Apparently, supporters of the proposed FDA tobacco legislation have come to realize that putting cigarette regulation into the hands of the FDA would create a perceived seal of approval that would falsely make the public believe that cigarettes have been made safer, potentially increasing cigarette consumption. In fact, they apparently believe it is so much of a problem that they have inserted language into the bill that would prevent cigarette companies from merely telling the public that the FDA regulates cigarettes.
In a last hour maneuver, the Senate Health, Education, Labor, and Pensions Committee Chairman - Senator Edward Kennedy - inserted a provision into the bill which would prevent the companies from making any statement to the public, in any communication, that informs people of the fact (the truth) that cigarettes are now regulated by the FDA.
The provision states that cigarette companies may not make "any statement directed to consumers through the media or through label, labeling, or advertising that would reasonably be expected to result in consumers believing that the product is regulated, inspected, or approved by the Food and Drug Administration, or that the product complies with the requirements of the Food and Drug Administration...".
The reason for this provision, as stated in the legislation?
"If manufacturers are permitted to state or imply in communications directed to consumers that a tobacco product is approved or inspected by the Food and Drug Administration or complies with Food and Drug Administration standards, consumers are likely to be confused and misled. Such a statement could result in consumers being misled into believing that the product is endorsed by the Food and Drug Administration for use or in consumers being misled about the harmfulness of the product because of such regulation, inspection, approval, or compliance."
The Rest of the Story
You know that regulation of cigarettes by the FDA is a terrible idea if the supporters of the bill have to insert a clause into it preventing tobacco companies from telling the public that the FDA regulates cigarettes. You know that FDA regulation of cigarettes is a pretty bad idea if we need to hide the truth from the public lest it have the expected adverse consequences for the public's health.
Apparently, the only way this legislation will work is if we trick people into thinking that the FDA does not regulate cigarettes.
Think about it. What kind of cockamamie regulatory scheme depends upon the public not knowing about that scheme in order to avoid severe public health consequences?
How sensible can a regulatory approach be if we need to hide from the public the very fact that the regulatory scheme is in place?
Clearly, precluding the tobacco companies from telling the public that the FDA regulates cigarettes is not going to keep this information from the public. The legislation is getting tremendous publicity, and I would bet that even if it is not enacted, a substantial proportion of the public is going to think that the FDA regulates cigarettes just because they heard so much about it. Surely, people are going to catch wind of the fact that cigarettes are under FDA's regulatory jurisdiction. Whether the tobacco companies tell them or not.
So the perceived FDA seal of approval that the bill's supporters are finally worried about is going to happen, despite the newly inserted provision that prevents the tobacco companies from telling the public the simple truth.
Ironically, in an apparent effort to save face in the light of this late realization that the regulatory scheme is indeed going to create the FDA seal of approval that I warned about months ago (actually, years ago), bill proponents hastily inserted a provision that is such an act of haste and desperation that it is unconstitutional.
I believe that this provision violates the tobacco companies' rights under the First Amendment to the Constitution. I think it clearly violates their free speech rights.
What the bill does, if it passes, is prevent tobacco companies from making a simple statement of the clear, undeniable, universally recognized truth: that cigarettes are regulated by the FDA. There is no compelling justification for interfering with the companies' First Amendment rights in this situation. I doubt that this provision would ever hold up if the companies rightfully challenge it.
How can you tell companies that they cannot make a simple statement of the truth that is widely known and widely disseminated through other sources?
Clearly, the FDA can regulate the labeling of cigarettes. And the FDA can certainly prevent companies from making statements that are false or misleading. But there is no compelling government interest that would justify taking away free speech rights to tell the public the truth.
Here is the rub: there would be no deception in the companies stating that the FDA regulates cigarettes. This would be undeniably true if the legislation is enacted; there would not be a shred of deception.
That is how foolish this legislation is. So foolish that we need to infringe upon the companies' First Amendment rights in order to make sure that the public doesn't catch wind that the legislation is in place.
The truth is that for this legislation to be effective and not harm the public's health by creating the perception of an FDA stamp of approval, the bill would have to do far more than prevent cigarette companies from telling the public that the FDA regulates cigarettes. It would have to require that public statements be made to the effect that the legislation did not pass. It would have to require a media conspiracy to lie to the public about the legislation's fate. Otherwise, it is going to be quite obvious to the public that cigarette safety is under the jurisdiction of the Food and Drug Administration.
Apparently, the bill's sponsors are so clear on the fact that the legislation will unlikely have any health benefits in terms of producing a safer cigarette that they are uncomfortable with the idea that the public might even be informed that a manufacturer's cigarettes comply with the requirements of the FDA.
If the FDA legislation were, as suggested by its anti-smoking group supporters, going to produce safer cigarettes, then we would not need to go to extreme measures (violating freedom of speech rights) in order to shield the public from finding out that indeed, cigarettes on the market do comply with FDA requirements.
In a brilliant way that I only wish I could have thought of, Senator Kennedy has revealed to the nation just how stupid this legislation is. What the bill is now essentially saying is the following: "We previously issued propaganda suggesting that FDA regulation of cigarettes will save millions of lives by reducing cigarette smoking and making the product safer through product standards. However, we now acknowledge our opponents' arguments that in reality, the legislation will create a perceived stamp of approval for cigarettes, undermining public health messages about the hazards of smoking. In addition, we now acknowledge that the product probably won't be safer, and that we need to go to great lengths to make sure that the public does not think that cigarettes actually comply with the FDA standards. Given our propaganda, they may think that compliance with FDA safety standards implies a safer product. But the truth is that our proposed safety standards are not actually 'safety' standards."
The rest of the story is that hastily, and obviously without too much insight, proponents of the FDA legislation have written into the bill the exact reasons to kill it. The bill now exposes its own folly. It reveals its lack of sensibility.
How ironic that what should be the death knell for this legislation was a last-minute, desperate act by the bill's chief sponsor.
Tuesday, July 17, 2007
Monday, July 16, 2007
Report Shows Cigarette Tax Increase is Least Defensible Way to Fund Children's Health Insurance
A report released Friday by the Tax Foundation reveals that the proposal to fund the State Children's Health Insurance Program (SCHIP) by increasing the federal cigarette excise tax hurts the poor more than other available funding options.
According to the report, raising the $35 billion needed to fund SCHIP by increasing the federal cigarette tax would impose an average tax increase of $249 for households in the bottom 20% income bracket. In contrast, relying on a corporate income tax increase to fund SCHIP would increase taxes in the lowest income bracket by only $41, and simply increasing individual income taxes to pay for SCHIP would cost the lowest-income households only $7 in extra tax.
The report concludes that "no other federal tax hurts the poor more than the cigarette tax. ... Not only are the payers of cigarette taxes poorer as a group than the payers of these other taxes, but there are fewer of them. In fact, the burden of the proposed cigarette tax hike on the lowest-earning 20 percent of households is 37 times heavier than it would be if the government raised the money with the federal income tax. Put another way, the proposed cigarette tax hike would hit the poor with the same force as cutting the Earned Income Tax Credit (EITC) by one-fourth." ...
"Taxing only cigarettes to finance higher spending on SCHIP has absolutely no justification in sound tax policy. Excise taxes on cigarettes should be used to compensate for the costs they impose on society. Taxes levied above and beyond that point may be politically expedient because smokers are unpopular, but they only serve to make the federal tax system less principled and more regressive."
The Rest of the Story
This analysis confirms my assertion, highlighted by Jacob Sullum in Hit&Run last week, that the proposed 61 cents per pack increase in the federal cigarette excise tax is not a sensible way to fund the expansion of the SCHIP program. As I argued: (1) it is a regressive tax that disproportionately hurts the poor; (2) it is unfair because the benefits do not accrue to those who bear the burden of paying the tax; (3) it is unacceptable because it makes children's health insurance dependent upon sustaining high levels of cigarette smoking; and (4) it removes any incentive for the federal government to substantially reduce cigarette consumption. The Tax Foundation analysis supports my contention that the tax is regressive as it disproportionately hurts the poor and that it is unacceptable because there are far better alternatives to fund SCHIP.
It is unfortunate that anti-smoking groups are incapable of anything other than knee-jerk support for any and all cigarette taxes. They have never met a cigarette tax increase that they didn't like, no matter who pays the tax, what the funds are used for, how regressive or unfair it is, how inappropriate the resulting fiscal dependence on smoking might be, and how sensible potential alternative funding sources, or alternative uses of the cigarette tax revenues might be.
As the Tax Foundation states, cigarette taxes should be used to compensate for the costs they impose on society. In other words, they should be used for smoking-related programs. For example, using cigarette tax revenues to fund expansion or improvement in treatment for smoking-related diseases makes sense from a tax policy perspective. It is fair, because the benefits accrue to precisely those who are paying the tax. It is sensible, because the money is being used to compensate for costs imposed specifically by smoking. It also avoids the problem of creating a dependence on continued smoking, because as smoking declines, the need for the revenue also declines, as there will be less smoking-related disease. To some extent, it is a self-regulating system.
In contrast, using the cigarette tax to fund SCHIP creates an unacceptable conundrum. If we reduce smoking, then we lose money that is needed to pay for children's health insurance. The more people continue to smoke, the fewer children who will have health insurance. As smoking rates fall, there is no direct decline in the need for children's health insurance, especially in the short-term.
I find it unfortunate that anti-smoking groups are so narrow-minded in their thinking that they do not seem capable of considering the broader implications of what they are supporting and the sensibleness of their proposal in light of available alternatives. It is as if these groups have blinders on which preclude them from seeing any issue or consideration other than smoking. They are blind to effects on the poor, fairness, and long-term implications, for example.
In my view, tobacco control was never intended to be a field all its own. It was intended to be a part of a broader public health perspective. Unfortunately, it is increasingly becoming separate from public health. It is becoming more and more narrow-minded.
It's time to take the blinders off. There's a whole world out there which we are not seeing.
According to the report, raising the $35 billion needed to fund SCHIP by increasing the federal cigarette tax would impose an average tax increase of $249 for households in the bottom 20% income bracket. In contrast, relying on a corporate income tax increase to fund SCHIP would increase taxes in the lowest income bracket by only $41, and simply increasing individual income taxes to pay for SCHIP would cost the lowest-income households only $7 in extra tax.
The report concludes that "no other federal tax hurts the poor more than the cigarette tax. ... Not only are the payers of cigarette taxes poorer as a group than the payers of these other taxes, but there are fewer of them. In fact, the burden of the proposed cigarette tax hike on the lowest-earning 20 percent of households is 37 times heavier than it would be if the government raised the money with the federal income tax. Put another way, the proposed cigarette tax hike would hit the poor with the same force as cutting the Earned Income Tax Credit (EITC) by one-fourth." ...
