Tuesday, August 31, 2010

20 California Legislators Write Letter to UCLA Chancellor Seeking Investigation of Enstrom Firing

Twenty California state legislators, under the letterhead of Assemblyman Dan Logue, have written the Chancellor of UCLA, expressing concern that the firing of Professor James Enstrom after 34 years at the University appears to be an effort to silence his dissenting views on the health effects of fine particulate matter.

The letter demands that Dr. Enstrom not be dismissed before his appeal has been fully evaluated. Otherwise, the legislators threaten to hold a hearing in Sacramento on the matter.

The letter states: "We are writing you as members of the California State Legislature regarding a serious personnel matter. ... Based on our understanding of the situation, [Enstrom] has not been given valid justification for the termination of his 34-year exemplary academic career at the UCLA School of Public Health. It appears to us that he is being dismissed in order to silence his scientific views on the health effects of fine particulate air pollution. In particular, we are concerned that he is being deprived of his academic freedom as a UCLA faculty member to speak out against draconian diesel vehicle regulations approved by the California Air Resources Board in 2007 and 2008." ...

"To ensure that his appeal is given proper consideration, we request that he be allowed to retain his current faculty position until his appeal has been fully evaluated. If Dr. Enstrom is dismissed before his appeal has been fully evaluated, we plan to promptly hold a hearing in Sacramento on this matter. In particular, we will allow Dr. Enstrom and others the opportunity to present evidence regarding academic freedom and scientific integrity at UCLA, particularly regarding the circumstances surrounding his dismissal."

The Rest of the Story

As I have written, the stated basis for Enstrom's termination is bogus. His termination letter states that he was fired because his research is not aligned with the mission of the Environmental Health Sciences department. However, the mission of the department is to study the health effects of environmental pollutants, and that is exactly what Dr. Enstrom's research does.

Apparently, the department faculty interprets alignment with the department's mission as meaning that the findings of one's research must be aligned with the mission of supporting regulation. Negative findings are apparently not allowed. This is an interference with academic freedom, because if one expresses a dissenting opinion, one risks being found not in alignment with the department, and this could lead to non-reappointment. It is also a threat to scientific integrity.

Readers may also want to see this article in the UCLA Daily Bruin.

Monday, August 30, 2010

New Article Accuses Tobacco Companies of Using YouTube to Market Cigarettes, But Fails to Provide any Evidence

An article published online ahead of print in the journal Tobacco Control accuses the tobacco companies of using YouTube to market cigarettes (see: Elkin L, Thomson G, Wilson N. Connecting world youth with tobacco brands: YouTube and the internet policy vacuum on Web 2.0. Tobacco Control 2010).

According to the article: "The authors conducted a YouTube search using five leading non-Chinese cigarette brands worldwide. The themes and content of up to 40 of the most viewed videos returned for each search were analysed: a total of 163 videos."

The authors found that: "A majority of the 163 tobacco brand-related videos analysed (71.2%, 95% CI 63.9 to 77.7) had pro-tobacco content, versus a small minority (3.7%) having anti-tobacco content (95% CI 1.4 to 7.8). Most of these videos contained tobacco brand content (70.6%), the brand name in the title (71.2%) or smoking imagery content (50.9%). One pro-smoking music video had been viewed over 2 million times. The four most prominent themes of the videos were celebrity/movies, sports, music and ‘archive’, the first three of which represent themes of interest to a youth audience."

The article concludes that: "Pro-tobacco videos have a significant presence on YouTube, consistent with indirect marketing activity by tobacco companies or their proxies."

Media coverage of the article disseminated worldwide the conclusion that cigarette companies are now using YouTube to market their products and get around restrictions on traditional forms of marketing. For example, the headline of an article on The Medical News read: "Tobacco Companies Use Web 2.0 Media to Get Around Marketing Restrictions."

The Rest of the Story

Despite their claim that tobacco companies are using YouTube to advertise cigarettes, the authors provide no evidence that this is the case.

It is very possible that individuals, not affiliated with the tobacco companies, have produced videos that portray cigarettes and cigarette brands. Has this not occurred to the study authors?

Before making the claim that cigarette companies are responsible for these YouTube videos, the authors need to provide evidence that the companies are behind the videos. This is a serious allegation, since it would put the tobacco companies in violation of a number of laws and agreements.

The only "evidence" that the authors provide is that some of the videos appear to be professionally made. This does not prove anything, however, since the ability to produce professional-looking videos is now widely available.

In fact, two major tobacco companies responded to the article by publicly denying that they are behind these YouTube videos.

British American Tobacco was quoted as stating: ""It is absolutely not our policy to use social networking sites such as Facebook or YouTube to promote our tobacco product brands, and not even the authors of this report claim we have done so. Using social media could breach local advertising laws and our own International Marketing Standards, which apply to our companies worldwide. Our employees, agencies and service providers should never use social media to promote our tobacco brands."

Philip Morris was quoted as stating: "Philip Morris USA does not post cigarette brand marketing videos on YouTube. In fact, PM USA has communicated with YouTube in the past asking them to remove YouTube video content that it believed infringed on PM USA's intellectual property rights."

Since the companies deny being responsible for the posting of these videos, it is incumbent upon the researchers of the study to document or at least provide evidence that the companies are behind this before making such an insinuation.

The rest of the story is that this article makes a serious but unsupported allegation against the tobacco companies. This undocumented accusation appears to be a recent phenomenon in tobacco control. The Rest of the Story has previously revealed a recent trend in undocumented accusations in tobacco control.

My sense is that the reason for this trend in the use of undocumented accusations is the tobacco industry's decision, some time around 2000, to discontinue its oversight of the claims being made by anti-smoking groups. Prior to that time, the tobacco companies would respond publicly and immediately to any undocumented claims. Since then, the companies have basically let anti-smoking groups make any claims they want. It used to be that we in tobacco control would be very careful to document any accusations against the industry because we knew our feet would be held to the fire. However, this is no longer the case and so anti-smoking groups and researchers are becoming much more lackadaisical about their documentation of allegations against the industry.

However, in my view, these undocumented accusations represent a deterioration of the scientific integrity of the tobacco control movement.

Thursday, August 26, 2010

New York City Considering Ordinance to Ban Smoking in All Parks

Mayor Bloomberg is considering reviving an ordinance that would ban smoking in all New York City parks, including 843-acre Central Park, according to an article on the local CBS site.

According to the article: "The new measure would widen the current smoking ban – in bars, subways, buildings, playgrounds and other public places – to include some 29,000 acres of park land and 14 miles of beaches. ... New York City Health Commissioner Dr. Thomas Farley proposed the park and beach ban almost a full year ago, and a statement from the mayor’s office Saturday night indicates the issue could soon come off the backburner. “The mayor is seriously considering it. A final decision has not yet been make,” the statement said."

The Rest of the Story

I think this proposal goes too far. In a place like Central Park, it is not difficult for nonsmokers to avoid smokers because it is so big. The duration of any unavoidable exposure is so small that it is not an issue of public health, but simply of comfort. And for that, I don't see government intrusion as being necessary.

The problem with these broad outdoor smoking bans is that they go beyond the issue of health protection. They go beyond the need to protect nonsmokers from significant exposure to secondhand smoke and instead, what they are protecting the public against is having to see smokers.

This demonstrates, once again, how the public health practice of tobacco control has shifted from a battle against cigarette smoke to a battle against cigarette smokers.

Public health advocates should remember that outdoors is exactly where we want smokers to be smoking. That is actually the way to minimize exposure of nonsmokers to secondhand smoke. Eventually, what these policies are going to do is make it impossible for smokers to smoke anywhere except in their own homes. And that would be detrimental to the public's health because it would expose their families - and their children - to the tobacco smoke.

Is it tobacco smoke exposure that we are fighting or is it the smoker?
The actions of the New York City Health Commissioner suggests that it is the smoker.

Wednesday, August 25, 2010

Mayor Bloomberg Tells Governor to "Get Yourself a Cowboy Hat and a Shotgun" to Enforce Collection of Cigarette Taxes from Seneca Indian Nation

New York City Mayor Michael Bloomberg instructed state governor David Paterson to "get yourself a cowboy hat and a shotgun" in order to collect cigarette taxes from the Seneca Indian Nation, according to numerous news sources, including an article in the Syracuse Post-Standard. The remark came during the mayor's weekly radio show and sparked outrage from Native Americans both in New York and across the country.

