Thursday, November 29, 2007

CHALLENGING DOGMA – POST #12: What the Tobacco Industry and Its Allies Say is Not Credible; What Tobacco Control Groups Say Has Merit

One of the most basic principles I was taught as a tobacco control practitioner was that there is no merit to anything that the tobacco companies or their allies say. By the simple virtue of any statement having been made by a tobacco company or tobacco ally, it was automatically invalid. In contrast, I was taught that virtually any statement made by a tobacco control group had merit.

In a showdown between conflicting statements between a tobacco company and a tobacco control group, it was unfathomable that the tobacco company could be correct. One did not even need to examine or analyze the statement at issue. Simply knowing the source of the two statements was enough to cast judgment. The tobacco control group’s statement was correct.

For many years, I believed this to be the case and I operated under this assumption. However, I have come to realize that it is no longer the case. The scientific integrity of the tobacco control movement has deteriorated to such a degree that one can no longer evaluate claims solely on the basis of whether they are made by a tobacco control group versus a tobacco company or tobacco ally. I’m not sure that was ever the case, but in this post, I will discuss the current state of affairs, not the past.

The Rest of the Story

Perhaps the most astounding example of the lack of credibility within tobacco control in 2007 is the Office of the Surgeon General itself.

When I worked at CDC in the Office on Smoking and Health between 1993 and 1995 and helped write and edit several of the Surgeon General’s reports, I had the highest degree of respect and admiration for the Surgeon General’s office and its scientific standards of excellence. The scientific review of the Surgeon General’s report and every statement made by the Surgeon General was meticulous. Every statement made was subjected to layer after layer of scientific review. We would analyze every word in the statement to make sure that it could not be misconstrued. There was a general feeling that the conclusions of the Surgeon General had to be completely beyond reproach.

Often, there were conclusions that I felt would be perfectly sound for the Surgeon General to make. However, because of slight hesitation on the part of some scientists, and out of fear that the tobacco industry might challenge these statements, we did not offer to the Surgeon General any statement that could not be easily and definitively defended. Even if the majority of scientific groups that had reviewed a particular health effect of smoking or secondhand smoke had concluded that the evidence for that effect was sufficient, we would hold out for the few remaining groups before putting that conclusion into the voice of the Surgeon General. The voice of the Surgeon General meant that the science was beyond reproach. The conclusion was extensively reviewed and meticulously well-documented.

Now in 2006, as I showed yesterday, the Surgeon General came in front of the American people and told them that just a brief exposure to secondhand smoke was enough to cause heart disease and lung cancer. The Surgeon General concluded that a brief exposure to secondhand smoke may have life-threatening cardiovascular and carcinogenic effects.

In contrast to the Surgeon General’s office that I once knew, this time there was not only absence of meticulous documentation for the statement, but there was the absence of any scientific evidence to support it. There are no studies (count them: zero point zero) which demonstrate that a brief exposure to secondhand smoke poses a risk of lung cancer. There are no studies which demonstrate that a brief exposure to secondhand smoke can cause hardening of the arteries (atherosclerosis). Yet this is precisely what the Surgeon General concluded in front of the television cameras for all to hear and read about. These conclusions remain online today, for all to continue to read.

Another example is a recent report by the Harvard School of Public Health on changes in nicotine yields of cigarettes over the past nine years. According to the report, cigarette companies - including Philip Morris - steadily increased the nicotine yield of their cigarettes - including Marlboro - during the period 1997-2005. The report describes the increase as being a total of 11% over the seven-year period 1998-2005, or an average increase of 1.6% each year during that period.

According to the report, Marlboro brands "showed a significant increase in smoke nicotine yield." During the overall study period of 1997-2005, the report estimates the increase to be 0.019 mg per year. The report concludes that there has been a "statistically significant trend in increased smoke nicotine yield of 0.019 mg per cigarette (1.1%) per year from 1997-2005 as measured by a smoking machine under the MA method." This trend was said to hold for all market categories, and in particular, for the most popular cigarette brand - Marlboro: "The present analysis of the leading U.S. brand family, Marlboro, demonstrates a significant increase in smoke nicotine yield, contradicting the PM USA claims."

