Friday, November 28, 2008

American Academy of Pediatrics Center Director Defends Violence and Abuse in Movies Based on the Non-Addictive Quality of These Behaviors

In a response to Dr. Simon Chapman's criticism of the policy being supported by many anti-smoking groups which would require an R-rating for any movie depicting smoking, Dr. Jonathan Klein - Director of the American Academy of Pediatrics Julius B. Richmond Center of Excellence - argues that smoking, unlike violence and spousal abuse - deserves an automatic R-rating for any depiction because unlike these other behaviors it is addictive.

Dr. Chapman argued, for example, that the R-rating for movies that depict smoking is a narrow-minded approach that ignores the many other unhealthy behaviors that are portrayed in movies (for which the anti-smoking groups are not calling for an automatic R-rating), including: crime, physical inactivity, over-eating, excessive use of alcohol, unsafe sex, speeding and dangerous driving, gambling, risk taking such as extreme sport and adventure, motor cycle use and helmet-less cycling.

Dr. Chapman argues that: "an illustration of how such inconsistency plays out in practice comes from which rates the 2008 'What Happens in Vegas,' starring Cameron Diaz, as a "thumbs up/pink lung" because it contains no smoking. However, it does contain binge drinking, failure to wear seat belts, intoxication leading to possibly unprotected sex, gambling and a parody of spousal abuse."

In his response, Dr. Klein defends the proposed policy - which the American Academy of Pediatrics has endorsed - by arguing that unlike other behaviors, smoking is addictive. Apparently, the addictive nature of smoking is what warrants giving the depiction of smoking an automatic R-rating. Dr. Klein writes: "Other potentially adverse role modeled behavior does not have tobacco's highly addictive drug, nicotine, as a factor in children's exposure. The behavioral expectancy establishes a modeled response which then is reinforced by pharmacology, with well established and substantial health results. This is why the American Academy of Pediatrics and many other medical and public health organizations have endorsed the R rating."

The Rest of the Story

So let's get this straight. While smoking, crime, physical inactivity, over-eating, excessive use of alcohol, unsafe sex, speeding and dangerous driving, failure to wear seat belts, physical and sexual abuse, gambling, risk taking such as extreme sport and adventure, motor cycle use and helmet-less cycling are all unhealthy behaviors depicted in film, smoking is the only one of these which should trigger an automatic R-rating because it, unlike the others, is addictive and in which its effect on children's and adolescent's behavior is pharmacologic.

Coming from the American Academy of Pediatrics, I find this to be an unfortunate and irresponsible statement. How can an organization that is supposed to have a wide view of health problems affecting children and adolescents defend the depiction of crime, binge drinking, unsafe sex, speeding and dangerous driving, and physical and sexual abuse in movies on the grounds that these are not pharmacologically addictive behaviors?

That is, unfortunately, exactly what the statement is doing.

This response seems to me to highlight just how narrow-minded a view of the world anti-smoking groups now have. The only thing that matters is preventing even a single depiction of smoking in movies. You can have all the binge drinking, sex, violence, and abuse that you want, but please - no cigarette smoking.

I don't exactly understand what has caused the anti-smoking movement to reach the point where it has a single-minded view of the world in which smoking is the only problem in the world that needs to be addressed. It perplexes me why we would want to address only the depiction of smoking in movies, while ignoring the extreme violence and physical abuse (and a host of other unhealthy behaviors) that dominate even children's films today.

But that narrow-minded, single-issue approach is exactly what the anti-smoking and health groups that have endorsed the R-rating policy are doing.

And this response to Dr. Chapman's broad-based and well-reasoned argument demonstrates just how unreasonable, irresponsible, and even damaging this single-issue, narrow-minded approach can be.

My published "rapid response" to the commentary and responses appears here.

Wednesday, November 26, 2008

Tobacco Control Commentary Criticizes Anti-Smoking Groups' Proposal for an R-Rating for All Movies that Depict Smoking

In a commentary published in the current issue of the journal Tobacco Control, the journal's editor - Dr. Simon Chapman - criticizes the proposal being supported by many anti-smoking groups (including Smoke Free Movies, the American Legacy Foundation, and the American Public Health Association) to require an R-rating of any movie that depicts smoking (see: Chapman S. What should be done about smoking in movies? Tobacco Control 2008; 17(6):363-367).

Dr. Chapman writes: "In many liberal societies sexual, violent and illicit drug scenes in movies invoke classification as unsuitable for very young children, although there is considerable variation between nations about what is permissible to screen to children. Parents do not have time to research the content of all movies and value movie classifications as a way of helping them avoid inappropriate, possibly disturbing, content. This brings us to the widely supported proposal that smoking should not be banned in movies, but that all but manifestly anti-smoking scenes—even those where smoking is only "implied"—should cause a movie to be classified as "R". Under the Smoke Free Movies policy, this would mean that even one instance of smoking would see a movie classified as being equivalent to the Motion Picture Association of America’s standard for those depicting "adult themes, adult activity, hard language, intense or persistent violence, sexually-oriented nudity, drug abuse or other elements", where such scenes are often sustained. Is this an equivalence that many in the community would find reasonable?"

"For example, the US-based Smoke Free Movies site currently rates the new Batman movie The Dark Knight as "promoting smoking" because, amid a cast of thousands, one minor character smokes a cigar. While activists dedicated to eradicating smoking in children’s movies engage in organised complaining about such closely monitored incidents, it seems improbable that many ordinary citizens would spontaneously rise up in community protest about such minor usage in the way they would about the sort of sustained adult content that currently sees movies classified as unsuitable for children, should those movies be not so classified. In this respect, arguments based on the unacceptability to the community of any smoking scenes are highly unlikely to find widespread support and be seen as overly extreme solutions proposed by single-minded interest groups." ...

"If even a single instance of smoking were to consign a movie to R status because of its potential to influence children to smoke, immediate parallel questions arise about a wide range of other potentially adverse role modelling cues in films. Smoking causes massive health problems, but in that it is not unique. Globally, large-scale health and social problems flow from many activities that also often appear in movies. These include crime, physical inactivity, over-eating, excessive use of alcohol, unsafe sex, speeding and dangerous driving, gambling, risk taking such as extreme sport and adventure, motor cycle use and helmet-less cycling. For example, by the same reasoning that movies showing smoking might normalise or glamorise tobacco use, it could be argued that film should never show positive scenes of gluttony or actors enthusiastically eating fast food because of the obesity epidemic and millions of overweight and obese children struggling to control their weight. Countless comedy scripts would need to go back to the drawing board. Scenes of people drinking alcohol might be excised from children’s movies—particularly if those drinking seemed to be enjoying it—because this might seed inappropriate ideas about alcohol in tender minds. All car chases and speeding scenes of course would be restricted to adult movies." ...

"an illustration of how such inconsistency plays out in practice comes from which rates the 2008 What Happens in Vegas, starring Cameron Diaz, as a "thumbs up/pink lung" because it contains no smoking. However, it does contain binge drinking, failure to wear seat belts, intoxication leading to possibly unprotected sex, gambling and a parody of spousal abuse."

The Rest of the Story

I agree with Dr. Chapman's analysis and I commend him for having the courage to publicly express his criticism of a proposal being championed by many mainstream anti-smoking groups.

To me, what this article highlights is the single-mindedness, the issue-specific focus of today's anti-smoking movement and the inability of the movement to see beyond the narrow blinders that restrict its vision to nothing but smoking. There are a lot of health risks beyond smoking and there are a lot of health-related problems with movie content beyond the depiction of cigarette smoking. But because of their narrow, single-minded view, anti-smoking groups ignore everything but the smoking.

As Dr. Chapman points out, Smoke Free Movies applauded the film "What Happens in Vegas" and gave it a favorable "thumbs up/pink lung" rating because it didn't contain a single portrayal of cigarette smoking. However, the movie does depict "binge drinking, failure to wear seat belts, intoxication leading to possibly unprotected sex, gambling and a parody of spousal abuse."

Is this a film to which responsible public health practitioners should be giving a thumbs up?