"Taxing only cigarettes to finance higher spending on SCHIP has absolutely no justification in sound tax policy. Excise taxes on cigarettes should be used to compensate for the costs they impose on society. Taxes levied above and beyond that point may be politically expedient because smokers are unpopular, but they only serve to make the federal tax system less principled and more regressive."
The Rest of the Story
This analysis confirms my assertion, highlighted by Jacob Sullum in Hit&Run last week, that the proposed 61 cents per pack increase in the federal cigarette excise tax is not a sensible way to fund the expansion of the SCHIP program. As I argued: (1) it is a regressive tax that disproportionately hurts the poor; (2) it is unfair because the benefits do not accrue to those who bear the burden of paying the tax; (3) it is unacceptable because it makes children's health insurance dependent upon sustaining high levels of cigarette smoking; and (4) it removes any incentive for the federal government to substantially reduce cigarette consumption. The Tax Foundation analysis supports my contention that the tax is regressive as it disproportionately hurts the poor and that it is unacceptable because there are far better alternatives to fund SCHIP.
It is unfortunate that anti-smoking groups are incapable of anything other than knee-jerk support for any and all cigarette taxes. They have never met a cigarette tax increase that they didn't like, no matter who pays the tax, what the funds are used for, how regressive or unfair it is, how inappropriate the resulting fiscal dependence on smoking might be, and how sensible potential alternative funding sources, or alternative uses of the cigarette tax revenues might be.
As the Tax Foundation states, cigarette taxes should be used to compensate for the costs they impose on society. In other words, they should be used for smoking-related programs. For example, using cigarette tax revenues to fund expansion or improvement in treatment for smoking-related diseases makes sense from a tax policy perspective. It is fair, because the benefits accrue to precisely those who are paying the tax. It is sensible, because the money is being used to compensate for costs imposed specifically by smoking. It also avoids the problem of creating a dependence on continued smoking, because as smoking declines, the need for the revenue also declines, as there will be less smoking-related disease. To some extent, it is a self-regulating system.
In contrast, using the cigarette tax to fund SCHIP creates an unacceptable conundrum. If we reduce smoking, then we lose money that is needed to pay for children's health insurance. The more people continue to smoke, the fewer children who will have health insurance. As smoking rates fall, there is no direct decline in the need for children's health insurance, especially in the short-term.
I find it unfortunate that anti-smoking groups are so narrow-minded in their thinking that they do not seem capable of considering the broader implications of what they are supporting and the sensibleness of their proposal in light of available alternatives. It is as if these groups have blinders on which preclude them from seeing any issue or consideration other than smoking. They are blind to effects on the poor, fairness, and long-term implications, for example.
In my view, tobacco control was never intended to be a field all its own. It was intended to be a part of a broader public health perspective. Unfortunately, it is increasingly becoming separate from public health. It is becoming more and more narrow-minded.
It's time to take the blinders off. There's a whole world out there which we are not seeing.
Friday, July 13, 2007
Study of Trends in State Heart Attack Admissions Refutes Conclusions of Helena et al. Studies
A study of trends in annual heart attack admissions through the emergency room by state refutes the conclusions of the Helena, Pueblo, Piedmont, and Bowling Green studies which concluded that smoking bans cause immediate, drastic declines in heart attacks. The study was conducted by Michael J. McFadden and David W. Kuneman. A preliminary version of the study appeared online in November 2005, while the final version, discussed on the American Council on Science and Health (ACSH) FactsAndFears blog, confirmed and strengthened the original findings.
McFadden and Kuneman overcame the two chief limitations of the existing research: (1) the small number of heart attacks in the cities studied, which resulted in tremendous baseline year-to-year variability in heart attack rates; and (2) the bias inherent in relying only upon the experiences of only a few small cities in making generalizations intended to apply to larger populations. They accomplished this by considering the following premise: if smoking bans cause an immediate decrease in heart attack admissions on the order of a 25% to 50% decline, then if one examines trends in heart attack admissions on an entire state level, then one should certainly observe a notable decline immediately following the implementation of statewide smoking bans.
Using data on emergency room admissions for acute myocardial infarction (heart attacks) from the Agency for Healthcare Research and Quality's HCUP database, McFadden and Kuneman examined trends in four states that implemented statewide bar and/or restaurant smoking bans - California, Oregon, Florida, and New York - and five states with neither a statewide smoking ban nor widespread local smoking bans - Arizona, New Jersey, South Carolina, and Iowa. They also examined trends in heart attack admissions for the United States as a whole.
California's restaurant smoking ban took effect in January 1995. In that year, heart attack admissions in California increased by 0.6%. In 1996, admissions increased by 2.9%. The corresponding changes for the United States were an increase of 3.2% in 1995 and 3.9% in 1996. California's bar smoking ban took effect in January 1998. In that year, heart attack admissions in California increased by 6.0%, compared to an increase of 6.2% in the nation as a whole. In 1999, admissions increased by 3.7% in California and decreased by 1.3% in the U.S.
Florida banned smoking in all restaurants in July 2003. Its heart attack admissions decreased by only 0.7% that year, and by only 2.0% the following year. In comparison, admissions in the U.S. decreased by 2.8% in 2003 and 8.2% in 2004.
Trends in heart attack admissions following the Oregon and New York smoking bans were also not found to be substantially different from national trends, or from trends in the comparison states without smoking bans.
The Rest of the Story
While this study certainly does not prove that smoking bans have no effect on heart attack admissions, what it does is demonstrate that when one examines population-based data for an entire state, one does not find any evidence of a dramatic decline in heart attacks immediately following the implementation of smoking bans. This casts serious doubt on the conclusion of the Helena, Pueblo, Piedmont, and Bowling Green studies. If smoking bans truly cause an immediate and dramatic decline in heart attacks, on the order of a 25% to 50% reduction, then why do we not observe any evident decline in heart attacks when entire states implement smoking bans.
The chief limitation of the study is that some localities within these states had already enacted smoking bans, so one would not expect to see as dramatic an effect on a statewide level. However, the proportion of residents in these states covered by local smoking bans was not particularly high. For example, the authors cite data that only 14% of Californians were covered by a smoke-free restaurant law in 1993. This increased to 100% in 1995. Yet the number of heart attack admissions increased from 1993 to 1995 (and increased further in 1996). The corresponding changes in the U.S. data were similar. So it does not seem that the existence of some local smoking bans is enough to invalidate the study conclusion.
I have already discussed in detail the reasons why I believe the conclusions of the Helena et al. studies are unjustified. Briefly, the chief flaw of these studies is that they are unable to rule out the very likely possibility that the observed changes in heart disease admissions in these cities during the study period are due primarily to random variation, rather than to the smoking bans. There is tremendous natural (random) variation in the heart disease admission rates in these cities because of the small population sizes. Because we are dealing with such small numbers of admissions, the percentage change in admissions from one year to the next is very high, even without any smoking ban.
While these papers make some attempt to account for these baseline trends, I do not believe that they go back far enough in time to do so adequately.
Because McFadden and Kuneman have examined heart attack trends among large populations, the number of heart attacks is much higher, and therefore the degree of underlying variability in the annual number of heart attacks is much lower. It is therefore easier to identify any major changes in the underlying trends.
I think it is high time that my fellow tobacco control researchers and practitioners recognize that the Helena et al. studies are examples of shoddy science that apparently now passes as acceptable in tobacco control research. While I support workplace smoking bans, I do not believe that we should be using shoddy science to promote them.
McFadden and Kuneman overcame the two chief limitations of the existing research: (1) the small number of heart attacks in the cities studied, which resulted in tremendous baseline year-to-year variability in heart attack rates; and (2) the bias inherent in relying only upon the experiences of only a few small cities in making generalizations intended to apply to larger populations. They accomplished this by considering the following premise: if smoking bans cause an immediate decrease in heart attack admissions on the order of a 25% to 50% decline, then if one examines trends in heart attack admissions on an entire state level, then one should certainly observe a notable decline immediately following the implementation of statewide smoking bans.
Using data on emergency room admissions for acute myocardial infarction (heart attacks) from the Agency for Healthcare Research and Quality's HCUP database, McFadden and Kuneman examined trends in four states that implemented statewide bar and/or restaurant smoking bans - California, Oregon, Florida, and New York - and five states with neither a statewide smoking ban nor widespread local smoking bans - Arizona, New Jersey, South Carolina, and Iowa. They also examined trends in heart attack admissions for the United States as a whole.
California's restaurant smoking ban took effect in January 1995. In that year, heart attack admissions in California increased by 0.6%. In 1996, admissions increased by 2.9%. The corresponding changes for the United States were an increase of 3.2% in 1995 and 3.9% in 1996. California's bar smoking ban took effect in January 1998. In that year, heart attack admissions in California increased by 6.0%, compared to an increase of 6.2% in the nation as a whole. In 1999, admissions increased by 3.7% in California and decreased by 1.3% in the U.S.
Florida banned smoking in all restaurants in July 2003. Its heart attack admissions decreased by only 0.7% that year, and by only 2.0% the following year. In comparison, admissions in the U.S. decreased by 2.8% in 2003 and 8.2% in 2004.
Trends in heart attack admissions following the Oregon and New York smoking bans were also not found to be substantially different from national trends, or from trends in the comparison states without smoking bans.
The Rest of the Story
While this study certainly does not prove that smoking bans have no effect on heart attack admissions, what it does is demonstrate that when one examines population-based data for an entire state, one does not find any evidence of a dramatic decline in heart attacks immediately following the implementation of smoking bans. This casts serious doubt on the conclusion of the Helena, Pueblo, Piedmont, and Bowling Green studies. If smoking bans truly cause an immediate and dramatic decline in heart attacks, on the order of a 25% to 50% reduction, then why do we not observe any evident decline in heart attacks when entire states implement smoking bans.
The chief limitation of the study is that some localities within these states had already enacted smoking bans, so one would not expect to see as dramatic an effect on a statewide level. However, the proportion of residents in these states covered by local smoking bans was not particularly high. For example, the authors cite data that only 14% of Californians were covered by a smoke-free restaurant law in 1993. This increased to 100% in 1995. Yet the number of heart attack admissions increased from 1993 to 1995 (and increased further in 1996). The corresponding changes in the U.S. data were similar. So it does not seem that the existence of some local smoking bans is enough to invalidate the study conclusion.
