Monday, April 30, 2007

Today's Highlights: Hypocrisy, Inconsistency, and Junk Science

Today I feature 3 posts that highlight hypocrisy, inconsistency, and junk science within the tobacco control movement:

1. Hypocrisy: The American Heart Association bans Miss New Hampshire from walking in the AHA Heart Walk, while at the same time teaming up with Philip Morris to support its chief legislative priority.

2. Inconsistency: The American Medical Association criticizes the tobacco industry not for advertising its deadly products, but for advertising too much.

3. Junk Science: The Campaign for Tobacco-Free Kids commissions a survey on the public's attitudes toward the FDA tobacco legislation.

Campaign for Tobacco-Free Kids' Public Opinion Poll Shows Widespread Support for FDA Tobacco Legislation, Or Does It? Junk Science Rears its Ugly Head

According to the Campaign for Tobacco-Free Kids (TFK), a new public opinion poll commissioned by TFK shows widespread public support for the proposed FDA tobacco legislation, which would grant the FDA severely limited authority to regulate tobacco products. That authority is specifically limited by the bill's provisions which were insisted upon by the nation's leading cigarette company - Philip Morris.

According to the poll: "83 percent support requiring tobacco companies to take measures, when scientifically possible, to make cigarettes less harmful; 76 percent support requiring the reduction or removal of harmful ingredients, including nicotine, from tobacco products."

The Campaign for Tobacco-Free Kids concludes that "A new national poll of registered voters finds that 77 percent of American voters support Congress passing a bill to give the U.S. Food and Drug Administration (FDA) the authority to regulate tobacco products."

The Rest of the Story

Junk science has reared its ugly head again in tobacco control. Frankly, this is junk science at about the worst as I have ever seen it in the movement. In my opinion, this poll - commissioned by the Campaign for Tobacco-Free Kids - is more shoddy than any public opinion poll that the tobacco industry has ever commissioned to "demonstrate" that smoke-free bar and restaurant laws result in devastating economic impacts to businesses.

In my opinion, this poll was rigged in order to generate the impression of widespread support for the legislation, when in fact, we have no idea based on the survey whether or not the public would actually support this legislation or not.

Why? Because the survey was rigged, in my opinion. It did not ask people the appropriate questions that would need to be asked in order to determine whether the public supports the legislation. The way that the questions were worded, and the topics they cover, ensured that the public would overwhelmingly express support for the legislation. But the public was specifically not asked about those aspects of the legislation that might have resulted in overwhelming disapproval of the legislation.

Incidentally, this is precisely the kind of thing we criticize the tobacco companies for in commissioning surveys that purported show that restaurant smoking bans are devastating for business. But apparently the same technique is acceptable as long as it works in our favor.

I'll make my point by suggesting the kinds of questions that I think would need to be asked to get an accurate reflection of the public's actual opinion about the proposed legislation. But first, let's just take a look at three of the questions that were asked.

The main question asked was: "Would you favor or oppose the U.S. Congress passing a bill that would give the Food and Drug Administration (the FDA) the authority to regulate tobacco products, including restrictions on sales and marketing to children?"

This question is virtually meaningless, because it doesn't indicate support for the actual legislation being proposed. It simply indicates support for the general idea of granting the FDA authority to regulate cigarettes. Much of the public probably would support the general idea of giving the FDA regulatory authority over cigarettes but would not support the specific regulatory scheme that Philip Morris helped craft that is reflected in this particular legislation.

I, for example, fall into that category. If I had been a subject in the survey, I would have responded that I indeed favor the U.S. Congress passing a bill that would give the FDA the authority to regulate tobacco products. But as all my readers know, I am one of the most vocal opponents of the proposed legislation out here. That's how meaningless this particular question is.

Another question asked whether respondents would favor a provision in legislation that would: "Require tobacco companies to take measures, when scientifically possible, to make cigarettes less harmful."

Who wouldn't support such a provision? The problem is that the bill contains no such provision. There is nothing in the bill that requires the tobacco companies to make cigarettes less harmful in any way that is scientifically possible. In fact, the bill precludes the FDA from taking precisely that action which would correspond with the question that was asked - to require companies to simply remove all the harmful constituents from their products. It is certainly scientifically possible to do that. But the bill precludes that action, because it does not allow FDA to ban any particular class of tobacco product. Once again, I would have answered that I indeed favor a provision in the bill that would require tobacco companies to take all measures that are possible to make cigarettes less harmful. Unfortunately, there is no such provision in the bill. If anything, the bill gives tobacco companies the ability to easily block any attempt by FDA to make even more minor changes in cigarette design.

Another question asked whether respondents would favor a provision in legislation that would: "Require the reduction or removal of harmful ingredients, including nicotine, from tobacco products."

Again, it's hard to imagine why anyone would not favor such a provision. However, once again there is no such provision in the bill. The legislation merely gives the FDA the ability to require the reduction or removal of particular harmful ingredients. The FDA could not require the reduction or removal of all harmful ingredients (which is implied by the question), nor does the bill require that the FDA take any particular action at all. In fact, the bill gives the tobacco companies the ability to block any required removal of an ingredient merely by getting a majority of Congressmembers to veto the regulation. Moreover, the bill specifically precludes the FDA from requiring the complete removal of nicotine from cigarettes. So this question - while it provides a result quite favorable to TFK - also has no relevance to the actual legislation in question.

If one were interested in getting a truthful impression of the level of support of the American people for the actual FDA legislation, rather than in simply using junk science to obtain rigged, politically useful, pre-ordained answers to irrelevant questions, here are examples of the questions that I think would also have to be asked of people:

1. Would you favor or oppose the U.S. Congress passing a bill to regulate tobacco products that is strongly favored by Philip Morris, the nation's leading cigarette manufacturer?

2. Would you favor or oppose the U.S. Congress passing a bill to regulate tobacco products that was negotiated with, and possibly written in part by Philip Morris?

3. Would you favor or oppose a bill that contains provisions, inserted to appease the interests of Philip Morris, that interfere with the protection of the public's health from the harms of cigarettes?

4. Would you favor or oppose a bill that ties the FDA's hands in terms of its ability to regulate tobacco products in an unfettered manner?

5. Would you favor or oppose a bill that provides Congress with veto power over any major regulation promulgated by FDA to protect the public's health from tobacco products?

6. Would you favor or oppose a bill that precludes the FDA from completely removing nicotine from cigarettes?

7. Would you favor or oppose a bill that preempts the ability of state governments to regulate tobacco products?

8. Would you favor or oppose a bill that makes it virtually impossible for cigarette companies to market what may be truly safer products?

9. Now I'm going to read a list of ways in which the Food and Drug Administration could regulate tobacco products. After each one, please tell me if you favor or oppose the FDA implementing that particular proposal or policy.

a. Increasing the age of sale of tobacco products to 19.

b. Banning the sale of tobacco products at pharmacies.

c. Keeping cigarettes out of the hands of minors by requiring prescription-only access.

d. Including two tobacco industry representatives on an advisory panel to recommend regulatory actions to the FDA.

It is hopefully clear from these questions that the Tobacco-Free Kids survey is a sham; it does not truly measure support for the bill in question. Instead, it is an example of using junk science to promote an anti-smoking group's agenda. The distinctions between the tactics of the tobacco companies and our leading anti-smoking organizations are becoming narrower by the day.

American Medical Association Suggests that Tobacco Companies Should Be Allowed to Market their Deadly Products; But Not Too Much

In response to the release of a Federal Trade Commission report revealing that tobacco companies spent approximately $13 billion on advertising and promotion of cigarettes in 2005 and $14 billion in 2004, the American Medical Association (AMA) issued a statement criticizing the companies for spending so much on marketing: "In 2004 and 2005 alone, the tobacco industry spent an exorbitant $27.7 billion to market their deadly products to the American people. That same money could pay for virtually every smoker in America to receive a full course of nicotine treatment to help them quit."

The AMA's statement is being widely interpreted as a complaint against the volume of cigarette advertising. For example, HealthDay summarized the story as follows: "Despite a two-year decline in the amount of money tobacco makers spend on marketing and advertising, the American Medical Association says too much is still spent on promoting cigarettes and other forms of smoking."

The Rest of the Story

It certainly sounds like what the AMA is bemoaning and criticizing is the amount of money that the cigarette companies spend on marketing their products. The AMA is using the new FTC report to argue that Congress should heed Philip Morris' desire for legislators to pass the company-supported FDA tobacco legislation. In other words, the amount of money tobacco companies spend on marketing is too high. That money could and should be put to better use - paying for pharmaceutical smoking cessation treatment for every smoker. That's why we must do something about it.

There are a number of things that I find wrong with the way the AMA is framing this issue.

First, it is not the amount of money that is being spent on cigarette marketing that makes it problematic or inappropriate. Cigarettes are a legal product and therefore there is no particular limit on the amount of money that the tobacco companies should be allowed to spend marketing the product. The tobacco companies are and should be free to determine their marketing budgets. Setting a limit on the advertising amount would almost certainly be unconstitutional.

