females than that reported in the study.

However, using the highest reported attributable fractions for each sex, which correspond to a smoking prevalence of 82% for men and 80% for women, the maximum attributable fraction for heart disease deaths in the U.S. (where smoking prevalence is about four times lower) would be 30%. This appears to be a conservative assumption for what the maximum attributable fraction is (it would likely be lower than this in the U.S. because smoking prevalence is so much lower).

This means that at most, about 30% of heart disease deaths in the U.S. are attributable to smoking. If all smoking were eliminated completely, one would expect to see about a 30% decline in heart disease deaths.

Now here's my point: if eliminating smoking completely would only reduce heart disease deaths by 30%, how could a simple smoking ban in bars and restaurants reduce heart attacks by 40%? It just isn't scientifically plausible.

Yet this conclusion is being widely disseminated by anti-smoking groups, and forms part of the basis of a national anti-smoking group campaign to heighten the emotional appeal of secondhand smoke messages in order to support our agenda.

While I support the agenda, I do not support the use of shoddy science to promote that agenda. And this is shoddy science. If it's scientifically implausible that an effect can occur in the first place, then it's certainly shoddy science to conclude that the effect did occur, especially based on the results of a small study in which there is only one data point following the smoking ban and in which the entire conclusion is based on observing 16 fewer heart attacks.

American Legacy Foundation Again Fails to Disclose Conflict of Interest in Citing Research on Effectiveness of Itself

In a press release publicizing its summer "On the Road Again" tour (which I have suggested should be more accurately termed the "Hypocrisy" tour, the American Legacy Foundation communicates to the public and the media that research has shown that its "truth" youth anti-smoking campaign has been effective in substantially reducing youth smoking.

According to Legacy: "Efforts like the tour are clearly working with young people, as continues to be a relevant and driving force in teen culture. Research has found the truth® campaign accelerated the decline in youth smoking rates between 2000-2002. In fact, 22 percent of the overall decline in youth smoking during these years is attributable directly to the truth® campaign."

The Rest of the Story

The story here isn't anything that Legacy says in its statement to the public and the media. The story is what they don't say.

And what they fail to reveal is that the article they are citing to document the effectiveness of their "truth" campaign was paid for and authored by ...

... the American Legacy Foundation.

The study's senior author is in fact the head of the Legacy Foundation.

Now that fact is indeed disclosed in the research paper itself. That's perfectly appropriate, and I'm not suggesting that there was anything wrong with Legacy funding the research or taking part in it (so long as that is disclosed, which it is in the paper).

However, I think that same disclosure really needs to made whenever Legacy publicly reports the data, especially if the impression that the public receives is that this was some sort of independent study that found that the Legacy campaign was effective.

And reading this statement, it does seem to suggest that the study was an independently conducted one. There is no way that the reader would know, and no reason for her to suspect, that the study was not an independent one.

There is little question that the funding of the study by Legacy and the fact that the senior author is the head of Legacy represent a substantial conflict of interest. There is certainly no doubt that this conflict of interest needs to be reported in the article itself. However, it is the usual case that requirements for disclosure of conflicts of interest apply not only to the published article, but also to any presentation of the study results . Certainly, I would think that those disclosure requirements should apply to a public statement or press release posted on a web site.

This is not the first time that Legacy has pulled this. I reported here last September that the conflict of interest was not revealed in a public statement which suggested to the public that the scientific article, which was published in the American Journal of Public Health, credited the "truth" campaign with reducing youth smoking. I pointed out there that it was actually Legacy which was crediting Legacy with reducing youth smoking. That doesn't invalidate the finding by any means, but it does have important implications for how the public evaluates and critically judges the research.

It's not clear to me why the American Legacy Foundation, which is the proud developer of the "truth" campaign, and its front group-like counterpart - the Citizens Commission to Protect the Truth - have so much trouble disclosing the truth. For organizations that are trying to appear that they are deeply concerned about the truth, so much that they have truth plastered all over their names and programs, you would think they would show a little more concern for the "truth."

American Legacy Foundation Anti-Smoking Summer Tour to Begin

The American Legacy Foundation announced yesterday that its "On the Road Again" summer anti-smoking tour will begin June 5th.

According to the press release: "The tour allows teens the opportunity to engage in peer-to-peer interaction with truth® crew members, spreading the truth about the addictiveness of tobacco products, the adverse health effects of tobacco use, and the social consequences of smoking; and, ultimately, counteracting the marketing tactics used by the tobacco industry."

There are apparently three tours: "Throughout the summer, truth® will travel with three of the season'’s hottest teen-oriented tours: the 2006 AND1 Mix Tape Tour® (25 stops), the Vans Warped Tour® (45 stops) and - the Cosmo GIRL! Beach House Tour (4 stops). Signature orange truth® “trucks” will criss-cross the country, making stops in 50 cities in 28 states. The state-of the art trucks are fully equipped with DJ decks, video monitors, and more. Scratch lessons will also be available through the Scratch DJ Academy, a group of DJs who school newcomers on the fundamentals of DJ'’ing, scratching and mixing music."

The Rest of the Story

This summer "On the Road Again" tour would be better termed "The Hypocrisy Road Tour."

To have a major component of the tour sponsored in the name of a magazine - Cosmo - that is exposing millions of girls to tobacco advertising and encouraging them to smoke, is a disgrace for a campaign that claims to be "counteracting the marketing tactics used by the tobacco industry."

In fact, what the tour is doing is aiding, supporting, enabling, and endorsing the marketing tactics used by the tobacco industry, since advertising in magazines with high youth exposure - such as Cosmopolitan - is an important tobacco industry marketing tactic.

By giving Cosmo magazine a prominent name in the tour and associating the magazine with health and with doing a major public service to promote health, Legacy is aiding and abetting Cosmopolitan in its delivery of glamorizing pro-smoking messages to millions of girls and young women, and thus aiding and abetting the tobacco industry in its recruitment of new young female smokers.

This is hypocrisy at its worst.

If Legacy doesn't feel that marketing of tobacco to girls and young women is a problem because it doesn't affect smoking initiation among these young people, then that's fine. But don't issue a press release telling the public about how bad tobacco marketing tactics are and how important a service Legacy is doing by devoting a summer tour to "counteract" these marketing tactics.

And if Legacy does feel that marketing of tobacco to girls and young women is a problem because it does affect smoking initiation among these young people, then that's also fine. But don't pretend to be fighting and counteracting tobacco marketing tactics when you're actually supporting them.

I can understand and respect the opinions of those who believe or do not believe that cigarette advertising in magazines affects smoking initiation among youths (my own opinion has been made clear in my own research and my trial testimony, but it's not really relevant to this post). The rest of the story here is the hypocrisy of one of the nation's leading anti-smoking organizations.

I understand that Legacy is hard up for money, as they admit in their press release, but is it really necessary to be this devoid of principle to practice tobacco control these days? Isn't there any integrity left in the movement?

Slate of Posts Scheduled for Tuesday; Happy Memorial Day Weekend

The Rest of the Story will not be publishing any new posts during this Memorial Day weekend. A slate of important posts, however, is set to be released on Tuesday. Have a nice weekend everyone!