Thumbs down to smoking, but thumbs up to binge drinking.
Thumbs down to smoking, but thumbs up to intoxication.
Thumbs down to smoking, but thumbs up to spousal abuse.

This is the message that Smoke Free Movies and other anti-smoking groups are actually sending to the public through their support of the very narrow-minded "R-rating for any depiction of smoking" policy.

As Dr. Chapman concludes: "If the more reasonable proposition were promoted that smoking ought to be considered as one element within movie rating panels’ assessments of how a movie should be rated, I would predict that many within government and the movie industry would be more receptive and more progress would be made."

Unfortunately, reason is not something that characterizes the anti-smoking movement. It has become more of a religion or an ideology than a specialized field of practice within the scope of public health.

Tuesday, November 25, 2008

Executive Director of Campaign for Tobacco-Free Kids Violates President-Elect Obama's New Rules for Lobbyists on Transition Team

One of the important principles upon which Senator Barack Obama based his campaign for the presidency was that the days of lobbyists running the White House were over and that he would institute tight controls over lobbying influence on administration policy. In a 2007 campaign speech in Iowa, Obama said he was "running to tell the lobbyists in Washington that their days of setting the agenda are over."

Perhaps the first manifestation of this new approach was strict rules that President-Elect Obama announced governing the appointment of lobbyists to his transition team. Describing these rules as "the strictest, and most far reaching ethics rules of any transition team in history," Obama Transition Co-Chair John Podesta announced that "If someone has lobbied in the last 12 months, they are prohibited from working in the fields of policy on which they lobbied."

According to a New York Times article: "Stephanie Cutter, a transition spokeswoman, said in a written statement that the transition team reflected what she called Mr. Obama’s 'commitment to change the way Washington does business and curb the influence of lobbyists on our government.' 'While these rules disqualify many well-qualified professionals from participating in the transition as a result, they also put in place the right safeguards to prevent any potential conflicts of interest,' Ms. Cutter said."

According to the Transition Team web site, one of the transition team leads for the agency review team that is making strategic policy decisions regarding the Department of Health and Human Services is Bill Corr, Executive Director of the Campaign for Tobacco-Free Kids.

As recently as September 2008, Mr. Corr was a registered lobbyist for the Campaign for Tobacco-Free Kids, who lobbied for the FDA tobacco legislation (the FDA is under the Department of Health and Human Services) and for Health and Human Services Department appropriations.

The Rest of the Story

By agreeing to serve on the transition team, it appears that Mr. Corr - the Executive Director of the Campaign for Tobacco-Free Kids - is in violation of the transition team policy by which any individual who has lobbied in the past 12 months is "prohibited from working in the fields of policy on which they lobbied." Since tobacco policy, the role of the FDA in tobacco policy, and the appropriation levels for the Department of Health and Human Services are all fields of policy that are intrinsically related to the Department of Health and Human Services, it seems apparent that Corr is in violation of the transition team lobbyist policy.

Even if he recuses himself from tobacco-specific issues, there is no way I believe that Corr can avoid working in the field of policy on which he lobbied. Even considering the funding, scope, and role of the FDA would be inappropriate - and in violation of the rules - because this clearly is related to the field of policy on which Corr lobbied within the past year.

On August 21, 2008, Corr issued a press release and public statement in which he called for passage of the FDA tobacco legislation and for federal funding for tobacco prevention and cessation programs (which would come from the Department of Health and Human Services): "Most immediately, Congress should enact pending legislation granting the U.S. Food and Drug Administration (FDA) authority over tobacco products, which would impose specific restrictions on tobacco marketing that appeals to kids and give the FDA authority to further restrict tobacco marketing to the full extent allowed by the First Amendment. ... Both the federal government and the states should increase funding for tobacco prevention and cessation programs, including mass media advertising campaigns."

In a July 30, 2008 press release, Corr wrote: "The FDA is the right agency to regulate tobacco products because it is the only agency with the combination of regulatory experience, scientific expertise and public health mandate. The pending legislation is carefully crafted to ensure the FDA's new tobacco-related responsibilities do not in any way impede or take resources from its current responsibilities. The legislation would require tobacco companies to pay user fees that would fully fund the FDA's tobacco-related responsibilities so no funding is taken from the FDA's current work. The legislation would also create a new, separate center for tobacco product regulation within the FDA, leaving existing offices and functions within FDA undisturbed by this new authority."

In a May 7, 2008 press release, Corr wrote: "Congress and the Administration should implement the National Action Plan for Tobacco Cessation recommended by an expert scientific advisory panel to the U.S. Department of Health and Human Services. The plan calls for increasing the federal cigarette tax by $2 per pack and using at least half the revenue for smoking cessation initiatives including: a national telephone quitline through which smokers could obtain cessation medication and counseling; a national paid media campaign encouraging cessation (such a campaign should also include a strong youth prevention component); providing coverage for smoking-cessation counseling and FDA-approved medicines under federally funded health care programs including Medicare and Medicaid; increased investment in research to improve smoking cessation therapies; and training for health care providers in treating tobacco dependence. The only portion of this plan the Administration has implemented is a network of state quitlines. Congress should also pass legislation giving the U.S. Food and Drug Administration (FDA) authority to regulate tobacco products."

Thus, Mr. Corr has been lobbying quite broadly on the issue of Department of Health and Human Services policy, priorities, structure, programs, research, training, and funding. It is not possible for him to serve as a lead for the HHS review team and not work in the field of policy on which he lobbied.

Failing to recuse themselves from national policy strategy groups is not something new to prominent tobacco control advocates. I previously criticized Dr. Michael Fiore for failing to recuse himself from the chairmanship of the NIH expert panel which developed a clinical practice guideline for the treatment of tobacco dependence, despite his significant financial interests in pharmaceutical companies.

This might not be all that bad, if it weren't for the fact that we in tobacco control vigorously attack those tied to the tobacco companies for their conflicts of interest and their attempts to influence public policy. It's really the hypocrisy that bothers me the most, more than simply the act of participating despite having what should be a disqualifying conflict of interest.

If President-Elect Obama had named to his transition team overseeing HHS a lobbyist who had represented tobacco companies during the past year, I assure you that anti-smoking groups (including the Campaign for Tobacco-Free Kids) would be attacking the future administration and the lobbyist for this egregious violation of the public's trust. But when it is a tobacco control lobbyist involved, it somehow becomes acceptable.

I guess what's bad for the goose isn't bad for the gander.

Monday, November 24, 2008

While Progress in Reducing Smoking Comes to a Halt, Anti-Smoking Groups are Pursuing More and More Draconian Policies

While preliminary data show that progress in reducing adult smoking prevalence came to a halt in 2008, anti-smoking groups continue to pursue increasingly draconian policies, including nearly complete bans on outdoor smoking and complete bans on smoking on college campuses.

In Glendale, California, the City Council enacted an ordinance - effective November 5 of this year - which bans smoking virtually everywhere outdoors in the city. The ordinance bans smoking in all non-enclosed (i.e., outdoors) public places, which are defined as an "area, location, place, site, property, lot, building, structure, facility, or complex— public or private— that is open or accessible to the general public, regardless of any fee or age requirement." Thus, virtually every outdoor area in the city is subject to the non-smoking restriction.

While the ordinance makes an exception for streets and sidewalks, the exception does not hold for places that are subject to the ban on smoking in non-enclosed public places. Thus, by my interpretation of this needlessly complicated ordinance language, one cannot smoke in any street or on any sidewalk in Glendale that is open to or accessible to the public (which would seemingly include every street and sidewalk).

While this would seemingly make Glendale's smoking ban the strictest in the nation, since it includes a provision that disallows smoking virtually anywhere outdoors in the city, the ordinance provides a convenient exception for smoking areas at shopping malls.

Meanwhile, in Bristol, Connecticut, city officials are considering a ban on smoking in outdoor areas, including streets and sidewalks.

Bristol's proposal was praised by Connecticut's Attorney General Richard Blumenthal, who was quoted in the Hartford Courant as stating: "This is an important public health goal that's on the cutting edge. The battle is really about life and survival. In Connecticut, we spend $1.6 billion to treat tobacco-related diseases. And the toll is not just in money, it's in families and lives."