I have already discussed in detail the reasons why I believe the conclusions of the Helena et al. studies are unjustified. Briefly, the chief flaw of these studies is that they are unable to rule out the very likely possibility that the observed changes in heart disease admissions in these cities during the study period are due primarily to random variation, rather than to the smoking bans. There is tremendous natural (random) variation in the heart disease admission rates in these cities because of the small population sizes. Because we are dealing with such small numbers of admissions, the percentage change in admissions from one year to the next is very high, even without any smoking ban.
While these papers make some attempt to account for these baseline trends, I do not believe that they go back far enough in time to do so adequately.
Because McFadden and Kuneman have examined heart attack trends among large populations, the number of heart attacks is much higher, and therefore the degree of underlying variability in the annual number of heart attacks is much lower. It is therefore easier to identify any major changes in the underlying trends.
I think it is high time that my fellow tobacco control researchers and practitioners recognize that the Helena et al. studies are examples of shoddy science that apparently now passes as acceptable in tobacco control research. While I support workplace smoking bans, I do not believe that we should be using shoddy science to promote them.
Thursday, July 12, 2007
IN MY VIEW: Senate Cigarette Tax Proposal is Not a Sensible Way to Fund Children's Health Care, But is a Big Win for Big Insurance
The proposed 61 cents per pack increase in the cigarette tax to raise funds to support the State Children's Health Insurance Program (SCHIP) appears quite likely to be enacted by Congress. President Bush has threatened to veto the bill, and although this may be a first, I am on the same side of the issue and hope that he does follow through with the veto.
This is no way to fund children's health insurance. You don't make children's health insurance dependent on the continued consumption of cigarettes. You don't create a reliance on high levels of smoking in order to provide health insurance to our nation's children. You don't create a situation where we have to hope that smokers continue to smoke because otherwise, we will lose necessary funding to provide health insurance for children.
What this proposal does is to take away any incentive for Congress to do anything that might jeopardize the program by substantially reducing smoking rates or cigarette consumption. What the anti-smoking groups are doing by supporting this proposal is inadvertently putting a death knell into any meaningful federal legislation to decrease youth or adult smoking.
Ironically, the Campaign for Tobacco-Free Kids (TFK) might be shooting itself in the foot by supporting the cigarette tax proposal. If it is enacted into law, it may actually make Congress less likely to pass the FDA tobacco legislation that TFK so desperately desires. Because the Campaign has spewed out so much propaganda indicating that the FDA legislation would greatly reduce smoking (I believe the exact opposite is true), legislators are likely to think that passage of the FDA legislation would reduce smoking and thus jeopardize the SCHIP program's funding. This would require finding an alternative funding source, which would be politically undesirable, or not funding the program - which could also be a political liability. At very least, the creation of a federal dependence on cigarette tax revenues is likely to lead to a watering down of the already weak legislation.
The real story behind the proposed cigarette tax increase is not any desire to protect health. Instead, it turns out that this is simply a way of avoiding what could have been a mechanism for funding the program - reducing federal subsidies to health insurers. As a MarketWatch article points out, the real beneficiaries of the tax proposal are: "Humana Inc., UnitedHealth Group, Aetna Inc., Healthspring Inc., Tenet Healthcare Corp., and Cigna Corp."
Instead of asking Big Insurance to bear the burden of providing health insurance to poor children, Congress is poised to ask smokers (who in general are poorer than the rest of the population) to fund the program. And it is in fact the poorest smokers who will be hurt most by the proposal.
This is all about politics, not health. Anti-smoking groups which are supporting this proposal are simply playing a political game. They are not promoting the public's health. Any proposal that makes a vital public health program entirely dependent upon continued high rates of smoking is not, ultimately, a way to promote the public's health. Any proposal that removes all incentive for the federal government to take any action to reduce smoking is not a way to promote the public's health.
There has to be a better, more sensible way of funding children's health insurance. Unfortunately, largely because of the actions of anti-smoking groups, we're not going to find that way.
This is no way to fund children's health insurance. You don't make children's health insurance dependent on the continued consumption of cigarettes. You don't create a reliance on high levels of smoking in order to provide health insurance to our nation's children. You don't create a situation where we have to hope that smokers continue to smoke because otherwise, we will lose necessary funding to provide health insurance for children.
What this proposal does is to take away any incentive for Congress to do anything that might jeopardize the program by substantially reducing smoking rates or cigarette consumption. What the anti-smoking groups are doing by supporting this proposal is inadvertently putting a death knell into any meaningful federal legislation to decrease youth or adult smoking.
Ironically, the Campaign for Tobacco-Free Kids (TFK) might be shooting itself in the foot by supporting the cigarette tax proposal. If it is enacted into law, it may actually make Congress less likely to pass the FDA tobacco legislation that TFK so desperately desires. Because the Campaign has spewed out so much propaganda indicating that the FDA legislation would greatly reduce smoking (I believe the exact opposite is true), legislators are likely to think that passage of the FDA legislation would reduce smoking and thus jeopardize the SCHIP program's funding. This would require finding an alternative funding source, which would be politically undesirable, or not funding the program - which could also be a political liability. At very least, the creation of a federal dependence on cigarette tax revenues is likely to lead to a watering down of the already weak legislation.
The real story behind the proposed cigarette tax increase is not any desire to protect health. Instead, it turns out that this is simply a way of avoiding what could have been a mechanism for funding the program - reducing federal subsidies to health insurers. As a MarketWatch article points out, the real beneficiaries of the tax proposal are: "Humana Inc., UnitedHealth Group, Aetna Inc., Healthspring Inc., Tenet Healthcare Corp., and Cigna Corp."
Instead of asking Big Insurance to bear the burden of providing health insurance to poor children, Congress is poised to ask smokers (who in general are poorer than the rest of the population) to fund the program. And it is in fact the poorest smokers who will be hurt most by the proposal.
This is all about politics, not health. Anti-smoking groups which are supporting this proposal are simply playing a political game. They are not promoting the public's health. Any proposal that makes a vital public health program entirely dependent upon continued high rates of smoking is not, ultimately, a way to promote the public's health. Any proposal that removes all incentive for the federal government to take any action to reduce smoking is not a way to promote the public's health.
There has to be a better, more sensible way of funding children's health insurance. Unfortunately, largely because of the actions of anti-smoking groups, we're not going to find that way.
Wednesday, July 11, 2007
TobaccoScam Responds to Challenge: Attacks Author, Fails to Address Substance of Argument, and Retains Claim that 30 Minutes of ETS Clogs Arteries
TobaccoScam has responded to my challenge of its claim that 30 minutes of secondhand smoke causes clogged arteries that increase the immediate risk of a heart attack.
Here is its response: "If you carefully look at the peer reviewed papers on secondhand smoke, as well as the most recent Surgeon General and California Environmental Protection Agency reports on secondhand smoke (linked from the Resource Library section of the web site), you will see that the statements on the web site represent the scientific consensus. Mike Siegel has a blog, which is his (rather uninformed) opinion." ...
"Siegel has never done any work on cardiovascular disease, in particular work on the vascular endothelium and his statements clearly reflect a lack of understanding of the effects of smoking on the endothelium or the role that even seemingly minor damage to the endothelium plays in both the immediate risk of a heart attack and also the long term cumulative risk."
The Rest of the Story
Now this is getting interesting. The organization which claims that if you are exposed to secondhand smoke for just 30 minutes, you will develop clogged arteries ("30 minutes exposure = stiffened, clogged arteries" is a direct quote from its web site) is accusing me of being uninformed.
Before addressing the response itself, let me first reiterate what the claim is that is under contention. TobaccoScam claims that 30 minutes of secondhand smoke exposure will cause any person exposed to have clogged arteries, and therefore, to be at an immediate increased risk of a heart attack.
After all, an "equals" sign means equals, is equivalent to, is the same as." So according to TobaccoScam's equation, 30 minutes of secondhand smoke is equivalent to having, is the same as, or equals having clogged arteries. Note that this claim is unqualified. It doesn't say that someone with severe existing coronary artery stenosis who is exposed briefly to secondhand smoke could potentially have a thrombus (clot) triggered by the exposure, as the terminal event that causes a heart attack in this highly susceptible individual. Instead, the assertion is that any person exposed, even a health individual, will develop clogged arteries from 30 minutes of exposure to secondhand smoke.
You might also note that the contention is not even that 30 minutes of secondhand smoke increases your risk of clogged arteries. The claim is that 30 minutes exposure equals clogged arteries: in other words, that if you are exposed for 30 minutes, you will have clogged arteries.
You can see that it doesn't take a rocket scientist, or even a rocket endotheliologist, to appreciate that TobaccoScam's claim is not only false, but absurd.
If 30 minutes of secondhand smoke exposure caused clogged coronary arteries in healthy people that put them at risk of an immediate heart attack, then wouldn't you expect to see a fair number of young people (in their 20s perhaps) suffering heart attacks? Twenty-year olds, for example, tend to spend a lot of time in smoky bars. You would think that if their coronary arteries got clogged every time they spent 30 minutes in a bar, at least some of them would be likely to suffer heart attacks.
How a group that is telling the public that if they are exposed briefly to secondhand smoke they will suffer clogged arteries and possibly a heart attack can start attacking other scientists for being uninformed is beyond me, but nevertheless, it is happening before my eyes.
Now to my comment on the response itself.
If you carefully look at the peer reviewed papers on secondhand smoke, as well as the most recent Surgeon General and California Environmental Protection Agency reports on secondhand smoke (linked from the Resource Library section of the web site), you will see that the statements on the web site represent the scientific consensus.
First of all, the issue at hand is not "the statements" on the web site; it is the specific statements that have been challenged, which I highlighted in my post. The key claim under contention is that 30 minutes of secondhand smoke exposure clogs arteries in otherwise healthy people. I can assure you that there is nothing in the Surgeon General's report or the California EPA report which suggests that 30 minutes of secondhand smoke exposure causes clogged arteries in anyone other than someone with severe pre-existing coronary artery stenosis.
TobaccoScam is misrepresenting the conclusions of these two reports. It is not the scientific consensus that 30 minutes of secondhand smoke clogs your arteries. That's a bunch of baloney. The scientific consensus is that brief exposure to secondhand smoke activates platelets and causes endothelial dysfunction, which if prolonged and repeated, can cause atherosclerosis and clogged arteries. The scientific consensus is that chronic exposure to secondhand smoke can clog your arteries. Not 30 minutes of exposure.
By conflating endothelial dysfunction and platelet activation with clogged arteries, TobaccoScam is grossly distorting and misrepresenting the science.