St. Cloud (Florida) Rescinds Smoker-Free Hiring Policy Due to Lack of Qualified Police Officers

According to an article in the Orlando Sentinel, the city of St. Cloud (Florida) has rescinded its policy of refusing to hire smokers. Two reasons were provided for this decision. First, the policy was not effective in reducing health insurance costs for the city. Second, the city was unable to recruit enough qualified applicants for employment, especially in the police force. The policy was putting too much of a crimp in its ability to recruit qualified applicants.

After initially enacting a ban on smokers working for the city in 2002, St. Cloud later changed the policy to allow hiring of smokers, but the smokers had to promise to quit within one year, and if they failed, they were fired. This apparently did not help the city recruit qualified workers, as smokers were not interested in accepting a job under these terms. Unable to effectively recruit a qualified work force, the entire policy has now been revoked.

St. Cloud now becomes the second city in Florida to rescind a smoker-free hiring policy. The city of North Miami revoked its ban on smokers in 2003 after also failing to observe any health insurance savings and being hampered in its ability to recruit qualified applicants for city jobs.

According to the article: "What seemed to many like a good idea several years ago has gone up in smoke. St. Cloud's ban on hiring employees who use tobacco, which was enacted in 2002, has been revoked by the City Council. 'Number one, it never did do what it was supposed to do -- help on insurance,' City Manager Tom Hurt said. 'And, it put a cramp on hiring.' With more jobs to fill as the city grows, there was a shrinking pool of workers to fill the jobs. Osceola's unemployment rate for the 12 months ending in April was 2.6 percent, substantially lower than the national average of 4.5 percent. 'We had certified operators that wanted to work for us, and then they found out they had to be a nonsmoker for a year,' said Robert MacKichan, public works director. His department employees about 100 workers and has 12 to 15 vacancies, he said. At one point the city loosened its policy by agreeing to hire smokers if they promised to stop. 'No one wants to take a job on the pretense they will be able to stop, not knowing if they will. In a year, if they're not smoke-free, they're [fired].'"

The Rest of the Story

It's interesting that the smoker-free hiring policy had no effect on reducing health care costs for the city. But even if it were effective in reducing costs, this was still a wise decision by the city to end its employment discrimination against its smoking citizens.

It's no surprise that the city was unable to effectively recruit a qualified work force when it eliminated smokers from the pool of potential applicants. When you throw out 20-25% of the population to begin with, you are going to have a lot more difficult time recruiting an effective work force.

And this fact helps to illustrate just why these policies are so discriminatory. Clearly, they do not have anything to do with the qualifications of applicants for employment. The policy is not helping to make sure that workers are well-qualified for employment; instead, it is hindering the employer's ability to identify and hire qualified individuals.

Hopefully, this announcement by St. Cloud will put a bit of a damper on the trend of increasing smoker-free hiring policies.

And I hope that it also deters us in the tobacco control movement from promoting these discriminatory policies. There is enough discrimination going on. We as a tobacco control movement don't need to add to the problem.

San Diego May Make it a Crime to Smoke in a Park or on a Beach

According to the Los Angeles Times, a San Diego City Council committee has voted to push forward an ordinance that would make it a crime to smoke anywhere in a park or on a beach in the city. Apparently, the ordinance would classify smoking on a beach or in a park as a misdemeanor, would be enforced by the police and by lifeguards, and smokers who light up in a park or on a beach would be subject to citizen's arrest.

The Rest of the Story

Is this what we really want? Police officers going around and pressing criminal charges against a guy smoking in a large park? Lifeguards diverting their attention from watching swimmers in the water and confronting smokers? Citizens confronting their fellow citizens and issuing citizen's arrests (which would probably spark fisticuffs or worse)? The court system logjammed because of numerous cases of people lighting up in Balboa Park?

As devastating a public health problem it creates when you have a couple of people smoking in a park or on a beach, I think there are better ways to deal with the problem than to criminalize these individuals. And the fact that the city would even consider making this a crime suggests to me that something else is going on here, beyond simply a concern for health.

I think that there is a primary desire to criminalize smoking, to further make smokers social pariahs, outcasts, subjects of societal scorn.

There's got to be a better way to achieve our public health goals. Unless the goal is to punish smokers for their addiction and personal choices, in which case this is an excellent way to proceed.

National Anti-Smoking Groups Instructed Organizations to Use Helena Conclusions to Convince Public that Smoking Bans Immediately Reduce Heart Attacks

Three major anti-smoking organizations - the American Cancer Society, the International Union Against Cancer, and the Campaign for Tobacco-Free Kids - urged anti-smoking groups to increase the emotional appeal of the secondhand smoke health hazard message by communicating to the public that smoking bans can virtually instantly reduce heart attacks among both smokers and nonsmokers, based on a finding that there were 16 fewer heart attacks in Helena during the first six months of the city's smoking ban.

In a strategy document entitled "Building Public Awareness About Passive Smoking Hazards," the American Cancer Society and International Union Against Cancer offer suggestions to anti-smoking advocates about how to increase the emotional appeal of secondhand smoke health hazard claims. The Campaign for Tobacco-Free Kids appears to also have been a part of this strategy guide, although it is not listed as a primary author but instead, referred to in the document's introduction:

"On behalf of the American Cancer Society, The International Union Against Cancer, the Campaign for Tobacco-Free Kids, and the many wise and experienced colleagues who contributed to this lengthy project, we are deeply pleased to offer this series of guides, Tobacco Control Strategy Planning to the global tobacco control community."

The guide was designed "to help advocates develop practical strategies to overcome specific barriers to effective tobacco control policies."

In the document, anti-smoking groups were instructed to use the claim that 30 minutes of secondhand smoke exposure causes hardening of the arteries, blood clots, reduced blood flow to the heart, heart attacks, and strokes in order to increase the emotional appeal of their messages, a point I have discussed previously.

Here, I will discuss another instruction given to anti-smoking advocates: "Another message that may encourage the public to take action concerns a 2002 case study conducted in Helena, Montana (USA). Researchers found that, in the six months following the enactment of a new smoke-free workplace law, heart attack frequency declined significantly.

This message is effective for several reasons.

• It offers a positive indication of what can happen to public health when people stop smoking and breathing secondhand smoke in public places.
• It indicates that a ban on smoking in public places can reduce the incidence of heart attacks for smokers and nonsmokers alike.
• It demonstrates that the health benefits of clean indoor air ordinances are virtually immediate.
  
• It provides more scientific evidence that smoke-free workplace policies improve health and save lives, which should encourage communities around the world to take action to protect the health of their citizens."

The Rest of the Story

As I commented in my previous post, I don't believe that the observed findings in the Helena study support a conclusion that the smoking ban caused an immediate and dramatic drop in heart attacks. It simply isn't clear that the 16 fewer heart attacks that were observed in Helena during the first six months after the smoking ban was in effect were not simply random variation in the heart attack data for Helena. In such a small city, there is tremendous underlying variability in semi-annual heart attack admission rates, and that study does not allow a causal conclusion to be made.