If the AMA is going to criticize the tobacco companies for spending so much money on marketing, then how can the AMA fail to call on the companies to cease their marketing altogether? It seems quite an inconsistent position to me to state that the companies spend too much on cigarette marketing. If the cigarette companies had cut their advertising and promotional expenditures from $15 billion in 2003 to $7 billion in 2005, would that have led the AMA to praise the companies? How could the AMA possibly praise a company for spending $7 billion a year to market a deadly product? There appears to be a huge inconsistency in the AMA's position.

Second, is the AMA seriously suggesting that it is the tobacco companies' responsibility to cease their marketing of their products and spend the same amount of money instead on trying to encourage people not to use their products? If you're going to criticize the companies for trying to sell their legal products and not trying to get every customer to stop using the product, then it seems to me that you ought to simply be calling for the prohibition of these products in the first place. Yet the AMA is doing the exact opposite: supporting a bill that precludes FDA from ever banning the sale of any class of tobacco product. Once again, the AMA's position is entirely inconsistent.

Third, it seems to me that the AMA's criticism is misplaced. It is not the amount of advertising and promotion that is irresponsible. After all, this is a legal product and how can you criticize a company merely for advertising a legal product? What is irresponsible is two things: (1) the use of misleading or deceptive advertising; and (2) the marketing of tobacco products to youths. By focusing on the amount of the advertising and criticizing the tobacco companies for spending too much money, the AMA is distracting attention away from the aspects of the marketing that really determine the level of responsibility of the companies: whether the advertising is truthful or deceptive and whether it is directed at youths versus adults.

Sometimes I get the feeling that anti-smoking groups, especially those supporting the proposed FDA legislation, are looking for any excuse to criticize the tobacco companies, whether or not the companies ought to be criticized for that reason or not. I get the idea that those groups supporting the FDA legislation are looking for any opportunity to show that this particular event or finding demonstrates that we need FDA legislation, regardless of whether that event or finding actually demonstrates the need for the FDA legislation or not.

I think what is happening is that our arguments are getting weaker and weaker, less and less consistent, as our zeal to criticize the companies and promote the FDA legislation spirals out of control. As a result, we are losing sight of the appropriate science and policy base that should underlie tobacco control. We are losing the footing of our movement, as we transfer our foundations from cement to ever-shifting and sinking quicksand.

American Heart Association Bans Miss New Hampshire from Walking in AHA Heart Walk; Has No Problem Teaming Up With Philip Morris to Support FDA Bill

According to an article on the WMUR (New Hampshire) web site, the American Heart Association (AHA) will not allow the Miss New Hampshire organization to participate in the AHA's Heart Walk as a team because the group has received funding from R.J. Reynolds.

According to the article: "The Miss New Hampshire organization has been banned from walking as a team in the annual American Heart Association Heart Walk because of the organization's ties to a tobacco company. Miss New Hampshire Emily Hughes travels to schools to talk to children about the dangers of smoking. But Dover Middle School recently withdrew its invitation to her once it was discovered that the anti-smoking program was funded by tobacco giant R.J. Reynolds. The American Heart Association has now decided to not allow walkers to march under the Miss New Hampshire banner during the Heart Walk. AHA officials said that they hope anyone who takes part in its signature event shares its message of no smoking. 'The American Heart Association has a national policy that prohibits us from working with organizations that accept funds from the tobacco industry,' said Deborah Hornor, AHA regional vice president."

The Rest of the Story

The rest of the story is that although the American Heart Association has a national policy that prohibits it from working with organizations that accept funds from the tobacco industry, the AHA apparently does not have a policy that prohibits it from teaming up with Philip Morris to support federal legislation that would provide unprecedented special protections for the tobacco industry.

Despite its refusal to allow an organization that has received funds from Big Tobacco to associate itself with an AHA event, the AHA apparently has no problem teaming up with Philip Morris to lobby for the FDA tobacco legislation - which contains special provisions that sacrifice the protection of the public's health in order to protect the profits of the nation's largest cigarette manufacturer.

I have no problem with the American Heart Association taking a principled stand and refusing to associate in any way with any organization that has anything to do with any tobacco company. But the hypocrisy of the American Heart Association's own actions - in contrast to its statement to others - is striking.

Obviously, I'm not suggesting that the Heart Association is working directly with Philip Morris. However, the reality is that the American Heart Association is standing shoulder-to-shoulder with Philip Morris in promoting the company's chief legislative priority, and that the AHA is supporting a bill that was essentially negotiated (although not directly) between the Campaign for Tobacco-Free Kids and Philip Morris. The AHA is supporting a bill that is a direct result of negotiations with Philip Morris! That's fine. It's the Heart Association's right to do so. But once they've made the decision to team up with Philip Morris in terms of setting national public health policy, I think the organization loses its ground in then telling other groups that they cannot so much as participate in a fund-raising event if they have accepted money from a tobacco company.

American Legacy Foundation and Action on Smoking and Health - move over. You may have some competition for the next hypocrisy in tobacco control awards.

Friday, April 27, 2007

Campaign for Tobacco-Free Kids Misleads the Public about FDA Legislation; Campaign of Deception Continues in Full Force

In a press release issued on Tuesday, the Campaign for Tobacco-Free Kids misleads the American public by telling us that the proposed FDA tobacco legislation requires tobacco companies to remove harmful ingredients from their cigarettes and by implying that all harmful ingredients would have to be removed.

According to the press release: "Among other things, the legislation would crack down on tobacco marketing and sales to kids; require that tobacco companies disclose the contents of tobacco products and remove harmful ingredients; stop tobacco companies from misleading the public about health risks of their products; and require larger, more effective health warnings on cigarette packs."

The statement under contention is the claim that "the legislation would...require that tobacco companies...remove harmful ingredients."

The Rest of the Story

The rest of the story is that the legislation would not require tobacco companies to remove harmful ingredients. There is nothing in the bill that requires tobacco companies to remove the harmful ingredients from their products.

What the bill does is authorize the Food and Drug Administration (FDA) to require the reduction or elimination of certain constituents. However, there is no requirement that the FDA actually demand the elimination of the harmful ingredients in cigarettes.

In fact, there are a number of provisions in the bill that give the tobacco industry tremendous power to block the FDA from actually requiring the elimination of harmful ingredients from cigarettes. For one thing, the bill grants Congress veto power - with a simple majority vote - over any significant FDA regulation, such as removing a cigarette ingredient. This puts the decisions about the safety of tobacco products into the hands of a political rather than a scientific body (although one could easily argue that FDA itself has become more of a political than a scientific body). It also allows the tobacco industry to use its power and influence in Congress to block any requirement for removal of ingredients that it does not like.

There is an immense difference between a bill that would require the companies to remove harmful ingredients and one that merely authorizes the FDA to require the removal of these ingredients. By failing to tell the public about this distinction, the Campaign for Tobacco-Free Kids is pulling the wool over the public's eye, continuing its long-standing campaign of deception in support of this legislation.

The second part of the rest of the story is that the Campaign for Tobacco-Free Kids' statement is also misleading because it suggests that the FDA legislation would require tobacco companies to remove all of the harmful ingredients from cigarettes. The bill would do nothing of the sort and it in fact precludes the FDA from taking such an action by prohibiting the FDA from banning the sale of any particular class of tobacco product.

Stating that the bill would require that tobacco companies remove harmful ingredients from their cigarettes implies - at least to a large segment of the public - that the bill would eliminate the harmful ingredients from cigarettes. Nothing could be further from the truth. Not only is there no requirement for any constituent of tobacco to be removed, but the best FDA could do is to require the removal of some of, or more likely a few of, the constituents. Contrary to what the Campaign is suggesting, the bill is not going to result in the elimination of harmful ingredients from cigarettes.

And by the way, the most harmful ingredient in cigarettes, by far, is the tobacco. And the bill precludes the FDA from requiring the removal of that ingredient.

Not only does the legislation fail to require tobacco companies to remove the harmful ingredients from their products, but there is, in fact, one provision in the bill that precludes the FDA from requiring cigarette companies to completely remove perhaps the most harmful component - the addictive nicotine - from their products.

The continued deception of the public about the facts relating to the proposed FDA tobacco legislation is, in my opinion, unethical behavior on the part of the Campaign for Tobacco-Free Kids. And I find it ironic that in an effort to promote legislation that it claims is intended to prevent deception by the tobacco companies, Tobacco-Free Kids is using deception of its own:

In order to prevent deception by the tobacco companies, we're going to deceive and mislead the American people. Why is it that deception by the tobacco companies is heinous, but deception by an anti-smoking group is acceptable.

The answer, of course, is that while the tobacco companies are working towards an evil end, the FDA legislation is promoting a noble end - the protection of the financial interests of Philip Morris. Wait a minute, even that reasoning doesn't quite work.

My point is that in using deception to pursue its legislative goals, the Campaign for Tobacco-Free Kids is acting as unethically as the tobacco companies. We are no better than the tobacco industry if we continue to use deception to promote our goals. In this case, the Campaign is not even using deception to promote a shared goal of the public health community. It is using deception to promote the chief legislative priority of the nation's leading cigarette company -- a legislative goal that is opposed by many of us in the public health community.