The article closes by noting: "Even if such laws proliferate, smokers will still have a final refuge. Nowhere in the country is smoking banned in private homes. 'It's the notion that a person's home is their castle,' said Daniel A. Schwartz, an attorney with the Hartford firm Pullman & Comley."

Elsewhere, last Thursday marked the first day of the total ban on tobacco product use on the campus of Grand Rapids Community College in western Michigan. The ban includes all parking lots, sidewalks, streets, outdoor areas, and even vehicles parked on the campus. Administrators said the purpose of the ban was to help smokers quit and to "promote a healthier learning environment."

The Rest of the Story

The saddest part of this story is that while anti-smoking groups and advocates continue to be obsessed with banning smoking in as many places as they can - regardless of whether anyone is actually exposed significantly to secondhand smoke in those places - the nation's progress in reducing smoking prevalence among adults is coming to a halt.

And frankly, I don't think it is a coincidence. I think that anti-smoking groups have gone so far off track in misplacing their priorities and in going way too far in their policies that they have lost sight of the basic and essential elements of tobacco control - the programs and policies that we know are effective in reducing tobacco use. In addition, I think their efforts are alienating many smokers and causing them to become more resistant to anti-smoking initiatives. They are becoming "hardened" to tobacco use - if you will.

By going way too far, the anti-smoking groups also risk losing their reputation as sensible, reasonable public health groups that base their policy recommendations on solid science.

But most importantly, these groups are demonstrating a lack of consideration for the intrusion into individual autonomy that their policies represent. These are paternalistic policies without any reasonable justification. While protecting people from secondhand smoke is reasonable, trying to ban smoking everywhere so that smokers will quit is not. And arguing that banning smoking everywhere on campus is necessary to create a healthy learning environment is simply hogwash.

Unfortunately, I do not believe that Attorney Schwartz's statement that a man's home is his castle and therefore smoking bans will not spread to the private home is true any longer. I am led to believe that the anti-smoking groups will stop at nothing - even throwing away parental autonomy - in order to eliminate secondhand smoke exposure. A number of groups have already expressed public support for smoking bans in the home, including bans on smoking by foster and adoptive parents. Bans on smoking by all parents are next.

Of course, the irony in this whole story is that by going overboard, the anti-smoking groups are losing sight of the real problem and the proven solutions. Draconian policies may make anti-smoking advocates feel good, and they sure punish smokers and make their lives more miserable, but they do not represent sound and effective public health policy.

Wednesday, November 19, 2008

More on the Massachusetts Smoking Ban and Heart Disease Mortality Study

On Reason Magazine's Hit & Run blog, Jacob Sullum explains my opinion about the recently-released Massachusetts smoking ban/heart disease mortality study better than I have yet articulated it.

First, he notes that the study does not support a conclusion that smoking bans lead to an immediate (within one year) reduction in heart attacks, as was reported by studies in Helena, Pueblo, Bowling Green, and elsewhere.

The rate of heart attack deaths was declining prior to the statewide ban, and after the ban, continued to decline - even more sharply. But this acceleration of the decline took place both in communities that were and were not already subject to a smoking ban, which is not what one would have expected if the statewide ban were the explanation for the accelerated decline.

Moreover, the study provides no evidence that secondhand smoke exposure is a trigger for heart attacks and that any significant, immediate decline in heart attacks occurred as a result of reduced secondhand smoke exposure, as is claimed by many anti-smoking groups and advocates.

What Sullum does note is that smoking bans can be expected to reduce heart disease incidence over the long term because of reductions in smoking.

From his column: "Siegel adds that cities with smoking bans did see significant reductions in heart attack deaths compared to cities without such laws in the seven-year period from 1999 through 2006. They also had lower smoking rates, which suggests they may be seeing the results of improving health in former smokers who quit as a result of the ordinances."

"Case-control studies indicate that the heart disease rate among former smokers falls by about 50 percent within four years of quitting. In short, even if secondhand smoke has no measurable impact on death rates, over the long term smoking bans can be expected to reduce the incidence of heart disease (and other smoking-related illnesses) by pressuring smokers to quit. From a "public health" perspective, in fact, that is the main benefit of smoking bans. But whether we're talking about smokers or nonsmokers, immediate, sharp reductions (within the first six months to a year) are not biologically plausible, and they're not what the Massachusetts study found."

The Rest of the Story

I hope that my position on this study is now clear. While I believe that it does provide evidence that smoking bans - due to the associated decline in smoking prevalence caused by the pressure on smokers to quit - will have a long-term effect on reducing heart disease incidence, I do not believe that the study supports either the conclusion that smoking bans lead to an immediate reduction in heart attacks or the conclusion that brief secondhand smoke exposure is causing people to keel over from heart attacks who would not otherwise have these heart attacks.

Tuesday, November 18, 2008

Attempt by Anti-Smoking Advocate to Defame My Character on SourceWatch

A tobacco control advocate has attempted - fortunately without success - to defame my character by writing a blatantly inaccurate and distorted biography of me on the SourceWatch web site.

SourceWatch, which is a project of the Center for Media and Democracy, describes itself as "a collaborative project of the Center for Media and Democracy to produce a directory of the people, organizations and issues shaping the public agenda. A primary purpose of SourceWatch is documenting the PR and propaganda activities of public relations firms and public relations professionals engaged in managing and manipulating public perception, opinion and policy. SourceWatch also includes profiles on think tanks, industry-funded organizations and industry-friendly experts that work to influence public opinion and public policy on behalf of corporations, governments and special interests. Over time, SourceWatch has broadened to include others involved in public debates including media outlets, journalists, government agencies, activists and nongovernmental organizations."

The advocate, identified only as "truthteller," wrote an entry about me on the site which stated that my primary role is to campaign against tobacco control measures, that I issue "tobacco-industry soundbytes" and that I am aiding the "tobacco industry's efforts to create a 'doubt' campaign" and assisting the tobacco industry in its fight "to return to smoky areas."

Fortunately, the site editors had the wisdom to retract this personal attack and substitute a more appropriate and accurate depiction of who I am and the role of my tobacco policy blog.

You can view the current entry on me here.

You can view the discussion between "truthteller" and the site's editors here.

The Rest of the Story

Ironically, "truthteller" is recklessly disregarding the truth and distorting it in order to attack me because he or she does not care for my dissent from the mainstream tobacco control movement and its blind support for every proposed tobacco control measure, whether scientifically justified or not. Apparently, in tobacco control, this is what "colleagues" do to one another when they can't tolerate someone's disagreement. It's a rough field. Definitely not one for the weak of heart.

The ultimate irony is that I always imagined that the harshest comments about me would come from the tobacco industry. Not true. The harshest attacks I have faced are coming from my own colleagues.

Moreover, while the tobacco industry has attacked me publicly (mainly in the courtroom), its attacks have been based on the facts. They have been fair, and I have had an immediate opportunity to respond. In contrast, anti-smoking advocates who have attacked me have done so with lies and innuendo.

It continually fascinates me how there is no room for nuance in tobacco control. Everything is black and white. Either you approve of all tobacco control measures or you are a traitor to the cause. Either you approve of all tobacco taxes or you are working to promote the tobacco industry. Either you support all smoking bans or you are trying to return to smoky areas. Either you support every scientific statement that tobacco control groups make or you are participating in the tobacco industry's doubt campaign.

The blind support for the cause, with no room for any dissent, is what categorizes the modern-day tobacco control movement as a "religion," rather than a true, grassroots, social, public health movement.

Monday, November 17, 2008

Massachusetts Study Shows Lower Smoking Prevalence Associated with Reduced Heart Attack Rates, But Doesn't Show Any Immediate Effect of Smoking Bans

After careful examination of the study released last week by the Massachusetts Department of Public Health, it is clear that the study fails to show any immediate decline in heart attacks following passage of the statewide smoking ban. The study does demonstrate, however, that declining smoking prevalence is closely tied to declines in heart attack rates. Thus, while the study documents that interventions - such as smoking bans - which reduce smoking prevalence will eventually result in declines in heart attacks, it does not provide any evidence that smoking bans will immediately reduce heart attacks. This study refutes, rather than supports the conclusion of studies from Helena, Pueblo, Bowling Green, and several other sites.