Moreover, I have previously argued that it is scientifically implausible that the Helena smoking ban could have reduced heart attacks by 40% within six months. Even if all smoking were eliminated in Helena completely, one would no more than about a 40% decline in heart attacks. So how could a smoking ban in bars and restaurants have created such a large effect?

Thus, I find it unfortunate that we instructed tobacco control advocates to use the Helena conclusion to try to increase the emotional appeal of the secondhand smoke message. Since we are always accusing the tobacco industry of shoddy science, I think it's important that we not use the same shoddy science. So I think more scrutiny should have been given to this conclusion before we instructed advocates to use this shoddy science to promote our agenda.

A few elements of the document are particularly disturbing. First is the statement that this study demonstrates that "a ban on smoking in public places can reduce the incidence of heart attacks for smokers and nonsmokers alike." Even if the Helena conclusion was valid, it does not indicate at all whether the reduction in heart attacks was due to reduced secondhand smoke exposure, reduced smoking, or both. No information on smoking status was collected, no data on changes in secondhand smoke exposure were presented, and no data on changes in smoking prevalence were put forth.

Second is the statement that the study "demonstrates that the health benefits of clean indoor air ordinances are virtually immediate." There are immediate health benefits from clean indoor air ordinances, but the Helena study doesn't demonstrate that reducing heart attacks by 40% is one of them.

The Centers for Disease Control and Prevention, in its commentary on the Helena study (see: Pechacek TF, Babb S. How acute and reversible are the cardiovascular risks of secondhand smoke? BMJ 2004; 328: 980-983), which his been widely cited as supporting the contention that 30 minutes of secondhand smoke can cause heart attacks in nonsmokers, points out critical limitations of the study and makes it clear that these findings are not conclusive and that more research is necessary before any conclusions can be drawn:

"Although the results of the study by Sargent and colleagues are consistent with the literature on the risks of acute myocardial infarction associated with secondhand smoke, the study has some important limitations. Firstly, it contains no data on actual exposures to secondhand smoke among residents or cases, and thus no data on the changes in exposure to secondhand smoke that may have occurred after the policy was implemented. It might be reasonable to assume that levels of important smoke toxins within public places in Helena covered by the ordinance dropped dramatically. This effect has been observed in other locations where similar policies have been implemented, with air quality measurements showing 80-90% declines in public places. Even if such declines also occurred in Helena, some proportion of non-smokers would still have been exposed in their homes, cars, or other enclosed places not covered by the ordinance. Thus, without more data, the proportion of non-smokers in Helena among whom exposures were significantly reduced during the six months that the ordinance was in effect cannot be known.

A second concern is that the geographical isolation of the city, while making this type of study feasible, also resulted in a small number of admissions for acute myocardial infarction. As reported elsewhere, the typical number of acute myocardial infarction events per month before the ordinance was only about six or seven and was highly variable, with the actual number per month ranging from none to about 10-12. Although conservative statistical analyses were applied to these data, due to the small number of events and the lack of data on changes in active smoking, random variation and factors other than secondhand smoke exposure may have contributed to the findings.

Finally, the observed effect (a decline of an average of 16 admissions for acute myocardial infarction for a six month period) was substantially greater than what might be expected. With smokers accounting for 38% of the admissions, we can estimate that about 25 admissions (40x0.62 = 24.8) were among former and never smokers during the equivalent six month period before the ordinance. Even assuming that the proportion of acute myocardial infarction cases among smokers was fairly constant across time, that all non-smokers were frequently exposed to secondhand smoke in public places, that virtually all this exposure was eliminated by the ordinance, and that all coronary heart disease risk related to this exposure was immediately reversed among non-smokers (that is, that risk dropped from 1.3 to 1.0), the maximum impact on admissions for acute myocardial infarction would be predicted to be about 18-19% (0.30x24.8 = 7.44; 7.44/40 = 18.6%) during the six months that the ordinance was in effect. Taking all of the above assumptions and issues into consideration, a more conservative estimate of the predicted reduction in acute myocardial infarction events might be 10-15%."

The shame of the whole thing is that we didn't have to lower ourselves to this level, we didn't have to abandon our scientific integrity, in order to accomplish what this document wants to achieve.

There are immediate health benefits of smoking bans on the health of restaurant and bar workers, and plenty of them. And they have nothing to do with avoiding heart attacks. And there are immediate health benefits to smokers who quit because of these policies.

We didn't need to stretch the science in order to communicate these messages effectively and to promote our agenda. We could have just stuck with the science, and with the plain truth.

Drastic Declines in Heart Attack Admissions in Nebraska and South Carolina in 2004: Cut in Anti-Smoking Programs May be the Reason

According to data from the Healthcare Cost and Utilization Project (HCUP) database, there was a dramatic decline in heart attack hospital admissions in Nebraska in 2004 and a sharp decline in heart attack admissions in South Carolina during the same year. These declines in heart attacks coincide precisely with sharp cuts in funding for anti-smoking programs in each of these states.

In Nebraska, heart attack admissions fell by 28.5% from 2003 to 2004. This is in marked contrast to the existing trend in heart attacks in the state. Heart attack admissions were increasing by an average of 2.3% per year during the period 2001-2003 in Nebraska.

In South Carolina, heart attack admissions fell by 12.5% from 2003 to 2004. This is also in marked contrast to the existing trend in heart attacks in that state. Heart attack admissions were increasing by an average of 3.0% per year during the period 2001-2003 in South Carolina.

These declines in heart attacks are much greater than what would have been expected based on trends in other states. In all other states for which data are available, heart attack admissions fell by 5.1% from 2003 to 2004.

The dramatic decline in heart attack admissions in Nebraska coincides with a dramatic cut in funding for the state's tobacco control programs. According to the state: "The Nebraska legislature did away with the funding for this [state tobacco control] program in the spring of 2003. Tobacco Free Nebraska's $21 million ($7 million in each of three years) was cut. Third year funding for Tobacco Free Nebraska was eliminated and the TFN staff resources must rely on state general funds and CDC funds to sustain a skeletal program. Local coalition funding was virtually eliminated as well. ... Tobacco Free Nebraska has launched a $700,000 media campaign to air radio and television commercials with anti-smoking themes. ... This effort has been eliminated by the historic legislative cut of the spring 2003."

It appears, then, that the historic legislative cut in anti-smoking programs in 2003 resulted in the greatest decline in heart attack admissions observed in Nebraska and in the successful reversal of the increasing trend in heart attacks in the state.

The huge decline in heart attack admissions in South Carolina, which reversed that states trend of increasing heart attack admissions during the previous two years, coincided with the complete elimination of what had been a successful anti-smoking program conducted during the previous four years.

These declines in heart attacks, which buck the national trend, occurred in states which have enacted no statewide smoking bans, few if any local smoking bans, and which both received grades of F in 2004 from the American Lung Association for the category of Smokefree Air in its State of Tobacco Control 2004 Report Card.

The Rest of the Story

Of course the observed declines in heart attacks in Nebraska and South Carolina in 2004 were not due to the cuts in anti-smoking programs. But this demonstrates the danger of using data from one year after an event to draw conclusions regarding the effect of that event on the phenomenon of interest, especially when the sample is small and there is great baseline variation.