Don't get me wrong - even if the Campaign were using deception to support what I perceived as a worthwhile measure, it would still be unethical and irresponsible. It just adds insult to injury when the leading anti-smoking group is using deception and promoting the financial interests of Philip Morris at the same time.

I'm all for demanding an end to tobacco industry deception of the public. But I think if we're going to make that demand, we need to first put an end to our own deception of the public. Otherwise, isn't this just the pot calling the kettle black?

Thursday, April 26, 2007

New Jersey Town Bans Smoking in Cars with Kids; Feel-Good Law Would Do Little to Protect Public's Health But Would Interfere with Parental Autonomy

The town of Keyport (New Jersey) on Tuesday enacted an ordinance banning smoking while in a vehicle with a child. The offense will be a secondary one, meaning that police cannot pull someone over for smoking in a car. However, if a person is stopped for another motor vehicle infraction (such as speeding), he or she could be given an additional citation for smoking in the presence of a child. The fine for this violation is $75.

The town's mayor stated that the law is not intended to protect children from secondhand smoke, but is simply intended to make a statement: "'We're not trying to use the power of the motor-vehicle system to punish people into behaving the way we want them to,' Mayor Robert Bergen said. 'This ordinance is really intended to be a positive public policy statement about the need to take care of our kids.'"

The mayor added: "'The Surgeon General's report clearly documents the dangers of secondhand smoke, particularly on young people,' he said. 'It's really not good for children.'"

Not everyone is happy with the new law. According to an Associated Press article: "Audrey Silk, the founder of a New York smokers' rights group, says Keyport is overstepping its authority. 'A car is an extension of your personal property,' said Silk, whose group, NYC Clash, stands for Citizens Lobbying Against Smoker Harassment and is active in New Jersey. 'For the government to regulate what you can do in your own private property, everybody should be afraid of that.'"

The Rest of the Story

The rest of the story is that the mayor has essentially admitted that the law is not intended to protect children from secondhand smoke, but simply to harass smokers about this particular health risk to which they are exposing their children. He stated that Keyport is not trying to get people with kids not to smoke in cars. What it is trying to do, apparently, is to send a statement to smokers who do smoke in cars with children so that they feel bad that they are not taking care of their kids.

The lack of any sincere intention on the part of the Keyport policy makers to actually reduce children's exposure to secondhand smoke is evidenced by the fact that they chose to make this a secondary - and therefore unenforceable - offense. Without the ability to stop people for violating the law, it lacks any teeth, and therefore will - like almost all other secondary traffic offenses - be ignored.

If the true intention of the Borough Council is to protect children from secondhand smoke, then it should have simply banned smoking around children, period. Most secondhand smoke exposure of children occurs in the home, not in cars. So if your true intent is to protect kids and their health, it makes little sense to ban smoking in cars but not homes with children present.

The fact that the Council failed to protect kids in the home and at the same time, essentially made the protections for kids in cars meaningless, suggests to me that the true intention is not really to protect kids after all. Instead, it appears to be a feel-good law that allows the policy makers to feel good about themselves for making a statement (albeit a meaningless one), but without actually having to confront the real issue by tackling the problem of smoking in the home.

Typical politicians! All talk and no action. Talk the talk, but not willing to walk the walk.

Frankly, the apparent intent of this law is to harass smokers and make them feel guilty about smoking around their kids in the car, but without actually changing their behavior. What the Keyport Borough Council is saying is: "You can smoke around kids if you want to, but we're going to make sure that you feel bad about it."

That's fine, but why not make parents also feel bad about feeding their kids fast food from McDonalds four days a week? Why not also make parents feel bad about not breastfeeding their infants? Why not make parents feel guilty for allowing their kids to drive a car before they are 18 years old. Why not make parents feel like they are not taking care of their kids if they allow them to play hockey?

The mayor is right. Smoking in a car is not good for children. But neither is feeding them junk food day after day, letting them risk life-threatening injury by getting pummeled into hard boards on ice, or letting them ride with their friends at probably too high a speed in a car.

The Borough Council could have made a statement about any of these choices that parents make that increase health risks for children. But they didn't. Instead, they singled out smoking. And not even all smoking. Just smoking in a car. Why?

The reason, I believe, is that it turns their stomach to think about parents smoking in a car with children. But it doesn't turn their stomach to think about parents not breastfeeding their kids. It doesn't turn their stomach to think about parents allowing their kids to drive a car. It doesn't turn their stomach to think about parents taking their kids to McDonalds four days a week?

So the really interesting question, then, is why it turns their stomachs to think about parents subjecting their kids to one health risk, but not to any other (equally, or more dangerous) health risks?

The only answer that is apparent to me is that there is some hatred of smokers. They are an easy target to pick on in terms of making a statement about "healthy" parenting. So politicians appear to be using smokers to bolster their own sense of good (they can claim that they are protecting the public's health) without actually having to confront the real issue (smoking in the home).

I agree completely with Audrey Silk. We should be afraid of this invasion of parental autonomy. Especially because it is coming without any substantial evidence that it will greatly protect the public's health. If the express intent of simply making a statement is all that it takes for policy makers to interfere with parental autonomy to this degree, then I think we should be scared.

While it may feel good for the policy makers, it does little (if anything) to protect kids, it distracts attention from the real issue at hand, and it represents an unjustified intrusion into parental autonomy.

Wednesday, April 25, 2007

New Study on Obesity Costs Shows Folly of Smoker-Free Employment Policies

According to an Associated Press article published Monday in the Boston Globe, a new study has shown that "fat workers cost employers more." AP writer Carla K. Johnson writes that: "Overweight workers cost their bosses more in injury claims than their lean colleagues, suggests a study that found the heaviest employees had twice the rate of workers' compensation claims as their fit co-workers."

"Duke University researchers also found that the fattest workers had 13 times more lost workdays due to work-related injuries, and their medical claims for those injuries were seven times higher than their fit co-workers. Overweight workers were more likely to have claims involving injuries to the back, wrist, arm, neck, shoulder, hip, knee and foot than other employees. The findings were based on eight years of data from 11,728 people employed by Duke and its health system. Researchers found that workers with higher body mass indexes, or BMIs, had higher rates of workers' compensation claims. The most obese workers -- those with BMIs of 40 or higher -- had the highest rates of claims and lost workdays."

The study was published in the current issue of Archives of Internal Medicine.

Based on these findings, the authors of the study recommended that employers institute fitness programs to help their overweight employees lose weight.

In response to the study: "New York employment attorney Richard Corenthal cautioned employers not to overreact with discriminatory policies. 'Employers need to be careful not to view this study as a green light to treat obese or overweight workers differently,' Corenthal said."

The Rest of the Story

The rest of the story here is not the study itself, but the response to the findings. And the story is not what researchers recommended, but what they did not recommend. You don't hear anyone suggesting that to save health care and workers compensation money, employers fire fat people or stop hiring them in the first place. It simply isn't part of the discourse. The suggestion simply does not arise. No public health groups are suggesting - or would suggest - anything of the sort. The response (and an appropriate one) is to recommend fitness or other programs to help employees control their weight.

Not so with an almost identical problem - off-the-job employee smoking. That problem is also costing employers money in terms of health care costs. However, in contrast to the obesity and overweight problem, many anti-smoking groups are supporting the idea of firing smokers or refusing to hire smokers in order for employers to save money. The World Health Organization has gone so far as to institute its own smoker-free employment policy, refusing to consider applications from smokers for any WHO job.

It is time that anti-smoking groups understand that the precise reasoning they are using to support discrimination against smokers in employment also supports discrimination against obese and overweight people. If we are going to support the idea of excluding smokers from employment to save health care costs for employers, then we must also support the idea of excluding fat people from employment.

Another aspect to the rest of the story is the immediate and vigorous way in which the mere possibility of employers discriminating against overweight people is confronted. The article concludes with a caution to employers not to take these findings as a green light to discriminate against overweight job applicants.

Not so with smoker-free employment policies. You generally are not hearing a vigorous response warning employers not to discriminate against smokers. You certainly will not hear such a warning from any U.S. anti-smoking group.

In fact, I might go so far as to say that my greatest disappointment right now as a tobacco control advocate is the failure of any U.S. anti-smoking group to step up and condemn discrimination against smokers in employment. I don't think that discrimination is something we should be supporting or even condoning in the tobacco control movement. The fact that we are supporting it is a grave disappointment to me, and it makes me quite ashamed to be a tobacco control practitioner and a part of that movement.

Tuesday, April 24, 2007

Another Anti-Smoking Group Calls Smoking Around Children a Clear Form of Child Abuse

In a letter published recently in The Telegram (St. Johns), the Alliance for the Control of Tobacco (Newfoundland and Labrador) calls smoking around children a clear form of child abuse:

"High-profile instances of child abuse get attention — and certainly they should get attention — but it is, indeed, time to see smoking in vehicles and homes in the presence of children for what it really is: a clear form of child abuse. A recent report from the U.S. Surgeon General clearly states that there is no safe amount of secondhand smoke. The report indicates that breathing even a little secondhand smoke can be dangerous. Further to this, it states that children are more likely to have lung problems, ear infections and severe asthma from being around smoke, and secondhand smoke causes heart disease and lung cancer. ... The days of ignoring this form of child abuse should be no more."