According to the article: "New York City Mayor Michael Bloomberg's advice to Gov. David Paterson on how to collect sales tax on cigarettes sold on Indian reservations was simple: "Get yourself a cowboy hat and a shotgun" and enforce the law. That comment on his weekly radio show has sparked outrage from Native Americans in Central New York and across the country. They charge the comment was racially insensitive and offensive. Twenty-five Oneida Nation members and other Native Americans who work at the Oneida Nation protested Monday on the steps of City Hall in New York. The Seneca Nation has called on the mayor to resign. National Congress of American Indians wants him to apologize. Oneida Nation Representative Ray Halbritter said the imagery of the governor "wearing a cowboy hat and holding a shotgun" to confront Native Americans is offensive and hurtful."

Bloomberg's comments come at a time when the state of New York is preparing to begin taxing cigarettes on Native American reservations. A new law, which goes into effect September 1, imposes a $4.35 per pack tax on cigarettes sold on Native American reservations to non-Native customers. The state is embroiled in a conflict with Native American nations. The Seneca Nation, for example, has filed a lawsuit against the state to block enforcement of the law.

According to the article: "The Seneca Nation of Indians passed a Tribal Council Resolution on Aug. 14 condemning Bloomberg's comment as derogatory against the nation and its membership. The resolution demands that Bloomberg resign his post as mayor of New York City and provide a formal written apology to the Seneca Nation and its members. The resolution also asks Paterson to publicly condemn Bloomberg's comments and authorizes Seneca President Barry Snyder to file human rights and hate crime violations with the state of New York, Justice Department and United Nations Special Rapporteur on Indigenous People. The National Congress of American Indians demanded an apology from the mayor. "We understand that the State of New York and the Senecas are having a disagreement about tax policy, but legal disagreements between governments require responsible leadership and diplomacy and not reckless calls for violence," said Jefferson Keel, the group's president. "It is insulting that a tribal government defending its legal rights today is threatened with the brutalities of the past," he said. "I have asked Mayor Bloomberg to apologize for his choice of words and to return the discourse to the level of civility that we all deserve."

According to the article, the Mayor initially did not have any comment on the complaints of the Native American groups. His spokesperson merely reiterated his demand that Native Americans pay cigarette taxes to the states as mandated in the law.

However, another article stated that the Mayor did respond, saying that he will not apologize: "Spokeswoman Jessica Scaperotti said the mayor is not planning to apologize or resign. "There will not be an apology forthcoming," she said. "What the New York City mayor's office is looking to do is to have the tribes follow the law."

The Rest of the Story

I condemn Mayor Bloomberg's remarks, which are insensitive and offensive to Native Americans and which are racist and derogatory.

Even more troubling than the remarks are the apparent refusal of the Mayor to apologize. It's one thing if he made a mistake on his radio show, but to refuse to apologize afterward is inexcusable.

Frankly, I've never seen a politician make racially insensitive and offensive remarks like this and refuse to apologize afterward. Even Imus apologized after the racially derogatory slurs he hurled at the Rutgers womens' basketball team.

The refusal to apologize is even more offensive than the initial remarks. Mayor Bloomberg has terribly insulted the Native Americans in his state and throughout the country. If it were any group other than Native Americans, there would be widespread calls for his resignation. The very least he can do in this situation is issue a profound apology.

Tuesday, August 24, 2010

Anti-Smoking Groups Intervene in Support of New York City Law Requiring Graphic Anti-Smoking Posters Wherever Tobacco Products are Sold

Twenty-five anti-smoking groups, including the American Medical Association, American Legacy Foundation, American Cancer Society, and American Lung Association, have intervened by filing an amicus brief in support of New York City's recently enacted law which requires stores that sell tobacco products to display city-designed, graphic anti-smoking posters at places where these products are offered for sale. The three major tobacco companies have challenged the constitutionality of this law, arguing that the requirement for graphic warnings violates the First Amendment rights of retail stores.

According to the press release, Cheryl G. Healton, DrPH, president and CEO of Legacy, stated: "This filing reiterates how serious public health and policy leaders are about doing everything it takes to put an end to the hundreds of thousands of needless deaths from tobacco in this country every year. ... Simply put, public health must always trump tobacco sales."

The Rest of the Story

If these groups are serious about doing everything it takes to put an end to the hundreds of thousands of needless deaths from tobacco in this country, then why did most of these very same organizations support legislation that:
  • Ensures that nicotine will never be removed from tobacco products;
  • Exempts menthol from the ban on all other flavored cigarettes;
  • Restricts the ability of the FDA to increase the age of sale of tobacco products;
  • Precludes the FDA from regulating the places where cigarettes can be sold;
  • Makes it impossible for reduced risk products to be successfully developed and marketed; and
  • Puts the government in the position of officially approving cigarettes.
These organizations are a bunch of hypocrites. They state that they are doing everything possible to put an end to the hundreds of thousands of needless deaths from tobacco, yet at the same time, they worked to enact legislation which institutionalizes tobacco products, makes it impossible for safer tobacco products to enter the market, and ensures that youth access to tobacco cannot be effectively curtailed.

Now, these groups are once again promoting feel-good legislation that does very little to actually reduce tobacco use, but allows them to pretend that they are doing something meaningful.

These groups do not have the courage to stand up for actions that would actually be effective. They are unwilling to take a stand on principle, rather than on politics and political feasibility.

If tobacco products are so unsuitable for public consumption that New York City must require stores to actively discourage customers from buying their own products, then New York City needs to simply prohibit stores from selling that product. Clearly, it is not the public's health that is of paramount importance here - it is preserving cigarette sales in the city.

Thus, this law does the exact opposite of what its anti-smoking supporters say it does: it puts economic profits above public health.

If these groups support such extreme intervention on the part of New York City -requiring stores to actively discourage their customers from buying their products with graphic posters urging their customers not to buy their products - then why do they not support the step of simply telling these stores: "Sorry, but these products are so deadly that we cannot allow you to sell them."

The answer, obviously, is that these organizations are putting tobacco sales above the public's health. While these posters will do very little to discourage people from smoking, a ban on the sale of tobacco in they City would likely have a significant effect - especially in terms of reducing youth smoking. But no, instead of doing something that would actually make a difference, these groups are supporting a feel-good policy that makes absolutely no sense and caves in to political pressure and purely economic concerns.

To be sure, I am a strong supporter of anti-tobacco advertising campaigns that discourage kids from starting to smoke and encourage existing smokers to quit. In fact, anti-tobacco advertising is - in my view - the appropriate way for the federal government to address the tobacco problem, rather than wasting its time regulating the ingredients in tobacco products. I would therefore be supportive of any efforts to encourage retailers to voluntarily agree to display tobacco warnings or educational posters to discourage tobacco use.

However, this is not a voluntary campaign. It is a government mandate that stores which sell tobacco must actively discourage their customers from buying the products which they sell. If the state health department believes that tobacco products are so harmful that retailers must be forced to urge customers not to buy their own merchandise, then the state should simply not be allowing these products to be sold. If the state is going to allow stores to sell these products, then I believe it is excessive government intervention to tell stores that they can sell them, but they have to discourage anyone from actually buying them.

Requiring retailers to actively discourage customers from buying their products seems to me to be an unreasonable degree of government intrusion. The reasoning that would support such an intervention would equally apply to all harmful products sold by businesses.

Would it be appropriate for the government to require all grocery stores to put graphic warning posters near the junk food aisle urging customers not to purchase these unhealthy snacks?

Would it be reasonable for the government to require grocery stores to post graphic posters at the soda aisle urging customers not to purchase soda because of the morbidity and mortality caused by obesity, to which soda contributes significantly?

Should tanning salons be required to post disgusting pictures of skin cancers at their entrances, urging potential customers not to enter?

Should wood stove stores be required to post graphic posters depicting the horrible consequences of lung disease, which we know is caused by wood smoke exposure?

Should fast food restaurants have to post large, graphic posters showing the terrible health consequences of excessive fat intake, actively discouraging potential customers from eating there?

If these anti-smoking groups were seriously concerned about reducing tobacco use, they should have spent their time and resources promoting federal funding for anti-smoking media campaigns in all 50 states, rather than wasting their time on trying to regulate the safety of a deadly product. They are hypocrites.

Thursday, August 19, 2010

IN MY VIEW: Secret Meeting of Faculty in Enstrom Firing Violated Due Process

The requirements for due process in the consideration of non-tenured faculty reappointment by faculty committees have been made very clear by several documents produced by the American Association of University Professors (AAUP). One critical component of due process in such proceedings is that the faculty member in question must be given the opportunity to submit to the committee any materials that he believes are important in the consideration of his reappointment (see: AAUP's Statement on Procedural Standards in the Renewal or Nonrenewal of Faculty Appointments).

