Under Plan to Use Cigarette Tax to Fund Children's Health Insurance, 22 Million New Smokers Would Be Required to Keep Program Solvent Over Next Decade

According to a report released by the Heritage Foundation, 22 million new smokers will be needed to fund the State Children's Health Insurance Program (SCHIP) by 2017 if a Congressional proposal to use a 61 cent per pack federal cigarette excise tax increase to fund expansion of the program is adopted.

A Senate panel has approved a plan to fund a $35 billion expansion of the SCHIP program using funds generated from a 61 cents per pack increase in the federal cigarette excise tax. The Heritage Foundation report notes that this proposal will make the government dependent upon continued smoking in order to adequately fund children's health insurance.

The major conclusion of the report is as follows: "Policymakers will somehow need to recruit new smokers if they insist on using the tobacco tax revenue to support SCHIP at proposed funding levels over the long term. In just five years, Congress will need over 9 million new smokers. Reauthorizing the program for 2013 to 2017 would require almost 22.4 million new smokers by the end of that period."

Policy makers may need even more smokers than this, since health insurance costs are rising: "But funding problems will likely begin before the end of the five-year horizon. Since the revenues from the tobacco tax are declining while the amount of SCHIP funds needed to maintain a level of purchasing power are increasing, Congress could face a shortage of smokers in just two years. In this case, Congress will need over 6.3 million new smokers between 2010 and 2012, which grows to 9 million new smokers needed in 2013 to support the government’s health program. Funding the expansion of a government health program through a tax on a toxic product with a declining revenue stream is not only paradoxical but also fiscally irresponsible. It is not a reliable source of continued funding."

The Rest of the Story

This is exactly the problem that I discussed in my earlier posts about this flawed proposal. You don't make something as critical as children's health insurance dependent upon recruiting a continuing new stream of smokers. Sure - the tax might cause some smokers to quit; however, those smokers need to be replaced in order for the nation's children to maintain their health insurance. This is an absurd way to fund health insurance for the children in this country.

If the cigarette tax is to be increased, revenues must be used for smoking-related causes. This is the one way to avoid the problem of making government programs dependent on recruiting new smokers. If the programs that are dependent on such revenues are programs such as smoking prevention, cessation, research, and treatment, then reducing the funding for them over time is ideal. It is a self-regulating system. As smoking falls, so does the need for the programs, and so does the revenue. Were smoking to increase, the need for the programs goes up, but so does the revenue to fund these programs.

Senator Enzi has introduced a proposal to increase the cigarette tax and use the resulting revenues to fund smoking prevention and cessation programs. He has done so both as an amendment to the FDA tobacco bill, which will be considered by a Senate committee tomorrow, and as a stand-alone bill.

Instead of wasting their time on two absurd proposals - one to ask the FDA to approve the most toxic consumer product on the market and the other to make the health care of our nation's children dependent upon recruiting millions of new smokers - Congress, if it is seriously interested in providing children's health insurance and making a dent in smoking, will nix the FDA and the SCHIP bills, find an alternative funding source to expand SCHIP, and consider using Senator Enzi's ideas as a starting point for a meaningful discussion about how federal policy might actually contribute something substantial to improving the public's health.

Incidentally, the winner of the T-shirt contest is Reynolds American, which designed the slogan "Congress Needs You To Smoke." That sums it up completely. Our policy makers, and ironically - our tobacco control groups - are promoting a measure that would require lawmakers to recruit millions of new smokers in order to provide health insurance for our nation's children.

New Gallup Poll Reveals that Nearly Half of Smokers Feel Discriminated Against As a Result of Smoking Restrictions

A new Gallup survey released last week reveals that nearly half of smokers (47%) feel unjustly discriminated against as a result of public smoking restrictions. This percentage is up from 32% in 2001, six years ago. The majority of Americans (58%) continue to feel sympathetic toward smokers, which represents no change from 2001.

According to the Gallup press release: "Americans are not blind to the difficulties faced by people who smoke; most say they are sympathetic toward smokers because they understand it is hard to quit even if someone wants to try. However, as the percentage of Americans willing to ban smoking in various public places continues to creep up, close to half of smokers now say they feel unjustly discriminated against by society."

Another important result of the survey: the percentage of Americans who believe secondhand smoke is very harmful (56%) was no higher in 2007 than a decade earlier - in 1997 - when that percentage was 55%.

The Rest of the Story

These results are of particular interest to me because they show that the feelings of many of the smokers who read and comment on this blog are not extreme views, but represent the attitude of about half of all smokers nationwide. I have been roundly criticized by my colleagues for allowing these commenters to express their opinions and have been even more harshly criticized for engaging in a dialogue with these readers, who many of my colleagues have called tobacco moles or angry and deluded. However, these results demonstrate that the views expressed on this blog are not atypical of how smokers in general feel and that these attitudes represent a reality that public health and tobacco control practitioners are going to have to acknowledge and address.

These results also show that anti-smoking groups are quickly stepping out of line from where the public stands in terms of its attitudes towards smokers. The majority of people remain sympathetic towards smokers, and this percentage has not been declining over the past decade. In fact, it actually increased from 53% in 1997 to 58% in 2007.

Why are smokers increasingly feeling discriminated against? The answer is evident if you scroll through the headlines of this blog. The anti-smoking movement is making smokers feel this way by pursuing increasingly discriminatory, invasive, unfair, and unjustified policies.

I believe that the promotion of policies that discriminate against smokers in employment (i.e., refusing to hire smokers or firing existing smokers), treat smokers as child abusers, punish smokers for exposing their children to small increases in health risks, and ban smoking beyond the places necessary to protect the health of nonsmokers are all contributing to the increasing perception among smokers that they are being unfairly targeted and discriminated against.

It should not come as a surprise to tobacco control advocates that discrimination against smokers is resulting in an increased perception of discrimination. It should.

Unfortunately, these numbers are likely to continue to increase, as smoker-free hiring policies, along with draconian bans on smoking in nearly all outdoors areas, are just getting off the ground and are starting to proliferate rapidly.

More importantly, not a single tobacco control organization in this country has been willing to publicly speak out against these discriminatory employment policies. Short of that, the proliferation of this discrimination is not going to stop. As long as businesses perceive that they are acting in the best interests of the public's health as perceived by anti-smoking groups, they will continue to adopt these policies.

The same is true of smoking bans that overstep the need to protect nonsmokers from secondhand smoke exposure. As more and more bans on smoking outdoors are enacted, especially in places where nonsmokers can easily avoid exposure, smokers will continue to feel discriminated against.

Another important finding of this poll is that despite anti-smoking groups' gross exaggerations of the acute cardiovascular health effects of secondhand smoke over the past six years, the proportion of people who believe that secondhand smoke is very harmful has not increased. This suggests that the anti-smoking groups' strategy of trying to increase the public's appreciation of the hazards of secondhand smoke by exaggerating their messages and creating the appearance of a more serious, more ominous, and more immediate threat to the heart than actually exists based on the scientific evidence is backfiring.

Apparently, the "30 minutes of exposure causes heart disease" and "there is no safe level of exposure to secondhand smoke" messages are not working to give the public a greater appreciation of the severity of the hazards of tobacco smoke exposure. If anything, these messages may have ended up being counter-productive, as the past years have seen a plateau in what was previously a rapidly increasing appreciation of the severity of secondhand smoke's hazards.

The proportion of adults who believe secondhand smoke is very harmful increased steadily from 36% in 1994 to 48% in 1996 to 55% in 1997. But it has gotten no higher in the past 10 years.

Even though anti-smoking groups do not seem to care about the scientific inaccuracy of their public messages, they may wish to reconsider their strategy in light of this evidence that the approach is not working.

Anti-Smoking Groups Up in Arms Over Failure to Give "Hairspray" an R-Rating Due to Momentary Teen Smoking

Anti-smoking groups are apparently up in arms over the decision by the Motion Picture Association of America (MPAA) to give the new movie "Hairspray" only a PG rating (instead of an R rating) due to its depiction of momentary teen smoking. The MPAA, in accordance with its new policy which considers smoking as one factor in determining a movie's rating, added a descriptor in the rating tag which notes that the movie contains "momentary teen smoking." The full tag states: "Language, Some Suggestive Content and Mometary Teen Smoking." However, the anti-smoking groups, headed by the SmokeFreeMovies campaign and the American Legacy Foundation, were outraged, complaining that this action does not go far enough and that the film should have received an R rating instead.

SmokeFreeMovies argued that the use of descriptors to note smoking depiction is meaningless: "The MPAA -- acting on behalf of the big media companies -- is pursuing exactly the kind of meaningless policy related to tobacco that we predicted back in 2002, namely just adding a tobacco descriptor to a youth rating."

The movie represents the film version of the Broadway musical (which follows the original 1988 John Waters film) and is set in Baltimore of the 1960s. It is described as containing "a fleeting scene of smoking in a high school bathroom. There are also brief shots of a character billed in the credits as 'smoking teacher' in a faculty lounge, as well as pregnant mothers smoking and drinking during a musical number."

The American Legacy Foundation is quoted as stating: "I don't know that just because a movie takes place in the '60s that it justifies a PG, since 14- and 15-year-olds are in the bull's-eye for the cigarette market. It's really unfortunate and a disappointingly anemic response to a public health problem."

In 1962, the exact year depicted in the film, more than half of men and about one-third of women smoked. It was just about the peak of female smoking in the United States, and was prior to the drastic decline in male smoking rates that began after the release of the 1964 Surgeon General's report.

The Rest of the Story

In the 1960s (as today), people's diets were crappy. People ingested (as they do today) high amounts of fat and low amounts of fruits and vegetables. However, I don't think too many health groups would describe the failure of the MPAA to rate "R" any movie that depicts a poor diet as an "anemic response to a public health problem."

It is clear that these groups were not just whistling Dixie. They actually believe that if a movie depicts smoking at all, even if just momentarily, it should automatically receive an R-rating because this is such a huge public health problem. And now that the MPAA has followed its policy, true to its word, by noting that momentary smoking takes place in "Hairspray," the anti-smoking groups are up in arms because apparently warning parents about this huge threat to our kids - the presence of a puff on a cigarette in a film depicting the 1960s - is not enough. The film needs to be rated R and made "inaccessible" to youths.

As Jacob Sullum noted in his column in today's Los Angeles Times, this approach by the anti-smoking groups could well make smoking more popular by casting it as a forbidden fruit. If a fleeting depiction of smoking is such a remarkable occurrence that needs to be hidden from teens, then doesn't that make smoking seem that much more rebellious and to a teenager - appealing?

Are we really supposed to change history and pretend that smoking didn't exist? If you go strictly by the percentages, the majority of men in 1962 were smokers. Are artists depicting 1962 actually supposed to ignore the historical facts and depict everyone as nonsmokers if they are not interested in producing an adult-oriented film?

Don't we actually want to reveal the truth to kids? Let them see that smoking was widespread. Then, by comparing that with the much lower rates of smoking they see today, they'll come to the realization that smoking is not as "cool" as it used to be. That it seems to be going out of favor. If anything, if they think that no one used to smoke but lots of people do today, it makes it seem like it is a fad.

I suppose that the depiction of racial segregation and discrimination as depicted in the film should also be removed. Perhaps we should also wipe away that aspect of our nation's history as well, so as not to expose kids to anything that might give them ideas. The reality, of course, is that the film is a great tribute to racial equality, integration, and harmony, and the message it sends is an important one.

It's now clear that anti-smoking groups are trying to meddle in artistic expression, not merely attempting to eliminate gratuitous smoking from films.

With this over-reaction and the crusade-like nature of their quest, it seems to me that they lose ground, not gain it.

I can tell you as a parent that the few fleeting scenes of smoking in the movie are of far less concern to me in terms of my kids seeing them than the highly suggestive sexual content of the film. If the film is not going to receive higher than a PG rating for that sexual content, there is no way it should receive an R-rating for the few fleeting scenes of smoking.

Senate Panel Approves Amendment to FDA Bill to Greatly Strengthen Warning Labels; Amendment Passes Unanimously over Objection of Tobacco-Free Kids

Yesterday, on the first day of its mark-up session on S.625 - the FDA tobacco bill - the Senate Health, Education, Labor, and Pensions Committee voted unanimously to accept an amendment offered by Senator Enzi which greatly strengthens the required warning labels on cigarettes. The bill itself required a series of stronger warning statements than currently appear on the packages. The amendment strengthens these warning statements by increasing the size of warning labels from 30% to 50% of the pack and adding color graphics that depict the negative health consequences of smoking. This is similar to warning labels that have been used with some success in Canada. The Senate panel is expected to continue its deliberations on S.625 today, considering more amendments before taking a vote on whether or not to send the bill forward.

Despite the unanimous vote indicating bipartisan support, and the substantial strengthening of the warning label provisions of the bill, passage of the amendment was opposed by the Campaign for Tobacco-Free Kids.

The Rest of the Story

This adds to the embarrassment that the Campaign for Tobacco-Free Kids and its partner health groups have endured over the past few days as the truth about the history of, and nature of the FDA bill has come to public light.

Despite unanimous bipartisan support, the only group publicly opposing this amendment, which unequivocally adds to the little public health protection that is offered by the bill, was the Campaign for Tobacco-Free Kids, supposedly an anti-smoking and public health group.

What business does the Campaign have opposing an amendment that simply strengthens the warning labels so that there is at least a chance that they may have a deterrent effect?

It is becoming clear that the Campaign for Tobacco-Free Kids has become completely overrun by politics, and in my opinion, by an obsession with the proverbial feather in the cap. So much so that they have lost sight of any responsibility whatsoever to stand up for some principles while claiming to be taking a leadership role to fight to protect the public's health. So much so that their statements have become filled with deception and devoid of substance.

It is getting more and more embarrassing by the minute for the tobacco control groups which are supporting this misguided legislation and which have agreed (albeit tacitly) to follow along with the Campaign's secret deal cut with Philip Morris and its strategy of deception.

Senator Enzi Responds to Attack from Tobacco-Free Kids by Contrasting His Openness with Campaign's Secret Deal with the Largest Tobacco Company

In response to the Campaign for Tobacco-Free Kids' public charge that Senator Enzi is a fraud who is apparently not sincere about his own proposal to reduce tobacco use, Senator Enzi criticized the Campaign for cutting a secret deal with Philip Morris that protects Big Tobacco profits at the expense of the public's health.

In addition, he has invited the Campaign for Tobacco-Free Kids to talk, become familiar with his position on tobacco issues, and work together to forge a tobacco policy proposal that will be effective in reducing tobacco use.

In his letter to the Campaign, Senator Enzi contrasted his open approach with what he intimates is a lack of honesty, forthrightness, and openness by the Campaign for Tobacco-Free Kids.

Enzi wrote: "You recently made some comments about my record and my position on various issues relating to tobacco. You claimed to know where I stand on these matters. A meeting between us would give me an opportunity to personally set the record straight and let you know where I stand on smoking and other related tobacco issues. I have put my name, and staked my reputation, on a proposal to get rid of tobacco once and for all, and I hope you will take that as seriously as I do."

"Let me be very clear, right from the start, on exactly what my position is. I stand for bringing innovative and new thinking to old and unsolved problems. I stand for helping current tobacco users quit their deadly habit, and making sure that others, particularly children and adolescents, do not start in the first place. I stand apart from the tobacco companies on these matters and I have never taken a dime in campaign contributions from the tobacco industry, and that is not going to change."

"Finally, in contrast to your organization, which cut a deal in the dead of night with the largest tobacco company in the country, I stand for an open debate and an honest and forthright discussion on these issues and the future of tobacco in the United States."

"I believe my plan has the potential to radically change how we tackle tobacco use in this country. But I also recognize that it is not perfect. I welcome your input and insight into improving it. I hope you will join me in working to eliminate the use of this deadly product. Please contact my office at your earliest convenience so that we can clear the air between us, and then get down to the vital task that is before us of truly saving lives."