The Rest of the Story

The major fallacy in the argument that smoking around children is a form of child abuse is that secondhand smoke does not necessarily cause harm to children - it increases the risk of ear infections, respiratory infections, and asthma. This failure by a number of anti-smoking groups to recognize the distinction between risk and harm is a dangerous one, and would lead to us categorizing as child abuse a wide range of parental behaviors - not just smoking.

A second fallacy in the argument is that the intention of the behavior is not viewed to be relevant. Child abuse is not being defined as knowingly inflicting harm upon a child, but as any behavior that increases health risk, whether the intention is to cause harm or not. This failure to distinguish between intentional infliction of harm and any exposure to increased risk is also dangerous.

What the Alliance for the Control of Tobacco is essentially arguing is that any time a parent exposes their child to an increased risk of health problems, that is child abuse. No harm need be done. Even a small increase in risk equates to child abuse.

By that definition, allowing a child to eat peanut butter prior to age 3, which is known to significantly increase the risk of potentially deadly peanut allergy, would be a clear form of child abuse. So would not breastfeeding an infant, which has been well-documented to decrease the risk of a host of medical problems. Allowing a child to play contact sports would also be child abuse. So would placing a child's car seat on the side of the back seat, rather than in the middle (the side locations significantly increase risk compared to the middle position).

Can you imagine a maternal and child health organization coming out and publicly suggesting that failing to breastfeed your child is a form of child abuse? Such a group would be instantly attacked and condemned. So should the Alliance for the Control of Tobacco for this particular statement.

The Alliance also fails to consider the fact that child abuse entails an intentional infliction of harm. If the harm occurs by accident or without knowledge of potential harm, it is not child abuse. For example, if you accidentally leave a bottle of vitamins on the kitchen table and a child swallows them, you will not be charged with child abuse. If you intentionally put a bottle of vitamins on the floor - hoping that the child will swallow them - that is child abuse. Consideration of the state of mind of the parent is critical to the definition of child abuse.

However, the Alliance is defining child abuse in a way that ignores the state of mind of the parent. If you smoke around your child, that is child abuse, regardless of whether you even know that secondhand smoke is potentially harmful to your child.

This, too, is a dangerous argument to make. Can you imagine a health organization calling on all parents who serve their kids nuts prior to age 2 to be treated as child abusers, even if those parents were not aware that this behavior increases the likelihood of serious allergies to nuts? They would be instantly attacked and condemned. So should the Alliance for the Control of Tobacco for this particular statement.

Interestingly, the Alliance seems to exempt from child abuse the intentional exposure of one's children to secondhand smoke produced by other smokers. If you smoke around your children, that is child abuse; however, if you bring your kids to a smoky restaurant, the Alliance is not suggesting that is child abuse. This exposes the weakness of their argument.

The rest of the story is that the anti-smoking movement is treading into dangerous territory. In our zeal to extract revenge on smokers, to punish them, and to condemn them, we are actually setting a dangerous precedent that could completely destroy parental autonomy. If policy makers actually listen to what these anti-smoking groups are saying, it will cause great harm to our children. But it will prevent ear infections!

Monday, April 23, 2007

ASH Suggests that Smokers are Weak and Stupid; Appears to Be Trying to Make Candidate Smoking an Issue in Presidential Race

In a commentary posted on its website, a national anti-smoking group - Action on Smoking and Health (ASH) - casts smokers as being weak and stupid, or at least as being perceived that way by the public.

Although Senator Barack Obama has apparently stated that he quit smoking for his health, ASH appears to contend that he is lying, and that he actually quit because the public views smokers as weak and stupid and he wants to avoid those connotations.

ASH quotes its executive director as stating: "Many figures in public life -- including politicians and broadcasters -- try to keep their cigarette smoking from the public. Unlike Edward R. Murrow and others of his era who were quite open about it, broadcasters and political figures today are wary of the image of a cigarette smoker as someone who lacks either the intelligence to understand how dangerous it is, or the willpower and resourcefulness to end it."

The Rest of the Story

To me, this has the appearance of ASH taking advantage of an opportunity to take a swipe at smokers. Why else would they want to force the issue, suggesting that Obama is lying about the true reasons for his quitting smoking? Since there is absolutely no evidence that he is lying, and no one would know but Obama himself, why does ASH need to publicly suggest that Obama is lying unless it wants to drum home the point that smokers are perceived as weak and stupid?

Frankly, I'm aware of no evidence - zero - that anyone (other than some anti-smoking advocates and groups, like ASH) perceive smokers as being so unintelligent that they are not capable of understanding how dangerous smoking is. It appears to me that ASH is trying to take a pot shot at smokers - casting them publicly as being stupid - but without having to fully accept responsibility for that claim.

If confronted, ASH could simply say: "We are not suggesting that smokers are stupid. We're just pointing out that the public thinks they are stupid."

But there is no evidence that the public feels this way. Moreover, even if they did, why would ASH go to great pains to reinforce, rather than confront that stereotype?

ASH had every opportunity to close its commentary by stating its own opinion that smokers are not stupid and weak and should not be viewed that way. But ASH chose not to do so. That makes it difficult for me to believe that it doesn't represent ASH's actual opinion. But regardless of how ASH actually feels, by suggesting to the public that smokers are stupid and weak, it is inevitably putting this idea in people's minds, helping to disseminate this idea.

It also seems to me that ASH is trying to reinforce the issue of smoking as a bona fide concern in the presidential race, rather than to counter this idea. Would it have been asking too much for ASH to conclude its post by suggesting that perhaps a candidate's individual health habits are not a primary concern in a political race? Why keep harping on this if ASH were not trying to keep this issue in the public's eye in order to reinforce or inject Obama's smoking as an issue in the campaign?

Maybe I'm overinterpreting, but can you see why I get the impression that there is a lot of hatred of smokers out here in the anti-smoking movement?

Friday, April 20, 2007

New Anti-Smoking Advertisement Suggests that Secondhand Smoke Kills Instantaneously

A new internet advertisement from the Department of Health (UK) tries to convince the public that people drop dead almost instantaneously from brief exposure to secondhand smoke.

In the internet advertisement, guests at a wedding are mysteriously dropping dead on the spot. The reader is asked to guess the culprit. When the reader clicks to reveal the answer, a pop-up window appears which exposes the fact that the deaths were due to secondhand smoke exposure: "With secondhand smoke present the identity of the killer finally becomes obvious and fears increase as it is clear that everyone in a room with secondhand smoke is at risk. Secondhand smoke is dangerous, as 85 per cent of it is invisible and odourless. What’s more, a smoker's well intentioned attempts to blow or waft smoke away from non-smokers does not eliminate the potential risk of secondhand smoke. Visit or call the NHS Smoking Helpline on 0800 169 0 169 for free and friendly advice on how to stop."

The Rest of the Story

I find this advertisement to be deceptive because it suggests that secondhand smoke routinely causes people to drop dead almost instantaneously from brief exposure. While it is true that chronic exposure to secondhand smoke causes heart disease and lung cancer and that acute exposure could have severe consequences for an asthmatic, it seems misleading to me to suggest that brief exposure puts people at widespread risk of immediate death.

A second problem with the ad, beyond the fact that it misleads the public about the true health risks of secondhand smoke, is that it undermines the public's appreciation of the known dangers of active smoking. After all, you don't see any anti-smoking ads showing people dropping dead from a few puffs of active smoking. The implication is that secondhand smoke is more deadly than active smoking because even a very brief exposure can kill you. In return for sensationalizing the health effects of secondhand smoke, I fear we are undermining the public's appreciation of the hazards of active smoking.

A third problem is that the advertisement is unlikely to be effective. People do not observe individuals dropping dead instantaneously from brief secondhand smoke exposure. The advertisement does not accord with people's observations and life experience. Thus, it is not believable. It seems unlikely, therefore, that anyone would take the ad seriously.

When you exaggerate too much, you may end up undermining the very message you are trying to deliver. By going this far overboard, the ad is actually destroying any chance it has of educating people about the real hazards of secondhand smoke. It is a lost opportunity. In fact, it risks alienating the public from secondhand smoke messages. Eventually, if we continue this type of blatant exaggeration, the public is going to completely tune out to our messages, because the whole thing will simply not be taken seriously.

The misleading nature of the Department of Health's secondhand smoke campaign is not restricted to this advertisement. Some of the "facts" about secondhand smoke on the NHS "Smokefree" web site are also quite misleading.

For example, the web site states that: "When you breathe in secondhand smoke you increase your risk of getting lung cancer by 24% and heart disease by 25%."

This is misleading, because it suggests that any exposure to secondhand smoke, even brief exposure, increases your risk of lung cancer and heart disease by 25%. The truth is that only if you breathe in secondhand smoke regularly for many, many years (such as living with a smoker or working for many years in a smoky workplace) do you increase your risk of lung cancer and heart disease by 25%.

The fact sheet, however, does not state that when you breathe in secondhand smoke for many years you increase your risk of lung cancer and heart disease by 25%. It simply states that when you breathe in secondhand smoke, the risk increases by this amount. The implication is that brief exposure has this effect, which is not true.