The Rest of the Story

The study was designed primarily to examine whether the statewide smoking ban, implemented on July 5, 2004, resulted in an immediate drop in heart attack deaths. In the first year after the smoking ban was implemented, there was no significant decline in heart attack deaths in the state. Moreover, there was no decline in heart attack deaths even among just those residents living in towns that did not previously have smoking bans. Thus, this study refutes the conclusions from Helena, Pueblo, Bowling Green, etc. that smoking bans immediately reduce heart attacks by decreasing secondhand smoke exposure.

The study did find a decline in heart attack rates from the first to second year after the statewide smoke-free law was implemented, but it turns out that the magnitude of this decline was not significantly different in towns with or without smoking bans prior to the state law. Thus, the study provides no evidence that the statewide smoking ban was associated with any significant decline in heart attacks, even up to two years after its implementation.

While not the primary purpose of the study, it did incidentally find that heart attack death rates were significantly lower, over the long-term period of 1999-2006, among residents of towns with smoking bans compared to residents living in towns without such bans. The mean smoking prevalence in these towns was substantially lower in these towns (17.6% vs. 20.1%). These data provide evidence that smoking prevalence is (not unexpectedly) closely related to heart attack death rates. From this, one can conclude that the observed declines in heart attack rates over time is due, in part, to the observed declines in smoking prevalence. It should be emphasized, however, that these are long-term effects that occur over a long period of time, not the six months to one year that were touted in the Helena et al. studies.

The rest of the story, then, is that the Massachusetts study provides no evidence that smoking bans are associated with an immediate decline in heart attacks and that it in fact refutes the conclusions of previous studies that heart attack rates decline within the first six months to one year following implementation of smoking bans. The study does, however, demonstrate that declines in smoking prevalence will, over time, result in declines in heart attack deaths.

The lack of solid scientific data that smoking bans lead to immediate reductions in heart attacks is not stopping anti-smoking advocates from making such a claim. In a press release from the Henry Ford Health System, the lead author of a new study on this very topic stated: "If Michigan were to implement a comprehensive smoking ban tomorrow, we would see a 12 percent drop in heart attack admissions after the first year."

Note that this study is simply a review of the previous flawed literature (Helena et al.). It provides no new evidence. Unfortunately, the statement by this researcher is unsupported by the scientific evidence. But as I have noted recently, anti-smoking advocates are now holding themselves to very low scientific standards. What now passes for science is what in the past we would have called an interesting anecdote.

One final point deserves emphasis. The release of the Massachusetts study represents yet another example of "science by press release." I do not understand why the researchers didn't wait until the study was accepted for publication and then release the results when the article was published, which is the usual practice. Since the study has been submitted for publication, it would have made sense to wait until publication to release the findings. In fact, many journals will not allow researchers to release a study to the public while it is under review.

If the study was not being submitted for publication, it would be a different matter (assuming that the full study was made available for public review). But because the study is under review at a journal, it cannot be released publicly. Thus, there is no opportunity for scrutiny and review of the study conclusions.

It is very interesting to me that it is always these heart attack and smoking ban studies that are released prior to scientific review. It almost makes one think that the researchers are subconsciously aware that the conclusions are shoddy and that they want to get press coverage of their hoped-for conclusions before the results are actually held up to high scientific standards. I have to admit that it's a great strategy, because once the results are disseminated through the media, it is too late to retract or clarify them later.

Friday, November 14, 2008

Smokers to Be Banned from Fostering or Adopting Children in Several Districts in Scotland

Following the lead of authorities in a London district, which - as I revealed last week - is banning fostering by smokers, several councils in Scotland are considering policies which ban smokers from either fostering or adopting children.

Last week, I revealed that the East London Borough of Redbridge is considering a new policy which would prohibit anyone who smokes from becoming a foster parent. That policy was adopted in a vote last Tuesday.

This week, The Scotsman reports that three councils in Scotland - Falkirk, Stirling and Clackmannanshire - are considering policies that would prohibit smokers from either fostering or adopting children under the age of five or any child with a physical or medical disability.

One of the arguments used by health advocates to support the policy is that: "We know that children whose parents smoke are 1.5 times more likely to develop asthma and we consider it vitally important to reduce this risk to children."

Not everyone quoted in the article was in support of the proposed policy. "Maggie Mellon, a spokeswoman for Children 1st Scotland, warned that by focusing on parents, the council could be seen to be judging adults rather than protecting children. She said: "You can be a smoker and a good parent, the thing is not to inflict the smoking on the child. What is the lesser of two evils – a child stuck in a care home or a loving parent who commits to never smoking in the house?"

The Rest of the Story

The argument that smokers need to be banned from fostering or adopting children because children whose parents smoke have a 1.5 times higher risk of developing asthma is a poor one. There are many health risks to which parents may expose their children, and I'm not aware of any other risk for which parents are completely banned - categorically - from adopting children.

Using wood stoves increases the risk of childhood illness - probably by even more than a factor of 1.5 based on some studies - yet these councils are not banning parents who have wood stoves from adopting or fostering children.

Children whose parents drink alcohol are also at increased risk of medical problems, but I don't see the councils banning parents who drink alcohol from fostering or adopting children.

Parents who take their children out frequently for fast food and do not serve them healthy foods greatly increase their children's risk of obesity and other medical problems. But I don't see any proposal for a ban on parents who eat frequently at fast food restaurants.

The one legitimate ground for precluding a smoker from adopting or fostering a child would be if that child has a condition such as asthma which would be exacerbated by tobacco smoke and the parent does not agree to smoke outside the house and otherwise ensure that the child is protected from tobacco smoke exposure. But the point is this: these decisions should be made on a case-by-case basis. Just as all other parental health behaviors are judged on a case-by-case basis.

The interesting aspect of this story to me is why smoking is being treated differently from all other health behaviors. And I can only conclude that the reason is that smokers have become marginalized citizens: an easy target for health authorities who want to make it look like they are really doing something to protect children's health. In the mean time, there are all kinds of horror stories about actual physical and sexual abuse going on and these very same authorities have often been negligent in acting quickly enough (or at all) in addressing these problems.

Most importantly, these categorical bans on smokers demonstrate a narrow view which fails to consider what is in the best interests of the child. As Ms. Mellon pointed out, is it really in the best interests of a child to be stuck in a care home rather than being placed with a person who happens to smoke and agrees not to smoke around the child?

Apparently, smokers are not to be trusted. Even if they agree not to smoke around the child, that is somehow not enough. Apparently, all smokers are liars.

I think this is what bothers me the most. Unlike nonsmokers whom we trust and whom we view as being honest people with whom we can discuss and negotiate various conditions, smokers are apparently all liars who cannot be trusted. We must set categorical restrictions on smokers adopting or fostering children.

Smokers are being treated as second-class citizens who are so abnormal and reviled that they clearly cannot possibly be honest or sincere in their intentions and statements.

I am beginning to be able to really sympathize with smokers and to see how this treatment by institutions in our society really marginalizes them and makes them feel like social outcasts or pariahs. Were I a smoker, this would probably make me angry and motivate me to identify even more strongly as a smoker and to resolve even more strongly to continue smoking. Any desire to quit would be tempered by the viciousness of these anti-smoking advocates and their bigotry. I am starting to really see where many of my readers are coming from.

Campaign for Tobacco-Free Kids Admits to Negotiating FDA Legislation with Philip Morris

In a press release, the Campaign for Tobacco-Free Kids has admitted that they negotiated the FDA legislation with Philip Morris, proving wrong the claim of Dr. Allan Brandt, published last week in the New England Journal of Medicine, that no such negotiations took place.

Dr. Brandt was responding to an article by Dr. Joel Nitzkin of the American Association of Public Health Physicians in which Dr. Nitzkin wrote: that the FDA tobacco legislation "was negotiated between Matthew Myers of the Campaign for Tobacco-Free Kids and Mr. Berlind [chief legislative counsel of Philip Morris] for purposes of securing an FDA bill with full support from our nation's largest cigarette maker."