This is why the claims being made from Helena, Pueblo, and Saskatoon are so suspect. In these studies, data from one year (6-18 months) after a smoking ban was implemented are being used to suggest that the smoking ban resulted in that single year's observed decline in heart attack admissions. Essentially, you have a single data point that is being used not only to assume that a definite trend is present but to ascertain the cause of the change in the statistic for that single year.

The reasoning used here is exactly the same as that used in the Helena, Pueblo, and Saskatoon studies. Baseline trends in heart attack admissions for a period of roughly four years prior to the event of interest were studied to establish the baseline trend in heart attack admissions. Then the heart attack data for the first year following implementation of the event of interest were used to assess the effect of the event on heart attack admissions. A dramatic decline in heart attacks was observed that coincided perfectly with the event in question. No similar decline (to the same extent) was observed in a number of control states that did not have the event of interest. Using the same reasoning as in Helena, Pueblo, or Saskatoon, one would conclude that the cut in anti-smoking programs resulted in the dramatic 28.5% decline in heart attack admissions in Nebraska in 2004 and in the large 12.5% decline in heart attack admissions in South Carolina in 2004.

This is shoddy science. It's shoddy because there is simply too much underlying variability in the data to establish a definite trend from one year's data point and to eliminate the possibility that the single year change that is being observed is simply due to random variation, rather than to an effect of the smoking ban.

And here, the sample sizes are huge compared to any of the studies that are being relied upon to claim that smoking bans dramatically and immediately reduce heart attack rates. In Nebraska, there were about 1800 heart attack admissions per year, compared to only about 80 in Helena. The Helena conclusion was based on a reduction of about 16 heart attacks, while the Nebraska "conclusion" is based on a reduction of about 540.

In fact, an examination of the HCUP data reveal that the variation in heart attacks is rather strongly related to the sample size. In states with very large populations, there is little variability. For example, in the two largest states in the database (Florida and California), there was no year-to-year variation of greater than 5.5%. But in the smallest state (Hawaii), there was as much as a 15% year-to-year variation in heart attack admissions.

With small populations, it is going to take more than just five years of data to adequately establish baseline trends and to estimate the random variability in heart attack admissions. And it is going to take more than one year to establish that a definite change in the trend has occurred, rather than simply random variation.

Massachusetts is a great example of this. There was a 12.0% decline in heart attacks in Massachusetts in 2004. This is in sharp contrast to the average 9.2% increase in heart attacks in Massachusetts during the period 2001-2003. Does this mean that something which occurred in late 2003 or early 2004 caused the sharp decline?

We can't really tell yet. First of all, we would need to know the underlying variation in the data. Do we observe changes from year-to-year in Massachusetts of this magnitude?

Well, from 2001 to 2002, heart attack admissions in the state increased by 18.3%, but admissions were essentially stable from 2002 to 2003. Is this just random variation, or is there a real trend? You need to go back further than 2001 and farther ahead than 2004 to find out. After all, there were more heart attacks in Massachusetts in 2004 than in 2000. That certainly doesn't sound like a trend of declining heart attacks. The 2005 data point may help to clarify this. If heart attacks continue to fall, then it appears there may be a real trend. But if they are up a little, it will make it appear that there is just a fair amount of variability occurring.

The bottom line is that even in a large population with many heart attacks occurring, we cannot draw causal conclusions regarding the effect of smoking bans based on these data. It is hard to imagine drawing sweeping causal conclusions from similar data in a population that is exceedingly smaller. It's hard to believe that a change in heart attack admissions from 40 to 24 is being used as the basis of a national campaign to convince the public that acute secondhand smoke exposure causes heart attacks.

The rest of the story is that shoddy science is being used to promote smoking bans and the science is shoddy because one cannot validly conclude that the observed year-to-year change in one data point in the rather small populations of Helena, Pueblo, and Saskatoon were due to the smoking ban, rather than to baseline variation, secular changes, or some other factors.

IN MY VIEW: Tobacco Control Movement is Legitimizing Junk Science Claims

For many years, tobacco companies and many other opponents of tobacco control policies have accused the tobacco control movement of engaging in junk science, especially regarding the health effects of secondhand smoke.

For example, we have been accused of cherry-picking the science on secondhand smoke, making up the science, and spreading scientific claims that are implausible, and therefore junk.

But recently, I believe that junk science has actually entered the anti-smoking movement.

The greatest example is the claim we are making that 30 minutes of secondhand smoke exposure can cause hardening of the arteries. Apparently, this claim stems from a study published in the Journal of the American Medical Association which showed that a 30-minute tobacco smoke exposure causes endothelial dysfunction (damage to the function of the cells lining the coronary arteries) in nonsmokers. Endothelial dysfunction is a marker of the earliest stage of atherosclerosis.

The significance of this study is that it demonstrates a plausible biologic mechanism by which chronic exposure to secondhand smoke can cause heart disease: repeated damage to the endothelial lining of the coronary arteries could result in a process of atherosclerosis, over a period of many years.

But instead of representing the study for what the science actually showed, we are distorting the scientific findings and using them to claim that a single 30-minute exposure to secondhand smoke is enough to cause atherosclerosis, forgetting to tell the public about the chronic (repeated) exposure part.

Moreover, a group of major anti-smoking organizations prepared a strategy document urging all of us in the movement to make this claim publicly in order to promote smoking bans. By making the damage from secondhand smoke seem immediate and severe, it was suggested, we could help break down barriers to the adoption of these smoking bans because our statements would have more of an emotional effect.

But by forgetting this key component of the scientific evidence - that it documented only a transient effect that represented the very earliest stage of atherosclerosis and did not imply that a single exposure could cause irreversible effects that would go on to result in heart disease - we turned what was otherwise good science into junk science claims.

And in doing so, we are doing everything that we had been accused of doing:

First, we are cherry-picking the evidence. For example, we are reporting the part of the study that showed that coronary blood flow under the artificial and strictly experimental conditions of hyperemia was impaired, but ignoring the part of the study which documented that there was no change in coronary blood flow in subjects exposed to secondhand smoke for 30 minutes. This is resulting in widespread claims by our organizations that 30 minutes of tobacco smoke exposure causes decreased coronary blood flow, which is a highly misleading, if not fallacious claim.

Second, we are making up the science. One of our major groups is claiming that a 30-minute exposure to secondhand smoke increased the risk of a fatal heart attack among nonsmokers to the same level as that of smokers. This is a "made up" claim, because there isn't a shred of evidence that this is the case. In fact, the claim is so preposterous that it fails, on its face, without even a need to conduct any scientific study. It simply can't be the case that a person exposed to just 30 minutes is at the same risk of a fatal heart attack as someone exposed for a lifetime to actively smoking 2-3 packs of cigarettes per day.

Third, we are making scientific claims that are completely implausible. You can't develop hardening of the arteries in just 30 minutes. It takes years.

The bottom line is that by turning otherwise good science into junk science, I believe that we as a movement are legitimizing the claims of groups (including the tobacco companies) that have wrongly (in the past) accused us of disseminating junk science claims. Now, I would have to agree with them. There is junk science in the anti-smoking movement.