The web site also states that: "You can't see or smell 85% of secondhand smoke. So no matter how much you try to avoid it, it's pointless."

This is very misleading, because it suggests that there is no way to avoid exposure to secondhand smoke. It seems to me that this is a dangerous message, because it tells the public that it is futile to even try to avoid exposure to secondhand smoke. The truth is that the public should be warned to try to avoid secondhand smoke exposure. And it is largely possible to avoid such exposure, especially when workplaces are smoke-free. While it is true that the vapor phase of secondhand smoke is not visible, I find that it is usually quite easy to smell secondhand smoke and know that it is there. In fact, I can usually detect the instant a smoker lights up in an environment, even if that person is located in a remote area of a room, far away from me. I don't see the point in trying to make people believe that it is pointless to even try to avoid secondhand smoke exposure.

Elsewhere on the web site, it states: "Breathing in other peoples' secondhand smoke can damage almost every organ in the human body. It increases the risk of lung cancer by 24% and heart disease by 25%."

This is misleading in two ways. First, while secondhand smoke can damage the heart and lungs, that doesn't represent almost every organ in the body. Second, once again, the statement implies that any exposure to secondhand smoke increases the risk of lung cancer and heart disease by 25%. It does not state that breathing in other peoples' secondhand smoke chronically increases these risks by 25%.

The web site also states that: "Breathing in secondhand smoke makes the blood more sticky. This means that there is a risk of blood clots forming. A blood clot can block an artery and cause heart attacks, strokes, angina or even complete heart failure."

This, too, is misleading because it suggests that any breathing of secondhand smoke, even brief exposure, increases the risk of forming a blood clot. This is simply not true. The only risk of clot formation from brief exposure is for someone who already has severe existing coronary artery disease. The "fact sheet" makes it sound like any person exposed to secondhand smoke is at risk of developing a blood clot, which could lead to a heart attack, stroke, or complete heart failure.

Interestingly, I've never heard any anti-smoking group warn the public that taking a few puffs on a cigarette makes the blood more sticky, increasing the risk of blood clots which can cause heart attacks, stroke, and complete heart failure. If it is true that even a little secondhand smoke can cause blood clots and death, then shouldn't we be warning kids that they put themselves at risk of death by actively smoking even a few puffs on a cigarette?

The implication, of course, is that secondhand smoke is far more deadly than active smoking. And this message, while presumably unintended, is a clear message that is coming from this campaign.

It is not worth undermining 4 decades of education about the hazards of active smoking in order to try to sensationalize the health effects of secondhand smoke and create a more emotional appeal to the public.

But most importantly, it's simply wrong to misrepresent the science and mislead the public. We risk losing all credibility, even when we are speaking truthfully about the hazards of secondhand smoke.

Finally, this makes me feel like there is little point to continuing my research on the actual health effects of secondhand smoke. After all, if anti-smoking groups are going to claim - regardless of the actual science - that secondhand smoke causes instant death, then what point is there to doing careful research to study the actual health effects? As the UK Department of Health's campaign states, "It's pointless."

Wednesday, April 18, 2007

Another Anti-Smoking Group Accusing FORCES of Being a Big Tobacco Front Group

A major international tobacco control organization is accusing FORCES International of being a Big Tobacco front group. On its website, the group Essential Action (Global Partnerships for Tobacco Control) lists FORCES as being a "proven (and probable) front group."

In lieu of documentation that FORCES receives tobacco industry funding, all that Essential Action states about FORCES is the following: "One of their action alerts calls on people to write letters to Honolulu city council (U.S. - HI) members urging them NOT to support a restaurant smoking ban because "Hawaii is very dependent on the Japanese tourists, and most of them smoke. Will they want to come to a city where they cannot be comfortable and smoke?" See For a related website, with links to affiliated groups in Canada, Italy, Netherlands, New Zealand, Russia, and the U.S., see"

The Rest of the Story

That's pretty weak. If the best you can do to support your accusation that a group receives major tobacco industry funding is to demonstrate that the group opposes smoking bans, you're on pretty shaky ground.

But this further demonstrates my point that the tobacco control movement has been brainwashed with the idea that any opposition to the anti-tobacco agenda is prima facie evidence of being a Big Tobacco front, is it not?

The apparent reasoning here is quite simple: FORCES opposed the Honolulu restaurant smoking ban; therefore, it is a tobacco industry front group. Essential Action provides no other evidence to support its assertion.

In fact, this may be considered to be a part of the brainwashing that is occurring. Here, Essential Action is "indoctrinating" tobacco control advocates throughout the world with the false information that FORCES is a Big Tobacco front group. If I am a tobacco control advocate reading this site, I would then be inclined to go out and make my own public claims that FORCES is a tobacco front group. And that information would spread further and further until it pretty much becomes accepted as the truth. This is exactly how brainwashing can occur when there is no opportunity provided to challenge the information or to provide an alternative perspective.

And what did happen when I made an attempt to challenge this false information? I was accused of being a tobacco lackey for defending FORCES against this accusation and I was promptly kicked off the list-serve on which I made this challenge. Truly, no challenging of the indoctrination is allowable. This is what allows it to spread unchecked; this is what allows these false claims to become more and more widely disseminated.

If you are going to indoctrinate tobacco control advocates with information like this, you have to do two things:
  1. Provide documentation to back up your assertions.
  2. Allow people to challenge your claim and then be prepared to defend it against these challenges.
The tobacco control movement has done neither of these things in indoctrinating advocates with the idea that any group or individual who opposes anti-tobacco policies is a tobacco front.

Believe me, I have come to know many of the folks over at FORCES pretty well, and being lackeys for anyone else is the last thing in the world they are. The opinions they express are about as genuine as they can be. They truly believe what they are saying, and they are speaking for themselves; they are not the mouthpiece for anyone else.

Even a cursory look at the FORCES website would tell you that they are not mouthpieces for Big Tobacco. The tobacco companies have stated that secondhand smoke is harmful. FORCES has never made such a claim. The tobacco companies entered into the Master Settlement Agreement, something which FORCES has blasted. I'm sure that FORCES would like nothing more than for the big tobacco companies to crumble so that smaller companies, with more reasonable prices, could take over.

Most importantly, of course, neither Essential Action nor ANR nor any of the other groups or advocates who have accused FORCES of being a tobacco industry front group have produced any evidence that FORCES has received or receives major funding from the tobacco companies and that Big Tobacco in any way directs their actions and agenda.

More than a year ago - on February 28, 2006 to be exact - I issued a challenge to all anti-smoking groups and advocates to produce evidence that FORCES had received major funding from tobacco companies. There was no response, and to date, I have still not received or seen any evidence to support the front group assertion.

It's interesting how these anti-smoking groups can be so loud and forceful in making the accusation, but when challenged to back it up, they become absolutely silent.

Tuesday, April 17, 2007

Prominent Anti-Smoking Advocate Accuses Rest of the Story Reader of Being Big Tobacco Lackey

In a letter to the editor published yesterday in the Edmonton Journal, an anti-smoking advocate who is past president of the Canadian Thoracic Society accuses Michael J. McFadden of being a Big Tobacco mole, but without providing any documentation to back up his claim. The letter comes in response to a letter written by McFadden several days ago, in which he argues against a ban on tobacco grants at the University of Alberta. The letter, written by Dr. Irvin Mayers, suggests that the reason why McFadden supports the funding of university research by tobacco companies is that he is a Big Tobacco front - working for an organization (The Smoker's Club) which receives major funding from tobacco companies.

Mayers writes: "Any time tobacco is discussed, the author must make full disclosure of conflicts of interest. Mr. McFadden did not state his full credentials; he is the mid-Atlantic regional director of the Smoker's Club, Inc. This organization avidly supports the freedom to smoke and finds fault in most anti-smoking legislation. The organization's web site does not declare its funding sources. Tobacco support groups often receive major funding from tobacco company affiliates. ... I suspect that Mr. McFadden is just "blowing smoke" and trying to keep a tobacco presence in all our lives."

The Rest of the Story

It certainly took no time at all for an anti-smoking advocate to demonstrate the point I made in yesterday's commentary about how tobacco control advocates are brainwashed into thinking that anyone who opposes an anti-tobacco policy is a Big Tobacco front and that we should publicly accuse them of being a tobacco lackey in order to discredit them.

In fact, the very same day, the past president of the Canadian Thoracic Society accused Michael McFadden of being a tobacco lackey. The clear accusation in the letter is that McFadden's arguments are not sincere - that he is merely blowing smoke in order to protect tobacco industry profits since he is affiliated with The Smoker's Club, which Mayers intimates receives tobacco funding.

The problem, however, is that Mayers provides no evidence or documentation to support his accusation.

Even worse, a cursory examination of the easily available and accessible factual information would have revealed the following disclosure which makes McFadden's funding situation eminently clear: "Michael J. McFadden does not have any financial connections or obligations to Big Tobacco."

When you make a public accusation that someone is blowing smoke because they are secretly being funded by tobacco companies (and not revealing it), you are making a serious charge. It could have substantial implications for that individual's reputation and for how the public views that person's character and integrity. So I think it is therefore very important that you be able to document the truth of your accusation before you make it.