Dr. Brandt wrote: "Nitzkin is wrong to claim that the currently pending bill was negotiated between Philip Morris and Matthew Myers of the Campaign for Tobacco-Free Kids. The current bill was the work of Senator Ted Kennedy (D-MA) and then-Senator Mike DeWine (R-OH), who have consistently been among Congress's strongest supporters of tobacco control."

The truth is that the bill was negotiated between the Campaign for Tobacco-Free Kids and Philip Morris and the Campaign has admitted it. In the press release, the Campaign writes: "Tobacco Bill Negotiations Failed Due To Loopholes Sought By Tobacco Industry ... In a statement released late Wednesday, Philip Morris claimed that negotiations over proposed legislation to grant the U.S. Food and Drug Administration (FDA) authority over tobacco products “have broken down due to the last-minute insistence that the FDA be given the power to ban the sale of all cigarettes to adults.” This statement is completely false, and Philip Morris knows it. The negotiations were not about whether the FDA should be permitted to ban cigarettes or other tobacco products. If it were about whether FDA could or should ban cigarettes, there would have been no dispute. The public health community made clear that our goal was not to ban tobacco products and offered straightforward, unambiguous compromise language that would have provided Congress and only Congress with the authority to take this action. The fact that this offer was dismissed out of hand is a clear indication that Philip Morris and some in Congress wanted to tie the FDA’s hands in requiring any changes in tobacco products, not just to prevent FDA from banning cigarettes. Rather than accept the compromise language we offered, some in Congress insisted on the inclusion of ambiguous language in the section entitled Powers Reserved to Congress that would have allowed the tobacco industry to challenge FDA efforts to require the removal of known harmful substances from current tobacco products."

In addition, in an article published in Roll Call, the Campaign for Tobacco-Free Kids was quoted as stating: "I believe there was at least one meeting with multiple parties present where both sides [the Campaign for Tobacco-Free Kids and Philip Morris] were there."

The Rest of the Story

The time has come for the Campaign for Tobacco-Free Kids to publicly admit to its constituents and to the public that the organization has been misleading them for years now, and that the legislation before Congress was indeed the result of a negotiation between the Campaign and Philip Morris.

It is time for the Campaign to admit, further, that the specific compromises (i.e., loopholes) present in the legislation are there not because they were desired to protect the public's health, but because they were necessary to appease Philip Morris during the negotiations and retain its support for the ultimate deal that resulted.

It is also time for the Campaign to admit that the reason it has opposed any and all changes that would have strengthened the bill is that it had cut a deal with Philip Morris and it didn't want to renege on that deal and threaten the withdrawal of Philip Morris' support for the bill (which would potentially lead to its defeat).

Moreover, it is also time for the Campaign for Tobacco-Free Kids to notify all the youths that it has recruited to lobby for the legislation (through Kick Butts Day and other activities) that they were misled about the bill and that it is supported by, and was negotiated with, the nation's leading cigarette company.

It is also time for the groups that have signed on to the legislation to withdraw their support and admonish the Campaign for Tobacco-Free Kids for not being honest about the history of the legislation, misleading their constituents, and having sacrificed public health in order to make a deal with the nation's leading tobacco company.

The fact that a Harvard historian with the qualifications and expertise of Dr. Brandt could get the story so wrong is evidence of the success of the Campaign for Tobacco-Free Kids in hiding the truth. Even Dr. Brandt was apparently not aware that the legislation was negotiated with Philip Morris.

Clearly, the Campaign has done a tremendous con job.

Forget about an apology -- I'd be willing to settle for a simple admission of the truth (although I think the Campaign owes Dr. Brandt an apology because their con job led to him embarrassing himself in a prominent medical journal).

Most importantly, it is time for all anti-smoking and public health groups to disavow themselves of the FDA tobacco legislation and go back to the drawing board to discuss, in an inclusive manner (with full representation of all constituents, including those representing racial/ethnic minority communities), what would be the best strategy for federal tobacco control legislation (I have already laid out my own proposal).

Thursday, November 13, 2008

Quoted in Article on Complete College Smoking Bans

Yesterday's Minneapolis Star-Tribune features an article on the increasing trend of complete smoking bans on college campuses. Instead of just banning smoking inside buildings and a reasonable distance outside the entrances, an increasing number of colleges are banning smoking completely on their campuses, even in remote outdoors locations where nonsmokers do not congregate or have to pass through.

In the article, anti-smoking advocates praise these measures and argue that they are justified because they are necessary to protect nonsmokers from secondhand smoke exposure. According to the article: "Many anti-smoking advocates are cheering the trend as a natural progression in the movement to protect people from second-hand smoke. Today's 18-year-olds grew up supporting smoke-free spaces, surveys show. 'Even five years ago, I was shocked at the thought of it [a ban],' said Katherine Morris, director of health services at the University of Minnesota, Duluth, which banished smoking last year. 'More people are saying that it's just not OK to have to live in somebody else's smoke.'"

In the article, one anti-smoking advocate speaks out against these measures: "Dr. Michael Siegel, professor at Boston University School of Public Health, has studied and testified in favor of smoking bans in bars and restaurants and considers himself "a strong anti-smoking advocate." But campus-wide bans "just do not make sense to me," he said. "They're not about protecting nonsmokers' health. They're about trying to change people's lifestyles. And that's a line which I don't think is appropriate to cross."

The Rest of the Story

The arguments of the anti-smoking advocates supporting these measures just do not make sense. Of course I agree that nonsmokers should not have to breathe in tobacco smoke. However, there is no need to ban smoking entirely on a campus to achieve that purpose. You can't tell me that the real purpose of a campus-wide smoking ban is to protect nonsmokers from secondhand smoke. Whether conscious or not, I believe the real purpose is to protect nonsmokers from even having to see a smoker.

What is interesting is that in this article, the anti-smoking advocate who is quoted does not even advance the argument that the campus smoking ban is intended to promote health on campus (i.e., to encourage smokers to quit). Clearly then, some logic is missing in the argument. How do you get from a need to protect nonsmokers to a need to ban smoking entirely on the campus, even in remote [from buildings] outdoors locations?

It seems to me that the way you get there is the unconscious desire to protect nonsmokers from having to even see a smoker. It's not the smoke that these policies protect nonsmokers from, it's the smoker.

These policies go too far. They do cross the line and they do represent an unwarranted intrusion into individual autonomy.

Anti-smoking groups should re-think their support of these policies. But of course, they won't. In tobacco control, policies do not need to be justified.

Tuesday, November 11, 2008

IN MY VIEW: After Election, Anti-Smoking Groups Should Go Back to the Drawing Board and Craft Effective Federal Legislation

Today I outline my proposal for what I believe would be effective federal legislation to address the problem of tobacco use.

Unlike the current FDA tobacco legislation, for which there is no evidence base (merely wild and unsupported conjecture), my proposal is based on solid scientific evidence about what interventions are most effective in actually reducing tobacco use.

While the anti-smoking groups promoting the FDA legislation claim that it will reduce smoking rates and save "countless" lives, they provide absolutely no evidence to support their claim, nor do they even explain the mechanism by which these countless lives will be saved. As I have argued, they are correct that "countless" lives will be saved because we won't be able to count them. The legislation will actually result in the loss of lives because it will undoubtedly increase smoking rates by undermining years of education about the hazards of cigarettes (it gives an FDA seal of approval to cigarettes and creates the public perception that cigarettes are safer).

The legislation also provides virtual immunity to the tobacco companies. Once the FDA asserts jurisdiction over tobacco products, there will be no chance for punitive damages in tobacco cases, thus ending any serious litigation threat for the industry.

Even worse, the legislation transfers over to the federal government the fraud that anti-smoking groups have accused the tobacco companies of committing. The government will now be in the business of defrauding the American public by implying, without scientific support, that cigarettes are safer.