The real problem is that the public cannot necessarily discriminate between good science and junk science. If some of the claims we are making are based on junk science, then what's to tell the public that all of our claims are not junk science claims. We are risking having the media, the public, and policy makers reject everything we are saying, because some of what we are saying is based on shoddy science or is completely untrue.

As I've stated before, the science is good enough. We don't need to distort it. We don't need to make it up. We don't need to cherry-pick. We don't need to make implausible claims. The truth is good enough.

By not being satisfied with letting the science speak for itself, by transforming good science into junk science in order to scare people into thinking that secondhand smoke is more severe of an acute hazard than it really is in order to support our agenda, I believe that we are in danger of losing our most prized possession - our reputation and credibility.

Boston Herald Op-Ed Cautions that Anti-Smoking Movement is Going Too Far

My op-ed published in the Boston Herald on Saturday suggests that the anti-smoking movement has lost its reliance on an evidence-based approach and is turning into a crusade that is divorced from public health. In the article, I cite two trends to demonstrate this.

First is the recent support of anti-smoking groups for bans on smoking almost everywhere outdoors, such as in Calabasas, where smoking was banned on all streets, sidewalks, and parking lots or any other outdoors location where a nonsmoker is present, with the exception of private residences (and shopping malls).

As I point out, these policies are not supported by scientific evidence that outdoor exposure to secondhand smoke in places like sidewalks and parking lots, where nonsmokers can avoid the smoke, is causing a substantial public health problem. Instead, anti-smoking groups have been forced to rely on alternate justifications, such as trying to prevent kids from seeing smokers in public. This is social engineering at its worst: it treats smokers as social pariahs and as moral affronts, demonstrates intolerance, and takes tobacco control out of the realm of public health, turning it instead into a non-evidence-based moral crusade.

The second disturbing trend I cite is the spread of policies that fire smoking employees or which refuse to hire smokers. I argue that these policies represent discrimination against smokers, are unduly intrusive into private, lawful behavior in the home, and treat smokers as second-class citizens who are not worthy of employment in our society.

Some excerpts from the piece:

"As a physician who has devoted 21 years to advocacy in tobacco control, conducting research and publishing a number of studies on the hazards of secondhand smoke, it is not surprising that I favor a wide range of anti-smoking measures. But anti-smoking tactics adopted by some municipalities, companies and organizations do not serve smokers or the public. The methods are mean-spirited, unsupported by science and attempt to stamp out smoking by punishing and marginalizing smokers. They go too far. ...

The hazards of exposure to smoking in the workplace have been proven, but there is no scientific evidence that shows that small, transient exposures to secondhand smoke in outdoor areas - places where people can easily avoid prolonged exposure - represent any serious public health problem. The argument that these policies are needed to prevent children from seeing people smoke in public would ostracize citizens for pursuing a legal activity. What comes next? Laws that ban fat people from the public square so that children won'’t associate obesity with public acceptability? Laws that prohibit people from eating fast food in public so children won'’t see this behavior and associate it with a healthy lifestyle? ...

Michigan-based Weyco Inc., announced a policy of denying employment to smokers last year, and it has been followed by the World Health Organization, Scotts Miracle-Gro, Crown Laboratories, the city of Melbourne, Fla., and Truman Medical Centers in Kansas City, Mo. ASH, along with these employers, argues that these policies are appropriate because they will reduce the increased health care costs associated with smoking. But what they also do is make smokers second-class citizens, depriving them of the right to make a living to support themselves and their families. Is ASH serious? Should smokers not be allowed to hold jobs? Does it somehow promote public health to make the families of smokers go hungry? Should our society have two distinct classes, one that can work and another which cannot, simply because of a lawful, off-the-job behavior? An appropriate public health policy for work-site health promotion would provide smoking employees with smoking-cessation programs, not fire them.

I fear that the anti-smoking movement is on the verge of running amok. Ultimately, what is at stake is the credibility of the tobacco-control movement, as well as the integrity of its evidence-based approach to the protection of the public'’s health. If we lose that, then the truly legitimate, science-based aspects of tobacco control will be undermined. And then it will become difficult, if not impossible, to advance any policies to protect the public from the hazards of tobacco."

IN MY VIEW: Making it Unlawful to Smoke Around Children Could have Detrimental Effect on Childrens' Health, Especially Among Disadvantaged Populations

There has recently been a push within the anti-smoking movement calling for the regulation of smoking around children in private homes to protect them from the hazards of secondhand smoke exposure. At least one major anti-smoking advocate has called for criminalization of smoking around children in the home, a major anti-smoking group supports banning smoking in homes with foster children present, and a number of advocates and groups have called for treating smoking around children as a form of child abuse and/or for the referral of parents who smoke around children to social services agencies or family courts.

While I have already argued against these proposals on a number of grounds not directly related to health, such as violation of parental autonomy, undue intrusion into privacy, and blind fanaticism that views a few ear infections as more important than preserving the ability of a child to remain with his or her loving parents and is willing to rip families apart in order to pursue its narrow aims, here I argue that the proposed policy could well harm the health of many children, especially the most disadvantaged, by inserting a nearly-insurmountable barrier to their obtaining appropriate medical care.

The Rest of the Story

By making it unlawful to smoke around one's children in a private home, imposing criminal or even civil penalties, referring parents who smoke around their children to authorities, or treating smoking around children as a form of child abuse, we would actually be imposing a huge barrier to children's access to appropriate medical treatment for conditions that are associated with secondhand smoke exposure.

The reason is simple: Parents who smoke around their children are going to be very reluctant to present to medical authorities if they are afraid they may be penalized, face criminal sanctions, be referred to social service agencies or the court system, or risk having their children taken away from them.

This problem is particularly important among children in already disadvantaged communities, where lack of health insurance and other barriers are now interfering with parents seeking appropriate care of their children's medical conditions. Based on my own experience, the emergency room is often used as a source of what should be primary care for many disadvantaged children. Existing fear of medical authorities, in some communities, already hinders parents from seeking medical attention for their children unless it is absolutely necessary.

This is why we often do not see children with ear infections in the doctor's office until the condition has progressed to become a more widespread infection and we often don't see asthmatic children until they are unable to breathe and need more extreme treatment then if they presented for medical treatment at an earlier stage.

To get a glimpse of what might occur if smoking around children were made unlawful, just look at what is happening in the field of immigrant health, where it is well-documented that many immigrant families (including children) are reluctant to present to medical authorities because of fear that the status of undocumented immigrants may be revealed and reported to authorities (see this Health Affairs article to see data on the lack of access of immigrants and children of immigrants to health care).

The rest of the story is that while some anti-smoking groups are promoting making it unlawful to smoke around children in order to protect childrens' health, such a policy would likely harm the health of large numbers of children by reducing their access to health care by creating fear among parents that they will be penalized, criminalized, or lose their children if they present for medical care and their smoking around children is found to be a cause of the child's health problem.

This is likely to be a particular problem among children who are already disadvantaged, and in communities where existing barriers to health care access are already undermining the health of our nation's children.

This is another example of the dangers of narrow-minded thinking that focuses on just one problem without maintaining a broader perspective on the public's health, especially factors that influence the health and well-being of children living in disadvantaged families or communities.