These procedural standards for due process state that: "Probationary [non-tenured] faculty members should be advised of the time when decisions affecting renewal and tenure are ordinarily made, and they should be given the opportunity to submit material that they believe will be helpful to an adequate consideration of their circumstances."

The Rest of the Story

It does not appear that Dr. Enstrom was given the opportunity to submit material to the Environmental Health Sciences faculty for their specific consideration at the April meeting at which a vote was taken on whether or not to terminate his appointment. I believe this violates due process.

A second violation of established procedures for non-reappointment is that the Department and School failed to give Dr. Enstrom the requisite 12-months advance notice of his non-reappointment. According to the AAUP's Statement on Procedural Standards in the Renewal or Nonrenewal of Faculty Appointments, a faculty member who has held a position for more than two years must be given 12-month notice of non-reappointment (AAUP, Policy Documents and Reports, 10th ed. [Washington, D.C., 2006], 54.)

Dr. Enstrom received his notice of non-reappointment on June 30th, with an effective date of August 30th. Thus, he was given only two-months advance notice, which is inappropriate and unacceptable for a faculty member with 34 years of continuous appointment at the School. (As a contrast, a faculty member in a similar situation at my institution - the Boston University School of Public Health) is guaranteed three years advance notice of non-reappointment.

I also believe it was inappropriate for Dr. Enstrom not to have been given an opportunity to directly address the faculty who were about to make a decision to terminate his appointment and I find it distasteful that he was not allowed to attend the meeting to hear the reasons that were used in supporting his termination and to be able to provide factual evidence, if appropriate, to counter any misrepresentation of the facts.

The rest of the story is that there were, in my view, at least three violations of due process in Dr. Enstrom's firing:

1. The failure to allow Dr. Enstrom the opportunity to directly address his faculty colleagues on the issue of his research and qualifications for re-appointment;

2. The failure to allow Dr. Enstrom the opportunity to submit materials for specific consideration at the meeting at which the decision to terminate his appointment was made; and

3. The failure to provide 12-month advance notice of termination of his long-standing faculty appointment.

ADDENDUM: While not related to due process, I wish to note that in declaring that Dr. Enstrom's research is not aligned with the Department's mission, the Department has (inadvertently) maligned the research of the esteemed Dr. Lester Breslow. Since Dr. Breslow was the co-author with Dr. Enstrom of an important 2008 article in Preventive Medicine that linked lifestyle factors and mortality, the Department's disavowing itself from Dr. Enstrom's research is also an indictment of Dr. Breslow. This is unfortunate, given that Dr. Breslow is a legendary figure in public health who has the utmost esteem of so many of us in the field. It is hard to imagine finding that a faculty member who collaborates in research with Dr. Breslow and publishes a major research article with him is doing research which are not aligned with the mission of a School of Public Health. I can only imagine how Dr. Breslow feels or would feel (I do not know if he is aware of the situation) about the way in which Dr. Enstrom was treated by his UCLA School of Public Health.

The Enstrom Firing: Further Thoughts on the Stated Reasons for Termination and the Violation of Due Process

A. Alignment of Dr. Enstrom's Work with the Mission of the Environmental Health Services Department at the UCLA School of Public Health

The primary reason given for Dr. Enstrom's firing was that his department voted and decided that his research is not aligned with the department's mission, which is to explore the relationship between environmental exposures and human health.

If one actually reviews Dr. Enstrom's research over the years, one will see that his work is directly related to this mission.

A review of Dr. Enstrom's work reveals a number of important points:

1. He has conducted high-quality and important epidemiologic investigations of cancer and overall mortality which has played a significant role in helping to identify the critical factors that are most strongly linked with good health and decreased cancer and mortality.

2. He has collaborated with legendary experts in the public health field, including Lester Breslow and Nobel Laureate Linus Pauling, to explore the impact of basic health behavior practices on mortality.

3. Throughout his career, he has not been afraid to report the results of his research as they unfold: whether positive or negative. Many of his studies report "positive" findings (such as the link between smoking and alcohol and cancer/mortality) and many report "negative" findings (such as the link between dietary fat and cancer and the link between vitamin intake and cancer). He reports the results as they are.

Here is a sampling and brief summary of a portion of Dr. Enstrom's research over the years:

a. Cancer mortality among Mormons. Cancer 1975; Sep;36(3):825-41.

Showed that cancer mortality is significantly lower among a population with very low rates of smoking and alcohol use, supporting the conclusion that smoking and alcohol are strongly associated with cancer mortality.

b. Colorectal cancer and consumption of beef and fat. Br J Cancer 1975; Oct;32(4):432-9.

Questions link between beef and fat consumption and colorectal cancer.

c. Colorectal cancer and beer drinking. Br J Cancer 1977; May;35(5):674-83.

Demonstrates strong statistical association between beer consumption and colorectal cancer risk.

d. Multiple sclerosis among Spanish-surnamed Californians. Neurology 1978; May;28(5):434-8.

With EA Operskalski, suggests both genetic and environmental factors in the etiology of multiple sclerosis.

e. Cancer and total mortality among active Mormons. Cancer 1978; Oct;42(4):1943-51.

Demonstrates much lower rates of cancer and overall mortality among active Mormons, documenting the enormous role that smoking and alcohol play in human health.

f. Rising lung cancer mortality among nonsmokers. J Natl Cancer Inst 1979; Apr;62(4):755-60.

One of the first studies to document that lung cancer mortality among nonsmokers was rising, marking the need for a search to uncover the reasons for this increase. Suggested the need to search for a factor other than active smoking in explaining these rising lung cancer mortality rates.

g. Cancer mortality among low-risk populations. CA Cancer J Clin 1979; Nov-Dec;29(6):352-61.

Demonstrates the enormous link between basic health behaviors - such as smoking - and cancer risk and estimates that a huge proportion of cancer mortality could be eliminated by simply adopting basic healthy practices.

h. Persistence of health habits and their relationship to mortality. Prev Med 1980; Jul;9(4):469-83.

With Lester Breslow, discussed the role of basic health habits in explaining a large proportion of premature death.

i. Cancer mortality among Mormons in California during 1968--75. J Natl Cancer Inst 1980; Nov;65(5):1073-82.

Demonstrated strong link between lifestyle and cancer risk.

j. Cancer mortality among a representative sample of nonsmokers in the United States during 1966--68. J Natl Cancer Inst 1980; Nov;65(5):1175-83.

With F.H. Godley, this study was a sentinel one which documented the link between smoking and cancer.

k. Reassessment of the role of dietary fat in cancer etiology. Cancer Res 1981; Sep;41(9 Pt 2):3722-3.

Discusses methodologic problems in studies that linked dietary fat and cancer.

l. Mortality among health-conscious elderly Californians. Proc Natl Acad Sci U S A 1982; Oct;79(19):6023-7.

With Nobel Laureate Linus Pauling, demonstrates link between healthy lifestyles and reduced mortality.

m. Cancer mortality patterns around the San Onofre nuclear power plant, 1960-1978. Am J Public Health 1983; Jan;73(1):83-92.

Showed no increase in cancer mortality surrounding the San Onofre nuclear power plant.

n. Trends in mortality among California physicians after giving up smoking: 1950-79. Br Med J (Clin Res Ed) 1983; Apr 2;286(6371):1101-5.

Documents substantial reduction in mortality associated with decrease in smoking.

o. The relationship between vitamin C intake, general health practices, and mortality in Alameda County, California. Am J Public Health 1986; Sep;76(9):1124-30.

With LE Kanim and Lester Breslow, shows no relation between vitamin C intake and mortality, but a strong relationship between basic health habits - such as not smoking, moderate alcohol intake, and physical activity - and decreased mortality.

p. Smoking cessation and mortality trends among 118,000 Californians, 1960-1997. Epidemiology 1999; Sep;10(5):500-12.

With Clark Heath of the American Cancer Society, demonstrates mortality reduction associated with smoking cessation.

q. Lifestyle and reduced mortality among active California Mormons, 1980-2004. Prev Med 2008; Feb;46(2):133-6. Epub 2007 Aug 3.

With Lester Breslow, shows strong impact of a healthy lifestyle on mortality and life expectancy.

This last publication in particular, which was published just two years ago, demonstrates that the work Dr. Enstrom is doing is directly aligned with the mission of the UCLA School of Public Health. In fact, he wrote the article with Lester Breslow, a legendary figure in the public health field.