In this situation, not only is no documentation provided, but there is easily available evidence that directly contradicts the assertion.

While Dr. Mayers has every right to his opinion about tobacco research funding (an opinion which, incidentally, I agree with) it is not responsible or appropriate for him to issue an ad hominem attack and accusation of impropriety without being able to back up his assertion.

To further demonstrate my point, another anti-smoking group - Smokefree Pennsylvania - made an undocumented accusation of its own on my blog yesterday. Its executive director insinuated that FORCES is a Big Tobacco front group, but again - failed to provide any documentation to support this claim. Other than perhaps a single website ad, I challenge anyone to document that FORCES has received any substantial funding from tobacco companies.

Not long ago, another prominent anti-smoking advocate publicly accused my good friend Martha Perske of being "a tobacco industry mole." This assertion appeared on a tobacco control list-serve. More publicly, Ms. Perske was accused of being a tobacco lackey in the American Journal of Public Health. Americans for Nonsmokers' Rights accused former Associate Attorney General Robert McCallum of being a former tobacco industry lawyer, without any documentation that he had ever personally represented any tobacco company. To this day, Americans for Nonsmokers' Rights continues to imply that FORCES is a Big Tobacco front group.

As I wrote a while back: My experience and observations have led me to challenge this dogmatic perspective within the anti-smoking movement. There are now two sides to this issue, and I hope that both can now be heard. As Hugh Trevor-Roper wrote in his introduction to Mark Lane's Rush to Judgment: "The fact that the advocate believes his own version is not relevant: advocates often do. Before judgment can be given, the advocate of the other side must also be heard. ... He too believes in his brief. Thanks to that belief, he too may err in detail. But at least he has the right, which in America has often been denied to him, to a fair hearing. When both sides have been heard, and not before, posterity may judge."

I am quite confident that when posterity judges the actions of the modern-day anti-smoking movement, it will conclude that a systematic process of indoctrination of anti-smoking advocates with the belief that anyone who opposes an tobacco policy is fronting for Big Tobacco has resulted in false and undocumented accusations against a number of individuals and groups.

Unfortunately, it will be too late: posterity cannot retract these accusations or apologize to the affected groups and individuals. That's something which the anti-smoking advocates and groups making these undocumented accusations ought to do - today.

Monday, April 16, 2007

IN MY VIEW: Brainwashing in the Anti-Smoking Movement: #1 - Smearing the Opposition

If you take part in secondhand smoke policy training in the tobacco control movement, chances are that you will be taught that all opposition to smoking bans is orchestrated by the tobacco industry, that anyone who challenges the science connecting secondhand smoke exposure and severe health effects is a paid lackey of Big Tobacco, and that any group which disseminates information challenging these health effects is a tobacco industry front group. Consequently, the a chief strategy of tobacco control is to smear the opposition by accusing them of being tobacco industry moles. And in no situation should one say anything positive about an opponent, even if true.

How do I know this?

Because for many years, I was one of the main trainers of tobacco control advocates in the United States. And this is what I taught, because this was what I was led to believe. I attended many conferences and trainings and this is precisely what I was taught. I accepted it for the truth, and passed it along to others.

However, in 1999, a sentinel event in my career occurred which woke me up to the fact that I had in fact been brainwashed to believe these errant ideas. I wrote an article summarizing some of these ideas. In the article, I suggested that if any group opposes a smoking ban, advocates should not discuss the substance of the opponents' claims, but should instead try to discredit them by exposing their ties to Big Tobacco.

I woke up one morning to find that, without my permission, my article had been posted on the internet by Americans for Nonsmokers' Rights (ANR). Something about having my work published on the world wide web for everyone to see awoke me from my brainwashing and snapped me back to reality. Immediately, I realized that I had made a mistake. I called ANR and asked them to please change the article to reflect a clarification, in which I made it clear that I was not in fact accusing certain individuals who had challenged the severity of secondhand smoke health effects of having personally received money from tobacco companies.

To my shock, ANR refused to accede to my request, even though I was the author of the article. They responded that they did not want to say anything even remotely positive about an opponent and that they had to place their own political agenda ahead of my scientific integrity:

"we have concluded that the possible 'clarification' that you and I discussed is simply not feasible. There is a strong concensus that we do not want to post ANYTHING on our web page that can be construed as an apology or as backtracking from the position taken in the paper you wrote. More specifically, XXXXXX has convinced me that, given XXXXX's long history of attacking ETS science, it would be a mistake to state anything that would give him credence. ... I realize that your views on the matter are heart-felt and sincere, and that mere removal of your name from the paper, without more, will not be entirely satisfactory to you. But at this point ANR must put its political credibility ahead of what you consider to be your scientific credibility."

ANR then decided to completely disrespect my authorship rights and my copyright of the article, and to subsume copyright of the article for itself by publishing it on its website without my name. I never gave ANR permission to do this. What I told ANR clearly was that given its refusal to change my article as I re-wrote it, I wanted the article removed from its website. It was only when ANR refused to honor this author's request that I demanded that my name be removed from its website.

(Read the entire story here)

What turned out to be errant information about the nature of opposition to smoking bans was delivered to me via a systematic method of formal trainings in which these ideas were deliberately spread to me and other tobacco control advocates with the purpose of furthering the anti-smoking cause.

These ideas ran counter to my own pre-conceived and firmly held ideas about the nature of opposition to smoking bans and to challenges of the health effects of secondhand smoke. After all, I had many good friends who challenged the connection between secondhand smoke and chronic disease, so I "knew" that not everyone who challenges the science is a Big Tobacco lackey. I also had met many of the opponents of smoking bans and it never occurred to me that they were tobacco moles. Nevertheless, this wisdom was so strongly imparted upon me in the trainings (which were largely delivered by, or influenced by ANR) that I came to believe this information, even though it was at odds with my pre-conceived beliefs.

Importantly, only one perspective on this issue was presented to us in the trainings. There was no room for disagreement or challenge. These ideas were presented as scientific facts, not subject to debate. In fact, if we were to challenge the ideas, the implication was that we - ourselves - might be accused of working for Big Tobacco or receiving secret payoffs.

The most prominent and dogmatic idea presented to us was that "The debate is over." There is no room for questioning of the link between secondhand smoke and chronic disease. Anyone who challenges that link or suggests that it is being exaggerated must therefore be a front for the tobacco industry. No reasonable person - acting of their own accord - would challenge this undebatable science.

This dogma, however, is untrue. While it is certainly the case that most of the scientific challenges to secondhand smoke science came from tobacco industry-funded initiatives, there are a number of scientists and others who have challenged the science but are not paid by Big Tobacco to do so. The American Council on Science and Health, for example, has challenged the strength of the link between secondhand smoke and chronic disease, while acknowledging the acute effects of tobacco smoke. Martha Perske wrote some very well-researched and meticulous critiques of secondhand smoke science. I have myself challenged the claims made by many anti-smoking groups about the acute cardiovascular effects of secondhand smoke. So no - not everyone who suggests that secondhand smoke health claims have been exaggerated is a paid lackey of the tobacco industry.

Moreover, not all opponents of smoking bans are tobacco industry front groups. FORCES International - one of the groups most prominent in opposing smoking bans - is not a Big Tobacco front group, despite continued accusations by ANR that this is the case.

To this day, ANR instructs local anti-smoking groups to suggest to the public that any group opposing a smoking ban is a Big Tobacco front group, even if we can't prove it: "Advocates should shine the light on these associations and connections to the tobacco industry. See our factsheet on how to follow the money to find industry connections in your community. There isn't always a "smoking gun" linking the tobacco industry to these groups, either due to lax local campaign finance laws, or money getting funneled through third parties. Often we don't find out until years later that the tobacco industry was funding opposition activities. In any case, showing that suspicious groups are pulling out all the familiar tricks will encourage people to take the Big Tobacco message delivered by these groups with a grain of salt."

ANR continues to claim that any scientist who finds no relationship between secondhand smoke and chronic disease is not legitimate: "All major governmental and public health agencies and legitimate researchers have clearly affirmed that secondhand smoke kills."

In other words, if I conduct a study and it fails to show a significant relationship between secondhand smoke and chronic disease, then all of the sudden, I have automatically become an illegitimate scientist.

Speaking of illegitimate scientific claims, keep in mind that ANR claims that active smoking is no worse than 30 minutes of secondhand smoke exposure in terms of the amount of heart damage that it causes and that this brief exposure to secondhand smoke deprives the heart of life-giving blood: "Just thirty minutes of exposure to secondhand smoke can cause heart damage similar to that of habitual smokers. Nonsmokers' heart arteries showed a reduced ability to dilate, diminishing the ability of the heart to get life-giving blood."

If one conducts a search of the ANR Tobacco Industry Tracking Database, looking for evidence that Michael Siegel is a Big Tobacco front, you will find an entry that describes my May 2006 appearance on 20/20, during which I suggested that it is inaccurate to claim that 30 minutes of secondhand smoke can cause heart disease. You will also find a link to my blog being quoted by Jacob Sullum in his article "Second Thoughts About Tobacco Tar." Furthermore, there is a link to my being quoted in an Inside Bay Area article in which I question the need to ban all outdoor smoking.