The Rest of the Story

The truth is finally coming out. I think the public in general, and tobacco control groups and advocates in particular, need to know the truth about how the FDA legislation came about.

The Campaign for Tobacco-Free Kids has been running a campaign of deception, in which they have been misleading their own constituents and the public into thinking that Big Tobacco is uniformly opposed to this legislation. They have also refused to be forthright about the negotiations with Philip Morris that led to this bill, and have refused to answer any questions about that secret process.

Attacking Senator Enzi for being a fraud was going one step too far. Now he has exposed their secret deal with the largest tobacco company, making the Campaign's attack on Enzi seem completely hypocritical. Even worse, Enzi does not take tobacco company contributions and has not sought tobacco industry input or agreement in developing his proposal. This contrasts with the Campaign, which agreed to a deal with provisions specifically negotiated with Philip Morris.

While the Campaign essentially let Philip Morris write its favored legislation, Senator Enzi wrote his legislation without tobacco industry involvement.

So who is actually doing Philip Morris' bidding here? It's clearly not Senator Enzi. But ironically, it is indeed the Campaign for Tobacco-Free Kids. Perhaps they ought to think twice before attacking someone else for doing the industry's bidding.

Supreme Court Justice Louis Brandeis might just as well have been talking about the Campaign for Tobacco-Free Kids efforts to promote this FDA bill when he wrote that "Sunlight is the best disinfectant."

Article Accuses Campaign for Tobacco-Free Kids of Engaging in Secret Negotiations with Philip Morris; Outlines Numerous Flaws of FDA Tobacco Bill

An article published in the current issue of Tobacco Control by Dr. Michael Givel, a professor in the Department of Political Science at the University of Oklahoma, attacks the Campaign for Tobacco-Free Kids for engaging in secret negotiations with Philip Morris, blasts the proposed FDA legislation by highlighting numerous flaws, and argues that the Campaign for Tobacco-Free Kids was outsmarted by Philip Morris.

According to the article, Philip Morris enticed the Campaign for Tobacco-Free Kids to the negotiating table by offering its support for the idea of FDA regulation of tobacco products. But what Philip Morris had in mind was "much weaker and alternative FDA regulation of tobacco. ... The beginning of this highly unusual effort by Philip Morris began in November 2001 when secret negotiations, of which many health advocates were unaware, were initiated between Philip Morris and the Campaign for Tobacco-Free Kids."

The article outlines numerous major flaws in the proposed legislation:

1. "One significant problem in the reduced risks requirements for new tobacco products is that the bill makes it very difficult and expensive to introduce new tobacco products. In combination with allowing menthol as an additive these risk reduction provisions stabilise the current tobacco market favouring current brands including Philip Morris’s Marlboro."

2. "Another significant problem with the bill is that it requires a scientifically unproved claim that removing ingredients will makes cigarettes ‘‘safer.’’ There is currently little conclusive evidence on what ingredients are linked to particular morbidities and mortalities and at what level. In fact proponents have not shown any scientifically reviewed evidence at all as to how this bill would save any lives. Also, the requirement prohibiting nicotine reduction to zero could actually force smokers to smoke more and inhale more deeply.

3. "The bill also provides a significant litigation shield for the tobacco industry. This occurs because an FDA seal of approval on a product will be used as a defence against higher punitive damages in product liability and tort lawsuits."

4. "Another concern with the legislation is that the FDA, which is a consumer protection agency, would be placed in an untenable role of approving a product that also causes significant disease and death.

5. "The bill also gives the tobacco industry numerous avenues to veto and delay any proposed change to tobacco products through legislative veto, judicial review, and administrative hearings."

The article concludes: "It does appear master chess player Philip Morris is eight moves ahead of the health groups so far with this FDA bill."

The Rest of the Story

This outstanding article is a must-read for anyone interested in national tobacco policy. You're not going to get this story from the health groups, but it's the truth and it is essential that all tobacco control advocates understand the rest of the story before they make a decision about whether or not to support the proposed FDA tobacco legislation.

Dr. Givel makes many of the same arguments I have been making on this blog over the past two years. He explains why this legislation actually protects the profits of the nation's largest cigarette manufacturer at the expense of the public's health.

I completely agree that Philip Morris is light-years ahead of the health groups. They saw a weak spot in the health groups and they attacked it with great cunning. The entire approach is brilliant.

In light of this article and its revelations, the Campaign for Tobacco-Free Kids has a little explaining to do.

Column Argues that Jurisdiction over Tobacco Products is the Last Thing in the World that the FDA Needs Right Now

An op-ed piece in the Portsmouth Herald argues that the Food and Drug Administration is so plagued with problems just trying to protect the public from risks in the food and drug supply that this is absolutely not the time to be giving it the tremendous responsibility and enormous task of regulating tobacco products.

The column, written by 60 Plus Association president Jim Martin, states: "For Americans who are 60-plus and for Americans of every age, an over-extended FDA is a prescription for disaster. That’s why I’m alarmed about reports out of China indicating a growing number of tainted products coming into this country. Already, despite a clear mandate and a healthy $2 billion budget, the FDA has proven itself unable to avoid or correct in a timely fashion nationwide outbreaks of deadly E. coli contamination of lettuce, spinach, green onions and other farm products; salmonella contamination of peanut butter; chemical poisoning of pet food, farmed fish, hogs and chickens; and deaths due to dangerous drugs previously approved by this very same agency. In recent weeks, we have learned that the FDA actually inspects less than 1 percent of all imported food."

"The FDA is overwhelmed. Its mandate calls for it to ensure the safety of the nation’s entire food supply, including home-grown and imported. It’s responsible for 11,000 drugs in the marketplace. It’s supposed to examine the safety and efficacy of proposed new drugs, including the burgeoning class of bioengineered pharmaceuticals, and monitor the safety of drugs after they are placed on pharmacy shelves. Additionally, the agency has been charged by the president to play a key role in the administration’s national bioterrorism defense initiatives.
The FDA is buckling under the strain." ...

"With the FDA in such obvious crisis, it is irresponsible, and appalling, for some members of Congress to be promoting legislation that would further burden the agency with regulatory responsibility for the massive tobacco industry."

The Rest of the Story

This excellent column speaks for itself. Just another reason the proposed FDA tobacco legislation is a seriously flawed proposal.

Senator Enzi Invites Health Agencies to Join Him in Reducing Smoking; How the Campaign for Tobacco-Free Kids Undermined the Tobacco Control Movement

In a press release issued yesterday, Senator Mike Enzi (R-WY) invited the directors of the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and Food and Drug Administration (FDA) to join him in an effort to design a national plan to greatly reduce smoking rates over the next 20 years, to be spearheaded by a bill he introduced last week that would increase the cigarette tax to fund tobacco prevention and cessation programs, levy penalties on tobacco companies if smoking rates do not decrease substantially, strengthen warning labels on cigarette packages, incentivize states to spend a substantial proportion of their Master Settlement Agreement money on tobacco control programs, and give the FDA authority to eliminate nicotine from cigarettes if the demand reaches a low enough level so that this becomes practical.

According to the press release: "Last week, Enzi introduced the “Help End Addiction to Lethal Tobacco Habits Act” (HEALTH Act), S.1834, a bill to wipe out tobacco use in America through an innovative cap-and-trade program that will shrink the size of the tobacco market over the next 20 years. S.1834 is Enzi’s alternative to the Democrat tobacco bill, which has drawn wide support from Big Tobacco and some anti-smoking organizations. 'I believe my plan has the potential to radically change how we tackle tobacco use in this country,' Enzi wrote. 'I would like to invite you to meet with me to discuss my proposal and how we can work together towards our shared goal: eliminating youth smoking and tobacco product usage and significantly reducing the number of Americans dying from the use of tobacco. Your leadership is desperately needed to move this plan forward and reduce the death and disability caused by tobacco,' Enzi added. 'I welcome your input and insight and hope you will join me in working to eliminate the use of this deadly product.'"

The Rest of the Story

The rest of the story is that this turn of events reveals the way in which the Campaign for Tobacco-Free Kids has undermined the entire tobacco control movement.

This is the way that you develop a national tobacco control strategy. You bring the major health agencies and health groups together and you discuss the most effective ways to reduce tobacco use. In contrast, the Campaign for Tobacco-Free Kids, over the past few years, has basically co-opted the entire tobacco control movement, representing itself as the sole face of the movement and unilaterally negotiating with Philip Morris, through Congressional mediation, a short-sighted and misguided bill which eschews all the major proven approaches to actually reducing smoking that have been documented by scientific research.

In contrast to Senator Enzi's expression of a willingness to discuss issues and consider improvements to his legislation, the Campaign for Tobacco-Free Kids essentially signed off on a deal with Philip Morris that was never, and is still not, subject to any changes, including substantial improvements. There was no real discussion with the tobacco control movement, no consultation with many of the established experts in the tobacco control field who have important insights into the most effective national policy strategies and who have been leaders in the movement over the past two or more decades.

Instead, the Campaign for Tobacco-Free Kids appears to have decided upon its own pet legislation and forced it down the throats of everyone else in the movement.

To make matters unacceptably worse, the Campaign took it upon itself to basically represent the public health community in negotiations that were essentially conducted with Philip Morris, but without approval from the rest of the public health community.

You don't develop an effective national tobacco control policy strategy by negotiating with Philip Morris, letting the nation's leading tobacco company have a large say in what does or does not get written into the policy. That was a fatal mistake, as it simply was destined to result in an ineffective policy.

This is now a source of great embarrassment, as Senator Enzi has stolen the show from the Campaign, showing them up by proposing a real bill - one that actually uses proven, effective interventions that would actually put a substantial dent in smoking rates. A proposal that was not written by or at least tailored to meet the needs of Philip Morris.

If not for the Campaign's obsession with its misguided proposal that completely misses the mark in terms of reducing smoking and sets the nation on an unacceptable course of granting official approval to the most deadly consumer product, it is entirely possible that meaningful discussion within the tobacco control movement would have been able to take place over the past two years, resulting in a uniform coalition of groups and advocates in the movement who would now be prepared to push measures like those outlined in Senator Enzi's proposal successfully through Congress.

The tobacco control movement is woefully prepared to deal with a real proposal for a federal approach to reducing tobacco use, because it is simply not something that has been discussed over the past few years. In my opinion, the only reason it has not been on the agenda is that the agenda has been co-opted by the Campaign for Tobacco-Free Kids.

Now is the time for the other major health groups - including the American Cancer Society, American Heart Association, American Lung Association, and American Medical Association - to break themselves away from the Campaign's stronghold and put themselves on the side of a real proposal. The more quickly that we can end the Campaign's dominance over the movement, the more quickly we'll be able to start talking about some real solutions to this problem.

Now that Senator Enzi's proposal is on the table, the FDA legislation is just not going to look so appealing any more to much of the tobacco control community. Sometimes it takes seeing an alternative to convince people of the folly of a policy proposal.

The fallacy which I believe led many advocates to support the FDA approach was the straw man argument that FDA legislation is better than the status quo. What supporters of the FDA legislation failed to tell you was that this is not a decision between the FDA legislation and the status quo. It is and has always actually been a decision between the FDA legislation and a real bona fide proposal to substantially cut smoking rates using measures that we have known all along are effective.

It's no longer the FDA legislation versus the status quo. There are now two hands on the table. And the Campaign for Tobacco-Free Kids, with its health group partners, have been left holding the rag hand.

Senator Enzi to Introduce Alternative to FDA Tobacco Legislation; Bill Far Stronger than FDA Bill; Embarrassment for Major Anti-Smoking Groups

Senator Michael Enzi (R-WY) has announced that he intends to introduce legislation into Congress that would serve as an alternative to the FDA tobacco legislation that is being supported by many anti-smoking and health groups as well as by Philip Morris.

In contrast to the FDA bill, Senator Enzi proposes an approach that relies on programs and incentives to reduce cigarette consumption and smoking rates, rather than on an attempt to regulate cigarettes to make them safer.

Senator Enzi explains the premise behind his alternative approach to federal tobacco control policy as follows: "Some have suggested that FDA regulation of tobacco is the way toward safer tobacco products. But we know that there is no such thing as a safe cigarette. Proposals to have FDA regulate tobacco are a misguided attempt to force a deadly product into the regulatory structure developed for drugs and devices - products which DO have health benefits. This new scheme for tobacco would be very costly, and would not result in much of a health benefit."

"Furthermore, FDA review and approval of tobacco products sends a terrible public health message - creating the sense that cigarettes are safe or can be made safer, when we know they cannot."

"Importantly, the proposal under consideration by the HELP Committee explicitly states that the FDA will not be permitted to ban nicotine or tobacco. That is not true regulation. That bill would gut the authority that Congress has bestowed and staunchly defended for the FDA - the authority to remove health threats from the marketplace. The FDA cannot be put in the position of approving a product which years of science and the personal experience of far too many Americans has shown to be dangerous. Simply put, tobacco kills people. We can do better."

"We should focus our efforts instead on helping people quit using tobacco, or better yet, to never start. The Enzi HEALTH Act would have a dramatic impact on the number of smokers in this country. ... It would ... use proven approaches to help people quit and implement tried and true prevention programs."

The two most important aspects of the legislation are as follows:

1. An increase in the federal excise cigarette tax, with revenues allocated to support a national counter-advertising campaign and grants to states for tobacco prevention and cessation media campaigns (there are similar provisions for other tobacco products). The amount of the increase varies by tobacco product, but is about 10 cents per pack on cigarettes. Revenues are allocated as follows: 25% to national and state tobacco prevention and cessation programs, including counter-advertising campaigns; 50% to Medicare; 25% to Medicaid.

2. The establishment of a system whereby tobacco companies would have to pay penalties if they do not gradually reduce the number of people who smoke their cigarettes according to a schedule, with a required 90% reduction in smokers over the next 20 years. The penalties begin in 2015, and from 2015 through 2026, the companies must reduce the number of smokers of their brands by 33% from current levels, or else pay $3,500 for each smoker above the 33%. From 2027 on, the companies must reduce the number of smokers of their brands by 90% from current levels.

For example, there are about 45 million smokers today. In 2015, tobacco companies would have to reduce the number of smokers to 30 million. For each million smokers above 30 million in 2015, they would have to pay $3.5 billion. Thus, if the number of smokers in 2015 is reduced to only 35 million, the total penalty would be $17.5 billion. The penalties are adjusted for inflation, so the $17.5 billion would represent the penalty in current dollars, not 2015 dollars. The penalty is assessed annually, so if no progress were made from 2015 on, the companies would be paying $17.5 billion per year.

There are also three other very important aspects to the legislation:

1. Much stronger cigarette and smokeless tobacco warning labels would be required (such as "Smoking kills" and "Cigarettes cause fatal lung cancer"). In addition to the text warning, a color graphic depicting the negative health consequences of smoking and occupying at least 50% of the pack would be required.

2. The FDA would be given explicit authority to require the removal of nicotine from cigarettes and other tobacco products. This represents a very narrow scope of authority given to FDA. The FDA would not be given jurisdiction to regulate the overall safety of cigarettes. They would not be in the business of approving cigarettes for sale (other than approving their nicotine content).

3. States would be incentivized to spend significant portions of their Master Settlement Agreement funds for tobacco control programs. The legislation sets up a matching grant program under which states would receive matching grants if they spend at least 25% of their MSA funds for tobacco control programs. The additional grant would be 50% of any amount spent above 25% of the MSA payment, and could be used for additional tobacco prevention and cessation programs.

The Rest of the Story

It is a long time in the making, and the anti-smoking groups have been so obsessed with trying to achieve futile (and counter-productive) FDA regulation of tobacco products that they have squandered a golden opportunity to promote a federal tobacco policy that actually would make a dent in smoking, but Senator Enzi appears to be the first to have the right idea about what the federal government could and should be doing to control the problem of tobacco use in this country.