In contrast to the FDA legislation's interventions, which have not been shown to have any impact on smoking (and which would actually increase it), two interventions which have been conclusively shown to reduce smoking are:

1. Increasing the price of cigarettes through substantial cigarette tax increases; and

2. Anti-smoking advertising campaigns using the mass media (such as the "truth" campaign).

My proposal would combine these two interventions.

In addition, it would create - for the first time - an incentive for cigarette companies to stop marketing their products to youths and to make serious efforts to decrease youth smoking.

Finally, it would directly benefit existing smokers by providing services and resources for medical treatment and research.

The Rest of the Story

This proposal, which is modeled after the proposal which Senator Enzi introduced into Congress this session, is based on the following three interventions:

1. An increase in the federal excise tax on cigarettes.

2. A graduated series of financial penalties for cigarette companies, which is based on the number of underage youths who are smoking each company's brands of cigarettes, and with targets for youth smoking prevalence that decrease gradually over time.

3. The specific allocation of the funds generated by #1 and #2 to the following programs:

a. A national anti-smoking media campaign, building on the "truth" campaign.

b. The creation, development, implementation, and maintenance of anti-smoking media campaigns in each of the 50 states.

c. Direct services to benefit existing smokers, including treatment of smoking-related diseases and research into better treatments and cures for these diseases.

The strength of the proposal is that even though the revenues generated would decrease over time if smoking prevalence declines, less funds will be necessary as fewer people smoke. In other words, the purpose of the program would be to put itself out of business. As smoking rates fall to very low levels, much less funding will be necessary. So in a sense, the program is self-regulating.

Furthermore, the program does not make the federal or state governments dependent upon cigarette consumption. There remains a strong incentive to reduce smoking because falling cigarette revenues will not threaten the funding of essential government services. It will reduce funding for the anti-smoking programs, but less funding will be necessary because fewer people will be smoking.

The national anti-smoking campaign would be directed by an independent foundation, most likely the American Legacy Foundation, which would work in concert with the states to plan and coordinate the federal and state-specific media campaigns.

The state-specific media campaigns would be run either by state health departments or by independent foundations established in the states. These would be closely coordinated with the national campaign. The American Legacy Foundation would play a critical role in these coordination efforts and would share the results of its formative research to assist the states in planning effective media campaigns. It would also create and share a repository of effective anti-smoking advertisements and allow for the tailoring of these ads towards specific states.

The penalties levied on tobacco companies would be based on the number of underage youths who are smoking their cigarette brands. Money would be allocated towards the conduct of a national survey to assess market share of each cigarette brand among underage youths and to monitor the prevalence of youth smoking. The penalties would be graduated over time -- meaning that targets for youth smoking prevalence would be set and penalties would increase over time for failure to meet these targets.

The research funding would help to address the lack of effort and success in treatment of certain smoking-related diseases, such as lung cancer, pancreatic cancer, and emphysema, for which little progress has been made. It would allow research and treatment of these diseases to accelerate at a time when federal funding for research into treatment for these diseases is declining.

Funding would also be included for smoking cessation services for those smokers who want to take advantage of such programs. This would include a national smoking cessation hotline with referral to subsidized or free treatment programs or services.

The Office on Smoking and Health at CDC would be the national coordinator of all of these programs. For the first time in history, the CDC would develop a true national tobacco control plan and would have the resources to develop and implement this plan, coordinating its efforts and providing technical assistance and needed resources to health departments of independent foundations in each of the 50 states.

Funding would not be decreased for states which have already funded their own anti-smoking media campaigns, so as not to serve as a deterrent for states to put funding into tobacco prevention and education programs. The federal funding would supplement, not replace these programs.

Unfortunately, I am afraid that the national anti-smoking groups are so committed to and obsessed with their ill-fated and ill-conceived FDA legislation that there is little chance my proposal will receive any serious consideration.

So while this post is probably a waste of time and I'm probably banging my head against the wall or speaking to a brick wall, it is sure nice - it least for a fleeting moment - to consider what a truly effective national tobacco control strategy might look like.

I offer this proposal in grateful appreciation and honor to the following individuals: my parents, and the heroes of tobacco control - Stanley and Susan Rosenblatt, Dr. Alan Blum, Dr. Stan Glantz, John Polito, Patty Young, Regina Carlson, and Frank and Margaret Amodeo; and in memory of my mom, my grandmother, Dr. Ronald Davis, and Dr. John Slade. I also extend appreciation to Senator Mike Enzi (R-WY) for having the courage to put on the table, for the first time, a Congressional tobacco control proposal that has real teeth. In doing so, he has achieved something that the major, national anti-smoking groups have failed to ever do.

Thursday, November 06, 2008

Anti-Smoking Advocates Re-Writing History to Support FDA Tobacco Legislation

In a point-counterpoint pairing of letters published today in the New England Journal of Medicine, Dr. Joel Nitzkin of the American Association of Public Health Physicians (which opposes the FDA tobacco legislation) and Dr. Allan Brandt of Harvard University (who supports the legislation) debate the history of the current legislation.

Dr. Nitzkin asserts that the legislation "was negotiated between Matthew Myers of the Campaign for Tobacco-Free Kids and Mr. Berlind [chief legislative counsel of Philip Morris] for purposes of securing an FDA bill with full support from our nation's largest cigarette maker."

Dr. Brandt counters: "Nitzkin is wrong to claim that the currently pending bill was negotiated between Philip Morris and Matthew Myers of the Campaign for Tobacco-Free Kids. The current bill was the work of Senator Ted Kennedy (D-MA) and then-Senator Mike DeWine (R-OH), who have consistently been among Congress's strongest supporters of tobacco control."

Dr. Nitzkin further argues that the legislation "is so distorted in favor of Altria–Philip Morris that, if passed in its current form, it will do more harm than good in terms of future levels of teen smoking and future rates of tobacco-related illness and death. It can protect cigarettes or it can protect the public's health. It cannot do both."

Dr. Brandt counters: "The bill has provisions that would require serious changes in the marketing and manufacture of cigarettes in the decades ahead, including the authority for the FDA to monitor and reduce levels of dangerous additives and nicotine. The improved warning labels — just one provision of the bill — could save thousands of lives. Nitzkin is certainly entitled to oppose the legislation, but he fails to offer any evidence for his claim that the bill will lead to increases in teen smoking and tobacco-related mortality. His position conflicts with the positions of virtually all the leading public health and medical organizations that are committed to reducing the burden of disease that cigarettes generate."

The Rest of the Story

While the FDA tobacco bill was introduced into Congress this year by Senators Kennedy and DeWine, the bill is virtually identical to the bill which was introduced in previous sessions, which was the result of a negotiation between the Campaign for Tobacco-Free Kids and Philip Morris.

Thus, Dr. Nitzkin is entirely correct in his statement that this legislation was negotiated between Matthew Myers of the Campaign and Philip Morris. Dr. Brandt, on the other hand, is attempting to re-write history to vindicate the anti-smoking groups for their despicable actions.

According to an article published in Roll Call in October 2004: "Moments after lawmakers unveiled landmark legislation last spring to impose the most sweeping regulations on cigarettes in history, two of the people most closely involved in the momentous compromise bumped into each other leaving a press conference on the deal. Though they were just a few steps from each other outside the Senate's television studio, Matt Myers and Mark Berlind didn't shake hands, embrace or even say hello. ... Myers and Berlind may be the biggest winners if Congress approves the tobacco bill this week. But they're about as comfortable as boys and girls at a sixth-grade dance."

"It's easy to see why: Myers is the president of Campaign for Tobacco-Free Kids ... Berlind is the chief legislative counsel for Altria Group, the parent of Philip Morris USA, the nation's leading cigarette maker." ...

"Thanks to separate but equally calculated decisions by Philip Morris and the Campaign for Tobacco Free Kids, each has broken ranks with their typical allies, formed a secret alliance and met clandestinely to iron out key sticking points on the legislation. The talks between Philip Morris and the Campaign for Tobacco Free Kids took place on Capitol Hill even as the two sides battled over a $200 billion Justice Department lawsuit in a federal courthouse a few blocks down Pennsylvania Avenue."