I find it interesting that Dr. Enstrom was a researcher at UCLA for 34 years, but never before has the School questioned the alignment of his research with the "mission" of the School. A review of his research makes it very clear that his work is directly aligned with the mission of the School and that he in fact established a line of research that played a critical role in helping to elucidate the factors that are most strongly linked with cancer and with overall mortality.

This review confirms that Dr. Enstrom's work is directly aligned with the missions of both his Department and his School. The nature of his work is at the very core of public health: the search for the major determinants of human disease and death. A rejection of Dr. Enstrom's research as not being aligned with the mission of the School and Department is essentially a rejection of the basic idea of public health: to explore the causes of human disease and death.

I am now even more convinced that what UCLA was saying in asserting that Dr. Enstrom's research is not aligned with the Department mission is that his findings are not aligned with the Department's mission.

B. Violation of Due Process

In the Bakersfield Californian article, Dr. Beate Ritz - a faculty member in the Department of Environmental Health Sciences - admits that she had not read Dr. Enstrom's 2005 article on the relationship between fine particulate matter exposure and overall mortality. It is not clear whether she voted in the meeting, but if she did, it is an abomination because it is terribly unfair to judge someone's research without actually reading it. Moreover, if her level of unfamiliarity with Enstrom's work is indicative of that of other faculty members as well, then it appears very unfair for the faculty to have voted on Enstrom's termination because they would not have even considered the evidence. It is unclear whether Enstrom's publications were provided to the faculty members before the vote. But since Dr. Ritz admits she didn't read the 2005 article - which appears to be the central one in the whole debate - this doesn't bode well for due process in this indictment of Dr. Enstrom.

The most critical point remains as follows: Dr. Enstrom was denied the opportunity to present his side of the story to the faculty. He was not permitted to present his research on fine particulate matter and mortality. He was not permitted to testify in his own defense. This is a breach of both due process and justice.

ADDENDUM (August 20, 2010 - 12:15 pm): I have confirmed that Dr. Ritz did not participate in the vote and played no role whatsoever in the decision, as she as a secondary appointment in Environmental Health Sciences. Her primary appointment is in Epidemiology, so she does not participate as a voting faculty on EHS faculty appointment matters.

Wednesday, August 18, 2010

UCLA School of Public Health Fires Professor James Enstrom, Apparently Because It Does Not Like the Direction of His Research Findings

Apparent Disrespect for Academic Freedom and Violation of Due Process Should Alarm Everyone Concerned about Academic Integrity

UCLA School of Public Health professor James Enstrom has been fired from his position in the School's Department of Environmental Health Sciences under the primary claim that his "research is not aligned with the academic mission of the Department."

Dr. Enstrom received official and final notice of the School's decision not to reappoint him (as of August 30, 2010) in a June 30 letter from the Chair of the Department of Environmental Health Sciences. This decision was confirmed in a July 29 letter from the Associate Dean for Academic Programs at the School.

The decision to terminate Dr. Enstrom's appointment followed a vote of the Environmental Health Sciences Department's faculty regarding his re-appointment.

In both letters, the primary reason for Dr. Enstrom's non-reappointment was that the Department faculty determined that his research was not aligned with the Department's mission.

In one letter, the primary reason for non-reappointment is that: "the faculty of [the Department of] Environmental Health Sciences have determined that your research is not aligned with the academic mission of the Department...". In the other letter, the primary reason for non-reappointment is that: "the faculty of the Department of Environmental Health Sciences has determined your research is not aligned with the academic mission of the Department...".

Thus, the primary stated reason for Dr. Enstrom's firing was that the faculty of his academic department had come to the decision that his research was not aligned with the Department's academic mission.

The story was reported in an article in the Bakersfield Californian and another article in the Sacramento Bee. It was also reported on Dr. Carl Phillips' blog Ep-ology, at Velvet Glove, Iron Fist, and at the American Council on Science and Health's Facts and Fears blog.

The Rest of the Story

Dr. Enstrom has held a continuous academic appointment at the UCLA School of Public Health for the past 34 years. Initially, his position was based in the Dean's Office. Since 2004, his position has been based in the Department of Environmental Health Sciences.

The stated mission of the Department of Environmental Health Sciences is to: "explore the fundamental relationship between human health and the environment."

In particular, the specific mission of one of the major centers housed in the Department of Environmental Health Sciences - the Southern California Particle Center (SCPC) is: "to identify and conduct high priority research to better understand the effects of particulate matter (PM) and ensure protection of public health." The SCPC is led by Professor John Froines of the Department of Environmental Health Sciences, and its research focus in the past decade has been on studying the health effects of particulate matter.

In fact, a presentation by Dr. Froines summarizing the work of the SCPC highlights its investigations into the effects of fine particulate air pollution.

Dr. Froines' major research interest is described as: "Chemical mechanisms and exposure assessment related to the health effects from exposure to airborne particulate matter."

In fact, an enormous amount of research by many faculty in the Department of Environmental Health Sciences involves investigation of the health effects of particulate matter, including fine particulates (PM2.5) and diesel particulate exhaust. The following are publications out of the Department of Environmental Health Sciences faculty, all of which focus on the health effects of particulate matter air pollution:

AK Di, Stefano E, You Y, Rodriguez CE, Schmitz DA, Kumagai Y, Miguel AH, Eiguren-Fernandez A, Kobayashi T, Avol E, Froines JR. Determination of Four Quinones in Diesel Exhaust Particles, SRM 1649a and Atmospheric PM2.5. Aerosol Science and Technology 2003.

Li N, Sioutas C, Cho A, Schmitz D, Misra C, Sempf J, Wang M, Oberley T, Froines J, Nel A. Ultrafine particulate pollutants induce oxidative stress and mitochondrial damage. Environmental Health Perspectives 2003; 111(4): 455-60.

Li N, Kim S, Wang M, Froines J, Sioutas C, Nel A. Use of a stratified oxidative stress model to study the biological effects of ambient concentrated and diesel exhaust particulate matter. Inhalation Toxicology 2002; 14(5): 459-86.

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And What About Dr. Enstrom's Research?

It turns out that a major focus of Dr. Enstrom's work during the past six years has been ...

... the effects of fine particulate matter air pollution on human health.

In fact, Dr. Enstrom was just invited by the Health Effects Institute to submit a full proposal under an RFP related to the health effects of air pollution. His preliminary application was accepted, meaning that (had he not been fired) he was about to submit a full proposal, entitled: "Criteria Pollutants and Mortality in the NIH-AARP Diet and Health Study Cohort."

In 2005, Dr. Enstrom published a study that examined the relationship between fine particulate exposure and total mortality among nearly 50,000 elderly Californians. This was one of the largest studies ever to look at the relationship between PM2.5 and mortality rates.

Clearly, Dr. Enstrom's research is directly related to the mission of the Department of Environmental Health Sciences. In fact, his work is directly aligned with the stated mission of the Department and one of its major centers and his research area is exactly the same as that of several other faculty members in the Department.

Since it is clear that Dr. Enstrom's research is directly aligned with the mission of the Department, how can the Department and the School claim that his research is "not aligned with the academic mission of the Department"?

Apprently, the problem with Dr. Enstrom's research is not the nature of the research, which obviously aligns perfectly with the mission of the Department of Environmental Health Sciences. Instead, the problem appears to be the direction of his research findings.

Dr. Enstrom happened to find that there was no significant relationship between PM2.5 exposure and overall mortality, at least during the time period 1983-2002.

This is apparently what the UCLA School of Public Health and the Department of Environmental Health Sciences mean when they conclude that Dr. Enstrom's research does not align with the "mission" of the Department. The nature of his research aligns perfectly, coinciding closely with the work of several other faculty members and coinciding perfectly with a major center housed in the Department. But apparently, the direction of his findings does not align with the Department's mission.

In other words, the mission of the Department of Environmental Health Sciences is not to "explore the fundamental relationship between human health and the environment." Instead, its mission is to show that fine particulate matter pollution and other environmental exposures adversely affect human health.

If your research fails to show an adverse effect of an environmental exposure on human health, then your research is apparently no longer "aligned" with the mission of the Department and School.

As long as your research results are "favorable" to increased regulation, then it appears your research is aligned with the School's mission. But as soon as you obtain negative findings and report them, you have deviated from the School's mission and you are at risk of being fired.

Think about the negative implications of this mentality for the integrity of research and of science. If your career success - and your ability to maintain your job - are going to measured by your ability to produce positive findings of the adverse effects of whatever you are studying - then you are going to become biased in your research.