Senator Enzi is precisely on the right track, a track which has been eschewed by all the major anti-smoking and health groups because of their obsession with the deal that was essentially negotiated between the Campaign for Tobacco-Free Kids and Philip Morris (with Congressional mediation) two years ago.

In my media interviews over the past few weeks, I have repeatedly been asked what I think the federal government should be doing to control tobacco use, since I don't support the approach of regulating the safety of cigarettes and asking the FDA to approve this deadly product. In response, I have noted my opinion that if Congress sincerely wants to do something about reducing smoking rates, it will dedicate money to the one program which we know is effective in reducing both youth and adult smoking: state-of-the-art counter-advertising media campaigns.

Senator Enzi's proposal establishes what would be the first national tobacco counter-advertising program run by the federal government. It also provides incentives for states to use their Master Settlement Agreement dollars on smoking prevention and cessation programs, provides funding for state tobacco control programs, and increases the federal excise cigarette tax (which will itself reduce cigarette consumption) to pay for these national and state programs.

There are a few weaknesses in the legislation, which I have communicated directly to Senator Enzi's staff, which I feel would need to be addressed. One is a need to remove the provision that allows money to be spent on youth access programs, which have been repeatedly shown not to work. The second is a need to allocate a significant portion of the revenues derived from the penalties for smoking prevention and cessation programs.

But the basic idea behind the HEALTH Act is exactly where the federal government should be in terms of a national tobacco control policy. We should not be spending our precious time and resources in a futile effort to try to develop a safer cigarette, when the product contains over 4,000 chemicals and we have no idea which of those chemicals is responsible for the diseases caused by cigarette smoke. We should not be setting up a system by which the FDA grants its approval to deadly products. We should not be institutionalizing cigarette consumption nor granting unprecedented special protections to Philip Morris and other tobacco companies.

What we should be doing is to get serious about actually trying to reduce the demand for cigarettes. That is something which the federal government has never been serious about.

The HEALTH Act serves as a tremendously valuable contribution because it focuses attention in exactly the area it needs to be if we wish to ever have an effective and meaningful federal policy on tobacco control.

This is an embarrassment for the Campaign for Tobacco-Free Kids and its partners, because they were beaten to the punch by a Senator who they claim is a fraud when it comes to tobacco policy. Frankly, Senator Enzi appears to have a far more insightful, informed, and mature understanding of the direction the federal government needs to be going if it wants to develop an effective tobacco control policy that will actually make a difference in reducing smoking and saving lives, rather than merely shell out window dressing to be able to claim that it is doing something about the problem.

To call the FDA proposal window dressing is actually not appropriate, because the FDA bill is not merely ineffective, it is actually counter-productive and would undermine 40 years of tobacco control efforts in this country.

But what Senator Enzi's proposal reveals is not just the misguided nature of the FDA legislation, but also the failure of the anti-smoking groups to promote meaningful federal tobacco control policy. They have wasted precious time and resources and a rare window of opportunity. They have squandered a real opportunity to have made a difference in the public's health by obsessing with the FDA and the illusion of making cigarettes safer by removing some of their constituents, when the real progress is going to come only by reducing the demand for cigarettes, something which can be done only through a combination of cigarette taxation and allocation of revenue to tobacco prevention and cessation programs, especially counter-advertising.

Senator Enzi is right. These are the tried and true programs for smoking prevention.

The alternative to granting the FDA jurisdiction over tobacco products is not the status quo, as the Campaign for Tobacco-Free Kids and its partners have been suggesting. Actually, the alternative is to establish a meaningful and effective federal tobacco control policy by which we actually use the tried and true methods of reducing smoking: increasing cigarette price and implementing state-of-the-art national and state counter-advertising programs.

The problem is that not only have the Campaign for Tobacco-Free Kids and our other supposed leaders in tobacco control missed the boat to take a ship that is headed for disaster. Instead, they have prevented the correct boat from even coming.

Senator Enzi's proposal steers us in the right direction. Now is the time for the health groups abandon the absurdity of their obsession of the past two years. It is time to have a meaningful discussion about how the federal government can, for the first time, make a difference in the nation's number one public health problem.

Summary of Major Amendments to be Offered in Committee that Would Substantially Strengthen FDA Tobacco Legislation; All are Opposed by Health Groups

At the Senate HELP Committee mark-up of the FDA tobacco bill - currently scheduled for this coming Wednesday - a number of amendments will be offered that would substantially strengthen the legislation. In this post, I will summarize these amendments.

But first, it is important to note that the health groups supporting this legislation, including the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society, and American Lung Association, oppose each and every one of these improvements to the bill.

Why would these health groups oppose amendments that will strengthen the legislation and take out some of the loopholes that protect Big Tobacco profits at the expense of the protection of the public's health?

To me, the reason appears to be simple. The Campaign for Tobacco-Free Kids essentially struck a deal with Philip Morris at the Congressional negotiating table two years ago. The two major parties to that negotiation process basically struck a deal, and it appears that the Campaign for Tobacco-Free Kids wants to preserve the terms of that deal because if the deal is broken, it will lose the support of Philip Morris and the whole thing may crumble. This would be a devastating blow to the Campaign, which has put so much on the line (using all kinds of deceptive and unethical tactics to try to even get to this point).

Two things, then, are clear:

First, the Campaign for Tobacco-Free Kids and the other health groups which appear to be taking marching orders from the Campaign apparently have no sincere interest in developing legislation that will be as effective as possible in protecting the public's health from the hazards of tobacco. They have no desire for input from other public health experts, they are not willing to consider criticism of the legislation, they are not willing to consider any changes that would strengthen the bill. There is no opportunity for a dialogue or discourse about what would represent effective regulation of tobacco products or what strategy would be most effective in reducing tobacco use or potentially creating safer cigarettes. All decisions have already been made. It is either this deal with Philip Morris, or no legislation at all. That's the only choice that the health groups are offering to the American people.

Frankly, that's a travesty, because the responsibility of public health is to protect public health, not to sell out the public's health to Big Tobacco merely to enact some legislation and be able to stick a feather in our cap.

Second, it's clear that the propaganda being put out by the Campaign is merely rhetoric. There is little sincerity in their proclamations that their desire is to end special protection for Big Tobacco and save countless lives. If the true desire were to end special protection for Big Tobacco, then the Campaign and its fellow health groups would have no choice but to support these amendments which would, indeed, get rid of special protections for Big Tobacco that Philip Morris has apparently required in order to support the bill. If the true desire were to save countless lives, then there would be no choice but to support amendments which would put the only teeth into the entire bill, which in its present form is devoid of anything that would actually put a dent in tobacco use or create a safer cigarette.

The Campaign for Tobacco-Free Kids told its constituents that it opposed Senator Kennedy's insertion of a last-minute change in the bill which allows tobacco companies to market clove cigarettes. However, the Campaign is not particularly sincere in that opposition, since it now opposes an amendment that would do nothing more than remove that special protection for Big Tobacco.

The Campaign also claims that it opposes this amendment because it would eliminate the bill's chances of passage through Congress. However, a majority of legislators in the Senate have already sponsored the bill with the clove ban in the bill. It would be politically untenable for them to oppose a bill with the exact language that was in the bill which they sponsored, solely because it is now apparent that Philip Morris is actually marketing clove cigarettes in Indonesia!

With those critical observations made, here then is a brief summary of the most important amendments that would strengthen the bill. Note that this is not a comprehensive list, but an attempt to inform the public of some of the most important amendments.

Enzi Amendment #1: This amendment would eliminate the loophole which precludes the FDA from banning any particular class of tobacco product. This would allow the FDA to mandate changes to improve the safety of cigarettes even if those changes required a major re-design of the cigarette. In its present form, this loophole allows the tobacco companies to challenge such a regulation on the grounds that it represents a de facto ban on a class of tobacco products. In addition, the amendment would allow the FDA to ban cigarettes at some point in the future if it becomes economically and socially feasible. A clause would probably need to be added by a further amendment to make it clear that the FDA can consider non-health factors, such as the social and economic feasibility of banning a class of tobacco products in any such deliberation.

Enzi Amendment #2: This amendment would eliminate the loophole which precludes the FDA from getting rid of nicotine in cigarettes. This would allow the FDA to get rid of the nicotine and thus require a cigarette that is greatly reduced in addictive potential. Under the current bill, the FDA cannot get rid of the nicotine, but can only reduce the nicotine yields. This would be a disaster, as smokers would smoke more to compensate for the reduced nicotine. In addition, if the FDA did try to reduce nicotine to extremely low levels, the tobacco companies would be able to tie such a rule up in courts for years, since it is clearly the intent of Congress to reserve to itself any decision regarding making cigarettes non-addictive. There is absolutely no reason for health groups to oppose this amendment, since if it is the intent of Congress to allow the FDA to make cigarettes non-addictive, then there will be no harm in explicitly stating that the FDA can do that. Short of this amendment, it will be clear that Congress' intent is not to allow the elimination or near elimination of nicotine, and any such attempt by the FDA will most certainly be overturned by Congress, using its veto power provided elsewhere in the bill (via yet another loophole).

Enzi Amendment #4: This amendment strengthens the required warning labels on cigarettes by increasing the size of warning labels from 30% to 50% of the pack and adding color graphics that depict the negative health consequences of smoking. This is similar to warning labels that have been used with some success in Canada. Again, there is absolutely no reason for health groups to oppose this amendment since it merely improves the warning labels.

Enzi Amendment #5: This amendment increases the federal cigarette excise tax by 39 cents per pack and allocates the revenues to support cancer research at the National Cancer Institute. This is a far better use of the revenues from a large cigarette tax increase than supporting children's health insurance - the last thing in the world that we want to become dependent upon continued cigarette consumption.

Enzi Amendment #6: This amendment would add menthol and clove to the list of flavorings that cannot be used as a primary flavor in cigarettes. This is a critical improvement, since it affects flavors that Big Tobacco actually does use to recruit smokers. Currently, the legislation bans plenty of flavors, but few, if any of them are actually being used to market cigarettes (when was the last time you saw a cherry cigarette?).

Enzi Amendment #7: This amendment increases the federal cigarette excise tax by 39 cents per pack and allocates 50% of the revenues to Medicare, 25% to Medicaid, and 25% to state tobacco education and cessation programs. This amendment alone would do more to reduce smoking than everything else in the FDA bill combined.

Enzi Amendment #8: This amendment increases the federal cigarette excise tax by 39 cents per pack and allocates the revenues to the FDA to allow it to increase the number of its inspectors. The amendment highlights the fact that FDA's ability to safeguard the public from food and drug threats is so impaired that it seems crazy to be considering adding tobacco products to its jurisdiction.

Enzi Amendment #11: This amendment would remove the exemption for menthol as one of only two flavorings allowable (along with clove). If Enzi Amendment #6 passes, then this amendment is not necessary.

Enzi Amendment #12: This amendment would remove the exemption for clove as one of only two flavorings allowable (along with menthol). This simply returns the bill to its form prior to Senator Kennedy's addition of the clove exemption in order to protect the financial interests of Philip Morris, which recently began marketing clove cigarettes in Indonesia. There is absolutely no reason for any of the health groups to fail to support this amendment, since it simply removes a special protection for Philip Morris which has no place in the legislation, and which wasn't even in the legislation to begin with. The explanation that this clause is necessary to avoid violating trade treaties is completely bogus. Besides, if that were true, then it would violate trade treaties for the FDA to require any changes in cigarette ingredients, since imported cigarettes wouldn't meet such requirements.

Burr Amendment #8: This amendment would strengthen the requirements for making a reduced exposure claim for a tobacco product and ease the requirements for making a reduced risk claim for a tobacco product. The problems with the current modified risk section of the bill are that it (1) makes it virtually impossible for a reduced risk claim to be approved, thus taking away any incentive for a tobacco company to research, develop, and seek to market what might be a truly reduced risk product; and (2) makes it too easy for a reduced exposure claim to be made, thus institutionalizing the fraud which tobacco companies were found guilty of committing in implying that low-tar and low-nicotine cigarettes are safer.

This amendment addresses, to some extent, these problems. First, it makes it at least possible for a reduced risk claim to be made (and thus restores the incentive for companies to develop a truly safer cigarette). Instead of having to conduct long-term epidemiologic studies to prove that a product reduces long-term risks, a company could instead demonstrate that the cigarette reduces actual human exposure to various constituents and that reduction in such constituents results in decreased disease as measured by some clinical marker of disease risk (but short of having to demonstrate reduced risk in a long-term epidemiologic study).

Second, this amendment makes it more difficult to make an undocumented reduced risk claim that might wrongly imply reduced disease risk. Under the current bill, a company merely needs to show that the yield of a certain constituent is reduced and that a reduction in disease risk is "anticipated." This amendment requires the demonstration of reduction in actual human exposure (not just in machine-measured yields). It also requires scientific documentation to back up that a reduction in disease risk is anticipated. The anticipation alone is not enough.

Finally, this amendment would allow the FDA to establish rankings which compare the risks of different classes of tobacco products. Communications of differences in risks between various classes of products is not allowed under the current bill.

Burr Amendment #10: This amendment would require states to spend Master Settlement Agreement funds on tobacco control programs at the amount recommended by the Centers for Disease Control and Prevention, or else they would face a reduction in their mental health and substance abuse block grants. This is a good idea and it would, if effective, actually make a dent in smoking, unlike the FDA bill itself. However, it's not clear to me that the financial penalties for not allocating the required amount of money to tobacco control programs are severe enough. I'm not aware of the amounts that states receive from substance abuse and mental health block grant funding to determine whether this provision would be effective. But clearly, the idea itself is an excellent one.

The Rest of the Story

I must emphasize that even with these amendments, I oppose the FDA legislation and I think it would be a public health disaster. The point is not that these amendments fix the legislation and address the concerns that I have expressed. The point is that they represent a significant strengthening of the legislation, and that it is telling that the health groups which supposedly want to end special protection for Big Tobacco and save countless lives are opposing each and every one of them.

Frankly, I would like to see a few of the amendments enacted into law as a stand-alone bill, while scrapping the rest of the FDA legislation. Some of these amendments demonstrate an appreciation of the types of actions that Congress could take to make a serious dent in smoking, rather than a bill which may appear great on the surface, but which is actually designed to institutionalize tobacco use, protect Big Tobacco at the expense of public health protection, and preserve and protect the profits of the nation's largest tobacco company.

Tobacco-Free Kids Suggests that Amendments to Ban Menthol and Clove, Potentially Eliminate Nicotine, and Improve Warning Labels Do Not Strengthen Bill

In a communication sent out yesterday, the Campaign for Tobacco-Free Kids tells tobacco control advocates throughout the country that changes to the FDA legislation that would ban the use of clove and menthol flavorings in cigarettes, greatly improve cigarette warning labels, and give the FDA the authority to actually eliminate nicotine from cigarettes do not strengthen the bill.

The Campaign, referring to the amendments that have been offered to the proposed FDA legislation, states: "All of their amendments fall into two strategies, both aimed at defeating the legislation. The majority would significantly weaken the bill. Others are presented in the guise of being pro-tobacco control ... . ...

If you don't have the votes to kill a bill, add amendments that appear to strengthen it but that proponents of the legislation will find hard to oppose, and, if passed, will divide the supporters of the bill and increase the number of its opponents. It was a tactic that was used successfully to defeat the McCain tobacco legislation in 1998. ...

In this case the amendments that appear favorable on the surface are all being offered by Sen. Mike Enzi (R-WY). ...

Three of Senator Enzi's amendments to S625 would increase the tax on tobacco products ... . Each of these amendments would supposedly fund an activity supported by the public health community."

The Rest of the Story

The truth is that each of the amendments referred to above would significantly strengthen the bill. In fact, I would go so far as to say that these amendments offer the only provisions in the bill which would actually have a substantial impact on smoking rates.

The current bill will do nothing to cut smoking rates, and will likely increase smoking, as it will create a perceived (and real) FDA stamp of approval for cigarettes.