"The face-to-face negotiating sessions and conference calls were so sensitive that Philip Morris and the Campaign for Tobacco Free Kids refused to tell even their closest allies."

According to Roll Call, Senator DeWine was indeed behind negotiations between these two parties: "Led by aide Abby Kral, DeWine's staff pressed Philip Morris, the Campaign for Tobacco Free Kids, national health organizations and other stakeholders to come together on a bill. ... Unbeknownst to their allies in the public health community, representatives of the Tobacco Free Kids spoke with Philip Morris lobbyists several times and met at least once to iron out language that both sides could accept. Both sides say most of the talks were arranged by DeWine's office because officials from Tobacco Free Kids and Philip Morris felt uncomfortable dealing with each other. Several times, however, Myers spoke directly to Philip Morris officials either face-to-face or by phone. 'I believe there was at least one meeting with multiple parties present where both sides were there,' said Myers." ...

Moreover, Roll Call documents that in the negotiations, the Campaign for Tobacco-Free Kids agreed to certain compromises being insisted upon by Philip Morris: "The discussions helped prompt several breakthroughs. ... Tobacco Free Kids swallowed a provision that gives Congress sole authority to ban cigarettes or to reduce nicotine levels to zero." Thus, the loopholes in the bill which I have been criticizing for months are the direct result of the Campaign for Tobacco-Free Kids caving into Philip Morris in order to maintain the company's support for the legislation.

Let me make one thing clear. Dr. Brandt has every right to support the legislation. However, anti-smoking advocates do not have the right to distort the truth and to re-write history in order to try to erase this ugly chapter. Ignoring and misrepresenting the truth does not make it go away. Moreover, re-writing history like this does a disservice to the public and to public health practitioners, because it does not allow them to make an informed decision on public health policy based on the actual facts.

I commend Dr. Nitzkin for trying to get the truth out there. It is unfortunate that anti-smoking supporters of the legislation are attempting to block the truth by distorting and re-writing history.

I understand that it is an ugly chapter in the anti-smoking movement's history -- to think that the movement allowed Philip Morris to play a pivotal role in crafting legislation to regulate.....Philip Morris. But it happened and it is unfair to the public to present a distorted version of the truth. If tobacco control practitioners want to make it go away, they ought to present their dismay to the Campaign for Tobacco-Free Kids and craft a new piece of legislation that is not written by Big Tobacco, rather than pretending that history never occurred.

I should also note that Dr. Nitzkin argues - correctly in my opinion - that the legislation would do more harm than good. By giving an FDA seal of approval to cigarettes, it would most likely increase cigarette consumption. It would provide virtual immunity to Big Tobacco and end the threat of meaningful litigation against the companies. In contrast, there is no evidence that the bill will do anything to protect the public's health. New research, in fact, suggests that even the mandated warning labels would not have any effect on smoking rates.

But instead of presenting evidence for why and how the bill will save lives, Dr. Brandt resorts to a personal attack. Instead of arguing the substance of the issue, he attacks Dr. Nitzkin for conflicting with the position of other health groups that "are committed to reducing the burden of disease that cigarettes generate." In other words, Nitzkin is nothing but a contrarian. Because he argues a position contrary to that of the mainstream organizations, he is ipso facto wrong.

That is, unfortunately, the typical response of anti-smoking groups which support the legislation. They will not enter into an actual discussion of the substance of the bill, including its weaknesses and loopholes. Instead, they attack anyone who opposes the bill as being a wacko.

The rest of the story is that supporters of the FDA tobacco legislation are attempting to re-write history to hide the truth behind the origins of this legislation.

I guess I would try to hide the truth too if I knew that the legislation was the direct result of a secret negotiation between the Campaign for Tobacco-Free Kids and Philip Morris.

Ironically, this doesn't say a lot for a movement that is trying to distinguish itself from an industry that we continually attack for dishonesty. If the movement isn't honest itself, how can it expect to hold the higher ground against the industry?

Wednesday, November 05, 2008

New Study Shows that De-Nicotinized Cigarettes Deliver Substantial Nicotine to the Brain; Claims that FDA Bill Will End Addiction are Unfounded

One of the key claims of proponents of the FDA tobacco legislation is that by mandating the lowering of nicotine to very low levels, cigarettes will no longer be addictive. Thus, millions of smokers will quit, millions less youths will start smoking, and "countless" lives will be saved.

As with other claims made by the anti-smoking groups in favor of this legislation, I have argued that this one is scientifically unfounded. There currently does not exist evidence that lowering the level of nicotine, even severely, would result in a product that is no longer addictive. In contrast, I have argued, lowering nicotine levels might well increase tobacco-related morbidity and mortality by causing smokers to inhale more deeply and to increase their cigarette consumption in order to maintain their current nicotine dosage.

Importantly, the deal struck by the Campaign for Tobacco-Free Kids and Philip Morris has a provision that precludes the FDA from eliminating the nicotine. It can lower the levels, but it cannot eliminate the nicotine entirely. New evidence published in the International Journal of Neuropsychopharmacology sheds light on why Philip Morris may have insisted on this loophole in the legislation.

The new study found that even de-nicotinized cigarettes, which contain only a trace amount of nicotine, deliver a substantial dose of nicotine to the brain and that this level of nicotine is sufficient to occupy a substantial proportion of nicotine receptors in the brain (see: Brody AL, et al. Brain nicotinic acetylcholine receptor occupancy: effect of smoking a denicotinized cigarette.
International Journal of Neuropsychopharmacology. doi: 10.1017/S146114570800922X).

According to the article, the smoking of a de-nicotinized cigarette resulted in 26% of the nicotine receptors in the brain being occupied, compared to 79% with a low-nicotine cigarette and 88% with a regular cigarette.

According to the authors: "The two take-home messages are that very little nicotine is needed to occupy a substantial portion of brain nicotine receptors and cigarettes with less nicotine than regular cigarettes, such as 'light' cigarettes, still occupy most brain nicotine receptors. Thus, low-nicotine cigarettes function almost the same as regular cigarettes in terms of brain nicotine-receptor occupancy. It also showed us that de-nicotinized cigarettes still deliver a considerable amount of nicotine to the brain. Researchers, clinicians and smokers themselves should consider that fact when trying to quit."

The occupancy of 26% of nicotine receptors in the brain, according to the authors, would still be substantial.

The Rest of the Story

Most likely, Philip Morris was aware of this fact and brilliantly negotiated a clause ensuring that very low levels of nicotine would always remain in cigarettes, thus ensuring that cigarettes would always have substantial nicotine activity in the brain, despite the ruse (sure to be created by anti-smoking groups) that the addiction problem has been taken care of.

The prospect of very low nicotine cigarettes was apparently too much for the anti-smoking groups to pass up and as they usually do, they ignored the lack of scientific support for their contention and instead were bought off by the opportunity for what would turn out to be a pyrrhic, solely political victory.

In fact, this research provides evidence that the FDA legislation would forever institutionalize nicotine addiction into society, backed by government acceptance and approval. Philip Morris could not dream of a more favorable outcome.

As I discussed in my columns on the anti-smoking movement's new obsession with getting rid of the color pink on cigarette packs (but giving official government approval to what is in the box while granting virtual immunity to the producers of the deadly product), the movement is now determined to achieve a solely political victory -- one which allows them to boast about their accomplishment but without actually putting a dent in cigarette use.

Indeed, it will be a pyrrhic victory. It will inflict severe (in fact, irreparable) damage on the tobacco control movement and on the public's health. It will do very little to address the problem of addiction or of the hazards of cigarette smoking, yet it will increase cigarette consumption by giving the product a government stamp of approval, institutionalize the fraud and deception of the American consumer, and grant virtual immunity to the tobacco industry.

While the anti-smoking groups could give the legislation some small chance of achieving a more favorable outcome by demanding that the Philip Morris nicotine protection clause be removed from the bill, they have adamantly refused to do so. Instead, they are protecting the right of Big Tobacco to continue to addict millions of our children and to do so with the approval and blessing of the federal government.