Mike Siegel has a blog, which is his (rather uninformed) opinion.
A nice ad-hominem attack, taken right from the anti-smoking playbook. If you are challenged, do not respond substantively. Just attack the challenger and try to discredit him. But do not, by any means, address the actual arguments being made.
Siegel has never done any work on cardiovascular disease, in particular work on the vascular endothelium and his statements clearly reflect a lack of understanding of the effects of smoking on the endothelium or the role that even seemingly minor damage to the endothelium plays in both the immediate risk of a heart attack and also the long term cumulative risk.
This is a classic tobacco industry argument used in the courtroom to try to discredit plaintiff's witnesses, and it's a good thing that TobaccoScam is not testifying in court cases, because this type of statement would be devastating to the cause. Because I have never actually done direct research on the vascular endothelium, I am incapable of offering an informed opinion about the cardiovascular effects of secondhand smoke.
Well, if that's the case, then I suppose I am not capable of offering an informed opinion about any of the health effects of secondhand smoke because I've never done laboratory or clinical research on any human cells, endothelial or otherwise. I suppose I should therefore ask TobaccoScam to remove all references to my work on its site, including my articles that concluded that secondhand smoke is a health hazard to bar and restaurant workers. It's interesting that when I am arguing that secondhand smoke is harmful, I am a credible and reliable and informed source, but when I take a contrary position, I automatically and suddenly become unreliable and uninformed.
I have news for you though. It doesn't take a vascular endotheliologist, or even a cardiologist to evaluate the scientific evidence. It does, however, help to be a physician and an epidemiologist and to have some experience treating patients with heart disease and heart attacks and to have taken a large number of histories from patients with varying degrees of heart disease and vascular damage.
If it were true that minor damage to the endothelium, as observed with 30 minutes of secondhand smoke, increased heart attack risk, then don't you think we would see young people suffering heart attacks? There is a reason why you don't see people starting to suffer heart attacks until they reach at least their 30's. That's because it takes years of damage to develop heart disease.
You don't have a heart attack from eating a single Big Mac. And yes, eating a Big Mac has been demonstrated to cause endothelial dysfunction and platelet activation, just like secondhand smoke.
Can you imagine the American Heart Association putting out a fact sheet that said:
Eating a Big Mac = Clogged Arteries and Increased Risk of Immediate Heart Attack
Eating Big Macs for many years, sure. Even eating a Big Mac if you have severe coronary artery stenosis to begin with and are a heart attack waiting to happen. Sure. But not just a healthy person eating a single Big Mac.
It doesn't seem to me that it would be too difficult to qualify the claim so that it is at least a reasonable representation of the science. As public health practitioners, I think we should be striving for accurate communication of the science to the public, not stretching the science to try to scare people into believing something that is not true.
Here is its response: "If you carefully look at the peer reviewed papers on secondhand smoke, as well as the most recent Surgeon General and California Environmental Protection Agency reports on secondhand smoke (linked from the Resource Library section of the web site), you will see that the statements on the web site represent the scientific consensus. Mike Siegel has a blog, which is his (rather uninformed) opinion." ...
"Siegel has never done any work on cardiovascular disease, in particular work on the vascular endothelium and his statements clearly reflect a lack of understanding of the effects of smoking on the endothelium or the role that even seemingly minor damage to the endothelium plays in both the immediate risk of a heart attack and also the long term cumulative risk."
The Rest of the Story
Now this is getting interesting. The organization which claims that if you are exposed to secondhand smoke for just 30 minutes, you will develop clogged arteries ("30 minutes exposure = stiffened, clogged arteries" is a direct quote from its web site) is accusing me of being uninformed.
Before addressing the response itself, let me first reiterate what the claim is that is under contention. TobaccoScam claims that 30 minutes of secondhand smoke exposure will cause any person exposed to have clogged arteries, and therefore, to be at an immediate increased risk of a heart attack.
After all, an "equals" sign means equals, is equivalent to, is the same as." So according to TobaccoScam's equation, 30 minutes of secondhand smoke is equivalent to having, is the same as, or equals having clogged arteries. Note that this claim is unqualified. It doesn't say that someone with severe existing coronary artery stenosis who is exposed briefly to secondhand smoke could potentially have a thrombus (clot) triggered by the exposure, as the terminal event that causes a heart attack in this highly susceptible individual. Instead, the assertion is that any person exposed, even a health individual, will develop clogged arteries from 30 minutes of exposure to secondhand smoke.
You might also note that the contention is not even that 30 minutes of secondhand smoke increases your risk of clogged arteries. The claim is that 30 minutes exposure equals clogged arteries: in other words, that if you are exposed for 30 minutes, you will have clogged arteries.
You can see that it doesn't take a rocket scientist, or even a rocket endotheliologist, to appreciate that TobaccoScam's claim is not only false, but absurd.
If 30 minutes of secondhand smoke exposure caused clogged coronary arteries in healthy people that put them at risk of an immediate heart attack, then wouldn't you expect to see a fair number of young people (in their 20s perhaps) suffering heart attacks? Twenty-year olds, for example, tend to spend a lot of time in smoky bars. You would think that if their coronary arteries got clogged every time they spent 30 minutes in a bar, at least some of them would be likely to suffer heart attacks.
How a group that is telling the public that if they are exposed briefly to secondhand smoke they will suffer clogged arteries and possibly a heart attack can start attacking other scientists for being uninformed is beyond me, but nevertheless, it is happening before my eyes.
Now to my comment on the response itself.
If you carefully look at the peer reviewed papers on secondhand smoke, as well as the most recent Surgeon General and California Environmental Protection Agency reports on secondhand smoke (linked from the Resource Library section of the web site), you will see that the statements on the web site represent the scientific consensus.
First of all, the issue at hand is not "the statements" on the web site; it is the specific statements that have been challenged, which I highlighted in my post. The key claim under contention is that 30 minutes of secondhand smoke exposure clogs arteries in otherwise healthy people. I can assure you that there is nothing in the Surgeon General's report or the California EPA report which suggests that 30 minutes of secondhand smoke exposure causes clogged arteries in anyone other than someone with severe pre-existing coronary artery stenosis.
TobaccoScam is misrepresenting the conclusions of these two reports. It is not the scientific consensus that 30 minutes of secondhand smoke clogs your arteries. That's a bunch of baloney. The scientific consensus is that brief exposure to secondhand smoke activates platelets and causes endothelial dysfunction, which if prolonged and repeated, can cause atherosclerosis and clogged arteries. The scientific consensus is that chronic exposure to secondhand smoke can clog your arteries. Not 30 minutes of exposure.
By conflating endothelial dysfunction and platelet activation with clogged arteries, TobaccoScam is grossly distorting and misrepresenting the science.
Mike Siegel has a blog, which is his (rather uninformed) opinion.
A nice ad-hominem attack, taken right from the anti-smoking playbook. If you are challenged, do not respond substantively. Just attack the challenger and try to discredit him. But do not, by any means, address the actual arguments being made.
Siegel has never done any work on cardiovascular disease, in particular work on the vascular endothelium and his statements clearly reflect a lack of understanding of the effects of smoking on the endothelium or the role that even seemingly minor damage to the endothelium plays in both the immediate risk of a heart attack and also the long term cumulative risk.
This is a classic tobacco industry argument used in the courtroom to try to discredit plaintiff's witnesses, and it's a good thing that TobaccoScam is not testifying in court cases, because this type of statement would be devastating to the cause. Because I have never actually done direct research on the vascular endothelium, I am incapable of offering an informed opinion about the cardiovascular effects of secondhand smoke.
Well, if that's the case, then I suppose I am not capable of offering an informed opinion about any of the health effects of secondhand smoke because I've never done laboratory or clinical research on any human cells, endothelial or otherwise. I suppose I should therefore ask TobaccoScam to remove all references to my work on its site, including my articles that concluded that secondhand smoke is a health hazard to bar and restaurant workers. It's interesting that when I am arguing that secondhand smoke is harmful, I am a credible and reliable and informed source, but when I take a contrary position, I automatically and suddenly become unreliable and uninformed.
I have news for you though. It doesn't take a vascular endotheliologist, or even a cardiologist to evaluate the scientific evidence. It does, however, help to be a physician and an epidemiologist and to have some experience treating patients with heart disease and heart attacks and to have taken a large number of histories from patients with varying degrees of heart disease and vascular damage.
If it were true that minor damage to the endothelium, as observed with 30 minutes of secondhand smoke, increased heart attack risk, then don't you think we would see young people suffering heart attacks? There is a reason why you don't see people starting to suffer heart attacks until they reach at least their 30's. That's because it takes years of damage to develop heart disease.
You don't have a heart attack from eating a single Big Mac. And yes, eating a Big Mac has been demonstrated to cause endothelial dysfunction and platelet activation, just like secondhand smoke.
Can you imagine the American Heart Association putting out a fact sheet that said:
Eating a Big Mac = Clogged Arteries and Increased Risk of Immediate Heart Attack
Eating Big Macs for many years, sure. Even eating a Big Mac if you have severe coronary artery stenosis to begin with and are a heart attack waiting to happen. Sure. But not just a healthy person eating a single Big Mac.
It doesn't seem to me that it would be too difficult to qualify the claim so that it is at least a reasonable representation of the science. As public health practitioners, I think we should be striving for accurate communication of the science to the public, not stretching the science to try to scare people into believing something that is not true.
Tuesday, July 10, 2007
FORCES Hits the Bullseye on FDA Tobacco Legislation; Shows More Insight than Top Anti-Smoking Groups Combined
In a concise and insightful summary of the broader implications of the proposed FDA tobacco legislation, FORCES International has hit the nail on the head, presenting a picture of the true meaning of the legislation and the reason why Philip Morris supports it, something which the leading anti-smoking groups (which are arm-in-arm with Philip Morris supporting this legislation) seem unable to comprehend.
FORCES presents the broader implications of the legislation in several bullet points, which include the following:
In this situation, FORCES is right on the money in its analysis of the FDA legislation. FORCES seems to have the ability to comprehend the broader and most important implications of this policy proposal, something which the leading anti-smoking groups do not appear able to do. It seems to me that it is a sad state of affairs when FORCES has a better understanding of the policy considerations underlying the proposed legislation than the health groups which are proposing it.
Let's take these important bullet points one by one.
Philip Morris had a big part in the writing of the law proposal.