But the amendments actually do something meaningful: they eliminate an additive which has been largely successful in recruiting African American (and other) smokers; they offer the prospect of the elimination of nicotine from cigarettes (which would clearly cause a drastic reduction in smoking); and they directly reduce cigarette consumption and save lives by increasing the cigarette tax and by dedicating these revenues to smoking-related programs.

So to suggest that these amendments are only favorable on the surface and that they merely have the guise of being pro-tobacco control seems to either show ignorance about the strategies that would actually be effective, or a deliberate attempt to mislead tobacco control advocates in order to get them to oppose these most favorable and most pro-tobacco control amendments.

I would go so far as to say that these amendments are essentially the only meaningful pro-tobacco control provisions and the only meaningful favorable provisions in the entire bill.

"All of their amendments fall into two strategies, both aimed at defeating the legislation. The majority would significantly weaken the bill. Others are presented in the guise of being pro-tobacco control ... . ...

Really? Eliminating nicotine is not really a pro-tobacco control provision? Maybe not, if your criterion for judging a bill is how well it protects the profits of the nation's largest cigarette company.

If you don't have the votes to kill a bill, add amendments that appear to strengthen it but that proponents of the legislation will find hard to oppose, and, if passed, will divide the supporters of the bill and increase the number of its opponents. It was a tactic that was used successfully to defeat the McCain tobacco legislation in 1998. ...

Appear to strengthen it? So eliminating menthol and clove doesn't actually strengthen the legislation? Again, it doesn't strengthen it only if your criterion for evaluating the bill is how well it protects Big Tobacco profits.

And I should add that the amendment that TFK refers to here as weakening the McCain legislation was actually a provision to eliminate tobacco industry immunity from the bill. In my mind, it was a provision that was absolutely essential to even give the bill a chance of being favorable to public health.

In this case the amendments that appear favorable on the surface are all being offered by Sen. Mike Enzi (R-WY). ...

Favorable on the surface? So again, these amendments are not actually favorable for public health? Perhaps not, if your goal is to protect the financial well-being of Philip Morris.

Three of Senator Enzi's amendments to S625 would increase the tax on tobacco products ... . Each of these amendments would supposedly fund an activity supported by the public health community."

Would supposedly fund an activity supported by the public health community? In other words, the bill is lying and the money actually wouldn't go to the purposes that is prescribed in the printed text? The amendments wouldn't supposedly fund these activities, they do fund these activities. Just read the actual language of the amendments. For example, from Enzi amendment #5: "such amounts [revenues] shall be transferered in such fiscal year to fund the National Cancer Institute of the National Institutes of Health." There is nothing supposed about it.

Look - if the Campaign for Tobacco-Free Kids wants to suggest that Senator Enzi is a fraud and has no actual concern about reducing smoking, then fine, go ahead and make that attack. But don't deceive people into thinking that these amendments are actually changes that weaken the bill and that while on the surface they look favorable, the truth is that they are harmful to the protection of the public's health.

Just tell the truth and admit that these amendments are indeed favorable and they do indeed strengthen the bill, but that you're afraid that with these amendments, the bill will be so strong that it no longer has a chance of passage.

It's not fair to deceive your constituents by implying that these amendments weaken the legislation. Most of these constituents do not have access to the actual amendments, so they are relying upon your information - and solely your information - to make their judgments. Just give them the truth and let them make their own decisions. Don't deceive them in order to mislead them into opposing amendments which many of them probably would actually support. Let them make their own decision. But they can't do that if they don't know the truth.

If the Campaign for Tobacco-Free Kids is going to hide the truth and deceive and mislead people, The Rest of the Story will get the truth out there. I'll make sure that the public understands exactly what the nature of these amendments is and what their actual significance is to the legislation and its strength in terms of the public health protection that they offer.

It's really not that difficult to tell the truth. All you have to do is try.

Who Wrote this Press Release?

FOR IMMEDIATE RELEASE
July 19, 2007

The U.S. Senate Health, Education, Labor and Pensions Committee can take an important step to protect the health of America's children and save lives by approving proposed amendments to the FDA legislation that would increase the federal cigarette tax by 78 cents a pack in order to fund tobacco control programs, cancer research, and health care for the poor and elderly. Increasing the cigarette tax is a proven strategy to reduce smoking, especially among children. Studies show that every 10 percent increase in the price of cigarettes reduces youth smoking by seven percent and overall cigarette consumption by about four percent.

This is an important first step toward enactment of legislation to increase the federal cigarette tax for the first time since 1997.

"The cigarette tax is a proven strategy to protect thousands of kids from tobacco addiction," said William V. Corr, Executive Director of the Campaign for Tobacco-Free Kids. "A higher cigarette tax is a win-win solution - a health win that will reduce tobacco use and save lives and a financial win that will raise much-needed revenue to fund important programs while also reducing tobacco-caused health care costs."

A higher cigarette tax is a win-win-win solution for the country - a health win that will reduce tobacco use and save lives, a financial win that will raise revenue to help fund tobacco control and cancer research programs and a political win that is popular with voters. A recent poll conducted for the Campaign for Tobacco-Free Kids found that 67 percent of voters support a 75-cent per pack increase in the federal cigarette tax, while only 28 percent oppose it. This support is evident among virtually every political and demographic subgroup of voters across the country, with large majorities of Democrats, Republicans and Independent, men and women, and urban and rural voters supporting the cigarette tax.

Research shows a clear health benefit from higher tobacco taxes. A 78-cent increase in the federal cigarette tax will prevent more than 2 million kids from ever starting to smoke, help more than 1.5 million adult smokers quit, prevent more than 1 million smoking-caused deaths and produce more than $50 billion in long-term health care savings.

Forty-three states and the District of Columbia have increased their cigarette taxes at least once since January 1, 2002 and the national average state cigarette tax is currently $1.04. Twenty-two states and the District of Columbia have cigarette tax rates of $1.00 or more and seven states have cigarette tax rates of $2.00 or more.

The current federal cigarette tax rate is 39 cents per pack. Congress has not enacted legislation increasing the federal cigarette tax since the Balanced Budget Act of 1997 (which phased in a 15-cent increase in 2000 and 2002). As a result, after adjusting for inflation, the federal cigarette tax is currently lower than historical levels and much lower as a percentage of overall retail cigarette prices.

Tobacco use is the leading preventable cause of death in the United States, killing more than 400,000 people and costing more than $96 billion in health care bills each year. Currently, about 23 percent of high school students smoke and more than 1,000 kids become new regular smokers every day.

The national poll of 1,000 registered voters was conducted by the Mellman Group May 29- June 3, 2007 and has a margin of error of plus or minus 3.1 percentage points.

The Rest of the Story

If you guessed the Campaign for Tobacco-Free Kids (TFK), you are wrong, at least partly.

This is actually a parody of press releases that the Campaign for Tobacco-Free Kids did write. In fact, almost the entire text is copied verbatim from a number of press releases that TFK issued in support of increasing the federal cigarette excise tax to support a variety of health-related programs (source 1; source 2; source 3; source 4; source 5; source 6; source 7).

The only change that I made was the specifics about the specific legislative proposal in question, including the amount of the tax increase and the uses of the revenues. Specifically, this mock press release refers to two amendments being offered by Senator Enzi to the FDA tobacco legislation. Taken together, these amendments (Enzi amendments #5 and #7) would increase the federal cigarette tax by 78 cents per pack, with 50% of the resulting revenue going to support cancer research at the National Cancer Institute, 25% going to anti-smoking education and smoking cessation programs, and 12.5% going to both health care for the elderly (Medicare) and health care for the poor (Medicaid).

So why is this not a real press release?

Because the Campaign for Tobacco-Free Kids opposes this proposed increase in the cigarette tax by 78 cents per pack to protect the health of America's children, save lives, and fund life-saving cancer research and anti-smoking education and cessation programs.

How can TFK possibly oppose these amendments? After all, cigarette taxes are a win-win-win proposition. They protect the health of America's children. They save lives - millions of lives. And to boot, this particular proposal will generate funds for much-needed cancer research, tobacco education programs, and smoking cessation. Because the revenues would actually be used to further reduce smoking, this is actually a win-win-win-win proposition for the American people.

There is overwhelming public support for a 78 cent per pack cigarette tax increase, as the Campaign for Tobacco-Free Kids itself has shown.

Moreover, this proposal would prevent more than 2 million kids from ever starting to smoke, help more than 1.5 million adult smokers quit, save more than 1 million lives, and produce more than $50 billion in long-term health care savings, according to TFK's own calculations.

As TFK itself has stated, "The cigarette tax is a proven strategy to protect thousands of kids from tobacco addiction. A higher cigarette tax is a win-win solution - a health win that will reduce tobacco use and save lives and a financial win that will raise much-needed revenue to fund important programs while also reducing tobacco-caused health care costs."

So how can TFK possibly oppose this proposal at the same time as it spews forth its abundant propaganda about how wonderful cigarette tax increases are?

And this proposal is even better than the one which TFK is actually supporting. That proposal will use the cigarette tax revenues to fund children's health insurance, which I have argued is a foolish idea, as it will make children's health care dependent upon high rates of consumption of cigarettes. That proposal, I have argued, is unfair and regressive. In contrast, Senator Enzi's proposal requires that the cigarette tax revenues be used to fund smoking-related programs, such as prevention, cessation, and treatment of smoking-related diseases. If anything, this proposal is far better than the one which TFK is actually supporting.

Moreover, President Bush has already indicated that he is going to veto the SCHIP bill. That legislation is dead in the water. But this bill has a really strong chance of passage, and it would be far more difficult for the president to veto this one.

The rest of the story is that once again, the Campaign for Tobacco-Free Kids has proven that it is full of rhetoric and propaganda, but that when it really comes down to it, the organization is not supporting a strategy that it says is a win-win-win proposition.

Even I - who opposes many of the recent cigarette tax increase proposals in many states, as well as the SCHIP bill - think that this proposal is a good one, as it will both save lives and directly benefit smokers by offering them support for smoking cessation services, research to benefit them, and medical treatment.

The bottom line is that this is really not about health. It is simply about politics. Apparently, the desire to put a feather in its cap is far more important than actually taking meaningful steps to protect the public's health.

Campaign for Tobacco-Free Kids and Other Health Groups Oppose Elimination of Nicotine, Menthol and Clove from Cigarettes; True Colors Now Show

Despite claiming to be overwhelmingly interested in saving lives, fighting Big Tobacco, protecting kids from addiction to cigarettes, and ending special protections for the tobacco industry, the Campaign for Tobacco-Free Kids (TFK) and three other health groups - the American Lung Association (ALA), American Cancer Society (ACS), and American Heart Association (AHA) - are opposing amendments to the proposed FDA legislation that would greatly strengthen it by allowing the Food and Drug Administration (FDA) to remove the nicotine from cigarettes, prohibiting the use of menthol and clove as primary flavorings in cigarettes, and increasing the size and strength of cigarette warning labels.

Here is what our leading anti-smoking and health organizations are opposed to, despite the fact that they repeatedly claim that their primary desire is to end special protections for Big Tobacco, curtail the recruitment of youth smokers, drastically reduce smoking, and save millions of lives:

1) The AHA, ALA, ACS, and TFK oppose an amendment that would allow the FDA to eliminate the nicotine from cigarettes.

2) The AHA, ALA, ACS, and TFK oppose an amendment that would ban the use of menthol as a primary flavoring in cigarettes, although they support a ban on all other flavors, including "strawberry, grape, orange, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee."

3) The AHA, ALA, ACS, and TFK oppose an amendment that would ban the use of clove as a primary flavoring in cigarettes, although they support a ban on all other flavors, including "strawberry, grape, orange, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee."

4) The AHA, ALA, ACS, and TFK oppose an amendment that would increase the size of the required warning labels from 30% to 50% of the pack and would require graphic picture warnings such as have been effective in countries such as Canada in reducing smoking.

The Rest of the Story

The rest of the story is that these health groups have shown their true colors. When it really comes down to it, they have no interest whatsoever in promoting measures that would actually be effective in drastically reducing smoking. Instead, they are intent upon granting Philip Morris' wish of permanently institutionalizing cigarettes. And they are content to support a watered down bill that sacrifices health protection to tobacco industry profits, writes racial discrimination in health protection into law, and makes sure that tobacco companies can continue to recruit youth smokers using flavorings that are actually common (while banning those which have never been, nor ever will be used anyway).

Let's take these amendments one by one:

1) The AHA, ALA, ACS, and TFK oppose an amendment that would allow the FDA to eliminate the nicotine from cigarettes.

If the health groups were sincere in their claim that they desire to give the FDA the authority to require cigarettes to be non-addictive, then there is absolutely no reason for them to oppose Senator Enzi's amendment #2, which would explicitly allow the FDA to eliminate the nicotine from cigarettes. Under the provisions of the current bill, the FDA could lower nicotine yields, but not get rid of the nicotine entirely.

As I have explained in detail previously, lowering nicotine yields is about the worst thing that the FDA could do from a public health standpoint. Reduced nicotine yields leads smokers to compensate (to smoke more heavily and to smoke more cigarettes) in order to maintain nicotine levels in their blood. This increases their tar exposure and as a result, their cancer and lung disease risk may actually increase. Lowering nicotine yields would be a public health disaster.

The only potential virtue of allowing the FDA to regulate nicotine would be if the Agency eventually eliminated the nicotine, so that cigarettes would lose much of their addictive potential. If the health groups are serious about supporting this idea, then why are they not supporting this amendment which makes it clear that the intent of Congress is to allow FDA to get rid of the nicotine?

2) The AHA, ALA, ACS, and TFK oppose an amendment that would ban the use of menthol as a primary flavoring in cigarettes, although they support a ban on all other flavors, including "strawberry, grape, orange, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee."

This exposes what the health groups are really doing here. They are basically supporting window dressing. They want to be able to say that they are doing something to protect the public's health, but when it really comes down to it, they want to tie FDA's hands to deal with the real issues, and allow the FDA to address the issues that are non-issues to begin with.

Menthol is by far the most common flavoring used in cigarettes. It is very popular among African American smokers in particular. In contrast, I am not aware of any cigarettes that feature strawberry, grape, orange, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee.

When was the last time you walked into a store and noticed the pineapple Marlboros on the shelf? How frequently do you see someone lighting up from a pack of cherry-flavored Camels? Has anyone ever asked you if you wanted to try a grape Newport?

The health groups are perfectly willing to require the elimination of flavorings that aren't actually used in cigarettes. But they want to protect the tobacco companies' ability to add flavorings that are actually used to recruit youth smokers.

In addition, the groups are supporting what amounts to writing racial discrimination in health protection into the law. To these groups, the idea of white youths being enticed by flavorings is unacceptable. However, it is perfectly acceptable for black youths to be enticed by menthol.

Right on the mark, Senator Enzi's amendment #11, which would add menthol to the list of prohibited flavorings, lists as its purpose "To protect African-American youth." The health groups don't seem interested in protecting African American youths, only white youths.

3) The AHA, ALA, ACS, and TFK oppose an amendment that would ban the use of clove as a primary flavoring in cigarettes, although they support a ban on all other flavors, including "strawberry, grape, orange, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee."

Once again, this exposes what the health groups are really doing here. They are supporting window dressing. They want to be able to say that they are doing something to protect the public's health, but when it really comes down to it, they want to tie FDA's hands to deal with the real issues, and allow the FDA to address the issues that are non-issues to begin with.

Clove is not only the most common flavoring used in cigarettes marketed in Indonesia, but clove cigarettes are becoming increasingly popular in the United States. In fact, in some areas of the country, clove cigarettes make up a substantial proportion of youth market share. In contrast, I am not aware of any cigarettes smoked by youths that feature strawberry, grape, orange, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee.

Again, the health groups are perfectly willing to require the elimination of flavorings that aren't actually used in cigarettes. But they want to protect the tobacco companies' ability to add flavorings that are actually used to recruit youth smokers.