While it is great that ANR is providing these important links, the fact that they are provided under the tobacco industry tracking database seems to me to suggest to the public that I am somehow affiliated with the tobacco industry. I can understand ANR linking to these documents, but it is beyond me why such documents would appear in a tobacco industry tracking database. In what way is tracking me related to tracking the tobacco industry? The implication, of course, is that there is indeed a connection there, and I'm sure that my appearance in the database has given reason to some members of the public who do not know me to suspect that I am a tobacco industry mole.

My point is simply that there is a systematic effort to try to put doubt in the minds of the public about the legitimacy and integrity (and financial independence) of anyone who expresses any opposition to a proposed smoking ban or who in any way challenges anti-smoking groups' claims about the health effects of secondhand smoke, despite the fact that not everyone who opposes smoke-free policies or challenges the health claims of anti-smoking groups is in fact on the tobacco payroll. This means that some individuals and groups are going to end up being falsely accused.

Given the indoctrination that takes place in the tobacco control movement, it is perhaps not a surprise that no less than five of my colleagues have recently accused me of taking tobacco money or implied that I am being paid by tobacco companies. The brainwashing that takes place is so strong that some anti-smoking advocates lose their ability to distinguish between a tobacco mole and a dedicated and committed, long-time tobacco control advocate.

Brainwashing is defined as "persuasion by propaganda." Propaganda is defined as "ideas, facts, or allegations spread deliberately to further one's cause or to damage an opposing cause." Thus, brainwashing is a systematic, deliberate attempt to further one's cause by persuading people via spreading ideas and allegations.

There is little question in my mind that there has been a systematic and deliberate attempt to promote the anti-smoking cause by spreading what turns out to be disinformation about the opposition to smoking bans and the challenges to secondhand smoke science. It is my opinion that many tobacco control advocates are indoctrinated with these ideas and beliefs and that this indoctrination may result in the implantation of beliefs that run counter to an individual's pre-conceived or natural ideas and conceptions. In addition, an environment has been created in which one cannot challenge the ideas being presented because by definition, those who challenge the establishment are viewed as being traitors to the movement. Thus, not only is brainwashing occurring, but it is a self-perpetuating type of process which feeds itself by placing a nearly insurmountable barrier to anyone challenging it.

I was able to overcome my "brainwashing," but it took a lot of courage to do so, and a lot of risk to my career. I paid a heavy price for breaking out of the mold into which I had been cast. It shattered my career in tobacco control. But at least it didn't shatter me, and the person who I really am.

I am not about personal attacks on individuals. I am not about making undocumented allegations and claims about people that could damage their reputations unfairly if they end up being untrue. I am not about denigrating the character of other researchers based on the opinions which they may express about secondhand smoke. I am not about making undocumented accusations against groups which may oppose policies that I support.

This, unfortunately, is what the anti-smoking movement has become. So be it, but don't try to indoctrinate yet another generation of public health advocates with this propaganda.

Wednesday, April 11, 2007

Harvard Report and Tobacco-Free Kids' Propaganda Continue to Deceive: When Lower Levels of a Harmful Substance are Not Safer

An editorial in Monday's Florida Times-Union, entitled "Tobacco: Lower Nicotine Levels," calls for a reduction in the nicotine levels in cigarettes. Interestingly, it does not call for an elimination of the nicotine - it merely calls for a reduction.

According to the editorial: "Critics argue that people will smoke more cigarettes, to feed their addiction, if nicotine levels are lowered. That's possible, particularly at first, but it seems less likely over the long run. Young people, who start smoking after the advent of weaker cigarettes, might have less of a habit to feed. A little of something bad is preferable to a lot of it."

The Rest of the Story

Let's stipulate, for the sake of argument, that the editorial is correct and that compensation is a short-lived phenomenon and that over the "long run," decreases in nicotine levels will actually result in decreased nicotine exposure and a reduction in the addictiveness or harm of cigarettes.

If that is correct, then Judge Kessler has made a terrible decision in finding the tobacco companies guilty of fraud in falsely implying that low-nicotine cigarettes confer a health benefit. And the tobacco control movement has been, and continues to be, gravely mistaken in criticizing cigarette companies for marketing low-tar and low-nicotine cigarettes and for implying a health benefit.

What this editorial is arguing is that there is, in fact, a health benefit to low-nicotine cigarettes and that cigarette companies are correct in implying such. Therefore, there is nothing wrong with marketing low-nicotine cigarettes such as "lights" and "ultra-lights" and tobacco control groups and the D.C. District Court have greatly erred.

The truth is that despite drastic declines in the nicotine levels of cigarettes over the past 30-40 years, there is absolutely no evidence of any health benefit over the "long run." And there is not a single health group which is claiming that these drastic reductions in nicotine levels has translated into any health benefit. In contrast, there is agreement that the reduction in nicotine levels has been harmful to health because it has misled people into believing that cigarettes are safer when they are not.

The argument that young people will be less likely to smoke if nicotine levels are lower is equally flawed. No one in the health community has argued that the drastic reductions in nicotine levels over the past four decades has been a good thing because it has made kids less likely to start smoking. If anything, lower nicotine levels make kids more likely to smoke because they are less likely to be turned off by the harshness of cigarettes upon initial experimentation.

If anything, a very high nicotine cigarette would confer health benefits and potentially make cigarettes less palatable to kids. High nicotine levels would allow smokers to get the same nicotine dose with less tar, thereby reducing carcinogenic and chronic lung effects. High nicotine levels would also make cigarettes much less palatable for youths and could therefore decrease, rather than increase youth smoking initiation.

Not only is the editorial wrong, but it is presenting the exact opposite of what I believe represents an accurate scientific and policy perspective on nicotine regulation. However, I want to make it clear that I do not blame the newspaper for this. I think the blame lies with the propaganda that has been put out by the Harvard report and groups like the Campaign for Tobacco-Free Kids, which has inappropriately used the Harvard report to support the proposed FDA tobacco legislation.

It may seem counter-intuitive, but this is one situation when a little of something bad is not necessarily preferable to a lot of it.

Tuesday, April 10, 2007

On Car Smoking Bans and Class Discrimination

What do car smoking bans have to do with class discrimination, you may be asking. Actually, quite a bit, I will argue.

First, consider these two parental behaviors, and tell me which one is more irresponsible:

A. Parent A drives an SUV on the highway at 75 miles per hour with her kid in the back seat. She has one hand on the steering wheel and one hand holding a cell phone, upon which she is having a heated conversation that is distracting her attention away from the road and the traffic hazards.

B. Parent B drives a small coupe down the highway at 60 miles per hour with her kid in the back seat. She has one hand on the steering wheel and is smoking a cigarette. The windows are open. She has her eyes on the road and is paying attention to traffic hazards. She is not distracted from what is happening in the path of her car. Her child does not have asthma.

To be sure, parent B is exposing her child to an increased risk of adverse health effects from the secondhand smoke. But the magnitude of that increased risk is relatively small. And if health effects do occur, they will not be terribly severe. There is a small increased risk of the child coming down with an ear infection or upper respiratory infection due to the secondhand smoke exposure during the course of the car trip.

In contrast, parent A is exposing her child to an increased risk of death from a fatal car accident. The magnitude of that increased risk is not all that small. If an accident does occur, it will likely be very severe, possibly even fatal. There is a reasonable chance that the child would die if such an accident occurred.

While both parents are exposing their kids to increased risk of an adverse health consequence, one could argue that parent A is acting less responsibly because the incremental risk of getting into a traffic accident from talking on a cell phone is far from negligible and the likely consequence of such an accident would be severe injury or death for the child. The incremental risk of an ear infection or upper respiratory infection for parent B's child is rather small, and the severity of such a consequence is obviously much less than that of a traffic accident.

While health groups are now issuing widespread calls for regulating parent B's behavior, making it a crime, and allowing the authorities to put the parent in jail as a high-end punishment, these same health groups are not calling for regulating parent A's behavior, making it a crime, and allowing the authorities to put parent A in jail as a high-end punishment.

While some might see this inconsistency as merely a curious discrepancy, I see it as a form of class discrimination. I honestly believe that the explanation for the differential treatment of the behavior of these two parents is the class difference between them. I think that health advocates who are supporting car smoking bans are viewing the unhealthy behaviors of parents from one social class group (smokers) to be far worse than equally unhealthy behavior of parents from a higher social class group (wealthy families who can afford to drive their kids around to and from soccer practice in an SUV).

These soccer moms and dads are most likely not smoking in cars with their children, but they sure as hell are putting their lives at risk when they talk on a cell phone while speeding down the highway with them. So how can we view the former as a crime potentially punishable by a jail sentence and the latter as simply a poor, but legal, behavior choice on the part of a parent?

The answer is that we are able to view these parents' behavior differently because of the social class difference. We treat them differently based on social class. In other words, this is a form of class discrimination.

We do not equally respect the parental autonomy and parental behavior choices of smokers and wealthy cell phone addicts when we aim to criminalize one but not the other. The differential respect afforded to parents in the two situations is based on their social class, and is therefore class discrimination.

Smokers have become a social class whose personal autonomy and behavior choices are not respected in the same way that we respect the autonomy and behavior choices of other groups, especially wealthier classes.