It is very clear that this bill was negotiated between two major parties - the Campaign for Tobacco-Free Kids (representing the health community) and Philip Morris - by way of Congressional mediation. So yes - Philip Morris did have a big part in the crafting of the proposal (whether they drafted any of the language is not something I know). This basic information is something which none of the major health groups, to the best of my knowledge, has ever disclosed to the public or to their constituents. Yet it is critical that the public and the constituents be aware of this information in order to be able to evaluate the proposal appropriately.
Once the FDA regulates cigarettes, ALL the responsibilities of the presumed and never demonstrated “tobacco-related” deaths will be on FDA’s shoulders.
Absolutely true. Once cigarettes are placed under the regulatory authority of the government, then the burden and responsibility of protecting the public, and therefore, the responsibility for the harms caused by cigarettes, shifts largely from the tobacco companies to the government. If FDA assumes the authority to require cigarettes to be less harmful and less addictive, as the Campaign for Tobacco-Free Kids claims it will, then the FDA bears the responsibility if cigarettes continue to kill and addict people.
What the major health groups supporting this legislation don't seem to appreciate is that to regulate means "to permit." The FDA, by assuming jurisdiction over the safety of tobacco products, is essentially permitting cigarette companies to kill people. So what if the product contains less nitrosamines or less nicotine? It's still going to be killing people. The only difference is that it will now be killing people with the FDA's blessing.
This is an unacceptable conundrum which the FDA itself recognizes, which FORCES recognizes, but which the Campaign for Tobacco-Free Kids and its partners in deception seem to have no appreciation of.
The rest of the tobacco industry opposes the FDA regulation because PM is far ahead of the rest of the industry in the research for a safer cigarette.
This is one of the major reasons why Philip Morris supports the legislation. Philip Morris probably stands to benefit the most from the "reduced exposure" provisions of the legislation, which would presumably allow it to roll out Marlboro Ultra Smooth (which has already been test-marketed) or something similar with an advertising campaign that emphasizes how the product will reduce exposure to this and that smoke constituent.
After PM has developed the safer cigarette, it will have an edge on the competition. Remember: industries would “kill” for a market share point! And in the case of the cigarette market, one market share point means very many millions of dollars a year return.
This follows from the above point.
The FDA will have no choice but to approve a “safer” cigarette. And since people are inebriated with authority, once such an “authority” DOES say that the cigarette is safer (because it is in charge and it has to show that “it’s doing something”), the public WILL believe it because – let’s face it – foolishness is a common human characteristic.
This is perhaps the most important point of all. I would go further than FORCES. I would go so far as to say that simply by virtue of assuming jurisdiction over the "safety" of cigarettes, the public is going to believe that cigarettes are safer. But certainly, when the FDA does take action - any action - the public is going to believe that cigarettes have been made a safer product. This despite the fact that there is no evidence that removing any particular constituents from cigarettes will make it safer. The public will essentially be used as guinea pigs to test out the effect of this regulatory approach. The answer will not be evident for years. In the mean time, people will believe that the product is safer.
The upshot of all of this is that the legislation will perpetuate the fraud that tobacco companies were found guilty of committing by implying that certain of their products were safer, except it will shift the perpetration of that fraud from the tobacco companies to the government.
Equally important is the fact that when the public's perception of the safety of cigarettes increases, so does cigarette consumption and smoking rates. When the public believes that cigarette smoking has been made safer, more people are going to smoke than would have otherwise. In other words, the proposed legislation will likely increase smoking, not decrease it. This could well be a public health nightmare, rather than the saving of countless lives as the Campaign for Tobacco-Free Kids claims or the saving of millions of lives as the American Medical Association claims.
FORCES presents the broader implications of the legislation in several bullet points, which include the following:
- "Philip Morris had a big part in the writing of the law proposal.
- Once the FDA regulates cigarettes, ALL the responsibilities of the presumed and never demonstrated “tobacco-related” deaths will be on FDA’s shoulders.
- The rest of the tobacco industry opposes the FDA regulation because PM is far ahead of the rest of the industry in the research for a safer cigarette. ...
- After PM has developed the safer cigarette, it will have an edge on the competition. Remember: industries would “kill” for a market share point! And in the case of the cigarette market, one market share point means very many millions of dollars a year return.
- The FDA will have no choice but to approve a “safer” cigarette. And since people are inebriated with authority, once such an “authority” DOES say that the cigarette is safer (because it is in charge and it has to show that “it’s doing something”), the public WILL believe it because – let’s face it – foolishness is a common human characteristic. ..."
In this situation, FORCES is right on the money in its analysis of the FDA legislation. FORCES seems to have the ability to comprehend the broader and most important implications of this policy proposal, something which the leading anti-smoking groups do not appear able to do. It seems to me that it is a sad state of affairs when FORCES has a better understanding of the policy considerations underlying the proposed legislation than the health groups which are proposing it.
Let's take these important bullet points one by one.
Philip Morris had a big part in the writing of the law proposal.
It is very clear that this bill was negotiated between two major parties - the Campaign for Tobacco-Free Kids (representing the health community) and Philip Morris - by way of Congressional mediation. So yes - Philip Morris did have a big part in the crafting of the proposal (whether they drafted any of the language is not something I know). This basic information is something which none of the major health groups, to the best of my knowledge, has ever disclosed to the public or to their constituents. Yet it is critical that the public and the constituents be aware of this information in order to be able to evaluate the proposal appropriately.
Once the FDA regulates cigarettes, ALL the responsibilities of the presumed and never demonstrated “tobacco-related” deaths will be on FDA’s shoulders.
Absolutely true. Once cigarettes are placed under the regulatory authority of the government, then the burden and responsibility of protecting the public, and therefore, the responsibility for the harms caused by cigarettes, shifts largely from the tobacco companies to the government. If FDA assumes the authority to require cigarettes to be less harmful and less addictive, as the Campaign for Tobacco-Free Kids claims it will, then the FDA bears the responsibility if cigarettes continue to kill and addict people.
What the major health groups supporting this legislation don't seem to appreciate is that to regulate means "to permit." The FDA, by assuming jurisdiction over the safety of tobacco products, is essentially permitting cigarette companies to kill people. So what if the product contains less nitrosamines or less nicotine? It's still going to be killing people. The only difference is that it will now be killing people with the FDA's blessing.
This is an unacceptable conundrum which the FDA itself recognizes, which FORCES recognizes, but which the Campaign for Tobacco-Free Kids and its partners in deception seem to have no appreciation of.
The rest of the tobacco industry opposes the FDA regulation because PM is far ahead of the rest of the industry in the research for a safer cigarette.
This is one of the major reasons why Philip Morris supports the legislation. Philip Morris probably stands to benefit the most from the "reduced exposure" provisions of the legislation, which would presumably allow it to roll out Marlboro Ultra Smooth (which has already been test-marketed) or something similar with an advertising campaign that emphasizes how the product will reduce exposure to this and that smoke constituent.
After PM has developed the safer cigarette, it will have an edge on the competition. Remember: industries would “kill” for a market share point! And in the case of the cigarette market, one market share point means very many millions of dollars a year return.
This follows from the above point.
The FDA will have no choice but to approve a “safer” cigarette. And since people are inebriated with authority, once such an “authority” DOES say that the cigarette is safer (because it is in charge and it has to show that “it’s doing something”), the public WILL believe it because – let’s face it – foolishness is a common human characteristic.
This is perhaps the most important point of all. I would go further than FORCES. I would go so far as to say that simply by virtue of assuming jurisdiction over the "safety" of cigarettes, the public is going to believe that cigarettes are safer. But certainly, when the FDA does take action - any action - the public is going to believe that cigarettes have been made a safer product. This despite the fact that there is no evidence that removing any particular constituents from cigarettes will make it safer. The public will essentially be used as guinea pigs to test out the effect of this regulatory approach. The answer will not be evident for years. In the mean time, people will believe that the product is safer.
The upshot of all of this is that the legislation will perpetuate the fraud that tobacco companies were found guilty of committing by implying that certain of their products were safer, except it will shift the perpetration of that fraud from the tobacco companies to the government.
Equally important is the fact that when the public's perception of the safety of cigarettes increases, so does cigarette consumption and smoking rates. When the public believes that cigarette smoking has been made safer, more people are going to smoke than would have otherwise. In other words, the proposed legislation will likely increase smoking, not decrease it. This could well be a public health nightmare, rather than the saving of countless lives as the Campaign for Tobacco-Free Kids claims or the saving of millions of lives as the American Medical Association claims.
Monday, July 09, 2007
Anti-Smoking Hypocrisy Awards - July 2007
This is the second installment of my Anti-Smoking Hypocrisy Awards (first installment is here). These awards are given out for the best examples of hypocrisy in the anti-smoking movement. This month's winners are:
#5 - American Medical Association
Cracking into the top 5 for the first time, the American Medical Association is being recognized for supporting legislation that is supposedly needed to prevent the tobacco companies from making undocumented claims, while at the same time making a doozy of an undocumented claim itself: that the proposed legislation will save "millions of lives."
Are we to seriously believe the AMA's suggestion that this legislation will save millions of lives when the Association doesn't so much as offer an explanation of how exactly the legislation will save even one life, much less millions?
I do, however, have to applaud the AMA for one thing. At least they didn't take the cowardly step that the Campaign for Tobacco-Free Kids took and merely claim that the legislation will save "countless" lives. The Campaign isn't able to actually count the lives because those saved lives don't exist. No plausible mechanism has yet been offered for how the legislation will save lives.
At least the AMA is willing to pin a number on its claim. We don't have any idea of the mechanism, but at least we now know that the proposed legislation will save millions of lives.
Boy - it would sure be nice for me to be able to make bold and grand claims like that without having to support them, back them up, or even offer a plausible mechanism for the purported effect.
The American Medical Association is also being acknowledged for its suggestion that the proposed FDA legislation is necessary because of the tremendous volume of tobacco industry advertising, when in fact the legislation does not regulate the volume of advertising by the industry. This is exactly the kind of deceptive doublespeak that the Campaign for Tobacco-Free Kids and American Cancer Society have perfected in their campaigns to promote the FDA legislation. By adopting similar tactics, the AMA earns its way into the top 5.
#4 - American Cancer Society
Fourth place goes to the American Cancer Society, which has run a campaign of deception in support of the proposed FDA tobacco legislation, which it says is needed because the tobacco industry "has proven that they can't be trusted."
The American Cancer Society publicly misrepresented Philip Morris' position on the legislation, telling the public that "The tobacco industry has fought us at every step of the way," when in fact Philip Morris has supported the Cancer Society's efforts the entire way. Apparently, the tobacco companies aren't the only ones who can't be trusted.