4) The AHA, ALA, ACS, and TFK oppose an amendment that would increase the size of the required warning labels from 30% to 50% of the pack and would require graphic picture warnings such as have been effective in countries such as Canada in reducing smoking.

This is a no-brainer. There is strong evidence that graphic warning labels are effective in reducing smoking. And obviously, a larger warning is going to be more effective than a larger one. But again, since this is a measure that would actually have an impact on smoking (as opposed to being merely window dressing), the health groups oppose it.

Once again, the health groups are protecting Big Tobacco profits at the expense of the protection of the public's health.

What This All Means

What this means is that the Campaign for Tobacco-Free Kids, American Cancer Society, American Heart Association, and American Lung Association are the best friends that Philip Morris could ask for. They are doing everything they can to protect Philip Morris profits at the expense of the public's health.

More importantly, what it means is that these organizations are full of baloney when they talk about their desire to end special protections for Big Tobacco. What they are doing is supporting the most special protections for Big Tobacco imaginable. These groups are opposing the very measures that could actually do something to put a dent in smoking. And they are supporting all the measures that would do nothing to curtail smoking, but would allow the companies to appear to the public as if they are complying with stringent safety regulations because they are concerned about the health of their customers.

Despite all my criticism of these groups over the past months, they actually had a chance to redeem themselves by supporting these amendments to strengthen the legislation and eliminate some of the glaring loopholes that were inserted specifically for Philip Morris.

But the groups - all of them - have failed miserably. It is a supreme disappointment to find out that the goal of being able to stick a feather in the cap is more important than actually doing something meaningful to protect the public's health.

I'm all for regulation of public health hazards. But if you're going to let Philip Morris write those regulations, then count me out.

Not so for the health groups. We now know that they are perfectly willing to stand shoulder-to-shoulder with Philip Morris and let the nation's leading cigarette company dictate the terms under which the FDA will be forced to approve cigarettes.

The Campaign for Tobacco-Free Kids, American Cancer Society, American Heart Association, and American Lung Association have sold out the public's health to protect tobacco industry profits. What a sad chapter in tobacco control and public health history.

Here and Now Radio Segment on FDA Tobacco Legislation

Here is a link to the Here and Now segment on the FDA legislation (in which I was interviewed), which aired yesterday on 53 National Public Radio affiliate stations.

This coverage is important because it emphasizes:

1) The concern that the FDA legislation would give cigarettes a federal government seal of approval, yet there is no documentation that the product will be any safer;

2) The fact that the key provisions of the bill were inserted specifically to protect the financial interests of Philip Morris, at the expense of the protection of the public's health; and

3) The fact that the major ways in which the FDA could actually have an impact on youth smoking are all precluded by the bill, as a favor for Philip Morris.

As I state in the interview, this bill is little other than a huge favor for Philip Morris.

CNBC Segment on Proposed FDA Legislation

Click here to watch the CNBC segment, aired last night, on the proposed FDA legislation, in which I was interviewed.

This is important coverage of the issue, because it raises the critical question of whether giving an FDA stamp of approval to cigarettes will undermine the public's appreciation of the hazards of smoking, and the safety of the particular cigarettes that are being marketed.

Apparently, the bill's sponsors believe that I am correct, as they have stated such in the preamble to the bill and have inserted language to prevent tobacco companies from telling the public not only that the FDA has approved cigarettes, but that FDA regulates cigarettes in the first place. Unfortunately, this clause is unconstitutional and will never hold up in court. Moreover, the public is going to find out that cigarettes are being approved for sale by the FDA, whether the tobacco companies tell them or not.

Senator Kennedy and Health Groups Do Huge Favor for Philip Morris; FDA Bill Protects Tobacco Company Profits at the Expense of the Public's Health

Philip Morris owes a debt of gratitude to Senator Kennedy and the major health groups (including the Campaign for Tobacco-Free Kids, American Heart Association, American Lung Association, American Cancer Society, and American Medical Association) for performing a huge favor.

Unbenownst to any of us, behind the scenes, Senator Kennedy inserted language into the proposed FDA legislation that exempts clove from the list of banned flavorings in cigarettes. The original bill banned the use of clove as a primary flavoring in cigarettes. However, the bill that the Senate Health, Education, Labor, and Pensions Committe will see tomorrow exempts clove from the ban that affects all other flavorings (other than menthol, which was already exempted).

This comes at a perfect time for Philip Morris, which according to a New York Times article, "recently introduced a clove-flavored version of its Marlboro brand in Indonesia. The company spent $5 billion in 2005 to buy a controlling stake in Sampoerna of Indonesia, a large maker of clove cigarettes."

While Senator Kennedy was the one who apparently inserted this Philip Morris protection clause into the legislation, it appears that the health groups are OK with the change - none of them has called for the removal of this protection clause and all continue to support the bill.

According to the article, "The American Lung Association and other health advocates said they were disappointed by the change in the bill but still supported it. 'We would prefer that the bill continue to prohibit clove-flavored cigarettes,' said Paul G. Billings, a spokesman for the American Lung Association. 'But Senator Kennedy is trying to craft a path that can move the legislation through to final passage.'”

The Rest of the Story

Philip Morris truly has friends at the Campaign for Tobacco-Free Kids and the other major health groups. What a dent it could have made in the company's business if it were prevented from pushing its clove-flavored Marlboro in the United States, as it is doing now in Indonesia. But the health groups made sure that this wasn't going to be a problem for the nation's leading cigarette company.

What a wonderful favor! Selling out the public's health for the sake of Big Tobacco profits.

Clearly, the health groups perceive that Philip Morris' support is necessary for the bill to have a chance. And clearly, all of their propaganda about ending special protections for Big Tobacco is little more than rhetoric in light of this revelation about clove cigarettes.

Most importantly, it shouldn't take a rocket scientist to figure out that if Philip Morris supports the bill, it cannot possibly be good for the public's health. When has Philip Morris ever previously supported legislation that would have hurt its own profits in order to substantially reduce cigarette consumption?

Why are the health groups deluding themselves into believing that somehow, they have tricked Philip Morris this time? As Dr. Richard Hurt stated astutely today in the New York Times: "This industry doesn’t miss a trick, and anything that Philip Morris wants can’t be good."

Also troubling are the racial aspects of the exemptions in the proposed legislation. The only two flavors which are exempt from the bill's ban on flavorings are menthol and clove - flavors which are predominantly used to entice people belonging to racial/ethnic minority groups. Kreteks are very popular in Indonesia, where 60% of men smoke them. Menthol cigarettes are smoked predominantly by African-Americans (75% of African-American smokers smoke menthol cigarettes compared to just 25% of white smokers).

What the FDA bill is basically saying is that it is acceptable to use flavorings to addict African-Americans or youths belonging to other minority groups, but it is not acceptable to do the same thing to our white youths.

This represents racial discrimination in health protection and it is not something that health groups should be supporting, for that reason alone.

The implications are very disturbing to me because they represent an institutionalized form of racial discrimination in health protection -- in other words, a form of racial discrimination that is actually written into the law. There is enough racial discrimination that occurs through institutional behavior. It is inexcusable to me to actually write racial discrimination in health protection into the law.

I want to emphasize that there is no scientific or public health rationale for exempting menthol and cloves. So it is not that this is merely an example of racial discrimination that creeps into the legislation in a completely unanticipated, unnoticed, and/or unavoidable way. It represents an intentional decision to treat differently flavorings that are traditionally targeted at different racial/ethnic groups. And to do this solely to protect potential profits of the nation's leading cigarette company.

With enemies like the health groups, it doesn't appear that Philip Morris needs friends. The health groups are doing a fine job of doing Philip Morris' bidding for it.

FDA Tobacco Regulation Idea So Detrimental that Supporters Amend Bill to Preclude Tobacco Companies from Stating that the FDA Regulates Cigarettes

Apparently, supporters of the proposed FDA tobacco legislation have come to realize that putting cigarette regulation into the hands of the FDA would create a perceived seal of approval that would falsely make the public believe that cigarettes have been made safer, potentially increasing cigarette consumption. In fact, they apparently believe it is so much of a problem that they have inserted language into the bill that would prevent cigarette companies from merely telling the public that the FDA regulates cigarettes.

In a last hour maneuver, the Senate Health, Education, Labor, and Pensions Committee Chairman - Senator Edward Kennedy - inserted a provision into the bill which would prevent the companies from making any statement to the public, in any communication, that informs people of the fact (the truth) that cigarettes are now regulated by the FDA.

The provision states that cigarette companies may not make "any statement directed to consumers through the media or through label, labeling, or advertising that would reasonably be expected to result in consumers believing that the product is regulated, inspected, or approved by the Food and Drug Administration, or that the product complies with the requirements of the Food and Drug Administration...".

The reason for this provision, as stated in the legislation?

"If manufacturers are permitted to state or imply in communications directed to consumers that a tobacco product is approved or inspected by the Food and Drug Administration or complies with Food and Drug Administration standards, consumers are likely to be confused and misled. Such a statement could result in consumers being misled into believing that the product is endorsed by the Food and Drug Administration for use or in consumers being misled about the harmfulness of the product because of such regulation, inspection, approval, or compliance."

The Rest of the Story

You know that regulation of cigarettes by the FDA is a terrible idea if the supporters of the bill have to insert a clause into it preventing tobacco companies from telling the public that the FDA regulates cigarettes. You know that FDA regulation of cigarettes is a pretty bad idea if we need to hide the truth from the public lest it have the expected adverse consequences for the public's health.

Apparently, the only way this legislation will work is if we trick people into thinking that the FDA does not regulate cigarettes.

Think about it. What kind of cockamamie regulatory scheme depends upon the public not knowing about that scheme in order to avoid severe public health consequences?

How sensible can a regulatory approach be if we need to hide from the public the very fact that the regulatory scheme is in place?

Clearly, precluding the tobacco companies from telling the public that the FDA regulates cigarettes is not going to keep this information from the public. The legislation is getting tremendous publicity, and I would bet that even if it is not enacted, a substantial proportion of the public is going to think that the FDA regulates cigarettes just because they heard so much about it. Surely, people are going to catch wind of the fact that cigarettes are under FDA's regulatory jurisdiction. Whether the tobacco companies tell them or not.

So the perceived FDA seal of approval that the bill's supporters are finally worried about is going to happen, despite the newly inserted provision that prevents the tobacco companies from telling the public the simple truth.

Ironically, in an apparent effort to save face in the light of this late realization that the regulatory scheme is indeed going to create the FDA seal of approval that I warned about months ago (actually, years ago), bill proponents hastily inserted a provision that is such an act of haste and desperation that it is unconstitutional.

I believe that this provision violates the tobacco companies' rights under the First Amendment to the Constitution. I think it clearly violates their free speech rights.

What the bill does, if it passes, is prevent tobacco companies from making a simple statement of the clear, undeniable, universally recognized truth: that cigarettes are regulated by the FDA. There is no compelling justification for interfering with the companies' First Amendment rights in this situation. I doubt that this provision would ever hold up if the companies rightfully challenge it.

How can you tell companies that they cannot make a simple statement of the truth that is widely known and widely disseminated through other sources?

Clearly, the FDA can regulate the labeling of cigarettes. And the FDA can certainly prevent companies from making statements that are false or misleading. But there is no compelling government interest that would justify taking away free speech rights to tell the public the truth.

Here is the rub: there would be no deception in the companies stating that the FDA regulates cigarettes. This would be undeniably true if the legislation is enacted; there would not be a shred of deception.

That is how foolish this legislation is. So foolish that we need to infringe upon the companies' First Amendment rights in order to make sure that the public doesn't catch wind that the legislation is in place.

The truth is that for this legislation to be effective and not harm the public's health by creating the perception of an FDA stamp of approval, the bill would have to do far more than prevent cigarette companies from telling the public that the FDA regulates cigarettes. It would have to require that public statements be made to the effect that the legislation did not pass. It would have to require a media conspiracy to lie to the public about the legislation's fate. Otherwise, it is going to be quite obvious to the public that cigarette safety is under the jurisdiction of the Food and Drug Administration.

Apparently, the bill's sponsors are so clear on the fact that the legislation will unlikely have any health benefits in terms of producing a safer cigarette that they are uncomfortable with the idea that the public might even be informed that a manufacturer's cigarettes comply with the requirements of the FDA.

If the FDA legislation were, as suggested by its anti-smoking group supporters, going to produce safer cigarettes, then we would not need to go to extreme measures (violating freedom of speech rights) in order to shield the public from finding out that indeed, cigarettes on the market do comply with FDA requirements.

In a brilliant way that I only wish I could have thought of, Senator Kennedy has revealed to the nation just how stupid this legislation is. What the bill is now essentially saying is the following: "We previously issued propaganda suggesting that FDA regulation of cigarettes will save millions of lives by reducing cigarette smoking and making the product safer through product standards. However, we now acknowledge our opponents' arguments that in reality, the legislation will create a perceived stamp of approval for cigarettes, undermining public health messages about the hazards of smoking. In addition, we now acknowledge that the product probably won't be safer, and that we need to go to great lengths to make sure that the public does not think that cigarettes actually comply with the FDA standards. Given our propaganda, they may think that compliance with FDA safety standards implies a safer product. But the truth is that our proposed safety standards are not actually 'safety' standards."

The rest of the story is that hastily, and obviously without too much insight, proponents of the FDA legislation have written into the bill the exact reasons to kill it. The bill now exposes its own folly. It reveals its lack of sensibility.

How ironic that what should be the death knell for this legislation was a last-minute, desperate act by the bill's chief sponsor.

Report Shows Cigarette Tax Increase is Least Defensible Way to Fund Children's Health Insurance

A report released Friday by the Tax Foundation reveals that the proposal to fund the State Children's Health Insurance Program (SCHIP) by increasing the federal cigarette excise tax hurts the poor more than other available funding options.

According to the report, raising the $35 billion needed to fund SCHIP by increasing the federal cigarette tax would impose an average tax increase of $249 for households in the bottom 20% income bracket. In contrast, relying on a corporate income tax increase to fund SCHIP would increase taxes in the lowest income bracket by only $41, and simply increasing individual income taxes to pay for SCHIP would cost the lowest-income households only $7 in extra tax.

The report concludes that "no other federal tax hurts the poor more than the cigarette tax. ... Not only are the payers of cigarette taxes poorer as a group than the payers of these other taxes, but there are fewer of them. In fact, the burden of the proposed cigarette tax hike on the lowest-earning 20 percent of households is 37 times heavier than it would be if the government raised the money with the federal income tax. Put another way, the proposed cigarette tax hike would hit the poor with the same force as cutting the Earned Income Tax Credit (EITC) by one-fourth." ...

"Taxing only cigarettes to finance higher spending on SCHIP has absolutely no justification in sound tax policy. Excise taxes on cigarettes should be used to compensate for the costs they impose on society. Taxes levied above and beyond that point may be politically expedient because smokers are unpopular, but they only serve to make the federal tax system less principled and more regressive."

The Rest of the Story

This analysis confirms my assertion, highlighted by Jacob Sullum in Hit&Run last week, that the proposed 61 cents per pack increase in the federal cigarette excise tax is not a sensible way to fund the expansion of the SCHIP program. As I argued: (1) it is a regressive tax that disproportionately hurts the poor; (2) it is unfair because the benefits do not accrue to those who bear the burden of paying the tax; (3) it is unacceptable because it makes children's health insurance dependent upon sustaining high levels of cigarette smoking; and (4) it removes any incentive for the federal government to substantially reduce cigarette consumption. The Tax Foundation analysis supports my contention that the tax is regressive as it disproportionately hurts the poor and that it is unacceptable because there are far better alternatives to fund SCHIP.

It is unfortunate that anti-smoking groups are incapable of anything other than knee-jerk support for any and all cigarette taxes. They have never met a cigarette tax increase that they didn't like, no matter who pays the tax, what the funds are used for, how regressive or unfair it is, how inappropriate the resulting fiscal dependence on smoking might be, and how sensible potential alternative funding sources, or alternative uses of the cigarette tax revenues might be.