The anti-smoking movement needs to broaden its perspective or we may well end up seriously harming the very citizens who we are purporting to be helping.

IN MY VIEW: Giving the Tobacco Industry Ammunition - Why in the World are We Doing This?

I'm going to come clean about something as this eventful week draws to a close.

For many years, the tobacco industry and some smokers' rights groups have made statements or implications about the anti-smoking movement that I felt were untrue. We have been called anti-smoking zealots and fanatics. We have been accused of distorting the science or misleading people about the facts in order to promote our agenda. We have been framed as being on a crusade, rather than being reasonable public health practitioners. We have been accused of being an "anti-smoker" movement rather than an "anti-smoking" movement.

And for years, I thought all this was complete crap.

Every time I testified in a tobacco trial, the defense would always ask me questions in my depositions that were trying to elicit a response that I am an anti-smoker or that I was a zealot or fanatic. I could see where they were going with that line of reasoning. The idea was to paint me not as a relatively unbiased scientist, but as a highly biased zealot who put the cause above the science and was ultimately out to get smokers.

While this was done on an individual level, I believe that the tobacco industry also engaged in an effort on a larger scale, directed at the movement as a whole, in which they tried to portray us as fanatics who were highly biased and unable to objectively examine or present the science.

In fact, a tobacco industry document outlines a plan to try to undermine the tobacco control movement and to harm its reputation and credibility by painting the movement as a bunch of intolerant prohibitionists:

"Our third strategy focuses on weakening the credibility of the ATI [anti-tobacco industry]. We want to 1) Hold the leadership of the ATI accountable for their statements and identify those anti-tobacco activists who either by words or actions are clearly pushing for tobacco prohibition. ...We will work with PM-USA Communications to implement a plan to: 1) Challenge the credibility of the ATI. ... whenever an anti-tobacco advocate makes an 'erroneous statement' in public, we want a 'truth squad' to call them on it."

The Rest of the Story

If the tobacco industry is looking for erroneous statements that anti-smoking groups are making, then they are going to have a field day.

Because we have provided them with innumerable examples of erroneous scientific claims as well as statements and actions that demonstrate zealotry, fanaticism, and intolerance. This blog alone has documented a large number of these claims, statements, and actions.

But we continue to give the companies even more ammunition by responding to the questioning of the science and of the justification behind our agenda by completely shunning any consideration of the science or the public policy issues and instead focusing efforts on trying to discredit the messenger and censor the expression of his opinions in a way that makes us look like we are intolerant of any dissenting viewpoint.

We are calling on policies that would result in children being taken away from their parents because of smoking in the home, preclude smokers from employment, and ban smoking virtually everywhere because we don't want our kids to be exposed to these social pariahs. We are using fallacious scientific claims to support our agenda, we are distorting the science, and we are widely misleading the public.

In short, we are doing precisely what the tobacco industry accused us of doing for so many years. We are essentially making what I considered at the time to be false accusations come true, at least to some degree.

Why are we doing this? Why would we give the tobacco companies the very ammunition that they need to discredit us, harm our reputation, destroy our credibility, and ultimately, undermine our efforts?

Why are we providing them with the precise material they need to execute their strategic plan which they outlined in 1997?

If the past week has shown me anything, it is that we are so intolerant of dissenting viewpoints, even if they are based on solid scientific grounds, that we are unwilling to even look at the arguments being made. Immediate attack on the dissenter is the order of the day. And we turn the tables, accusing the dissenter of being the one who has not looked at, and is unwilling to look at, the scientific data.

To me, that's a sign of zealotry and fanaticism. It's a sign that the agenda is more important than the science. It's a sign that perhaps this is more of a crusade than a true science- and public health-based movement.

In other words, what is becoming evident to me is that to some degree, the tobacco companies were right. Whether we like it or not, we're proving them to be right by demonstrating precisely what they said about us.

Of course I'm not arguing that everything they said about us was true. But the statements, claims, and actions of anti-smoking groups over the past weeks and months has provided strong ammunition for the tobacco companies that they could, if they wish, use to help discredit the movement and harm our credibility and reputation.

Although I thought it was a bunch of crap at the time, I don't think it's crap now. Unfortunately, we're proving them to be right. And that means we're doing something very wrong.

Attacks on Tobacco Control Researcher: PART III - Accused of Being a Scientific Fraud and of Lying

Apparently, the anti-smoking advocate who I reported yesterday publicly accused me of being funded by the tobacco industry retracted his claim and had simply made a mistake in leaving out a word. So he does not accuse me of being on the tobacco industry dole. Instead, what he is accusing me of is being a complete scientific fraud: of going on national television in front of millions of people and making scientific claims without having reviewed any of the scientific evidence. He is also accusing me of lying, since he is aware that I have stated that I have indeed reviewed the scientific data.

What the advocate told a list-serve of more than 100 of my colleagues in tobacco control is that he has no reason to believe that I have looked at the science regarding the statements I am making:

"I have no reason to believe Siegel is getting paid by the cartel. I also have no reason to believe he's looked at the science."

Interestingly, a similar accusation was made on national television last Friday when Dr. Glantz seemed to suggest to millions of people that I hadn't reviewed the scientific evidence regarding the acute cardiovascular effects of secondhand smoke.

The Rest of the Story

While I am truly gratified that my colleagues do not think that I am taking tobacco industry money, I am just slightly miffed at the accusation, on the part of these colleagues, that I am a complete scientific fraud.

Do you mean to tell me that I am going to go in front of a national television audience of millions of people and deceive them into thinking that I am an expert on this issue and have reviewed the scientific evidence when the truth is that I haven't even looked at the studies?

This is a far more damning accusation than anything we have ever levied at the tobacco companies themselves. We've accused the tobacco companies of distorting the science or misleading the public about the science, but we've never suggested that they have made claims without having any knowledge of what they are talking about. In fact, we've made it clear that they have known exactly what they are talking about.

Here, I am actually being accused by my colleagues of being a complete fraud. How special is that?

To add insult to injury, I am also being accused of lying about being a complete fraud. Since I have indicated that I have indeed reviewed the scientific evidence and my colleague continues to stand by his accusation, he is not only accusing me of being a scientific fraud but of lying publicly.

So now, not only am I accused of being a fraud, but I'm also a conniving liar. That's even more special!

It is becoming clear to me that there is a very good reason why these colleagues are resorting to blatantly untruthful, insulting personal attacks. It is because they don't have a leg to stand on with regards to the science and so they refuse to enter into a discussion of the scientific evidence. Instead, they have to distract attention from the issue at hand by turning the discussion into a vicious personal attack in an effort to destroy my reputation and defame my character.

Hey - I'm open for a good debate any time. If you want to take me on regarding the issue of whether coronary artery stenosis can occur in 30 minutes, I'll gladly debate you any time, any place.

I don't even have a problem with a colleague arguing that I'm wrong and that atherosclerosis can occur in 30 minutes and that people can "come down with" heart disease from sitting in a smoky room for a half hour. If anyone wants to make that argument, that's fine. I won't accuse them of being a fraud, of not examining the evidence, of taking money from one group or the other, of lying, or of being a traitor to a particular cause. Instead, I'll just stick to the facts and try to present the evidence of why I believe they are wrong.