Philip Morris took issue with the study's conclusions, arguing that there was no increase in the nicotine yield of Marlboro cigarettes between 1997 and 2006 and that there are no consistent trends indicating an increase in these yields over time, although there are random fluctuations over the time period.

Using the data on nicotine yields of Marlboro cigarettes provided by Philip Morris to the Massachusetts Department of Public Health (MDPH) for the years 1997 through 2006, I conducted my own analysis of the trends in Marlboro nicotine yields. I found that the average nicotine yield of all 16 Marlboro sub-brands in 1997 was 1.81 mg, and the average nicotine yield of all 16 Marlboro sub-brands in 2006 was 1.81 mg. In other words, there was no change in the average nicotine yield of Marlboro cigarettes from 1997 to 2006.

In this particular case, Philip Morris was right and the report by anti-smoking researchers was wrong.

Another example is the decision by the Department of Justice to alter a proposed smoking cessation remedy in the RICO lawsuit from a $130 billion program to a $10 billion program. Anti-smoking groups widely attacked Associate Attorney General Robert McCallum and accused him of ethical wrongdoing. They also attacked the Bush administration for political interference in changing the nature of the proposed remedy and weakening the case.

The truth, however, was that the change in remedy did not weaken the case (if anything, it strengthened it). The initial remedy would never have passed muster with the D.C. Court of Appeals because it was not consistent with the Court's interpretation of the RICO civil remedies provisions. As it turns out, even the altered remedy did not pass muster with Judge Kessler herself.

Most recently – yesterday in fact – tobacco companies and anti-smoking groups came head-to-head over whether R.J. Reynolds’ decision to discontinue cigarette advertising in magazines in 2008 was a political response to the Campaign for Tobacco-Free Kids’ complaint about its Camel insert in Rolling Stone magazine (as claimed by the Campaign for Tobacco-Free Kids) or whether it was a business decision made prior to that revelation (as claimed by R.J. Reynolds).

If this were 1995, I would have without hesitation put my faith in the Campaign for Tobacco-Free Kids and believed that R.J. Reynolds was lying to the public. Today, however, I find myself leaning toward the R.J. Reynolds side of these conflicting views of what occurred.

The rest of the story is that it is no longer the case that you can simply trust the anti-smoking groups as being credible sources of information and discount opposing tobacco industry or tobacco industry ally accounts of the same information.

This is precisely why I have been so outspoken in challenging anti-smoking groups to remain accountable for their public statements. The days of anti-smoking groups having credibility and tobacco companies and their allies being automatically untrustworthy appear to be over. Now, you have to be skeptical of everything you hear, no matter what the source.

In fact, this is part of the reason why The Rest of the Story exists. There needs to be some source for at least a somewhat balanced and at least partially open and broad perspective on tobacco control news, policies, and issues.

Here is a complete list with links to all of my previous Challenging Dogma posts in this series:

CHALLENGING DOGMA: Post #1 - Tobacco Taxes are Not Always Appropriate Public Health Policy

CHALLENGING DOGMA: Post #2 - Anyone Who Disagrees With the Anti-Smoking Movement is Affiliated with the Tobacco Industry

CHALLENGING DOGMA: Post #3 - Promoting a Smoker-Free Workplace

CHALLENGING DOGMA: Post #4 - All Groups that Oppose Tobacco Control Policies are Big Tobacco Front Groups

CHALLENGING DOGMA: Post #5 - Anyone who Questions the Party Line is A Discredit to the Tobacco Control Movement

CHALLENGING DOGMA: Post #6 - Cigarette Companies Have a Responsibility to Produce a Safer Product

CHALLENGING DOGMA: Post #7 - Smoking Should Be Banned in All Public Areas

CHALLENGING DOGMA: Post #8 - The Anti-Smoking Agenda Justifies Itself

CHALLENGING DOGMA: Post #9 - The Agenda of All Anti-Smoking Groups is a Noble One

CHALLENGING DOGMA: Post #10 - Anyone Who Disagrees that Secondhand Smoke Causes Chronic Disease Must Be Personally Discredited

CHALLENGING DOGMA: Post #11 - Maintaining Cigarette Addiction by Increasing Nicotine Yields is the Sign of a Rogue Industry

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