#3 - American Heart Association
Third place goes to the American Heart Association which, in announcing a new policy to hold its annual scientific meetings only in smoke-free cities, supported the policy by telling the public that just 30 minutes of secondhand smoke slows the flow of blood to the heart muscle, making people much more susceptible to a heart attack - a statement which is untrue. The Heart Association then announced that its next scientific conference will be held in Orlando, a city in which bar workers are exposed to extremely high levels of secondhand smoke.
You see - in Florida, smoking is still allowed in bars. If attendees of the AHA conference this fall go out for drinks in the evening in an Orlando bar, they will more likely than not be exposed to high levels of secondhand smoke. Can you imagine all the heart attacks that are going to occur during the conference? It's a good thing that there will be so many cardiologists around.
The hypocrisy of the AHA's press release is startling. Secondhand smoke is so dangerous that only 30 minutes of exposure decreases your coronary blood flow and can trigger a heart attack; however, it's not so bad that we need to protect bar workers from secondhand smoke. Let them keel over from heart attacks - as long as the AHA conference attendees have a place to enjoy their evening cocktails to unwind after a long day of scientific presentations (many of which, incidentally, are going to be about how harmful secondhand smoke is).
#2 - Campaign for Tobacco-Free Kids
The Campaign for Tobacco-Free Kids earns a well-deserved and solid second place finish for its support of legislation that it says is needed to stop the tobacco companies from making deceptive and misleading representations to the public, but with the use of a deceptive campaign of its own in which the Campaign is deceiving its own constituents and the public about the legislation.
On multiple occasions (it has become essentially a weekly occurrence), the Campaign for Tobacco-Free Kids has misled its constituents by stating or implying that the proposed FDA tobacco legislation is opposed by Big Tobacco, when in fact the largest company within Big Tobacco - Philip Morris - supports the legislation and is vigorously promoting its passage.
The Campaign's misrepresentation of the truth, which I have documented in multiple posts (example 1; example 2; example 3; example 4; example 5; example 6; example 7; example 8), is glaringly hypocritical in light of its stated purpose: to make sure that the tobacco companies do not deceive the public in their public communications.
The Campaign's seeming inability to tell the truth even garnered the attention of R.J. Reynolds, which rarely in recent years has called any anti-smoking group to task. Reynolds, most likely in vain, asked the Campaign to try sticking to the facts.
The fact that the Campaign for Tobacco-Free Kids is misusing youths in order to get them to lobby for this legislation only adds to the Campaign's case for a strong second place (example 1; example 2; example 3; example 4; example 5).
#1 - American Legacy Foundation
There are multiple levels of hypocrisy for which the American Legacy Foundation is being rewarded here.
First, the American Legacy Foundation testified before Congress last month, decrying the actions of companies like Time Warner, whose depiction of "smoking on screen recruits about 390,000 new youth smokers every year." According to Legacy, "youth exposure to movie smoking explains between one-third and one-half of all adolescent smoking initiation." Legacy has repeatedly bemoaned the exposure of youths to smoking in non-R rated movies, and has called for the Motion Picture Association of America to adopt a policy of giving an "R" rating to any movie that depicts smoking in a non-historically correct manner.
So who did the American Legacy Foundation choose as its leading corporate partner? You guessed it...Time Warner, the chief culprit of what Legacy says is basically the killing of our nation's children by addicting them to smoking. That pretty much defines hypocrisy. For that alone, Legacy probably would have carried home first place in the July 2007 Anti-Smoking Hypocrisy Awards.
But wait - there's more. As a condition for Schools of Public Health accepting funding from the American Legacy Foundation, schools were required to sign a statement agreeing not to take funding from any tobacco company for the duration of the grant. This clause in the grant conditions is known as Clause 12.
As explained in a recent Public Health Reports article: "Grants awarded under this program required that the dean or CEO of the school of public health confirm that the school of public health does not currently accept nor will accept any grant or anything else of value from any tobacco manufacturer, distributor, or other tobacco-related company during the grant period. This restriction is a policy of the American Legacy Foundation and applies to all of the foundation'’s grantees and sub-grantees."
Thus, a School, in order to receive Legacy funding, has to agree that none of the researchers at the institution will accept tobacco funding. If I were to successfully apply for an American Legacy Foundation grant, then the conditions of that grant would mean that my colleagues at the School - all of them - would be bound from applying for funding from any tobacco-related company.
Of course, the ultimate irony of this whole story is that the American Legacy Foundation receives all of its funding from...
... you guessed it: the tobacco companies!
So you can imagine how heavily the hypocrisy is spread out over the Legacy Foundation, to have the gall to say that taking tobacco money is fine for them, but completely unacceptable for anyone else.
Moreover, to make matters much, much worse, Legacy is attempting to obtain funding to sustain its "truth" campaign from...
... you guessed it: the tobacco companies!
Legacy is doing this by funding a front group - the Citizens' Commission to Protect the Truth - to push for tobacco company funding of the campaign. According to its web site, the Commission is working toward either voluntary or involuntary tobacco company funding to support the campaign: 'The Commission is seeking to persuade or force the tobacco companies to accede to court-supervised funding of the Public Education Fund through the Master Settlement Agreement (MSA), which they signed with the states in 1998."
Apparently, persuading the companies to fund Legacy by voluntarily continuing MSA payments would be acceptable to Legacy.
I don't think it's possible to be any more hypocritical than this.
Essentially, what Legacy is saying is that what Legacy is doing is so valuable that taking tobacco company money is justifiable, but no matter what anybody else is doing, taking tobacco money is completely unacceptable.
When the corrupt, filthy, criminal tobacco money hits anyone else's hands, it stays corrupt, filthy, and criminal, but when it hits Legacy's hands, it is immediately purified.
Maybe they run it through some sort of Holy Water, or something. Or have a Rabbi perform a special blessing?
Notice, by the way, that no where on the Commission's home page does it notify the public that the Commission is not some sort of independent group. Instead, it is funded by the American Legacy Foundation! Isn't that special? Funding a so-called citizens' group to support funding for... you! Sounds exactly like something the tobacco companies would do. But if you don't read the fine print on an entirely separate web page, you'll miss that small detail.
Under these circumstances, I do not find it acceptable for Schools to accept funding from the American Legacy Foundation. So like its benefactors, I would add Legacy to the short list of companies and organizations from which I would argue that universities should not accept research funding.
Third, despite calling smoking in movies one of the gravest threats to children's health, and despite making a big fuss to Congress about how an R-rating is needed for any movie that depicts any smoking in order to protect children from seeing smoking and starting to smoke because of it (which 390,000 of them apparently do every year), Legacy is calling for an exception to be made for any movie that depicts smoking in a historically correct manner.
If it is indeed true that depiction of smoking in movies is going to result in killing people (as the American Legacy Foundation has put it), then what possible justification is there for allowing kids to be exposed to any depiction of smoking, whether it is historically correct or not?
Who cares if a smoking depiction is historically correct if it is going to cause kids to become addicted to smoking and ultimately, for many of them to die because of it? If a depiction of smoking in a movie is going to result in disease and premature death among many of those in the audience, then how can we possibly allow an exemption for movies that depict smoking in a historically correct manner? Who cares if the person actually smoked or not? It is the smoking depiction that is killing kids, not the historical accuracy or inaccuracy of that depiction.
I find it extremely hypocritical for anti-smoking groups to suggest that smoking in movies is so bad that we need to remove any shred of it from any movies which kids may view, but that it is not so bad that we need to remove the historical depiction of smoking.
Finally, despite calling its youth anti-smoking media campaign "truth," Legacy repeatedly fails to disclose the truth about the research which it alleges demonstrates the effectiveness of this campaign in greatly reducing youth smoking in the nation: that the research was funded by, and authored by, the American Legacy Foundation itself. Legacy continues to fail to disclose this inherent conflict of interest, which in my view is an ethical violation. Even in its recent testimony before Congress, Legacy represented this research simply as being "peer-reviewed research," failing to disclose that the chief executive officer of Legacy was a senior author of the paper, the research behind which Legacy funded.
For these many examples of hypocrisy, I award the American Legacy Foundation the highest possible honor: #1 in the Anti-Smoking Hypocrisy Awards for July 2007.
For more details and documentation on Legacy hypocrisy, see the following posts:
post 1
post 2
post 3
post 4
post 5
post 6
#5 - American Medical Association
Cracking into the top 5 for the first time, the American Medical Association is being recognized for supporting legislation that is supposedly needed to prevent the tobacco companies from making undocumented claims, while at the same time making a doozy of an undocumented claim itself: that the proposed legislation will save "millions of lives."
Are we to seriously believe the AMA's suggestion that this legislation will save millions of lives when the Association doesn't so much as offer an explanation of how exactly the legislation will save even one life, much less millions?
I do, however, have to applaud the AMA for one thing. At least they didn't take the cowardly step that the Campaign for Tobacco-Free Kids took and merely claim that the legislation will save "countless" lives. The Campaign isn't able to actually count the lives because those saved lives don't exist. No plausible mechanism has yet been offered for how the legislation will save lives.
At least the AMA is willing to pin a number on its claim. We don't have any idea of the mechanism, but at least we now know that the proposed legislation will save millions of lives.
Boy - it would sure be nice for me to be able to make bold and grand claims like that without having to support them, back them up, or even offer a plausible mechanism for the purported effect.
The American Medical Association is also being acknowledged for its suggestion that the proposed FDA legislation is necessary because of the tremendous volume of tobacco industry advertising, when in fact the legislation does not regulate the volume of advertising by the industry. This is exactly the kind of deceptive doublespeak that the Campaign for Tobacco-Free Kids and American Cancer Society have perfected in their campaigns to promote the FDA legislation. By adopting similar tactics, the AMA earns its way into the top 5.
#4 - American Cancer Society
Fourth place goes to the American Cancer Society, which has run a campaign of deception in support of the proposed FDA tobacco legislation, which it says is needed because the tobacco industry "has proven that they can't be trusted."
The American Cancer Society publicly misrepresented Philip Morris' position on the legislation, telling the public that "The tobacco industry has fought us at every step of the way," when in fact Philip Morris has supported the Cancer Society's efforts the entire way. Apparently, the tobacco companies aren't the only ones who can't be trusted.
#3 - American Heart Association
Third place goes to the American Heart Association which, in announcing a new policy to hold its annual scientific meetings only in smoke-free cities, supported the policy by telling the public that just 30 minutes of secondhand smoke slows the flow of blood to the heart muscle, making people much more susceptible to a heart attack - a statement which is untrue. The Heart Association then announced that its next scientific conference will be held in Orlando, a city in which bar workers are exposed to extremely high levels of secondhand smoke.