While proponents of car smoking bans may not realize it, and certainly they are not doing it consciously, I believe that they are inadvertently falling into class discriminatory thinking in their singular preoccupation with the relatively minor incremental risks of exposing kids to secondhand smoke while driving short distances in a car, while ignoring the far more serious risks of smoking for long periods of time in a home or of talking on a cell phone while driving kids around.

In the first case, the failure to aim to regulate smoking in the home reveals a respect for parental privacy and autonomy in the home which is apparently not respected for this group of parents in their own cars. In the second case, the failure to aim to regulate cell phone use while driving kids around at the same time as banning cigarette use while driving reveals a respect for the parental privacy and autonomy of one group but not for the other.

So the next time someone asks you the connection between car smoking bans and class discrimination, you can tell them the rest of the story.

Monday, April 09, 2007

Going Too Far: POST #2 - Complete College Smoking Bans

In the first part of this two-part series, "Going Too Far," I highlighted an example of a proposed citywide outdoor smoking ban that is too excessive to be justified in terms of protecting nonsmokers from a significant health hazard. In this second part, I comment on the growing trend of college campuses that are instituting complete bans on smoking and/or all tobacco use.

According to an article in the Orange County Register, three colleges in California ban smoking completely - both indoors and outdoors. Fullerton College recently enacted a ban on all smoking by students and part-time faculty and staff members; full-time employees of the college are exempt.

According to the same article, at least some anti-smoking groups are encouraging and supporting these complete college smoking bans: "The American Cancer Society publishes a how-to guide for campuses that want to prohibit smoking. Among the recommendations: Find students to spearhead the effort. Phase it in slowly. Combine it with stop-smoking programs."

Another anti-smoking group that appears to be supporting these efforts is the California Youth Advocacy Network, which describes itself as a "statewide coalition promoting tobacco-free colleges and universities in California." This group, supported by the California Department of Health Services, has put out a model college smoke-free policy, which includes as one option a complete ban on all outdoor and indoor smoking on campuses: "As of August 1, 2004, smoking is prohibited on all property and in all indoor and outdoor spaces owned, leased, licensed, or otherwise controlled by [campus name]. Signs stating “NO SMOKING ON CAMPUS and other [campus name] controlled locations.” shall be posted at major campus entry points."

Perhaps the most stringent nonsmoking policy was recently approved by the staff council at the University of New Mexico. This policy would ban all tobacco use on campus -- both smoking and smokeless tobacco use and both indoors and outdoors. It needs approval by the regents before it goes into effect.

According to an article in the New Mexico Daily Lobo: "
Donald Burge, who presented the resolution, said it goes beyond the resolution for the Health Sciences Center. The Board of Regents approved a smoking ban for the Health Sciences Center on Feb. 14. 'What the resolution that I put forward (Tuesday) calls for is not just smoke-free but to go tobacco-free,' he said. 'There are deleterious effects of people chewing and spitting. Those effects are just as bad if not worse than secondhand smoke.' Burge said there was no discussion in the crafting of the resolution about including a smoking section on campus to accommodate smokers."

"'Quite frankly, I do not buy into the argument of smokers' rights,' he said. 'If you're going to talk about the rights of smokers, you're going to have to ask at what point the smoker has the right to harm others.' Burge said a smoking section outdoors is unacceptable, because people's lives would still be in danger. 'When you have a public institution, that institution has a duty to protect the safety of the people in or on that institution,' he said. Cigarettes are still a danger to people, even after they have been put out, Burge said. 'Most people will, in fact, simply throw it on the ground. Somebody has to clean that up,' he said. 'Picking up cigarette butts exposes the person who has to pick them up.'"

The Rest of the Story

So let's get this straight. There are deleterious effects of smokeless tobacco on non-smokeless tobacco users that are "just as bad if not worse" than the effects of secondhand smoke on nonsmokers. And since we all know that even 30 minutes of secondhand smoke can cause instant death, I can only imagine all the people that are dropping dead from being in the vicinity of someone with a wad of chewing tobacco in their mouth.

I have to admit that the concept of secondhand smokeless tobacco is a new one to me. I realize that back in my playground days, kids used to put chewing gum in each other's hair as a practical joke, but I didn't realize that anything similar was going on with smokeless tobacco. Or is the idea that the chewing action causes the tobacco constituents to vaporize and then float through the air and expose non-users? I admit that I have to brush up on the part of my epidemiologic education that dealt with secondhand effects of smokeless tobacco use.

I also have to admit that I didn't realize how hazardous cigarette butts are, or that sweeping a butt with a broom or other outdoor cleaning device causes the sweeper to be exposed to noxious fumes. I recognize that cigarette butts may represent a nuisance or a source of litter, but I didn't realize that they represented a substantial immediate human health hazard.

I also have to admit that I didn't realize that people's "lives are in danger" from a remote outdoor smoking area. It always seemed to me that nonsmokers could simply avoid walking near that smoking area. I didn't realize that these outdoor smoking areas are killing people. Had I known that, I might not have lobbied so vigorously for bar and restaurant smoking bans, since I know that those policies have resulted in smokers congregating in outdoor areas, which is apparently putting people's lives in danger.

But my apparent ignorance of these scientific facts pales in comparison to my ignorance about the differential effects of smoking on students compared to faculty members and on full-time as opposed to part-time employees. I honestly had no idea that smoking was a severe health hazard for students, but that it was perfectly acceptable for faculty members. I also had no idea that while smoking is an unacceptable health threat to part-time employees, it is not so much of a problem for full-time employees. I had always thought that tobacco was an equal opportunity killer, but apparently it discriminates on the basis of employment status.

Frankly, the anti-smoking movement is going to make itself look stupid if it continues to pursue these extreme policies and to back them up with such ridiculous arguments. If you're going to support complete smoking bans on college campuses, then at least acknowledge the real reason behind it. Don't hide behind these idiotic explanations.

The inescapable fact is that those who are supporting complete college smoking bans have crossed the line from protecting nonsmokers from secondhand smoke to trying to protect smokers from themselves. In other words, they have crossed the line from health protection to unenlightened paternalism.

That may be acceptable, but at very least, call it what it is. These policies represent the use of coercion to attempt to change a health behavior, not to protect innocent bystanders, but to protect the person engaging in that behavior.

To me, this crosses a line that we ought not cross in public health. While I think we are justified in using educational and persuasive approaches to try to protect people from their own unhealthy behaviors, I do not believe that we are justified in using a coercive approach unless the person's behavior is affecting other people.

If we're willing to cross this line with regards to smoking, then there is really nothing to stop us from crossing the same line with regards to all other health behaviors. If we are willing to ban tobacco use on college campuses to promote health, then there is no reason why we should not also ban alcohol use, ban trans-fat intake, ban excessive fat intake, ban the consumption of tater tots, require a set amount of daily physical activity, and ban the consumption of more than 2 grams of sodium per day among hypertensives on campus. We should also ban college hockey, football, and lacrosse. I'm just saying...if we truly want healthy college campus environments.

If anti-smoking groups want to pursue this type of paternalism on their own, I suppose that is their right, but I do find it problematic that these efforts are apparently being supported by taxpayer funding (through the California Department of Health Services). If the California Department of Health Services wants to support paternalistic intervention, that's fine I guess, but the Department at least needs to be consistent. Let's also see some taxpayer funding of initiatives to dictate people's diet, physical activity, sexual activity, alcohol use, and the other major health behaviors which are responsible for the bulk of preventable disease in California.

It's odd that you don't see public health advocacy groups pushing for alcohol-free college campuses, trans-fat free college campuses, or requirements on physical activity for college students. The only behavior for which we see a paternalistic approach is tobacco use.

I can't help but wonder why that is. Why would smoking be singled out as the one behavior for which we need to coerce its non-use, while for every other health behavior, people are allowed to make their own decisions (although we educate them and try to persuade them to make healthy choices). But not for smoking and tobacco use. It's apparently not enough to educate people or even to use aggressive persuasion to get them to quit smoking. Instead, we have to coerce the non-use of tobacco products.

I'll be honest. My perception is that the reason smoking is being singled out is that there is some underlying hatred of smokers and a disrespect for their life choices, as well as for their right to make these choices. To some extent, I think this is a class issue (keep reading The Rest of the Story later this week for more on the class issues in recent anti-smoking initiatives). We do tend to disrespect choices made by smokers, but to respect equally unhealthy choices made by the upper classes.

In fact, you can see this class issue start to bear out on the Fullerton campus. The students and part-time workers are coerced into not smoking, while the faculty are left to make their own health decisions.

The rest of the story is that complete college smoking bans are an example of the anti-smoking movement going too far because they cross the line into unenlightened paternalism. They aim to control health behavior through the use of coercion, rather than using education and persuasion to try to encourage people to make healthy behavior choices.

While I oppose such an approach and would hope that the anti-smoking movement would not continue in this direction, at very least, we should admit what we are doing and the reasons behind it, rather than hide behind inane excuses such as the life-threatening hazards of outdoor smoking in remote areas, the harmful effects of secondhand smokeless tobacco, or the extreme hazards of cleaning up cigarette butts.