The rest of the story is that for holding our movement accountable to basic standards of scientific integrity and accuracy, some of my colleagues are attacking me, accusing me of lying and of being a liar and a complete scientific fraud.

I have a lot of flaws, but being a liar and a complete scientific fraud is not one of them.

Suggestion that Heart Disease Takes More than 30 Minutes to Develop Spurns Attacks on Tobacco Researcher: PART II - Accused of Taking Tobacco Money

mIn response to my suggestion that heart disease cannot develop in just 30 minutes and that therefore, anti-smoking groups are being inaccurate in claiming that 30 minutes of exposure can cause hardening of the arteries in nonsmokers, I was yesterday publicly accused of taking tobacco money on a prominent tobacco control list-serve read by 110 of my colleagues.

I was also accused of going on national television, in front of millions of people, and spouting off without having even looked at the science on the acute cardiovascular effects of secondhand smoke.

In other words, I was publicly accused of not only being a tobacco industry-paid scientist, but also of being a complete fraud.

Here's what my colleague had to say about me:

"I have reason to believe Siegel is getting paid by the cartel. I also have no reason to believe he's looked at the science."

Incidentally, the list-serve upon which this defamatory accusation was made is the same one which expelled me several months ago for expressing opinions that the readers didn't like; thus, the accusation is made without any opportunity for me to "defend" myself and my professional reputation.

The Rest of the Story

I'm very curious to see what this evidence is that I am getting paid by the tobacco industry.

Does this advocate have copies of cancelled checks that were issued to me by tobacco companies? Does he have copies of tax returns that I have filed which indicate that I received money from tobacco sources? Does he have copies of tobacco industry documents which reveal payments made to me in return for my services?

Or is he just recklessly disregarding the truth and attacking me with malicious intent, in a way that is likely to harm my reputation and my career?

I'm also curious to see the evidence that I haven't even looked at the science of the acute effects of secondhand smoke.

That's a curious accusation, since I have authored a large number of peer-reviewed, scientific papers that have helped form the basis for much of what we now know about the health effects of secondhand smoke. In fact, I was actually one of the first (perhaps the first) to review the scientific evidence of the effects of secondhand smoke on cardiovascular disease; I did that all the way back in 1985, before the Surgeon General had even issued the first report on involuntary smoking. I've been producing and reviewing the evidence for the past 21 years and I am constantly reviewing papers for scientific journals on this topic, so it's hard for me to imagine how I might somehow have failed to even have looked at the science.

Hey - I won't even go in front of a classroom of 15 students without being thoroughly prepared before making any scientific statements. Why would I go in front of millions of people and make statements without having examined the scientific evidence?

I may be wrong in my opinions and I might be terrible in what I do, but there's one thing I'm certainly not: a tobacco industry-paid, dishonest, conniving fraud.

Unfortunately, when you challenge the prevailing dogma of the anti-smoking movement, those are the kinds of reckless, defamatory attacks that you have to sustain. It only makes sense, because we wouldn't want anyone who challenges our agenda to be able to sustain their reputation and their career in the field, would we? How else could we eradicate dissent?


CORRECTION (May 18, 2006; 12:10 p.m.): Apparently, the accusation that I am being funded by the tobacco industry was a mistake - the anti-smoking advocate who made the accusation indicated that he simply left a word out and that he immediately corrected the statement to indicate that he has no reason to believe that I am taking tobacco industry money. However, the accusation that I am a complete scientific fraud was correct and the advocate stands by that claim.

Suggestion that Heart Disease Takes More than 30 Minutes to Develop Spurns Attacks on Tobacco Control Researcher: PART I - Kicked Out of the Movement

In response to my attempts to ensure scientific integrity in the tobacco control movement and to help save the movement from the potential damage that will be done if it loses its public credibility, Smoke-Free Pennsylvania has publicly "ex-communicated" me from the tobacco control movement.

My colleague - the executive director of the Smoke-Free Pennsylvania organization - with whom I have worked closely for over a decade to fight the tobacco industry - has stated publicly that I am no longer a part of the tobacco control movement:

"Since Mike's allies are primarily affiliated with FORCES (instead of the anti-smoking movement), it is inaccurate for Mike to continue using the term "we" to refer to the anti smoking movement. I suggest that from now on Mike correctly use the term "we" to refer to his lying colleagues at FORCES."

The Rest of the Story

I am highlighting this personal attack only because it is an important illustration of a general principle that I have observed in the tobacco control movement: there is no room for dissent and when someone expresses an opinion which goes against the established dogma of the movement, that person must be personally attacked and expelled from the movement, rather than actually entering into an evidence-based consideration of the issues that are being raised.

Gian Turci, the executive director of FORCES Italy, once laid out what he perceives to be the 4 commandments of the tobacco control movement. The third commandment is quite interesting, and I think is worthy of some exploration and discussion here:

"Public health is the paramount value of society. All other values - such as liberty, constitutionality, truth, economics, free enterprise, personal responsibility and moral integrity - are absolutely irrelevant and/or have to submit unconditionally. Any dissent from that credo only defines the enemy to be silenced."

In this blog, I have been suggesting that the value of truth needs to take precedence over our desire to pass smoking bans. (The "truth" is that I actually don't think that it helps us to pass smoking bans by exaggerating the science, but let's assume that it is the case that making these exaggerated claims will actually help the cause).

Apparently, Gian Turci is correct. My view is not tolerated because the movement will not allow the truth to get in the way of the agenda. So instead of discussing the scientific evidence, the almost uniform reaction is to attack me and try to silence me.

Let's assume, for the sake of argument, that I'm completely wrong. Let's stipulate that a healthy person can walk into a smoky restaurant, order a sandwich, and walk out 30 minutes later with coronary artery stenosis (narrowing of the arteries that supply blood to the heart muscle).

If that's the case, then an appropriate response to my suggestion that it is false to tell the public that it takes more than 30 minutes to develop hardening of the arteries would be to provide scientific evidence that I am wrong. Put forward a study that demonstrates that a person can develop heart disease from being exposed to secondhand smoke for just 30 minutes.

Frankly, if someone did that, it would not only shut me up, but I would issue an apology and retract all of my recent posts.

But the unfortunate truth is that there is no such study. (Actually, it's quite fortunate, because if it there were such a study, the majority of the population would be walking around with heart disease, and mortality rates would be astronomically higher than they presently are).

So instead, the response is to attack the dissenter and treat me as if I am no longer in the tobacco control movement.

Well if it's true that I'm no longer in the movement, then I guess I was a spy last week when I spent two days at the FAMRI scientific symposium and served on a panel of "Distinguished Professors" who had been rewarded for their efforts in confronting the diseases caused by secondhand smoke. And I guess FORCES must support 100% smoking bans in all workplaces, especially casinos, since it was apparently as a colleague of FORCES that I expressed sharp criticism of the exemption of casino workers from protection from the hazards of secondhand smoke in their workplace, in front of hundreds of people at that meeting.