You see - in Florida, smoking is still allowed in bars. If attendees of the AHA conference this fall go out for drinks in the evening in an Orlando bar, they will more likely than not be exposed to high levels of secondhand smoke. Can you imagine all the heart attacks that are going to occur during the conference? It's a good thing that there will be so many cardiologists around.
The hypocrisy of the AHA's press release is startling. Secondhand smoke is so dangerous that only 30 minutes of exposure decreases your coronary blood flow and can trigger a heart attack; however, it's not so bad that we need to protect bar workers from secondhand smoke. Let them keel over from heart attacks - as long as the AHA conference attendees have a place to enjoy their evening cocktails to unwind after a long day of scientific presentations (many of which, incidentally, are going to be about how harmful secondhand smoke is).
#2 - Campaign for Tobacco-Free Kids
The Campaign for Tobacco-Free Kids earns a well-deserved and solid second place finish for its support of legislation that it says is needed to stop the tobacco companies from making deceptive and misleading representations to the public, but with the use of a deceptive campaign of its own in which the Campaign is deceiving its own constituents and the public about the legislation.
On multiple occasions (it has become essentially a weekly occurrence), the Campaign for Tobacco-Free Kids has misled its constituents by stating or implying that the proposed FDA tobacco legislation is opposed by Big Tobacco, when in fact the largest company within Big Tobacco - Philip Morris - supports the legislation and is vigorously promoting its passage.
The Campaign's misrepresentation of the truth, which I have documented in multiple posts (example 1; example 2; example 3; example 4; example 5; example 6; example 7; example 8), is glaringly hypocritical in light of its stated purpose: to make sure that the tobacco companies do not deceive the public in their public communications.
The Campaign's seeming inability to tell the truth even garnered the attention of R.J. Reynolds, which rarely in recent years has called any anti-smoking group to task. Reynolds, most likely in vain, asked the Campaign to try sticking to the facts.
The fact that the Campaign for Tobacco-Free Kids is misusing youths in order to get them to lobby for this legislation only adds to the Campaign's case for a strong second place (example 1; example 2; example 3; example 4; example 5).
#1 - American Legacy Foundation
There are multiple levels of hypocrisy for which the American Legacy Foundation is being rewarded here.
First, the American Legacy Foundation testified before Congress last month, decrying the actions of companies like Time Warner, whose depiction of "smoking on screen recruits about 390,000 new youth smokers every year." According to Legacy, "youth exposure to movie smoking explains between one-third and one-half of all adolescent smoking initiation." Legacy has repeatedly bemoaned the exposure of youths to smoking in non-R rated movies, and has called for the Motion Picture Association of America to adopt a policy of giving an "R" rating to any movie that depicts smoking in a non-historically correct manner.
So who did the American Legacy Foundation choose as its leading corporate partner? You guessed it...Time Warner, the chief culprit of what Legacy says is basically the killing of our nation's children by addicting them to smoking. That pretty much defines hypocrisy. For that alone, Legacy probably would have carried home first place in the July 2007 Anti-Smoking Hypocrisy Awards.
But wait - there's more. As a condition for Schools of Public Health accepting funding from the American Legacy Foundation, schools were required to sign a statement agreeing not to take funding from any tobacco company for the duration of the grant. This clause in the grant conditions is known as Clause 12.
As explained in a recent Public Health Reports article: "Grants awarded under this program required that the dean or CEO of the school of public health confirm that the school of public health does not currently accept nor will accept any grant or anything else of value from any tobacco manufacturer, distributor, or other tobacco-related company during the grant period. This restriction is a policy of the American Legacy Foundation and applies to all of the foundation'’s grantees and sub-grantees."
Thus, a School, in order to receive Legacy funding, has to agree that none of the researchers at the institution will accept tobacco funding. If I were to successfully apply for an American Legacy Foundation grant, then the conditions of that grant would mean that my colleagues at the School - all of them - would be bound from applying for funding from any tobacco-related company.
Of course, the ultimate irony of this whole story is that the American Legacy Foundation receives all of its funding from...
... you guessed it: the tobacco companies!
So you can imagine how heavily the hypocrisy is spread out over the Legacy Foundation, to have the gall to say that taking tobacco money is fine for them, but completely unacceptable for anyone else.
Moreover, to make matters much, much worse, Legacy is attempting to obtain funding to sustain its "truth" campaign from...
... you guessed it: the tobacco companies!
Legacy is doing this by funding a front group - the Citizens' Commission to Protect the Truth - to push for tobacco company funding of the campaign. According to its web site, the Commission is working toward either voluntary or involuntary tobacco company funding to support the campaign: 'The Commission is seeking to persuade or force the tobacco companies to accede to court-supervised funding of the Public Education Fund through the Master Settlement Agreement (MSA), which they signed with the states in 1998."
Apparently, persuading the companies to fund Legacy by voluntarily continuing MSA payments would be acceptable to Legacy.
I don't think it's possible to be any more hypocritical than this.
Essentially, what Legacy is saying is that what Legacy is doing is so valuable that taking tobacco company money is justifiable, but no matter what anybody else is doing, taking tobacco money is completely unacceptable.
When the corrupt, filthy, criminal tobacco money hits anyone else's hands, it stays corrupt, filthy, and criminal, but when it hits Legacy's hands, it is immediately purified.
Maybe they run it through some sort of Holy Water, or something. Or have a Rabbi perform a special blessing?
Notice, by the way, that no where on the Commission's home page does it notify the public that the Commission is not some sort of independent group. Instead, it is funded by the American Legacy Foundation! Isn't that special? Funding a so-called citizens' group to support funding for... you! Sounds exactly like something the tobacco companies would do. But if you don't read the fine print on an entirely separate web page, you'll miss that small detail.
Under these circumstances, I do not find it acceptable for Schools to accept funding from the American Legacy Foundation. So like its benefactors, I would add Legacy to the short list of companies and organizations from which I would argue that universities should not accept research funding.
Third, despite calling smoking in movies one of the gravest threats to children's health, and despite making a big fuss to Congress about how an R-rating is needed for any movie that depicts any smoking in order to protect children from seeing smoking and starting to smoke because of it (which 390,000 of them apparently do every year), Legacy is calling for an exception to be made for any movie that depicts smoking in a historically correct manner.
If it is indeed true that depiction of smoking in movies is going to result in killing people (as the American Legacy Foundation has put it), then what possible justification is there for allowing kids to be exposed to any depiction of smoking, whether it is historically correct or not?
Who cares if a smoking depiction is historically correct if it is going to cause kids to become addicted to smoking and ultimately, for many of them to die because of it? If a depiction of smoking in a movie is going to result in disease and premature death among many of those in the audience, then how can we possibly allow an exemption for movies that depict smoking in a historically correct manner? Who cares if the person actually smoked or not? It is the smoking depiction that is killing kids, not the historical accuracy or inaccuracy of that depiction.
I find it extremely hypocritical for anti-smoking groups to suggest that smoking in movies is so bad that we need to remove any shred of it from any movies which kids may view, but that it is not so bad that we need to remove the historical depiction of smoking.
Finally, despite calling its youth anti-smoking media campaign "truth," Legacy repeatedly fails to disclose the truth about the research which it alleges demonstrates the effectiveness of this campaign in greatly reducing youth smoking in the nation: that the research was funded by, and authored by, the American Legacy Foundation itself. Legacy continues to fail to disclose this inherent conflict of interest, which in my view is an ethical violation. Even in its recent testimony before Congress, Legacy represented this research simply as being "peer-reviewed research," failing to disclose that the chief executive officer of Legacy was a senior author of the paper, the research behind which Legacy funded.
For these many examples of hypocrisy, I award the American Legacy Foundation the highest possible honor: #1 in the Anti-Smoking Hypocrisy Awards for July 2007.
For more details and documentation on Legacy hypocrisy, see the following posts:
post 1
post 2
post 3
post 4
post 5
post 6
Friday, July 06, 2007
Anti-Smoking Groups Supporting 61 Cents Per Pack Increase in Federal Cigarette Tax to Fund Children's Health Insurance Program
Senators Ted Kennedy (D-MA) and Orrin Hatch (R-UT) have announced a proposal to increase the federal cigarette excise tax from 39 cents to one dollar per pack in order to fund the State Children's Health Insurance (S-CHIP) program, which is up for re-authorization this year.
According to a Cybercast News Service article, the proposal is supported by the American Academy of Family Physicians, which stated: "By discouraging smoking through an increase in the tobacco tax and using the resulting revenues to improve enrollment in children's health insurance programs, we are creating a win-win proposition in support of our children's health."
The proposal is also supported by the Campaign for Tobacco-Free Kids, which stated: "A higher cigarette tax is a win-win solution - a health win that will reduce tobacco use and save lives and a financial win that will raise much-needed revenue to fund important programs while also reducing tobacco-caused health care costs."
The Rest of the Story
While on the surface it may appear that this is a great idea that serves two purposes - reducing smoking and providing revenues to fund health insurance for children - a closer examination reveals that the idea is severely flawed and unacceptable from a public health perspective.
Essentially, what the proposal does is make the coverage of children's health care dependent upon the continued sale of cigarettes. In other words, it asks smokers to take on the responsibility of funding children's health care. And it depends on smokers continuing to smoke in order to continue the funding. As such, it greatly reduces any incentive for the federal government to take any action that might substantially reduce smoking rates and therefore cigarette tax revenues.
The tax is an unfair one because it places the burden of funding children's health care entirely on smokers, yet the benefits of the tax do not accrue to smokers at all. And it is a regressive tax because it places the burden of funding children's health care disproportionately on people who can least afford it.
The National Center for Policy Analysis recently released a report that explains why this proposal is a regressive one and exposes the financial burden that it places upon the poor. It provides a nice profile of exactly who is going to be funding children's health care under Kennedy and Hatch's proposal. In addition, the Tax Foundation issued a report which reveals that the poor in many states will shoulder the burden of paying for the S-CHIP program but without accruing any of the benefits.
I do not understand the knee-jerk support of anti-smoking groups for any cigarette tax increase under the sun. There seems to be no consideration of the fairness of the proposal, the regressiveness of the proposal, and the long-term consequences of tying a vital health care program to the continued consumption of cigarettes.
Especially at the federal level, funding for children's health insurance should be a top-level priority. It should not require the creation of revenue from the sale of cigarettes to fund health care for our nation's children.