How can we ever have objective environmental science research if faculty members are scared that if they report negative findings, they are going to lose their jobs? You want to talk about publication bias? The actions of the UCLA School of Public Health with respect to Dr. Enstrom's firing may well contribute toward publication bias. If you can't report the findings of your research as they actually come out because you are afraid of losing your job, then negative findings would never be reported and there would be a complete destruction of scientific integrity.

Moreover, the Department of Environmental Health Sciences at UCLA appears to be interfering with academic freedom. If they are going to conclude that a faculty member's research doesn't align with the mission of the Department because they are unhappy with the direction of the research findings, then faculty are no longer free to express their opinions. Expressing a dissenting opinion could be grounds for termination.

The actions of UCLA in this case appear to be an alarming threat to the integrity of academic freedom and scientific integrity in academia.

As it turns out, Dr. Enstrom's findings about the lack of a significant relationship between PM2.5 exposure and overall mortality are not an anomaly. Nor are they a result of poorly conducted science. A study by Dr. Michael Jerrett at UC Berkeley, using data from the Cancer Prevention Study - II, found exactly the same result. Dr. Jerrett reported no increased relative risk for all-cause mortality associated with PM2.5 exposure. Specifically, he reported "null PM2.5 effects on all cause mortality."

Dr. Jerrett is a well-respected scientist who conducted research similar to that of Dr. Enstrom and found essentially the same result. In fact, he reported the results of another California study which found no evidence of increased heart disease mortality associated with PM2.5 exposure among males.

I am not arguing here that PM2.5 is not a major health threat. There are reasons why one might not detect effects on overall mortality and any conclusion must be based on the totality of the evidence, not based on a single study. Dr. Jerrett was apparently struggling to find an explanation for the lack of a significant association between particulate exposure and overall mortality. The finding does not necessarily rule out a positive association between fine particulates and cardiovascular disease. My point is simply to show that Dr. Enstrom's findings were validated in an independent study, thus refuting any argument that his research was invalid. It appears that his finding of a lack of a significant association between fine particulate exposure and overall mortality is not an anomaly.

Is there no room for a difference of opinion in a public health institution? Must all faculty members tow a certain party line, regardless of what their research shows?

Well, at UCLA School of Public Health, at least in the Department of Environmental Health Sciences, the answer to both questions appears to be yes. If your research happens to report negative findings, you are apparently in danger of being terminated because your research suddenly becomes misaligned with the Department mission.

You know, there are a large number of reasons why a faculty member can be terminated. In fact, a non-tenured faculty member can essentially be terminated simply because the Department Chair no longer wants that faculty member in the Department. Great deference is given to the School in making faculty re-appointments. In light of this, it is striking that the Department and the School would go to such an effort to emphasize that the reason for Dr. Enstrom's firing is that his research is not aligned with the mission of the Department.

It creates the appearance that the faculty was out to get him because they didn't like the direction of his findings.

Not only is this a danger to academic freedom and academic integrity, but it also is a form of censorship. If we suppress dissent by making sure that those with differing opinions cannot freely publish their findings without the threat of losing their jobs, then we are in essence censoring dissenting opinions. In fact, what we have just seen occur at UCLA is a very effective form of censorship. It cuts right to the heart: it threatens to destroy a faculty member's career and possibly livelihood if he or she publishes negative findings.

I need to make an important point at this time. I am not arguing here either for or against Dr. Enstrom's reappointment. There could be valid reasons for his non-reappointment. However, that his research does not align with the Department's mission is not one of them. My argument is related to the primary reason given for his termination in the official termination letter and to the process by which he was terminated. These arguments do not depend on whether or not there was merit in the decision to terminate Dr. Enstrom. They depend, instead, on an analysis of the validity of the stated reason for his termination and the process that led to the decision.

In the Bakersfield Californian article, Department Chair Dr. Richard Jackson alludes to "poor quality science" being the reason for Enstrom's termination. If that is the case, then why does the termination letter fail to mention poor quality science and instead, list the primary reason for termination as Enstrom's research not aligning with the Department's mission? And if poor quality science was the reason for his termination, why was a vote of the Department faculty an appropriate way to make the decision?

The UCLA School of Public Health has every right to fire Dr. Enstrom because of poor quality science, or because they are unhappy with his funding sources, or because they are displeased with his productivity (the second reason stated in his termination letter), or for any number of other reasons. However, these reasons do not require or merit a vote of the Departmental faculty, nor do they warrant a statement in the termination letter falsely stating the primary reason for the termination. We have to, therefore, take the School's and the Department's word for it and assume that when they say he was fired because the Department faculty do not view his research as being aligned with the Department's mission, they mean it.

Something just doesn't smell right and perhaps that is why Dan Walters of the Sacramento Bee speculated that there is something more sinister going on. Walters reveals that Enstrom was the one who exposed the fact that a previous member of the Air Resources Board - Hien Tran - whose report on diesel emissions was the basis for tough regulations, had falsified his academic credentials. Walters wrote: "By all appearances, not only did the ARB cover up Tran's falsification but its sycophants on the UCLA faculty are punishing the man who blew the whistle. If the legislature's oversight committees and investigative staffs were doing their jobs, they'd delve into this mess."

Violation of Due Process

I find it distasteful that the decision to terminate Dr. Enstrom's employment was made by a secret vote of his faculty colleagues - the Departmental faculty. In general, I think employment decisions - especially firing decisions - should be made by the Department Chair in consultation with the Dean of the School. It seems inappropriate to have faculty making firing decisions about one another.

This is especially problematic because faculty compete with each other. To have one faculty member making a firing decision about another faculty member is inappropriate. There are numerous conflicts of interest that are inevitably going to enter into the process - conflicts that have nothing to do with the actual qualifications or merit of the faculty member to continue in his or her appointment.

In this case, there are a number of conflicts of interest, some of them blatant. For one, Dr. Enstrom's research findings conflict with those of several other faculty members. Thus, these faculty members have a potential vested interest in ousting Dr. Enstrom from the faculty, or at least, they were given the opportunity to exercise any grudges that might have against Dr. Enstrom because of his conflicting research findings.

More blatant is the fact that Dr. Froines was allowed to participate in the decision. Dr. Froines has the serious potential to have an incentive to retaliate against Dr. Enstrom, because it was Enstrom's actions that led recently to the removal of Dr. Froines from his position on the California Scientific Review Panel for Toxic Air Contaminants, a position that Dr. Froines held for 26 years.

Although state law (Health and Safety Code Section 39670-39671) states that members of the Scientific Review Panel shall have terms of three years, Dr. Froines was apparently on the panel for 26 years. Dr. Enstrom was the one who pointed this out to the legislature and the Air Resources Board. A lawsuit was filed by the Pacific Legal Foundation and eventually, the administrators of the Scientific Review Panel complied with state law and dismissed Froines from the panel.

Surely, one would not want Dr. Froines to be participating in a decision on whether to fire Dr. Enstrom, given the potential incentive for him to retaliate against Enstrom.

To make matters worse, it seems that Dr. Froines had a history of holding a grudge against Enstrom, as he apparently publicly ridiculed Dr. Enstrom during a June 20, 2003 Scientific Review Panel meeting. The panel appears to have been discussing Dr. Enstrom's research and Dr. Froines stated: "As a member of the UCLA School of Public Health, I apologize." This was followed by laughter. Then Dr. Stan Glantz said: "You should." This was followed by more laughter. Then Dr. Glantz said: "We're doing a study of how that paper came to pass. And it's going to get even more unpleasant." Froines said: "James Enstrom's paper." And Glantz said: "that dreamt up by Philip Morris."

That UCLA would allow a decision about Dr. Enstrom's firing to be made by faculty colleagues with these potential conflicts - especially with Dr. Froines participating - is beyond me.

Once again, I am not arguing the merit of Dr. Enstrom's research on secondhand smoke - the topic of the paper that was apparently ridiculed at the SRP meeting. I am simply stating that there is an apparent reason why Dr. Froines should not participate in the decision about whether to fire Dr. Enstrom because of the conflict between them.

To me, the worst part of the story, however, is that in my view, due process was violated because although the departmental faculty were entrusted with the responsibility of making the decision whether to retain or fire Enstrom, Dr. Enstrom was apparently not given the opportunity to directly address the faculty and present his side of the story prior to the departmental vote on his job. In fact, he had been scheduled to give a presentation on his research regarding fine particulate matter and mortality, but that presentation was canceled by the department chair and Dr. Enstrom apparently never had the opportunity to directly address the faculty, answer questions, and present his side of the story about his research prior to the vote to fire him.

I believe that the opportunity to directly address the people who are accusing you of violating your contract or violating the mission of the school is an essential part of due process, especially if they are going to directly make a decision about your employment status. It is not a fair trial if the accused is not given the opportunity to testify in his defense.

In the end, regardless of the reasons for terminating Dr. Enstrom, I do not believe that it was appropriate for the decision to be made by the department faculty through a secret vote after a discussion at which Enstrom was not present and without Enstrom being given the opportunity to directly address the voting faculty and present his side of the story. I think that violates due process and is an inappropriate way to terminate a faculty member, even if the reasons given for termination were true and accurate.

As you can see, this is a complicated story and I have done my best to present it accurately and with a focus on the most relevant issues. Based on my assessment, I agree with Dan Walters that an investigation is warranted into the process of this firing decision and the validity of the stated reasons for the termination. This story is very concerning for the principles of academic freedom and academic and scientific integrity, as well as for the principle of due process in academic employment decisions. I therefore hope that this commentary is just the beginning of what appears to be a much-needed investigation and discussion.

Tuesday, August 17, 2010

Westford Considering Ordinance to Ban Sale of Cigarettes in Pharmacies

The town of Westford (Massachusetts) is considering an ordinance that would ban the sale of tobacco products in pharmacies.

According to an article in the Lowell Sun, the head of the Board of Health explained the rationale for the ordinance as follows: "The thinking is pharmacies are supposed to sell items that are healthy, good for you and to help you get better. Selling cigarettes behind the same counter is counterproductive."

The director of health care services for the town explained the rationale for the ordinance in similar terms: "Pharmacies are supposedly a location that helps people overcome illness and disease. We don't want them to sell something that can cause cancer or is a health concern."

The Rest of the Story

This is terrible hypocrisy. The Board of Health doesn't want pharmacies to "sell something that can cause cancer." However, the Board of Health is perfectly fine with any other type of store selling products that cause cancer.

Not only is the policy hypocritical, but it is also unjustified. The Board of Health is charged with the mission of protecting the public's health, not with the mission of ensuring that stores do not take actions that it views as counterproductive. It is not a justified or appropriate use of the city's police powers to start regulating whether stores are being counterproductive. The appropriate use of the city's police powers is to take actions that will improve the public's health.

Everyone - even the ordinance's supporters - agrees that this ordinance would not improve the public's health. It would not decrease the sale of tobacco products, as consumers would simply buy their cigarettes at other stores. It would not decrease the sale of tobacco products to minors as there are plenty of other places where youth can obtain these products. In fact, pharmacies are the least likely place where minors currently buy their cigarettes. They are much more likely to purchase cigarettes from gas stations and convenience stores.

So if it doesn't improve the public's health, then the only purpose of the ordinance is to regulate the mission of pharmacies. In other words, the purpose is to make sure that the products being sold meet some sort of arbitrary standard of what pharmacies are supposed to sell. This is far beyond the mission of the city government.

I think the ordinance is not only hypocritical and unjustified, but damaging. It is damaging because it frames the issue of tobacco products in the wrong way. It says that the sale of tobacco products is fine as long as you are not a pharmacy. It says that the only thing wrong with cigarettes is the place where they are sold. It doesn't bring me any consolation to know that if a person dies from lung cancer, they purchased their cigarettes at a gas station rather than at a pharmacy. It serves no public health purpose to ensure that when consumers buy deadly products, they do so at convenience stores rather than at pharmacies.

These policies are just another example of the recent trend in tobacco control to enact feel-good laws that make it look like politicians are doing something about the problem, but which actually don't do anything to address the death and disease caused by tobacco products. They do, however, allow politicians to say that they did something about the problem. While they may garner some votes, they do nothing to improve the public's health or save people's lives.

Monday, August 16, 2010

Actions of FDA and TPSAC on Cigarette Constituents Show Absurdity of Product Regulatory Approach and are Bureaucratic Waste of Resources

The FDA's Center for Tobacco Products has released the materials for the August 30th meeting of the Tobacco Product Scientific Advisory Committee (TPSAC), which will produce a list of harmful and potentially harmful constituents in tobacco smoke. These materials include a draft list of harmful and potentially harmful constituents and recommendations of the Constituent Subcommittee regarding the testing of constituent levels in cigarettes.

The draft list contains 108 chemical constituents that have been demonstrated to be either carcinogens, cardiovascular toxicants, respiratory toxicants, reproductive/developmental toxicants, or addictive components.

The Rest of the Story

To me, this seems like a pointless waste of time.

First of all, there is nothing new here. We have known about the harm or potential harmfulness of these 108 chemicals in tobacco smoke for many years.

Second, and more importantly, who cares?

Compiling this list does absolutely nothing to protect or improve the public's health. The only way this list would make a difference would be if the FDA were going to, or could, actually do something to remedy the problem.

However, the FDA tobacco law does not allow the FDA to get rid of all of these harmful constituents. At best, the FDA can require the selective removal of one or a handful of them. There is no evidence that such an action would make smoking any safer. It would, however, lead smokers to believe that cigarettes were safer. Such an action would essentially represent fraud against American consumers, similar to the fraud tobacco companies were accused of with their low-tar, "light" cigarette deception.

Moreover, such an action would undermine the public's appreciation of the hazards of smoking and could lead to increases in cigarette consumption, resulting in significant harm to the public's health.

There is only one way to remedy the harm caused by these toxicants and that is to remove them from cigarettes. The only way to do this is to produce a cigarette that delivers nicotine without the use of tobacco. This technology does, in fact, exist. It is called an electronic cigarette. The electronic cigarette delivers nicotine to users without 107 of these 108 chemicals (only nicotine is present in anything more than trace quantities).

Ironically, the FDA has essentially banned electronic cigarettes, or at least threatened to take enforcement action against companies which import or distribute these products.

This reveals the utter absurdity of the entire FDA tobacco regulatory scheme:

The product which contains only 1 of the 108 harmful chemicals is banned.

The product which contains 108 of the 108 harmful chemicals is approved for marketing and sale to millions of consumers, including hundreds of thousands of youth.

Now that makes great sense!

This whole exercise strikes me as not only a waste of time and resources, but as a huge hoax. It is giving the public the impression that the FDA is doing something to make cigarettes safer by compiling a list of harmful constituents in tobacco smoke. But nothing could be further from the truth.

Compiling a list protects nobody. The only thing that would protect the public would be to remove the 108 harmful chemicals. This would require the development of a cigarette that does not contain tobacco (it is called an electronic cigarette).

Why could the FDA not simply ban these 108 chemicals from cigarette smoke? Because there is no technology to remove all of these 108 chemicals. Placing a ban on these 108 chemicals would amount to a ban on existing cigarettes, which is specifically precluded by the Tobacco Act.

Thus, this entire exercise is an exercise in futility. A waste of time and resources. A fraud and a deception. A public hoax.

Despite the Tobacco Act's primary stated intention of making cigarettes safer by giving FDA the authority to regulate the constituents of the cigarette, even Dr. David Kessler - a staunch supporter of the bill and former FDA Commissioner - admitted that it was neither the intention nor the expectation of the bill's supporters that the bill actually achieve this purpose. He readily admitted that there is no scientific way for the FDA to make the product safer -- it's not even possible, he said: "I'm not sure that scientifically we're smart enough to know how to do that or that's possible when you're burning a tobacco leaf or you're inhaling all these chemicals that are very reinforcing."

Despite Kessler's proper understanding of cigarette toxicology, the science (i.e., the truth) did not stop him from joining many anti-smoking advocates and groups in pulling a hoax on the American people. And a hoax of massive proportions, I would add.

Just look at what supporters of the legislation told and continue to tell the American people. For example, Senator Christopher Dodd (D-CT) boasted that because of this legislation, cigarette manufacturers will "be forced to stop using some of the most dangerous ingredients." As if that makes any difference. There are more than 10,000 chemicals in cigarettes and there is no evidence that removing "some" of the most dangerous ones will result in a safer product. But this scientific fact did not stop Senator Dodd from pulling the wool over the eyes of the public and contributing to the public hoax.

Even the late Senator Ted Kennedy played a part in this hoax. He told the American public that the legislation would "help addicted smokers quit" and that it would "require manufacturers to make tobacco products less toxic and less addictive for those who continue to use them." But the law does nothing to help addicted smokers quit. There is no support of smoking cessation programs. There is no money for smoking quitlines or any inteventions that will help smokers quit. There are no funds for campaigns to motivate smokers to quit. In fact, the only relevant power the law gives the FDA is to reduce nicotine levels in cigarettes. However, we know from the scientific evidence that this will just result in smokers smoking more not less, as they need to compensate to maintain a constant dose of nicotine.