As the Tax Foundation states, cigarette taxes should be used to compensate for the costs they impose on society. In other words, they should be used for smoking-related programs. For example, using cigarette tax revenues to fund expansion or improvement in treatment for smoking-related diseases makes sense from a tax policy perspective. It is fair, because the benefits accrue to precisely those who are paying the tax. It is sensible, because the money is being used to compensate for costs imposed specifically by smoking. It also avoids the problem of creating a dependence on continued smoking, because as smoking declines, the need for the revenue also declines, as there will be less smoking-related disease. To some extent, it is a self-regulating system.

In contrast, using the cigarette tax to fund SCHIP creates an unacceptable conundrum. If we reduce smoking, then we lose money that is needed to pay for children's health insurance. The more people continue to smoke, the fewer children who will have health insurance. As smoking rates fall, there is no direct decline in the need for children's health insurance, especially in the short-term.

I find it unfortunate that anti-smoking groups are so narrow-minded in their thinking that they do not seem capable of considering the broader implications of what they are supporting and the sensibleness of their proposal in light of available alternatives. It is as if these groups have blinders on which preclude them from seeing any issue or consideration other than smoking. They are blind to effects on the poor, fairness, and long-term implications, for example.

In my view, tobacco control was never intended to be a field all its own. It was intended to be a part of a broader public health perspective. Unfortunately, it is increasingly becoming separate from public health. It is becoming more and more narrow-minded.

It's time to take the blinders off. There's a whole world out there which we are not seeing.

Study of Trends in State Heart Attack Admissions Refutes Conclusions of Helena et al. Studies

A study of trends in annual heart attack admissions through the emergency room by state refutes the conclusions of the Helena, Pueblo, Piedmont, and Bowling Green studies which concluded that smoking bans cause immediate, drastic declines in heart attacks. The study was conducted by Michael J. McFadden and David W. Kuneman. A preliminary version of the study appeared online in November 2005, while the final version, discussed on the American Council on Science and Health (ACSH) FactsAndFears blog, confirmed and strengthened the original findings.

McFadden and Kuneman overcame the two chief limitations of the existing research: (1) the small number of heart attacks in the cities studied, which resulted in tremendous baseline year-to-year variability in heart attack rates; and (2) the bias inherent in relying only upon the experiences of only a few small cities in making generalizations intended to apply to larger populations. They accomplished this by considering the following premise: if smoking bans cause an immediate decrease in heart attack admissions on the order of a 25% to 50% decline, then if one examines trends in heart attack admissions on an entire state level, then one should certainly observe a notable decline immediately following the implementation of statewide smoking bans.

Using data on emergency room admissions for acute myocardial infarction (heart attacks) from the Agency for Healthcare Research and Quality's HCUP database, McFadden and Kuneman examined trends in four states that implemented statewide bar and/or restaurant smoking bans - California, Oregon, Florida, and New York - and five states with neither a statewide smoking ban nor widespread local smoking bans - Arizona, New Jersey, South Carolina, and Iowa. They also examined trends in heart attack admissions for the United States as a whole.

California's restaurant smoking ban took effect in January 1995. In that year, heart attack admissions in California increased by 0.6%. In 1996, admissions increased by 2.9%. The corresponding changes for the United States were an increase of 3.2% in 1995 and 3.9% in 1996. California's bar smoking ban took effect in January 1998. In that year, heart attack admissions in California increased by 6.0%, compared to an increase of 6.2% in the nation as a whole. In 1999, admissions increased by 3.7% in California and decreased by 1.3% in the U.S.

Florida banned smoking in all restaurants in July 2003. Its heart attack admissions decreased by only 0.7% that year, and by only 2.0% the following year. In comparison, admissions in the U.S. decreased by 2.8% in 2003 and 8.2% in 2004.

Trends in heart attack admissions following the Oregon and New York smoking bans were also not found to be substantially different from national trends, or from trends in the comparison states without smoking bans.

The Rest of the Story

While this study certainly does not prove that smoking bans have no effect on heart attack admissions, what it does is demonstrate that when one examines population-based data for an entire state, one does not find any evidence of a dramatic decline in heart attacks immediately following the implementation of smoking bans. This casts serious doubt on the conclusion of the Helena, Pueblo, Piedmont, and Bowling Green studies. If smoking bans truly cause an immediate and dramatic decline in heart attacks, on the order of a 25% to 50% reduction, then why do we not observe any evident decline in heart attacks when entire states implement smoking bans.

The chief limitation of the study is that some localities within these states had already enacted smoking bans, so one would not expect to see as dramatic an effect on a statewide level. However, the proportion of residents in these states covered by local smoking bans was not particularly high. For example, the authors cite data that only 14% of Californians were covered by a smoke-free restaurant law in 1993. This increased to 100% in 1995. Yet the number of heart attack admissions increased from 1993 to 1995 (and increased further in 1996). The corresponding changes in the U.S. data were similar. So it does not seem that the existence of some local smoking bans is enough to invalidate the study conclusion.

I have already discussed in detail the reasons why I believe the conclusions of the Helena et al. studies are unjustified. Briefly, the chief flaw of these studies is that they are unable to rule out the very likely possibility that the observed changes in heart disease admissions in these cities during the study period are due primarily to random variation, rather than to the smoking bans. There is tremendous natural (random) variation in the heart disease admission rates in these cities because of the small population sizes. Because we are dealing with such small numbers of admissions, the percentage change in admissions from one year to the next is very high, even without any smoking ban.

While these papers make some attempt to account for these baseline trends, I do not believe that they go back far enough in time to do so adequately.

Because McFadden and Kuneman have examined heart attack trends among large populations, the number of heart attacks is much higher, and therefore the degree of underlying variability in the annual number of heart attacks is much lower. It is therefore easier to identify any major changes in the underlying trends.

I think it is high time that my fellow tobacco control researchers and practitioners recognize that the Helena et al. studies are examples of shoddy science that apparently now passes as acceptable in tobacco control research. While I support workplace smoking bans, I do not believe that we should be using shoddy science to promote them.

IN MY VIEW: Senate Cigarette Tax Proposal is Not a Sensible Way to Fund Children's Health Care, But is a Big Win for Big Insurance

The proposed 61 cents per pack increase in the cigarette tax to raise funds to support the State Children's Health Insurance Program (SCHIP) appears quite likely to be enacted by Congress. President Bush has threatened to veto the bill, and although this may be a first, I am on the same side of the issue and hope that he does follow through with the veto.

This is no way to fund children's health insurance. You don't make children's health insurance dependent on the continued consumption of cigarettes. You don't create a reliance on high levels of smoking in order to provide health insurance to our nation's children. You don't create a situation where we have to hope that smokers continue to smoke because otherwise, we will lose necessary funding to provide health insurance for children.

What this proposal does is to take away any incentive for Congress to do anything that might jeopardize the program by substantially reducing smoking rates or cigarette consumption. What the anti-smoking groups are doing by supporting this proposal is inadvertently putting a death knell into any meaningful federal legislation to decrease youth or adult smoking.

Ironically, the Campaign for Tobacco-Free Kids (TFK) might be shooting itself in the foot by supporting the cigarette tax proposal. If it is enacted into law, it may actually make Congress less likely to pass the FDA tobacco legislation that TFK so desperately desires. Because the Campaign has spewed out so much propaganda indicating that the FDA legislation would greatly reduce smoking (I believe the exact opposite is true), legislators are likely to think that passage of the FDA legislation would reduce smoking and thus jeopardize the SCHIP program's funding. This would require finding an alternative funding source, which would be politically undesirable, or not funding the program - which could also be a political liability. At very least, the creation of a federal dependence on cigarette tax revenues is likely to lead to a watering down of the already weak legislation.

The real story behind the proposed cigarette tax increase is not any desire to protect health. Instead, it turns out that this is simply a way of avoiding what could have been a mechanism for funding the program - reducing federal subsidies to health insurers. As a MarketWatch article points out, the real beneficiaries of the tax proposal are: "Humana Inc., UnitedHealth Group, Aetna Inc., Healthspring Inc., Tenet Healthcare Corp., and Cigna Corp."

Instead of asking Big Insurance to bear the burden of providing health insurance to poor children, Congress is poised to ask smokers (who in general are poorer than the rest of the population) to fund the program. And it is in fact the poorest smokers who will be hurt most by the proposal.

This is all about politics, not health. Anti-smoking groups which are supporting this proposal are simply playing a political game. They are not promoting the public's health. Any proposal that makes a vital public health program entirely dependent upon continued high rates of smoking is not, ultimately, a way to promote the public's health. Any proposal that removes all incentive for the federal government to take any action to reduce smoking is not a way to promote the public's health.

There has to be a better, more sensible way of funding children's health insurance. Unfortunately, largely because of the actions of anti-smoking groups, we're not going to find that way.

TobaccoScam Responds to Challenge: Attacks Author, Fails to Address Substance of Argument, and Retains Claim that 30 Minutes of ETS Clogs Arteries

TobaccoScam has responded to my challenge of its claim that 30 minutes of secondhand smoke causes clogged arteries that increase the immediate risk of a heart attack.

Here is its response: "If you carefully look at the peer reviewed papers on secondhand smoke, as well as the most recent Surgeon General and California Environmental Protection Agency reports on secondhand smoke (linked from the Resource Library section of the web site), you will see that the statements on the web site represent the scientific consensus. Mike Siegel has a blog, which is his (rather uninformed) opinion." ...

"Siegel has never done any work on cardiovascular disease, in particular work on the vascular endothelium and his statements clearly reflect a lack of understanding of the effects of smoking on the endothelium or the role that even seemingly minor damage to the endothelium plays in both the immediate risk of a heart attack and also the long term cumulative risk."

The Rest of the Story

Now this is getting interesting. The organization which claims that if you are exposed to secondhand smoke for just 30 minutes, you will develop clogged arteries ("30 minutes exposure = stiffened, clogged arteries" is a direct quote from its web site) is accusing me of being uninformed.

Before addressing the response itself, let me first reiterate what the claim is that is under contention. TobaccoScam claims that 30 minutes of secondhand smoke exposure will cause any person exposed to have clogged arteries, and therefore, to be at an immediate increased risk of a heart attack.

After all, an "equals" sign means equals, is equivalent to, is the same as." So according to TobaccoScam's equation, 30 minutes of secondhand smoke is equivalent to having, is the same as, or equals having clogged arteries. Note that this claim is unqualified. It doesn't say that someone with severe existing coronary artery stenosis who is exposed briefly to secondhand smoke could potentially have a thrombus (clot) triggered by the exposure, as the terminal event that causes a heart attack in this highly susceptible individual. Instead, the assertion is that any person exposed, even a health individual, will develop clogged arteries from 30 minutes of exposure to secondhand smoke.

You might also note that the contention is not even that 30 minutes of secondhand smoke increases your risk of clogged arteries. The claim is that 30 minutes exposure equals clogged arteries: in other words, that if you are exposed for 30 minutes, you will have clogged arteries.

You can see that it doesn't take a rocket scientist, or even a rocket endotheliologist, to appreciate that TobaccoScam's claim is not only false, but absurd.

If 30 minutes of secondhand smoke exposure caused clogged coronary arteries in healthy people that put them at risk of an immediate heart attack, then wouldn't you expect to see a fair number of young people (in their 20s perhaps) suffering heart attacks? Twenty-year olds, for example, tend to spend a lot of time in smoky bars. You would think that if their coronary arteries got clogged every time they spent 30 minutes in a bar, at least some of them would be likely to suffer heart attacks.

How a group that is telling the public that if they are exposed briefly to secondhand smoke they will suffer clogged arteries and possibly a heart attack can start attacking other scientists for being uninformed is beyond me, but nevertheless, it is happening before my eyes.

Now to my comment on the response itself.

If you carefully look at the peer reviewed papers on secondhand smoke, as well as the most recent Surgeon General and California Environmental Protection Agency reports on secondhand smoke (linked from the Resource Library section of the web site), you will see that the statements on the web site represent the scientific consensus.

First of all, the issue at hand is not "the statements" on the web site; it is the specific statements that have been challenged, which I highlighted in my post. The key claim under contention is that 30 minutes of secondhand smoke exposure clogs arteries in otherwise healthy people. I can assure you that there is nothing in the Surgeon General's report or the California EPA report which suggests that 30 minutes of secondhand smoke exposure causes clogged arteries in anyone other than someone with severe pre-existing coronary artery stenosis.

TobaccoScam is misrepresenting the conclusions of these two reports. It is not the scientific consensus that 30 minutes of secondhand smoke clogs your arteries. That's a bunch of baloney. The scientific consensus is that brief exposure to secondhand smoke activates platelets and causes endothelial dysfunction, which if prolonged and repeated, can cause atherosclerosis and clogged arteries. The scientific consensus is that chronic exposure to secondhand smoke can clog your arteries. Not 30 minutes of exposure.

By conflating endothelial dysfunction and platelet activation with clogged arteries, TobaccoScam is grossly distorting and misrepresenting the science.

Mike Siegel has a blog, which is his (rather uninformed) opinion.

A nice ad-hominem attack, taken right from the anti-smoking playbook. If you are challenged, do not respond substantively. Just attack the challenger and try to discredit him. But do not, by any means, address the actual arguments being made.

Siegel has never done any work on cardiovascular disease, in particular work on the vascular endothelium and his statements clearly reflect a lack of understanding of the effects of smoking on the endothelium or the role that even seemingly minor damage to the endothelium plays in both the immediate risk of a heart attack and also the long term cumulative risk.

This is a classic tobacco industry argument used in the courtroom to try to discredit plaintiff's witnesses, and it's a good thing that TobaccoScam is not testifying in court cases, because this type of statement would be devastating to the cause. Because I have never actually done direct research on the vascular endothelium, I am incapable of offering an informed opinion about the cardiovascular effects of secondhand smoke.

Well, if that's the case, then I suppose I am not capable of offering an informed opinion about any of the health effects of secondhand smoke because I've never done laboratory or clinical research on any human cells, endothelial or otherwise. I suppose I should therefore ask TobaccoScam to remove all references to my work on its site, including my articles that concluded that secondhand smoke is a health hazard to bar and restaurant workers. It's interesting that when I am arguing that secondhand smoke is harmful, I am a credible and reliable and informed source, but when I take a contrary position, I automatically and suddenly become unreliable and uninformed.

I have news for you though. It doesn't take a vascular endotheliologist, or even a cardiologist to evaluate the scientific evidence. It does, however, help to be a physician and an epidemiologist and to have some experience treating patients with heart disease and heart attacks and to have taken a large number of histories from patients with varying degrees of heart disease and vascular damage.

If it were true that minor damage to the endothelium, as observed with 30 minutes of secondhand smoke, increased heart attack risk, then don't you think we would see young people suffering heart attacks? There is a reason why you don't see people starting to suffer heart attacks until they reach at least their 30's. That's because it takes years of damage to develop heart disease.

You don't have a heart attack from eating a single Big Mac. And yes, eating a Big Mac has been demonstrated to cause endothelial dysfunction and platelet activation, just like secondhand smoke.

Can you imagine the American Heart Association putting out a fact sheet that said:
Eating a Big Mac = Clogged Arteries and Increased Risk of Immediate Heart Attack

Eating Big Macs for many years, sure. Even eating a Big Mac if you have severe coronary artery stenosis to begin with and are a heart attack waiting to happen. Sure. But not just a healthy person eating a single Big Mac.

It doesn't seem to me that it would be too difficult to qualify the claim so that it is at least a reasonable representation of the science. As public health practitioners, I think we should be striving for accurate communication of the science to the public, not stretching the science to try to scare people into believing something that is not true.