By supporting this tax proposal, health and anti-smoking groups are actually stating that they do not believe that the federal government should fund children's health care out of the general revenues. They are actually stating that they do not believe that the wealthiest citizens and corporations should bear the burden of funding health care for the poorest. They are supporting the creation of a system in which one of the most critical public health programs imaginable will be entirely dependent upon high levels of cigarette consumption in order to remain solvent.
The American Academy of Family Physicians actually responded to this argument, by stating: "the fact of the matter is that we've got so many adults that still smoke that there's going to be tax money coming in to fund CHIP ... it's going to be a long time before there's any significant decrease of funding coming in through the tobacco tax."
This is a very disturbing defense of the proposal. The AAFP is essentially admitting that it has no interest in taking any initiative that would greatly reduce smoking. The Academy is convinced that there will be high rates of smoking well into the future and seemingly accepts that fact. I would think that our nation's family physicians would actually believe that it is worth trying to reduce smoking rates, rather than merely accepting the high rates well into the future, and being reassured that the money will keep coming through so that children's health care is covered and they do not have to provide as much free care.
I suggest that organizations like the American Academy of Family Physicians and the Campaign for Tobacco-Free Kids (and other anti-smoking groups that support this proposal) start a fund-raiser to help raise money to promote this proposed policy. My idea is simple - a T-shirt sale. Here is what the T-shirts would say:
Support children's health. Smoke cigarettes.
I support children's health. I smoke.
Light up as often as you can. Support the health of our nation's children.
Contribute your share to help the children. Buy cigarettes.
I really care about our kids. I buy by the carton.
Children's health supporter.
Smoker.
You may not like my smoke, but my money is paying for your kids' health care.
I welcome readers' suggestions for additional T-shirt slogans.
According to a Cybercast News Service article, the proposal is supported by the American Academy of Family Physicians, which stated: "By discouraging smoking through an increase in the tobacco tax and using the resulting revenues to improve enrollment in children's health insurance programs, we are creating a win-win proposition in support of our children's health."
The proposal is also supported by the Campaign for Tobacco-Free Kids, which stated: "A higher cigarette tax is a win-win solution - a health win that will reduce tobacco use and save lives and a financial win that will raise much-needed revenue to fund important programs while also reducing tobacco-caused health care costs."
The Rest of the Story
While on the surface it may appear that this is a great idea that serves two purposes - reducing smoking and providing revenues to fund health insurance for children - a closer examination reveals that the idea is severely flawed and unacceptable from a public health perspective.
Essentially, what the proposal does is make the coverage of children's health care dependent upon the continued sale of cigarettes. In other words, it asks smokers to take on the responsibility of funding children's health care. And it depends on smokers continuing to smoke in order to continue the funding. As such, it greatly reduces any incentive for the federal government to take any action that might substantially reduce smoking rates and therefore cigarette tax revenues.
The tax is an unfair one because it places the burden of funding children's health care entirely on smokers, yet the benefits of the tax do not accrue to smokers at all. And it is a regressive tax because it places the burden of funding children's health care disproportionately on people who can least afford it.
The National Center for Policy Analysis recently released a report that explains why this proposal is a regressive one and exposes the financial burden that it places upon the poor. It provides a nice profile of exactly who is going to be funding children's health care under Kennedy and Hatch's proposal. In addition, the Tax Foundation issued a report which reveals that the poor in many states will shoulder the burden of paying for the S-CHIP program but without accruing any of the benefits.
I do not understand the knee-jerk support of anti-smoking groups for any cigarette tax increase under the sun. There seems to be no consideration of the fairness of the proposal, the regressiveness of the proposal, and the long-term consequences of tying a vital health care program to the continued consumption of cigarettes.
Especially at the federal level, funding for children's health insurance should be a top-level priority. It should not require the creation of revenue from the sale of cigarettes to fund health care for our nation's children.
By supporting this tax proposal, health and anti-smoking groups are actually stating that they do not believe that the federal government should fund children's health care out of the general revenues. They are actually stating that they do not believe that the wealthiest citizens and corporations should bear the burden of funding health care for the poorest. They are supporting the creation of a system in which one of the most critical public health programs imaginable will be entirely dependent upon high levels of cigarette consumption in order to remain solvent.
The American Academy of Family Physicians actually responded to this argument, by stating: "the fact of the matter is that we've got so many adults that still smoke that there's going to be tax money coming in to fund CHIP ... it's going to be a long time before there's any significant decrease of funding coming in through the tobacco tax."
This is a very disturbing defense of the proposal. The AAFP is essentially admitting that it has no interest in taking any initiative that would greatly reduce smoking. The Academy is convinced that there will be high rates of smoking well into the future and seemingly accepts that fact. I would think that our nation's family physicians would actually believe that it is worth trying to reduce smoking rates, rather than merely accepting the high rates well into the future, and being reassured that the money will keep coming through so that children's health care is covered and they do not have to provide as much free care.
I suggest that organizations like the American Academy of Family Physicians and the Campaign for Tobacco-Free Kids (and other anti-smoking groups that support this proposal) start a fund-raiser to help raise money to promote this proposed policy. My idea is simple - a T-shirt sale. Here is what the T-shirts would say:
Support children's health. Smoke cigarettes.
I support children's health. I smoke.
Light up as often as you can. Support the health of our nation's children.
Contribute your share to help the children. Buy cigarettes.
I really care about our kids. I buy by the carton.
Children's health supporter.
Smoker.
You may not like my smoke, but my money is paying for your kids' health care.
I welcome readers' suggestions for additional T-shirt slogans.
Thursday, July 05, 2007
Campaign for Tobacco-Free Kids Honesty Challenge Sweepstakes
A June 30 solicitation from the Campaign for Tobacco-Free Kids, seeking support from constituents for the proposed FDA tobacco legislation sought by Philip Morris, suggests once again (incorrectly and deceptively) that the legislation is opposed by Big Tobacco and that supporting the legislation is therefore fighting Big Tobacco.
The Campaign for Tobacco-Free Kids' plea states: "Last week, we asked E-champions to share how tobacco use has impacted their lives. Within a few days we received more than 200 personal stories sharing the devastating effects that tobacco use brings. E-champions described how loved ones' lives were tragically cut short because of deadly tobacco addictions. Grandparents and parents missed weddings, graduations and births due to tobacco-related deaths. Has your life been impacted by tobacco use? There's still time to add your voice! Click here to visit VoicesAgainstTobacco.org and share your story. Right now Congress is considering a bill that would give the Food and Drug Administration the authority to regulate tobacco products. Your stories are crucial to passing this life-saving legislation. Not only do these stories allow you to share your concern and outrage over Big Tobacco, but they also help our team on Capitol Hill. Hearing stories directly from their constituents help Members of Congress realize that tobacco hurts their own community. Please visit VoicesAgainstTobacco.org today and add your story to the hundreds who have already spoken against the harms of a deadly tobacco addiction. ... Help us fight Big Tobacco by sharing how tobacco has affected you."
The Rest of the Story
Once again, the Campaign for Tobacco-Free Kids has disseminated a deceptive communication which misleads its constituents about the FDA tobacco legislation. The Campaign is deceiving its constituents by suggesting that the legislation is uniformly opposed by Big Tobacco, when in fact the largest member of Big Tobacco - Philip Morris - actually supports the legislation.
This deceptive campaign is really getting out of control. One after another, the deceptive communications continue to roll out from the Campaign for Tobacco-Free Kids. The organization simply does not appear to be capable of telling the truth. It is now about as trustworthy as the very companies that it is claiming to be fighting in the halls of Congress.
Today I announce the Campaign for Tobacco-Free Kids Honesty Challenge Sweepstakes. Here's how it works:
I am challenging the Campaign for Tobacco-Free Kids to put out one - just one - honest communication that does not deceive its constituents and the public about the nature of the proposed FDA tobacco legislation. And I am offering a financial reward - a virtual sweepstakes - for a successful response to this challenge. Reaping in this money will be even easier than soliciting personal donations to support the YAYAs. All the Campaign has to do is tell the truth.
Here are the dollar amounts the Campaign will receive for being honest about various critical facts concerning the legislation:
If the Campaign tells the public that Philip Morris is supporting this bill, I will contribute (no questions asked) $25 to the Campaign.
If the Campaign tells the public that Philip Morris is supporting this bill and that they are supporting it because it will help the company's bottom line, I will contribute (no questions asked) $50 to the Campaign.
If the Campaign tells the public that Philip Morris is supporting the bill because it contains a number of specific provisions that were inserted to protect the company's profits, I will contribute (no questions asked) $100 to the Campaign.
If the Campaign tells the public that the bill was negotiated between itself and Philip Morris through Congressional intermediaries, I will contribute $250 to the Campaign.
If the Campaign tells the public that the bill was negotiated between itself and Philip Morris and that it contains specific provisions that weaken the FDA's ability to regulate tobacco products in order to protect Big Tobacco financial interests, I will contribute $350 to the Campaign.
If the Campaign tells the public that the bill was negotiated between itself and Philip Morris and that it contains specific provisions that weaken the FDA's ability to regulate tobacco products in order to protect Big Tobacco financial interests, and that these provisions were placed into the legislation and approved by the Campaign because it didn't want to risk losing Philip Morris' support, I will contribute $500 to the Campaign.
Here is the only caveat: the Campaign must be honest in the next communication that it sends out. This is a one-chance sweepstakes. If the next communication sent out by the Campaign related to this topic is dishonest, as its previous communications have been, I will find a different way to use the money that I have allocated to this sweepstakes.
Note: This offer is void where prohibited by law. Any sweepstakes contributions will be tax deductible to the maximum amount allowed by the law. No purchase necessary. Sweepstakes is offered only to the Campaign for Tobacco-Free Kids or its affiliated lobbying group - the Tobacco-Free Action Fund. Prize is non-transferable by winner. Sponsor reserves the right to disqualify the entrant if these Sweepstakes rules are not followed. By entering, you agree to comply with all applicable law and these Sweepstakes rules, and you agree to abide by all decisions of the Sponsor. Sweepstakes entrant may enter beginning July 5, 2007. Contest ends on August 5, 2007. All decisions of Sponsor are final. Sponsor is not responsible for the inability to contact winners resulting from incomplete, incorrect, incomprehensible, illegible, or out of service e-mail addresses or phone numbers provided by entrants.
Odds of Winning. If the entrant tells the truth, odds of winning are 100%. If the entrant is dishonest, misleading, or deceptive, the odds of winning are 0%.
The Campaign for Tobacco-Free Kids' plea states: "Last week, we asked E-champions to share how tobacco use has impacted their lives. