Wednesday, December 12, 2012

Once Again, Anti-Smoking Advocate Responds with Personal Attack Rather than Substantive Argument

In a commentary published yesterday on my blog, I criticized a post on Dr. Stan Glantz' blog which embraced the Congressional Budget Office's analysis of the costs to society of an anti-smoking intervention (a 50 cent federal tax increase) due to its saving of lives, thus resulting in more people on the Social Security rolls. Dr. Glantz had taken solace in the fact that the CBO's analysis ultimately found long-term savings to society, while I dismissed the entire approach, arguing that even if the CBO analysis had found that the long-term costs did outweigh the benefits, we should not reject a public health intervention because it will increase Social Security costs by saving lives. I noted that this is a perverse concept and has no place in policy analysis, even if it is ultimately outweighed by benefits of a proposed program. I also pointed out that when Philip Morris set forth the exact same argument in 2001, anti-smoking groups roundly attacked the company, which was forced to apologize and disavow itself from the argument. But rather than disavow himself from this line of reasoning, Dr. Glantz has embraced the approach and went so far as arguing that it sets an example for the analysis of other public health policy issues.

In response to my commentary, Dr. Glantz has attacked me, calling me non-credible as a scientist who is driven purely by ideology and pays no attention to science.

Dr. Glantz writes:

"I normally do not comment on Mike Siegel's blog because he has long since lost all credibility with me as a scientist. He praises any study -- no matter how poorly done -- if it supports his ideological position that he is the one ethical voice in tobacco and trashes any study -- no matter how well done -- if it does not.
His latest commentary, on my praise for the Congressional Budget Office analysis of the effect of a 50 cent tobacco tax increase (indexed to inflation) on federal spending so seriously misrepresents my position that it warrants response. ... Having a reasonable projection of effects over a long time does not require that one use that time for policy making. Just to be clear, here is what I think about the ... issue:
  • The appropriate time horizon for health policy decision making is 10 years, 20 if you really stretch it.  (That does not mean that one ought not try an develop longer-term projections, but decisions should be based on time horizons over which the projections are most reliable.)  As the CBO notes, the uncertainty in projections grows with time.
  • Policies to improve health are worth doing even if they cost money.  If society did not accept this position, we would eliminate almost all medical care, certainly for the elderly or people with serious disabilities.
The reality is that actual policy decisions are usually made with very short time horizons, often just months. ... That is why I have put a lot of energy into estimating the short-term effects of tobacco control policies. ... Urging that 10 to 20 years is the appropriate horizon for health decisions does not make it invalid to do your best to develop longer term models."

The Rest of the Story

What troubles me is not that Dr. Glantz accuses me of being completely non-credible and of being a quack scientist. After all, I recently lost all credibility when I appeared on the same page as Khloe Kardashian and Lindsay Lohan in Star Magazine (see the latest issue of Star if you want to see the humbling picture - well, humbling for me and Lindsay, but perhaps not for Khloe).

By the way, my picture appearing within millimeters of Linsday Lohan puts me only 4 degrees of separation from Kevin Bacon, as Lindsay Lohan was in Georgia Rule with Felicity Huffman, Felicity Huffman was in Magnolia with Tom Cruise, and Tom Cruise was in A Few Good Men with Kevin Bacon.

If you're wondering, no - I didn't appear because like Lindsay Lohan I had been arrested - but because I was featured in an "Ask the Expert" column regarding electronic cigarettes.

What does trouble me is that Dr. Glantz fails to respond substantively to my argument, attacks me personally and then diverts the issue.

The issue is: whether it is appropriate to consider as a negative factor in a policy decision the Social Security savings because lives will be saved.

But Dr. Glantz switches the issue to: what is the appropriate time frame for a policy analysis?

But that's not the issue at all. Arguing that a policy analysis should only look 10-20 years down the road is not the same as arguing that a policy analysis should not consider whether saved lives will lead to Social Security savings.

For example, suppose we are analyzing a policy to require insurance coverage for mammograms for women in their 50's. These mammograms will save a considerable number of lives among the screened women and the costs of those saved lives in terms of increased Social Security spending will being to accrue in less than 10 years. This is within the time frame that Dr. Glantz argues is appropriate to consider. Thus, Dr. Glantz is implying that it is perfectly appropriate to consider these costs because they are short-term, not long-term costs.

I disagree. I believe that it is inappropriate to consider these costs at all in making a policy decision, regardless of when they accrue.

It would be valuable to have this discussion. And it is an important issue because the CBO has now legitimized the argument and set an example that may be followed in analysis of a wide range of public health issues. I'm afraid that Dr. Glantz has helped to legitimize the consideration of these costs and I am merely trying to point out the danger of doing so.

My argument hardly seems like such a radical argument that it requires an attack on my credibility (there are plenty of other things on which one could attack my credibility - but this is not one of them!). In fact, my argument is exactly the same one that many anti-smoking organizations made in 2001 in response to Philip Morris' report that counted these costs as a benefit of smoking.

While there are many reasons one could attack my credibility, that I evaluate science based on whether the results support my pre-determined position is not one of them. This attack makes no sense because if it were true, then I would not be criticizing studies that report finding an immediate effect of smoking bans on heart attacks or which find that thirdhand smoke causes massive skin and nerve damage in babies. I have devoted my career to preventing the public from the hazards of secondhand smoke and if I simply judged studies by my ideology, I would be praising all of these studies.

Dr. Glantz is correct about one thing. I am guided by ideology. My ideology is that science is about the pursuit of the truth, and that we have to seek the truth wherever it takes us, even if it sometimes turns out that the truth is not favorable to our advocacy positions. I believe, also, in honesty and transparency and believe that public health practitioners should not deceive the public or distort the science, even if doing so might garner more support for our policies.

And finally, I believe that science is about disagreement and dissent, but that disagreement should garner substantive discussion, not personal attacks on character. The most important advances in science have come from some of the sharpest disagreements. The focus, however, must always be on the science itself - on the arguments and the evidence - not on the personal qualities of those advancing the arguments.

Thus, despite his attacks on me, Dr. Glantz remains a hero of mine. He was my original mentor and teacher and role model in tobacco control and it was his passion, zeal, and ability to develop research that will have the greatest impact on policy that has guided me throughout my career. In many ways, I view Dr. Glantz and another mentor of mine - Dr. Alan Blum - as two of the "fathers" of the anti-smoking movement. One of the things that I admire most about Dr. Glantz is his ability to always be ahead of the rest of the tobacco control movement. Of course, I also admire his willingness to tell it like it is and not be afraid of organizations or politicians and what they might say about him. That quality of Stan's continues to guide me.

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