Anti-Smoking Groups Blast Philip Morris for Putting Pink on Its Cigarette Packs

In a statement issued Friday by the Campaign for Tobacco-Free Kids, American Lung Association, American Heart Association, American Cancer Society, and the American Medical Association, these anti-smoking groups blasted Philip Morris for its plans to launch a new Virginia Slims "superslim" cigarette which will feature a pink cigarette package.

According to an article on Promo Magazine's web site: "'Philip Morris shows contempt for women and their health by putting a pink gloss on a product that causes lung cancer and heart disease, two of the leading killers of women,' read a joint statement issued by the American Cancer Society Action Network, the American Heart Association, the American Lung Association, the American Medical Association and the Campaign for Tobacco-Free Kids."

"According to the statement, the pink “purse packs” will make smoking look feminine and fashionable, while the use of “slim” in the name will set up a link between smoking and weight loss—something that might appeal to young women with body-image issue." ...

"The American Legacy Foundation, the non-profit group behind the Truth antismoking campaigns, joined with the Susan G. Komen for the Cure organization to protest the new Virginia Slims products. The new “Purse Packs,” wrapped in pink packaging and clearly designed to appeal to young women, present a serious public health issue at a time when tobacco-related diseases kill more than 178,000 in the U.S. annually, according to the two groups. “Philip Morris’ timing of this announcement is particularly outrageous,” ALF president and CEO Cheryl Healton said in the statement. “The pink ‘Purse packs’ of cigarettes—the deadliest consumer product in the world—are an insult to the women and their families who have suffered from breast cancer.”"

The Rest of the Story

It seems to me that the tobacco control movement has largely become a movement about political correctness, rather than about protecting the public's health. Philip Morris has the right to put its deadly product in whatever color packaging it wants to, as long as it is not targeting underage youths. The company certainly has a right to market its product to women. The threat to the public's health comes not from the fact that the product is not being marketed exclusively to men; the threat comes from the fact that the product is killing more than 400,000 people a year. Whether people are dying from cigarettes that are in black, white, pink, or green packages doesn't seem to be the key issue. The key issue is that the product is killing people and something needs to be done about it. Restricting the color of the packaging does not make me feel any bit better about the loss of hundreds of thousands of lives a year from tobacco-related disease.

Why are the anti-smoking groups spending so much time worrying about the color of the packages, rather than what is in the packages? It's not the color that's killing people, it's the cigarettes. By focusing on the color of the packs, the anti-smoking groups are essentially framing the problem of tobacco as one of inappropriate packaging. Is it somehow appropriate for the companies to pack their deadly products in a non-colorful box? Does that somehow make it acceptable for hundreds of thousands of people to die each year from cigarette use?

This is an act of political correctness, not true public health protection.

At the same time that these groups are attacking Philip Morris for putting pink on their packages, these same groups have signed off on a deal (the FDA legislation) that was secretly negotiated with Philip Morris (by the Campaign for Tobacco-Free Kids), which sells out the public's health and institutionalizes tobacco use, protecting the profits of Big Tobacco under the guise of definitively addressing the tobacco epidemic.

I am very frustrated because it is all window-dressing these days in tobacco control. There is no substance any more. These groups no longer have any real integrity. On the one hand, they are attacking Philip Morris because they don't like the color of the packaging for some cigarettes. On the other hand, they are working hand-in-hand with Philip Morris to help it achieve a monopoly in the U.S. cigarette market by stifling competition and ending - definitively - the liability threat that would otherwise hang over the company.

But at least these groups are making it look good. Unfortunately, they are devoting their constituents' resources to fighting a color - not the tobacco companies. They may succeed in ending the scourge of pink cigarette packs, but with their FDA legislation, they are going to institutionalize the scourge of tobacco-related disease and death - with the government's blessing.

Monday, November 03, 2008

American Lung Association on Track for 2008 Anti-Smoking Hypocrisy of the Year Award

An action alert put out around Halloween by the American Lung Association asks constituents to write to the CEO of Reynolds American and urge her to stop selling candy-flavored cigarettes, such as those with chocolate, watermelon, lime, vanilla, and berry flavors.

The alert states: "For kids, Halloween is about fun costumes, trick or treating, and of course, candy. And the tobacco companies - especially RJ Reynolds - know that kids love candy. That's why they are dressing up their tobacco products in candy and fruit flavored costumes - to addict a new generation of kids. Over the last few years, RJ Reynolds has sold tobacco products with chocolate, watermelon, lime, vanilla and berry flavors to increase their sales."

"Please click here to send a letter to Reynolds today asking them to stop adding these kid-friendly flavors to their deadly products. Each day, more than 1100 kids become addicted to cigarettes. One-third to one-half of these children will die prematurely from their addiction. Candy flavors should be reminiscent of Halloween and innocence - not death and disease."

"Please send a letter to RJ Reynolds today, telling them to unmask their cigarettes and leave candy for kids."

The prepared letter which the American Lung Association asks you to send states the following: "Chocolate. Mint. Lime. Pineapple. Toffee. Coconut. Vanilla. Berry. Watermelon. Apple. These are just some of the candy and fruit flavors your company has added to its tobacco products, in an effort to addict kids and subject them to a lifetime addiction and a premature death."

"I'm writing today to urge you - as the Chairman, President and CEO of Reynolds American - to stop selling candy-flavored cigarettes, snus and other tobacco products - including your soon-to-be released strips, orbs and sticks. These products are a blatant attempt to addict kids - all for your company's bottom line profits. But by using candy-flavors to sell your products of death, you are taking candy - a youthful indulgence - and turning it into a product that will likely result in users not living to see their own children's or grandchildren's childhoods."

"Selling candy-flavored tobacco products isn't good business. It's unconscionable."

The Rest of the Story

Of course, while it's unconscionable to sell candy-flavored cigarettes, which hardly any adolescents smoke, it's perfectly acceptable to sell menthol-flavored cigarettes, which thousands of adolescents smoke.

The glaring omission in the American Lung Association's action alert is asking Reynolds American to stop selling the one flavoring that is actually being used successfully to help addict millions of American smokers: menthol.

How can it possibly be unconscionable to add candy flavorings to cigarettes but perfectly acceptable to add menthol flavoring, which has been found to preferentially appeal to African American smokers and to contribute to the addiction of millions of Americans?

The answer, of course, is purely political. The American Lung Association has to be careful of what it asks for. The organization has committed itself to supporting the FDA tobacco legislation, which specifically exempts menthol from its list of banned flavorings in cigarettes. To include menthol in its action alert would undermine the organization's support for the currently proposed FDA legislation. It would undermine the organization's argument in favor of the legislation, which has been opposed by numerous African American groups because of its exemption for menthol flavoring.

While the candy flavorings are smoked by very few adolescents, the menthol flavorings are important in the addiction of thousands upon thousands of adolescents. Thus, while getting rid of the candy flavorings will be of little to no consequence to Reynolds American, eliminating the menthol would be huge. It would actually put a dent into cigarette consumption, something the American Lung Association is apparently not too anxious to do.

Constituents of the American Lung Association should be outraged. How can their organization, which purports to be striving to protect the lung health of Americans, run a campaign to get rid of the flavorings that are hardly ever used in cigarettes and addict almost no one, yet at the same time, run a campaign to exempt the flavoring that is most responsible for the very death and destruction that the organization is attributing to the pineapple cigarettes?

Does the organization really want to end addiction, death and disease caused by flavorings in cigarettes or does it not?

Based on its actions, one would be forced to conclude that the American Lung Association does not want to actually end the disease and death caused by cigarette flavorings. It just doesn't want death and disease caused by candy flavorings.

Menthol is OK for death and destruction, but not candy flavors.

This is just the latest example of the hypocrisy that seems to be taking hold in the tobacco control movement.

These window dressing actions might make the groups feel good, but they do nothing to actually deal with the problem.

If I were the CEO of Reynolds American, I would toast the American Lung Association. I would write back and tell them that if they are serious about getting the flavorings out of cigarettes, they should demand that the menthol exemption in the FDA legislation be removed immediately.

Let's see if they are willing to stand for something meaningful or whether this is all window dressing.