As John Jonik pointed out in a letter to the editor in the Seattle Times, Senator Kennedy's false promise was merely a continuation of the tobacco industry's fradulent statements about the benefits of low-nicotine cigarettes. In fact, Senator Kennedy's claim is probably worse because while the tobacco companies merely implied that "light" cigarettes might be less addictive, Kennedy was clearly asserting that low-nicotine yield products will be less addictive. Why is it that the tobacco companies were found guilty of fraud for making the same statement (in an even less assertive way) that Kennedy made?

Moreover, Senator Kennedy's assertion that the law will require manufactureres to make tobacco products less toxic is also false - another hoax. As Dr. Kessler admitted, there is no expectation that FDA regulation of certain of the ingredients in tobacco will be able to make cigarettes safer. Senator Kennedy, too, pulled the wool over the eyes of the American public.

And now, albeit not by specific intention, the FDA and its Tobacco Products Scientific Advisory Committee are continuing to carry out this hoax on the American public by going through the motions of pretending that by making a list of the constituents in tobacco smoke, it is magically going to result in a safer cigarette.

The Regulatory Scheme Established by the Legislation is Pure Lunacy

The system of tobacco product safety standards set up by the Tobacco Act is pure lunacy. Although the rhetoric by groups like the Campaign for Tobacco-Free Kids sounds great, the truth is that there is no evidence that these standards would actually result in a safer product.

The problem is that we simply do not know which of the constituents in tobacco smoke, and at what quantities, are responsible for what diseases. So the Campaign for Tobacco-Free Kids can talk all they want about how FDA will be able to reduce levels of certain toxins and produce a safer cigarette, but that's a pipe dream. It would take difficult to conduct, long-term epidemiologic studies, where you'd have to follow smokers of conventional vs. new products for 10-20 years, before you could have an answer to this question. But in the mean time, we wouldn't know what the risks are - or even if the risk could be decreased.

Essentially, the law gives the FDA a mandate which it cannot carry out. The only way to know whether any particular reductions in specific smoke constituents would result in a safer product would be to carry out long-term epidemiologic studies, using smokers as guinea pigs. Perhaps some would view that as acceptable because the product is dangerous anyway. However, the problem is that smokers are going to naturally assume that these products are safer - and we won't know that is true. This law greatly deceives smokers into thinking that the product is safer, when it may well not be any safer at all, and could potentially be more hazardous.

Unfortunately, we simply do not have any idea whether it is even possible to reduce the toxicity of cigarettes by reducing the levels of specified components.

The entire approach is flawed, because if you want safer cigarettes, you need to use the free market approach to set up competition between the companies for a safer product. This legislation does the opposite. It takes away the free market completely and puts all decisions into the hands of FDA. But it gives the FDA a mandate which sets up impossible standards that could never be met for new products. What it really does is ensure that existing products will be institutionalized and protected from competition. This, indeed, is the reason why Philip Morris supported the bill, and all the smaller companies opposed the bill. What the smaller companies despised is the removal of any serious chance to compete in the market - and largely, the market we are talking about is potentially safer products.

Philip Morris wanted to freeze the market as is, so that Marlboro - one of the highest risk products imaginable - will be able to continue to dominate the market in perpetuity, without any serious competition from potentially safer products which could advertise themselves as being safer than Marlboro and thus gain market share among the "health-conscious" segment of smokers who are looking to reduce their risks while still satisfying their demand for cigarettes.

If you really think about it, you'll see that the approach of trying to reduce the levels of specific smoke constituents is complete lunacy. When you have no idea which constituents, in what combination, and at what concentrations, cause which diseases that are associated with smoking, then it is impossible to produce a cigarette that you know will be safer simply by mandating a reduction in the levels of various smoke constituents.

The one thing you will never hear the supporters of the Act do is estimate the number of lives they think this legislation will save. All they can do is talk about "countless" lives being saved. And they are quite correct. The lives are countless. You cannot count them because they do not exist.

It is estimated, for example, that there are over 60 compounds in tobacco smoke which cause cancer. So what sense does it make to require the companies to take out two or three of them? What if they take out the wrong ones? What if the actual compound which causes most of the cancer is not one of those chosen to be removed? What if smokers believe that this is a safer product and start smoking more? This approach could actually kill people, rather than save lives.

And it could also kill people by reducing youths' perceptions of the hazards of cigarette smoking. If youths are led to believe –correctly - that the FDA now regulates every ingredient of the cigarette and that – incorrectly - because of this, countless lives will be saved, does it not make sense for these kids to infer that cigarettes are not as bad as they used to be? We know for a fact that any decline in the perceived harm of cigarettes results in an increase in youth smoking. So the law could well kill more people than it saves.

I'm sorry, but there is simply no such thing - at least at the present time - as a "safety standard" for cigarettes. And it is absurd for the FDA to be pursuing such a thing.

To be clear, I am not necessarily blaming the FDA entirely. The Agency was given a mission (albeit an absurd and pointless one) by the statute, and to some extent, the Agency has to carry out this mission. However, I don't believe the statute requires the FDA to deceive the American people into thinking that this particular task (compiling a list of harmful chemicals in tobacco smoke) has any relation to protecting the public's health.

Nor do I believe the statute requires the FDA to take the ridiculous (and ironic) step of approving the products with these 108 harmful chemicals and banning the products with only 1 of them.

It is ironic that the very best the FDA could do - require the elimination or near elimination of each of the 108 harmful constituents except nicotine (which cannot be eliminated, by statute) - would be to mandate that cigarettes essentially become electronic cigarettes. In other words, that companies must develop products that can deliver nicotine without the harmful chemicals. Of course, FDA can't do this because it would amount to a ban on all existing cigarettes. But the point is that the best the FDA could do, even in theory, is to mandate a product like electronic cigarettes. Yet the Agency is warning the public that electronic cigarettes are potentially toxic and carcinogenic and recommending that smokers not quit smoking via the use of electronic cigarettes.

The rest of the story is that the production of a list of harmful chemicals in tobacco smoke is a waste of time and resources and will do nothing to protect the public's health or contribute to the betterment of the public's health in any way. Instead, this approach threatens to put an unnecessary burden on tobacco companies to comply with regulation simply for the sake of regulation, with no documentable public health benefits. In fact, the regulatory actions that are allowable under the statute would almost invariably lead to harm of the public's health and the fraud previously committed by the tobacco companies in deceiving consumers about the relative safety of reduced exposure products would simply be transferred over to the federal government.

Friday, August 13, 2010

Middletown Smokers Who Light Up in a Park Could Face Jail Time

A new ordinance enacted by the Middletown (New York) City Council makes smoking in a park a potentially criminal offense that could result in jail time, according to an article in the Times Herald-Record.

According to the article: "Middletown voted to ban smoking in two parks and 30 feet from any city playground on Monday. The City of Kingston prohibits smoking outside City Hall, and Port Jervis and Tuxedo forbid smoking in their parks and playgrounds. Middletown's new law includes fines of up to $150 and jail time for repeat offenders, and it passed without a single person speaking against it at Monday's meeting."

In the article, I am quoted and present an opposing viewpoint: "But Michael Siegel, a professor at Boston University's School of Public Health and an anti-smoking activist, is concerned that some overzealous groups could damage the credibility of legitimate efforts to protect people from second-hand smoke. Siegel said the intent of Middletown's ban was reasonable, but he added that imposing jail time would enforce a criminal penalty on an offense that only rises to the level of a parking violation. 'We should always base policy on scientific evidence of adverse health effects,' he said. 'Anything beyond that and (smoking restrictions) become an ideology.'"

The Rest of the Story

I can just see the conversation going on between the chief warden of the Middletown jail and the city department that produces signs:

Warden: I'd like to order the signs for the different sections of our prison facility.
Sign Maker: Sure, how many do you need?
Warden: A total of five.
Sign Maker: No problem. What should the first one say?
Warden: Murderers.
Sign Maker: OK. The second?
Warden: Sexual offenders.
Sign Maker: No problem. The third?
Warden: Burglars.
Sign Maker: The fourth?
Warden: Assaulters and Batterers.
Sign Maker: And the fifth?
Warden: Smokers who lit up in a park.
Sign Maker: Excuse me. Could you repeat that?
Warden: Smokers who lit up in a park.
Sign Maker: I think there's a problem with our phone connection. Could you call me back from a land line?

Thursday, August 12, 2010

San Francisco Lawmakers are More Interested in Regulating the Mission of Stores and Feeling Good About Themselves than Protecting the Public's Health

After its ban on tobacco sales in pharmacies was struck down by the courts because there was no rational basis to exclude pharmacies in supermarkets and box stores from the ban, the San Francisco Board of Supervisors is now considering extending the ban to all pharmacies. The purpose of the ban, according to one Supervisor, is to ensure that pharmacies sell healthy products, not products that harm people.

An article in the San Francisco Examiner explains the rationale: “Cigarettes and chewing tobacco are a tiny fraction of the products sold, and pharmacies should be selling medicine and helpful items, not items like cigarettes that kill you,” said Supervisor Eric Mar, who introduced legislation Tuesday that broadens the tobacco ban. “It sends the strong message that we are a city that promotes healthy living and stores should sell products with some accountability to the public.”

ADDENDUM: I should also point out that the rationale for this ordinance is flawed on its face because the premise that stores selling helpful products shouldn't sell deadly products would lead to the conclusion that no store should sell tobacco. All stores sell products that are helpful in some way. Why should a gas station, which sells a very helpful product - gas - be allowed to sell a product that kills people? Why should a convenience store, which sells many helpful products - like toothpaste, mouthwash, sunscreen (which prevents skin cancer), and aspirin - be allowed to sell a product that kills people? How can the Board of Supervisors possibly rationalize allowing any stores in San Francisco to sell a product which kills people?

Wednesday, August 11, 2010

Leading Physician in UK Calls Smoking in Cars with Children a Form of Child Abuse

Dr. Steve Field, a UK physician who is the chairman of the Royal College of General Physicians, has stated that smoking in a car with a child is a form of child abuse. He has also claimed that parental smoking kills more young children than all other forms of unintentional injuries.

According to an article at BBC News: "Parents who smoke in cars in front of small children are "committing a form of child abuse", a leading GP has said. Professor Steve Field, chairman of the Royal College of General Practitioners, has condemned society's attitudes to food, alcohol and cigarettes. In a letter to the Observer newspaper, he said parents had to take more responsibility for their children's health - and set a good example. He said irresponsible behaviour led to high levels of disease and early death. ... Professor Field, who represents 42,000 GPs across the UK, added: "I suppose the same people also smoke at home in front of their children. Evidence from the US indicates that more young children are killed by parental smoking than by all other unintentional injuries combined."

The Rest of the Story

I'm not aware that any significant number of young children are killed by parental smoking, much less more children than are killed by all other unintentional injuries combined. While secondhand smoke has been linked with deaths from sudden infant death syndrome, this affects infants - not young children. So the first problem is that Dr. Field is disseminating false, or at least very misleading information.

The second problem is that there are a number of severe problems with his argument that smoking in a car with a child is a form of child abuse.

First, this argument confuses the concepts of harm and risk. There is little doubt that secondhand smoke exposure during young childhood increases the risk of a number of adverse health conditions. But it doesn't necessarily cause harm. In contrast, child abuse is an act that results in inflicted injury - there is direct, immediate, and definite harm. Since smoking around a child does not usually inflict injury, it is not child abuse.

It is important to recognize that by Dr. Field's definition of child abuse, any woman who takes a drink of alcohol during pregnancy is a child abuser. There is strong evidence that alcohol use during pregnancy increases the risk of adverse health outcomes. Any woman who drives in a car with a child is also a child abuser. Riding in a car increases the risk of injury and death. So does changing cat litter while pregnant, another form of child abuse according to Dr. Field's logic. And I don't even want to talk about parents who serve their children raw fish. That increases the risk of intestinal infection, which could cause adverse consequences, and represents child abuse, according to Dr. Field's definition.

You can see how dangerous this type of argument is. If we adopted such a definition here, as suggested by Dr. Field, then any parent who allows their child to ride on a roller coaster is a child abuser. Letting your child play hockey is a serious form of child abuse. Parents of children who are allowed to play football are also child abusers, according to this argument.

A second problem with the argument is that it would treat people who smoke around children in the same way as people who beat their children. If we are unable to see a world of difference between these, then we have some serious problems that could truly put our children at risk. Ultimately, society addresses child abuse by removing children from the custody of their parents. Resorting to such an approach to deal with smoking would be a tragedy and would cause much more harm to children than is being caused by tobacco smoke in the first place.

A third flaw in Dr. Field's argument is that child abuse and physical abuse are terms that generally imply an intent to cause harm. The action that causes the harm is the primary intention of the perpetrator.

For example, when someone beats a child, the primary intent of the action was to beat the child. It is not the case that hitting the child was a secondary, unfortunate side effect of some other primary action.

But in the case of smoking around a child, it is not the primary intent of the alleged perpetrator of the "child abuse" to injure the child. The injury, if it does occur, happens as an unfortunate, unintended secondary consequence of the primary action, which was simply to smoke.

This is also why driving with kids in a car at 60 miles an hour on a crowded Los Angeles freeway is not child abuse, nor is changing a cat litter and getting toxoplasmosis, which can result in severe neonatal injury or death. The primary intention of the act of driving was not to injure a child, it was to get somewhere. Similarly, the primary intention of changing the cat litter was not to harm the neonate; it was to change the cat litter.

Hopefully, other physicians and anti-smoking groups worldwide will condemn these comments made by Dr. Field. Because if we are unable to differentiate between child abuse and exposure of children to secondhand smoke, we are going to end up causing far more harm to children's welfare than would be caused by secondhand smoke.

To be clear, I am not minimizing the hazardous effects of secondhand smoke exposure on children. However, equating this with child abuse minimizes the tragic effects of actual child abuse on its victims. It is an inappropriate, incorrect, insensitive, and irresponsible comparison.

Tuesday, August 10, 2010

Major Health Care Cuts for the Poor Necessary Due to Smokers Not Smoking Enough

According to an article in the Scranton Times-Tribune, declines in smoking are resulting in health insurance cuts for low-income Pennsylvanians, due to reduced tobacco settlement payments to the state as a result of the lower cigarette consumption.

According to the article: "Pennsylvania received a significantly smaller payment from tobacco companies this year, and that has led to funding cuts for some state programs dependent upon tobacco money. The state Tobacco Settlement Fund received nearly $66 million less than in 2009. Activists attribute this to a marked decline in public smoking, while state officials say part of the drop is attributable to the absence of a one-time payment that temporarily boosted the total payment in 2009. The result of the mix of factors at work is that a half-dozen state programs designated to receive tobacco money have less funding under the new state budget just when finances are especially tight because of the recession. For example, the adult Basic program for low-income adults who lack health insurance receives $10.8 million in tobacco money this year, down two-thirds from $36.6 million in 2009-10, according to the House Appropriations Committee and governor's budget office."

Thus, the health insurance program for low-income adults who lack health insurance is suffering about a $26 million cut this year due to the decreased tobacco settlement payment.

This problem is not unique to Pennsylvania. According to an article at Stateline.org, the states as a whole will see their tobacco settlement payments reduced by a whopping 16% this year, largely due to the decline in cigarette consumption attributable to the large federal cigarette tax increase.

The Rest of the Story

This is exactly what I warned about in numerous commentaries criticizing the unqualified support of anti-smoking groups for cigarette tax increases, regardless of how the revenues are spent. It is thanks to these groups that the low-income population of Pennsylvania (and many other states) are going to suffer from dramatic budget cuts, affecting everything from health care to human services programs.

It is one thing when cigarette tax revenues are allocated toward anti-tobacco programs. As smoking declines, so do the revenues, but that is appropriate as fewer people are smoking so fewer people need to be reached by the programs. As Bill Godshall points out in the Times-Tribune article: "It's one of the few government programs set up to put itself out of business if the problem goes away."

This is not true, however, of other programs such as health care and human services. These problems do not go away as smoking declines and people reliant upon such programs are truly going to be hurt because of the anti-smoking groups' support for the idea of depending upon cigarette consumption to fund critical government programs.

A related problem is that these same policies have resulted in states becoming dependent upon maintaining current levels of cigarette consumption. The incentive to take any action that would seriously threaten cigarette sales is gone, as it would result in decreased payments to the states, and therefore, in funding cuts for critical programs. Perhaps this is why so many states are jumping at the opportunity to outlaw electronic cigarettes, as they threaten to take away sales from the cigarette companies. Apparently, it is better that smokers continue to use the most dangerous nicotine-delivering product - but in a way which funds the state - rather than quit smoking and substitute a much safer product, but one from whose sale the state loses financially.