FORCES Hits the Bullseye on FDA Tobacco Legislation; Shows More Insight than Top Anti-Smoking Groups Combined

In a concise and insightful summary of the broader implications of the proposed FDA tobacco legislation, FORCES International has hit the nail on the head, presenting a picture of the true meaning of the legislation and the reason why Philip Morris supports it, something which the leading anti-smoking groups (which are arm-in-arm with Philip Morris supporting this legislation) seem unable to comprehend.

FORCES presents the broader implications of the legislation in several bullet points, which include the following:

• "Philip Morris had a big part in the writing of the law proposal.
• Once the FDA regulates cigarettes, ALL the responsibilities of the presumed and never demonstrated “tobacco-related” deaths will be on FDA’s shoulders.
• The rest of the tobacco industry opposes the FDA regulation because PM is far ahead of the rest of the industry in the research for a safer cigarette. ...
• After PM has developed the safer cigarette, it will have an edge on the competition. Remember: industries would “kill” for a market share point! And in the case of the cigarette market, one market share point means very many millions of dollars a year return.
• The FDA will have no choice but to approve a “safer” cigarette. And since people are inebriated with authority, once such an “authority” DOES say that the cigarette is safer (because it is in charge and it has to show that “it’s doing something”), the public WILL believe it because – let’s face it – foolishness is a common human characteristic. ..."

The Rest of the Story

In this situation, FORCES is right on the money in its analysis of the FDA legislation. FORCES seems to have the ability to comprehend the broader and most important implications of this policy proposal, something which the leading anti-smoking groups do not appear able to do. It seems to me that it is a sad state of affairs when FORCES has a better understanding of the policy considerations underlying the proposed legislation than the health groups which are proposing it.

Let's take these important bullet points one by one.

Philip Morris had a big part in the writing of the law proposal.

It is very clear that this bill was negotiated between two major parties - the Campaign for Tobacco-Free Kids (representing the health community) and Philip Morris - by way of Congressional mediation. So yes - Philip Morris did have a big part in the crafting of the proposal (whether they drafted any of the language is not something I know). This basic information is something which none of the major health groups, to the best of my knowledge, has ever disclosed to the public or to their constituents. Yet it is critical that the public and the constituents be aware of this information in order to be able to evaluate the proposal appropriately.

Once the FDA regulates cigarettes, ALL the responsibilities of the presumed and never demonstrated “tobacco-related” deaths will be on FDA’s shoulders.

Absolutely true. Once cigarettes are placed under the regulatory authority of the government, then the burden and responsibility of protecting the public, and therefore, the responsibility for the harms caused by cigarettes, shifts largely from the tobacco companies to the government. If FDA assumes the authority to require cigarettes to be less harmful and less addictive, as the Campaign for Tobacco-Free Kids claims it will, then the FDA bears the responsibility if cigarettes continue to kill and addict people.

What the major health groups supporting this legislation don't seem to appreciate is that to regulate means "to permit." The FDA, by assuming jurisdiction over the safety of tobacco products, is essentially permitting cigarette companies to kill people. So what if the product contains less nitrosamines or less nicotine? It's still going to be killing people. The only difference is that it will now be killing people with the FDA's blessing.

This is an unacceptable conundrum which the FDA itself recognizes, which FORCES recognizes, but which the Campaign for Tobacco-Free Kids and its partners in deception seem to have no appreciation of.

The rest of the tobacco industry opposes the FDA regulation because PM is far ahead of the rest of the industry in the research for a safer cigarette.

This is one of the major reasons why Philip Morris supports the legislation. Philip Morris probably stands to benefit the most from the "reduced exposure" provisions of the legislation, which would presumably allow it to roll out Marlboro Ultra Smooth (which has already been test-marketed) or something similar with an advertising campaign that emphasizes how the product will reduce exposure to this and that smoke constituent.

After PM has developed the safer cigarette, it will have an edge on the competition. Remember: industries would “kill” for a market share point! And in the case of the cigarette market, one market share point means very many millions of dollars a year return.

This follows from the above point.

The FDA will have no choice but to approve a “safer” cigarette. And since people are inebriated with authority, once such an “authority” DOES say that the cigarette is safer (because it is in charge and it has to show that “it’s doing something”), the public WILL believe it because – let’s face it – foolishness is a common human characteristic.

This is perhaps the most important point of all. I would go further than FORCES. I would go so far as to say that simply by virtue of assuming jurisdiction over the "safety" of cigarettes, the public is going to believe that cigarettes are safer. But certainly, when the FDA does take action - any action - the public is going to believe that cigarettes have been made a safer product. This despite the fact that there is no evidence that removing any particular constituents from cigarettes will make it safer. The public will essentially be used as guinea pigs to test out the effect of this regulatory approach. The answer will not be evident for years. In the mean time, people will believe that the product is safer.

The upshot of all of this is that the legislation will perpetuate the fraud that tobacco companies were found guilty of committing by implying that certain of their products were safer, except it will shift the perpetration of that fraud from the tobacco companies to the government.

Equally important is the fact that when the public's perception of the safety of cigarettes increases, so does cigarette consumption and smoking rates. When the public believes that cigarette smoking has been made safer, more people are going to smoke than would have otherwise. In other words, the proposed legislation will likely increase smoking, not decrease it. This could well be a public health nightmare, rather than the saving of countless lives as the Campaign for Tobacco-Free Kids claims or the saving of millions of lives as the American Medical Association claims.

Anti-Smoking Hypocrisy Awards - July 2007

This is the second installment of my Anti-Smoking Hypocrisy Awards (first installment is here). These awards are given out for the best examples of hypocrisy in the anti-smoking movement. This month's winners are:

#5 - American Medical Association

Cracking into the top 5 for the first time, the American Medical Association is being recognized for supporting legislation that is supposedly needed to prevent the tobacco companies from making undocumented claims, while at the same time making a doozy of an undocumented claim itself: that the proposed legislation will save "millions of lives."

Are we to seriously believe the AMA's suggestion that this legislation will save millions of lives when the Association doesn't so much as offer an explanation of how exactly the legislation will save even one life, much less millions?

I do, however, have to applaud the AMA for one thing. At least they didn't take the cowardly step that the Campaign for Tobacco-Free Kids took and merely claim that the legislation will save "countless" lives. The Campaign isn't able to actually count the lives because those saved lives don't exist. No plausible mechanism has yet been offered for how the legislation will save lives.

At least the AMA is willing to pin a number on its claim. We don't have any idea of the mechanism, but at least we now know that the proposed legislation will save millions of lives.

Boy - it would sure be nice for me to be able to make bold and grand claims like that without having to support them, back them up, or even offer a plausible mechanism for the purported effect.

The American Medical Association is also being acknowledged for its suggestion that the proposed FDA legislation is necessary because of the tremendous volume of tobacco industry advertising, when in fact the legislation does not regulate the volume of advertising by the industry. This is exactly the kind of deceptive doublespeak that the Campaign for Tobacco-Free Kids and American Cancer Society have perfected in their campaigns to promote the FDA legislation. By adopting similar tactics, the AMA earns its way into the top 5.

#4 - American Cancer Society

Fourth place goes to the American Cancer Society, which has run a campaign of deception in support of the proposed FDA tobacco legislation, which it says is needed because the tobacco industry "has proven that they can't be trusted."

The American Cancer Society publicly misrepresented Philip Morris' position on the legislation, telling the public that "The tobacco industry has fought us at every step of the way," when in fact Philip Morris has supported the Cancer Society's efforts the entire way. Apparently, the tobacco companies aren't the only ones who can't be trusted.

#3 - American Heart Association

Third place goes to the American Heart Association which, in announcing a new policy to hold its annual scientific meetings only in smoke-free cities, supported the policy by telling the public that just 30 minutes of secondhand smoke slows the flow of blood to the heart muscle, making people much more susceptible to a heart attack - a statement which is untrue. The Heart Association then announced that its next scientific conference will be held in Orlando, a city in which bar workers are exposed to extremely high levels of secondhand smoke.

You see - in Florida, smoking is still allowed in bars. If attendees of the AHA conference this fall go out for drinks in the evening in an Orlando bar, they will more likely than not be exposed to high levels of secondhand smoke. Can you imagine all the heart attacks that are going to occur during the conference? It's a good thing that there will be so many cardiologists around.

The hypocrisy of the AHA's press release is startling. Secondhand smoke is so dangerous that only 30 minutes of exposure decreases your coronary blood flow and can trigger a heart attack; however, it's not so bad that we need to protect bar workers from secondhand smoke. Let them keel over from heart attacks - as long as the AHA conference attendees have a place to enjoy their evening cocktails to unwind after a long day of scientific presentations (many of which, incidentally, are going to be about how harmful secondhand smoke is).

#2 - Campaign for Tobacco-Free Kids

The Campaign for Tobacco-Free Kids earns a well-deserved and solid second place finish for its support of legislation that it says is needed to stop the tobacco companies from making deceptive and misleading representations to the public, but with the use of a deceptive campaign of its own in which the Campaign is deceiving its own constituents and the public about the legislation.

On multiple occasions (it has become essentially a weekly occurrence), the Campaign for Tobacco-Free Kids has misled its constituents by stating or implying that the proposed FDA tobacco legislation is opposed by Big Tobacco, when in fact the largest company within Big Tobacco - Philip Morris - supports the legislation and is vigorously promoting its passage.

The Campaign's misrepresentation of the truth, which I have documented in multiple posts (example 1; example 2; example 3; example 4; example 5; example 6; example 7; example 8), is glaringly hypocritical in light of its stated purpose: to make sure that the tobacco companies do not deceive the public in their public communications.

The Campaign's seeming inability to tell the truth even garnered the attention of R.J. Reynolds, which rarely in recent years has called any anti-smoking group to task. Reynolds, most likely in vain, asked the Campaign to try sticking to the facts.

The fact that the Campaign for Tobacco-Free Kids is misusing youths in order to get them to lobby for this legislation only adds to the Campaign's case for a strong second place (example 1; example 2; example 3; example 4; example 5).

#1 - American Legacy Foundation

There are multiple levels of hypocrisy for which the American Legacy Foundation is being rewarded here.

First, the American Legacy Foundation testified before Congress last month, decrying the actions of companies like Time Warner, whose depiction of "smoking on screen recruits about 390,000 new youth smokers every year." According to Legacy, "youth exposure to movie smoking explains between one-third and one-half of all adolescent smoking initiation." Legacy has repeatedly bemoaned the exposure of youths to smoking in non-R rated movies, and has called for the Motion Picture Association of America to adopt a policy of giving an "R" rating to any movie that depicts smoking in a non-historically correct manner.

So who did the American Legacy Foundation choose as its leading corporate partner? You guessed it...Time Warner, the chief culprit of what Legacy says is basically the killing of our nation's children by addicting them to smoking. That pretty much defines hypocrisy. For that alone, Legacy probably would have carried home first place in the July 2007 Anti-Smoking Hypocrisy Awards.

But wait - there's more. As a condition for Schools of Public Health accepting funding from the American Legacy Foundation, schools were required to sign a statement agreeing not to take funding from any tobacco company for the duration of the grant. This clause in the grant conditions is known as Clause 12.

As explained in a recent Public Health Reports article: "Grants awarded under this program required that the dean or CEO of the school of public health confirm that the school of public health does not currently accept nor will accept any grant or anything else of value from any tobacco manufacturer, distributor, or other tobacco-related company during the grant period. This restriction is a policy of the American Legacy Foundation and applies to all of the foundation'’s grantees and sub-grantees."

Thus, a School, in order to receive Legacy funding, has to agree that none of the researchers at the institution will accept tobacco funding. If I were to successfully apply for an American Legacy Foundation grant, then the conditions of that grant would mean that my colleagues at the School - all of them - would be bound from applying for funding from any tobacco-related company.

Of course, the ultimate irony of this whole story is that the American Legacy Foundation receives all of its funding from...
... you guessed it: the tobacco companies!

So you can imagine how heavily the hypocrisy is spread out over the Legacy Foundation, to have the gall to say that taking tobacco money is fine for them, but completely unacceptable for anyone else.

Moreover, to make matters much, much worse, Legacy is attempting to obtain funding to sustain its "truth" campaign from...
... you guessed it: the tobacco companies!

Legacy is doing this by funding a front group - the Citizens' Commission to Protect the Truth - to push for tobacco company funding of the campaign. According to its web site, the Commission is working toward either voluntary or involuntary tobacco company funding to support the campaign: 'The Commission is seeking to persuade or force the tobacco companies to accede to court-supervised funding of the Public Education Fund through the Master Settlement Agreement (MSA), which they signed with the states in 1998."

Apparently, persuading the companies to fund Legacy by voluntarily continuing MSA payments would be acceptable to Legacy.

I don't think it's possible to be any more hypocritical than this.

Essentially, what Legacy is saying is that what Legacy is doing is so valuable that taking tobacco company money is justifiable, but no matter what anybody else is doing, taking tobacco money is completely unacceptable.

When the corrupt, filthy, criminal tobacco money hits anyone else's hands, it stays corrupt, filthy, and criminal, but when it hits Legacy's hands, it is immediately purified.

Maybe they run it through some sort of Holy Water, or something. Or have a Rabbi perform a special blessing?

Notice, by the way, that no where on the Commission's home page does it notify the public that the Commission is not some sort of independent group. Instead, it is funded by the American Legacy Foundation! Isn't that special? Funding a so-called citizens' group to support funding for... you! Sounds exactly like something the tobacco companies would do. But if you don't read the fine print on an entirely separate web page, you'll miss that small detail.

Under these circumstances, I do not find it acceptable for Schools to accept funding from the American Legacy Foundation. So like its benefactors, I would add Legacy to the short list of companies and organizations from which I would argue that universities should not accept research funding.

Third, despite calling smoking in movies one of the gravest threats to children's health, and despite making a big fuss to Congress about how an R-rating is needed for any movie that depicts any smoking in order to protect children from seeing smoking and starting to smoke because of it (which 390,000 of them apparently do every year), Legacy is calling for an exception to be made for any movie that depicts smoking in a historically correct manner.

If it is indeed true that depiction of smoking in movies is going to result in killing people (as the American Legacy Foundation has put it), then what possible justification is there for allowing kids to be exposed to any depiction of smoking, whether it is historically correct or not?

Who cares if a smoking depiction is historically correct if it is going to cause kids to become addicted to smoking and ultimately, for many of them to die because of it? If a depiction of smoking in a movie is going to result in disease and premature death among many of those in the audience, then how can we possibly allow an exemption for movies that depict smoking in a historically correct manner? Who cares if the person actually smoked or not? It is the smoking depiction that is killing kids, not the historical accuracy or inaccuracy of that depiction.

I find it extremely hypocritical for anti-smoking groups to suggest that smoking in movies is so bad that we need to remove any shred of it from any movies which kids may view, but that it is not so bad that we need to remove the historical depiction of smoking.

Finally, despite calling its youth anti-smoking media campaign "truth," Legacy repeatedly fails to disclose the truth about the research which it alleges demonstrates the effectiveness of this campaign in greatly reducing youth smoking in the nation: that the research was funded by, and authored by, the American Legacy Foundation itself. Legacy continues to fail to disclose this inherent conflict of interest, which in my view is an ethical violation. Even in its recent testimony before Congress, Legacy represented this research simply as being "peer-reviewed research," failing to disclose that the chief executive officer of Legacy was a senior author of the paper, the research behind which Legacy funded.

For these many examples of hypocrisy, I award the American Legacy Foundation the highest possible honor: #1 in the Anti-Smoking Hypocrisy Awards for July 2007.

For more details and documentation on Legacy hypocrisy, see the following posts:
post 1
post 2
post 3
post 4
post 5
post 6

Anti-Smoking Groups Supporting 61 Cents Per Pack Increase in Federal Cigarette Tax to Fund Children's Health Insurance Program

Senators Ted Kennedy (D-MA) and Orrin Hatch (R-UT) have announced a proposal to increase the federal cigarette excise tax from 39 cents to one dollar per pack in order to fund the State Children's Health Insurance (S-CHIP) program, which is up for re-authorization this year.