And I guess I am an external "plant" in my capacity as a statistical editor for one of the leading two journals on tobacco control science in the world (Tobacco Control).

And I suppose that the research I am presently doing, which is the first of its kind to document that restaurant smoking bans lead to a dramatic decline in youth smoking initiation, is just a ruse.

The rest of the story is that any challenge to the established dogma of the movement and its dominant agenda cannot be tolerated. There is apparently no room for the expression of such opinions in the movement. If you challenge the dogma, you're out.

New Study Reveals Deadly Effects of Swedish Moist Snuff Use

A new study conducted by researchers from the Institute of Environmental Medicine of the Karolinska Institute in Sweden and presented last Friday at a scientific conference reveals that far from being a safe alternative to smoking as some anti-smoking advocates have been claiming, the use of Swedish moist snuff is actually a deadly product that substantially increases the risk of death from heart attacks.

According to the study, snuff users who consumed one box or more per day were more than twice as likely to suffer a fatal heart attack.

This longitudinal study was a large one, with a sample of 117,000 men who were followed for between 8 and 23 years. Only men who had never smoked and who had no history of heart attack were included in the study.

The Rest of the Story

This study dispels the myth that somehow, Swedish moist snuff is a relatively safe, hazard-free alternative to cigarette smoking. It clearly is not.

Religious Leaders Support FDA Tobacco Legislation

A coalition of Ohio religious leaders Monday launched a campaign to put pressure on Congressmembers to enact legislation (currently pending before the House and Senate) that would give the Food and Drug Administration (FDA) regulatory authority over tobacco products.

According to an article in the Columbus Dispatch: "Saying the federal government has a moral responsibility to keep cigarettes out of the hands of children, a coalition of central Ohio religious leaders launched a campaign yesterday to pressure lawmakers to put the Food and Drug Administration in charge of tobacco regulations. The campaign moved from Texas to Ohio in February after Rep. John Boehner, R-West Chester, replaced Rep. Tom DeLay, R-Texas, as House majority leader. ...

The group held a news conference yesterday at Mt. Olivet Baptist Church in Columbus to announce a petition drive and letter-writing campaign to persuade Boehner and other lawmakers to support legislation making tobacco products an FDA responsibility. 'As people of faith and as community leaders, we are here today to say, '‘Enough is enough,'’ ' said Dr. Asma Mobin-Uddin, president of the Ohio chapter of the Council on American Islamic Relations. 'This means standing up against an unregulated tobacco industry that markets candyflavored products that look like cigarettes to children.'

U.S. Sen. Mike DeWine, R-Ohio, has sponsored a bill to put tobacco under FDA oversight. A similar bill is pending in the House, but neither has been scheduled for a vote. ...

About a dozen central Ohio leaders representing Christian, Jewish, Islamic, Sikh and other religions appeared at yesterday'’s news conference. ... Rabbi Harold Berman, of Congregation Tifereth Israel in Columbus, pointed to a box of macaroni and cheese and said it is subject to stricter federal regulation than cigarettes are."

The Rest of the Story

I don't think God would be too happy with these efforts to promote passage of Senate Bill 666 and House Bill 1376. In fact, if God were elected to the 109th Congress, I strongly suspect that he would oppose this legislation, because I doubt he would support legislation that contains compromise provisions negotiated by Philip Morris that put loopholes in the bill that would weaken the FDA's ability to protect the public's health and that would ensure that the most critical decisions regarding the regulation of tobacco products were made on political, not scientific grounds.

I also doubt that God would support legislation that provides virtual immunity to the tobacco companies for wrongdoing and which helps ensure the market share and profit for the nation's largest cigarette manufacturer.

The proposed FDA legislation that these religious leaders are apparently supporting on the grounds of their "faith" would provide the following special protections for Big Tobacco:

• ensure that any decision to eliminate the addictive chemical - nicotine - from cigarettes would be a political, rather than a scientific decision by putting it into the hands of Congress;
• ensure that any decision to require changes in the product substantial enough that the courts could interpret it as eliminating an entire class of cigarettes would be a political, rather than a scientific decision by putting it into the hands of Congress;
• prohibit the FDA from increasing the legal age of sale of cigarettes;
• prohibit the FDA from eliminating tobacco sales in pharmacies, as well as any other specific type of retail outlet;
• require the FDA to make cigarettes the only drug that it regulates for which it cannot require a doctor's prescription, thus ensuring widespread access to this deadly drug by kids;
• ensure that all decisions regarding the regulation of tobacco products, unlike those regarding any other consumer product regulated by FDA, would be political rather than scientific ones by specifically granting Congress the authority to overturn any major FDA tobacco regulation deemed necessary to protect the public's health

It's unclear to me why these religious leaders would put their "faith" in legislation that includes these special loopholes that were negotiated into the bill by Philip Morris and which provide special protections for the industry that are not enjoyed by the manufacturers of other products regulated by FDA (such as macaroni and cheese).

If these leaders are really serious about ending special protections for Big Tobacco, then they should not be supporting the FDA tobacco legislation, but instead should be demanding that these special protections for Big Tobacco, which were negotiated by the industry and apparently agreed to on behalf of the American public by the Campaign for Tobacco-Free Kids, be eliminated from the legislation.

There is no reason why Big Tobacco should enjoy a huge number of special protections that manufacturers of drugs currently regulated by FDA do not enjoy, and there is no reason why politics, and not science and public health, should be is the ultimate arbiter of the regulation of this deadly product.

Let me make one thing clear, however. I am not necessarily blaming these religious leaders for supporting legislation that provides unprecedented and unconscionable special protections for an industry that kills hundreds of thousands of Americans each year. It may well be that they are not aware of the loopholes in the bill and that they have been fooled and deceived by the propaganda campaign of deception being run by the Campaign for Tobacco-Free Kids.

Is Rabbi Berman, aware, for example, that there are special protections in this bill for Philip Morris that were inserted into the bill upon the insistence of the tobacco company in order to appease it and gain its support for the legislation?

Is Rabbi Berman, aware, for example, that the biggest supporter of this legislation is Philip Morris itself, which desperately wants the legislation because it will help it build a monopoly, secure its market share, allow it to increase its market share by finally marketing reduced exposure risk tobacco products that may well deceive people into thinking they are at reduced risk when they are not, and protect it from any damaging future litigation?

My guess is that the Rabbi, along with the other religious leaders, have been deceived by the Campaign for Tobacco-Free Kids' propaganda and are not aware of the extent to which this legislation has been watered down through compromises inserted to protect the profit and security of the nation's leading tobacco company.

It's perhaps understandable. The legislation itself is long and difficult to read through and interpret - possibly more difficult than interpreting a Talmudic passage. I don't blame anyone for failing to understand the extent of the loopholes in the bill.

I therefore think that the major anti-smoking organizations which are supporting this legislation - the Campaign for Tobacco-Free Kids, American Cancer Society, American Lung Association, and American Heart Association - have a responsibility to educate groups such as these religious leaders about the truth behind the legislation, the loopholes it contains, and the reasons why those loopholes are present in the bills. This is a responsibility that so far as I can tell, these groups have completely shirked up to this point.