According to a Cybercast News Service article, the proposal is supported by the American Academy of Family Physicians, which stated: "By discouraging smoking through an increase in the tobacco tax and using the resulting revenues to improve enrollment in children's health insurance programs, we are creating a win-win proposition in support of our children's health."

The proposal is also supported by the Campaign for Tobacco-Free Kids, which stated: "A higher cigarette tax is a win-win solution - a health win that will reduce tobacco use and save lives and a financial win that will raise much-needed revenue to fund important programs while also reducing tobacco-caused health care costs."

The Rest of the Story

While on the surface it may appear that this is a great idea that serves two purposes - reducing smoking and providing revenues to fund health insurance for children - a closer examination reveals that the idea is severely flawed and unacceptable from a public health perspective.

Essentially, what the proposal does is make the coverage of children's health care dependent upon the continued sale of cigarettes. In other words, it asks smokers to take on the responsibility of funding children's health care. And it depends on smokers continuing to smoke in order to continue the funding. As such, it greatly reduces any incentive for the federal government to take any action that might substantially reduce smoking rates and therefore cigarette tax revenues.

The tax is an unfair one because it places the burden of funding children's health care entirely on smokers, yet the benefits of the tax do not accrue to smokers at all. And it is a regressive tax because it places the burden of funding children's health care disproportionately on people who can least afford it.

The National Center for Policy Analysis recently released a report that explains why this proposal is a regressive one and exposes the financial burden that it places upon the poor. It provides a nice profile of exactly who is going to be funding children's health care under Kennedy and Hatch's proposal. In addition, the Tax Foundation issued a report which reveals that the poor in many states will shoulder the burden of paying for the S-CHIP program but without accruing any of the benefits.

I do not understand the knee-jerk support of anti-smoking groups for any cigarette tax increase under the sun. There seems to be no consideration of the fairness of the proposal, the regressiveness of the proposal, and the long-term consequences of tying a vital health care program to the continued consumption of cigarettes.

Especially at the federal level, funding for children's health insurance should be a top-level priority. It should not require the creation of revenue from the sale of cigarettes to fund health care for our nation's children.

By supporting this tax proposal, health and anti-smoking groups are actually stating that they do not believe that the federal government should fund children's health care out of the general revenues. They are actually stating that they do not believe that the wealthiest citizens and corporations should bear the burden of funding health care for the poorest. They are supporting the creation of a system in which one of the most critical public health programs imaginable will be entirely dependent upon high levels of cigarette consumption in order to remain solvent.

The American Academy of Family Physicians actually responded to this argument, by stating: "the fact of the matter is that we've got so many adults that still smoke that there's going to be tax money coming in to fund CHIP ... it's going to be a long time before there's any significant decrease of funding coming in through the tobacco tax."

This is a very disturbing defense of the proposal. The AAFP is essentially admitting that it has no interest in taking any initiative that would greatly reduce smoking. The Academy is convinced that there will be high rates of smoking well into the future and seemingly accepts that fact. I would think that our nation's family physicians would actually believe that it is worth trying to reduce smoking rates, rather than merely accepting the high rates well into the future, and being reassured that the money will keep coming through so that children's health care is covered and they do not have to provide as much free care.

I suggest that organizations like the American Academy of Family Physicians and the Campaign for Tobacco-Free Kids (and other anti-smoking groups that support this proposal) start a fund-raiser to help raise money to promote this proposed policy. My idea is simple - a T-shirt sale. Here is what the T-shirts would say:

Support children's health. Smoke cigarettes.

I support children's health. I smoke.

Light up as often as you can. Support the health of our nation's children.

Contribute your share to help the children. Buy cigarettes.

I really care about our kids. I buy by the carton.

Children's health supporter.
Smoker.

You may not like my smoke, but my money is paying for your kids' health care.

I welcome readers' suggestions for additional T-shirt slogans.

Campaign for Tobacco-Free Kids Honesty Challenge Sweepstakes

A June 30 solicitation from the Campaign for Tobacco-Free Kids, seeking support from constituents for the proposed FDA tobacco legislation sought by Philip Morris, suggests once again (incorrectly and deceptively) that the legislation is opposed by Big Tobacco and that supporting the legislation is therefore fighting Big Tobacco.

The Campaign for Tobacco-Free Kids' plea states: "Last week, we asked E-champions to share how tobacco use has impacted their lives. Within a few days we received more than 200 personal stories sharing the devastating effects that tobacco use brings. E-champions described how loved ones' lives were tragically cut short because of deadly tobacco addictions. Grandparents and parents missed weddings, graduations and births due to tobacco-related deaths. Has your life been impacted by tobacco use? There's still time to add your voice! Click here to visit VoicesAgainstTobacco.org and share your story. Right now Congress is considering a bill that would give the Food and Drug Administration the authority to regulate tobacco products. Your stories are crucial to passing this life-saving legislation. Not only do these stories allow you to share your concern and outrage over Big Tobacco, but they also help our team on Capitol Hill. Hearing stories directly from their constituents help Members of Congress realize that tobacco hurts their own community. Please visit VoicesAgainstTobacco.org today and add your story to the hundreds who have already spoken against the harms of a deadly tobacco addiction. ... Help us fight Big Tobacco by sharing how tobacco has affected you."

The Rest of the Story

Once again, the Campaign for Tobacco-Free Kids has disseminated a deceptive communication which misleads its constituents about the FDA tobacco legislation. The Campaign is deceiving its constituents by suggesting that the legislation is uniformly opposed by Big Tobacco, when in fact the largest member of Big Tobacco - Philip Morris - actually supports the legislation.

This deceptive campaign is really getting out of control. One after another, the deceptive communications continue to roll out from the Campaign for Tobacco-Free Kids. The organization simply does not appear to be capable of telling the truth. It is now about as trustworthy as the very companies that it is claiming to be fighting in the halls of Congress.

Today I announce the Campaign for Tobacco-Free Kids Honesty Challenge Sweepstakes. Here's how it works:

I am challenging the Campaign for Tobacco-Free Kids to put out one - just one - honest communication that does not deceive its constituents and the public about the nature of the proposed FDA tobacco legislation. And I am offering a financial reward - a virtual sweepstakes - for a successful response to this challenge. Reaping in this money will be even easier than soliciting personal donations to support the YAYAs. All the Campaign has to do is tell the truth.

Here are the dollar amounts the Campaign will receive for being honest about various critical facts concerning the legislation:

If the Campaign tells the public that Philip Morris is supporting this bill, I will contribute (no questions asked) $25 to the Campaign.

If the Campaign tells the public that Philip Morris is supporting this bill and that they are supporting it because it will help the company's bottom line, I will contribute (no questions asked) $50 to the Campaign.

If the Campaign tells the public that Philip Morris is supporting the bill because it contains a number of specific provisions that were inserted to protect the company's profits, I will contribute (no questions asked) $100 to the Campaign.

If the Campaign tells the public that the bill was negotiated between itself and Philip Morris through Congressional intermediaries, I will contribute $250 to the Campaign.

If the Campaign tells the public that the bill was negotiated between itself and Philip Morris and that it contains specific provisions that weaken the FDA's ability to regulate tobacco products in order to protect Big Tobacco financial interests, I will contribute $350 to the Campaign.

If the Campaign tells the public that the bill was negotiated between itself and Philip Morris and that it contains specific provisions that weaken the FDA's ability to regulate tobacco products in order to protect Big Tobacco financial interests, and that these provisions were placed into the legislation and approved by the Campaign because it didn't want to risk losing Philip Morris' support, I will contribute $500 to the Campaign.

Here is the only caveat: the Campaign must be honest in the next communication that it sends out. This is a one-chance sweepstakes. If the next communication sent out by the Campaign related to this topic is dishonest, as its previous communications have been, I will find a different way to use the money that I have allocated to this sweepstakes.

Note: This offer is void where prohibited by law. Any sweepstakes contributions will be tax deductible to the maximum amount allowed by the law. No purchase necessary. Sweepstakes is offered only to the Campaign for Tobacco-Free Kids or its affiliated lobbying group - the Tobacco-Free Action Fund. Prize is non-transferable by winner. Sponsor reserves the right to disqualify the entrant if these Sweepstakes rules are not followed. By entering, you agree to comply with all applicable law and these Sweepstakes rules, and you agree to abide by all decisions of the Sponsor. Sweepstakes entrant may enter beginning July 5, 2007. Contest ends on August 5, 2007. All decisions of Sponsor are final. Sponsor is not responsible for the inability to contact winners resulting from incomplete, incorrect, incomprehensible, illegible, or out of service e-mail addresses or phone numbers provided by entrants.

Odds of Winning. If the entrant tells the truth, odds of winning are 100%. If the entrant is dishonest, misleading, or deceptive, the odds of winning are 0%.

Smokers Deemed Unsuitable for Employment at Cleveland Clinic

Beginning September 1, all applicants for jobs with the Cleveland Clinic - a health system that is Ohio's second largest employer - will be tested for cotinine and rejected for employment automatically if the test indicates that they smoke or use smokeless tobacco (article 1; article 2; article 3).

The non-hiring of smokers policy will apply to all Cleveland Clinic sites in Ohio and Florida, as well as to all vendors hired at these sites. The clinic has more than 36,000 employees. It now joins Medical Mutual and Scotts Miracle-Gro as a large Ohio company which refuses to hire smokers. The policy will apply only to new applicants.

According to the official new policy: "Beginning Sept. 1, the policy goes into full effect, and all applicants who test positive for cotinine will not be offered employment at Cleveland Clinic. This policy applies to all Cleveland Clinic campuses in Ohio and Florida (but not Canada). Applicants will be referred to a free tobacco cessation program paid for by Cleveland Clinic. After 90 days, those who have been successful in quitting will be encouraged to reapply."

The reason for this policy provided by Cleveland Clinic is as follows: "Cleveland Clinic has been a leader in preventative health and wellness. In 2005, we designated the entire health system smoke-free. Last fall, we supported the SmokeFreeOhio Initiative on ballots. Recently, trans fats were banned from all patient and cafeteria menus. Cleveland Clinic will join the World Health Organization, the American Cancer Society and more than 6,000 other employers in the United States who have chosen to advocate for healthier living. 'As a leading healthcare organization dedicated to fighting disease and advocating healthy living, our policies and procedures must reflect that commitment,' says Toby Cosgrove, M.D., President and CEO."

"As Cleveland Clinic helps move society from “sick” care to “health” care, it’s important to acknowledge these startling statistics: The treatment of chronic medical conditions comprises more than 75 percent of the nation’s $1.4 trillion medical expenditures. Chronic medical conditions account for 70 percent of all deaths in the United States. Smoking costs more than $75 billion annually in direct and indirect medical costs. These costs and statistics call for healthcare organizations to take the lead in promoting wellness and disease prevention, regardless of the tough choices that may be involved. By instituting this new hiring policy, Cleveland Clinic will play a role in reducing healthcare costs for patients, employers and the government by promoting prevention and wellness."

The Rest of the Story

Clearly, by its own reasoning, the Cleveland Clinic's policies and procedures do not reflect a commitment to advocating healthy living. While smoking may account for $75 billion in medical costs, obesity accounts for more than $78 billion (even more than smoking). Yet the Cleveland Clinic has not announced a policy to refuse to hire fat people. If the Cleveland Clinic were true to its word about adopting policies and procedures that reflect a consistent commitment to advocate healthy living, then surely they would institute a policy of refusing to hire people who are overweight or obese. As with smoking, such applicants could be referred to a weight loss program and encouraged to reapply after 90 days if they lose sufficient weight.

Similarly, the Cleveland Clinic doesn't appear to care about the alcohol problem that afflicts American society and causes a huge burden of chronic disease. While smokers need not apply, persons who drink too much alcohol are free to seek employment with this health system that considers itself a leader in "preventative" health and wellness. So are those who engage in unsafe sexual activities, eat far too much fat in their diets, consume high amounts of unhealthy trans-fats, or engage in a sedentary lifestyle and get absolutely no physical activity or exercise.

To be clear, what the Cleveland Clinic is doing is discriminating against smokers in employment. They are justifying this selective and targeted employment discrimination on the grounds that it is important to promote a healthy workforce. Yet they show no desire to actually promote a healthy workforce by making sure that prospective employees are actually healthy. They can be as unhealthy as they want to be, as long as they don't smoke.

Obesity - that's fine. Alcohol overuse - fine. An unhealthy diet - fine. High trans-fat intake - fine. High cholesterol intake - fine. No exercise at all - fine. The only thing that is not fine is smoking. You can't convince me that the Cleveland Clinic is solely motivated by a desire for a healthy workforce. Clearly, they don't give a particular damn about whether their new employees have a host of other health problems (which may be far more severe than smoking at their particular ages). They only care about whether they smoke or not.

Perhaps the Cleveland Clinic would argue that they do care about these other problems - that's why they have health and wellness programs at their facilities to address them. Great, then implement health and wellness programs to address smoking as well. You don't deal with these other health problems through corporate wellness programs and deal with smoking by throwing applicants' resumes in the trash can.

Sadly, the precise reasoning the Cleveland Clinic is 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 and to promote a healthy workforce, then we must also support the idea of excluding fat people from employment.

If the Cleveland Clinic were taking a broad and consistent approach to hiring in terms of healthy lifestyles, and refusing to hire anyone who engages in a behavior that has serious long-term health implications, it would be one thing. Then I might take them seriously and believe that the health and economic concerns are really at the forefront of their action. But by discriminating only against smokers, I think they have exposed the true force beyond the policy: bigotry and intolerance of a large segment of the population whose personal and private lifestyle choices they are unwilling to accept.

I'm sorry, but employers have no business inside the homes of their employees, other than to ensure that they are not engaging in illegal behaviors or behaviors that directly impair their job performance. And employers certainly have no business getting inside the body fluids of their employees, except, again, to ensure that they are not using illegal substances. But when it comes to engaging in lawful behaviors in one's home that do not directly influence job performance, an employer has no business interfering with an employee's or potential employee's privacy.

Perhaps most disturbing is the degree to which the Cleveland Clinic appears willing to intrude into the privacy of employees' homes. I don't want my employer snooping around my house to see what I do in my own home on my own time. If they suspect me of illegal behavior and they want to pry on me, that's one thing. But if it's lawful behavior that's not in any way unprofessional, then they have no business controlling what I do in my home. And they have no business making employment decisions based on it.

This is what scares me most, because it suggests that anti-smoking groups have completely lost a sense of perspective. The only thing that matters is whether people smoke or not and how much we pay for smoking-related costs. We need to reduce smoking and these smoking-related costs at all cost. No matter how intrusive of our privacy, autonomy, or rights. There's nothing to stop us. Nothing to get in the way of our agenda.

The anti-smoking movement does not appear to understand or respect that what people do in their homes is their own business, as long as it is lawful and does not directly impair their job ability.

Even if the movement didn't respect the privacy and autonomy of individuals, it would still be more respectable in my eyes if it wanted to impose its intrusion systematically and consistently. So if these groups were calling on a workforce of non-smoking, physically active, thin (but not too thin), normocholesterolemic, non-hypertensive, non-hyperglycemic, and sexually non-promiscuous individuals, then I might believe that this is all motivated by a true concern for health and health care costs.

But the singling out of one particular risk factor suggests that there is something deeper going on, something beneath the surface. And I think what's underlying it is some sort of basic intolerance of smokers, and perhaps a desire to punish smokers and coerce them to change their behavior in a desired way.

Ohio needs a law to prevent this type of intrusion and discrimination. And it needs it now. As much as I hate to support the idea of government intervention to control this problem and protect people's privacy and rights, I don't see that the anti-smoking movement is going to back down.

This type of employment discrimination and bigotry is a terrible precedent, and it paves the way for even more serious discrimination. If we want to eliminate the most severe forms of discrimination from society, then I think we need to be concerned about the less egregious forms, which will otherwise open the door for, and pave the way for more serious breaches of personal rights, privacy, and autonomy.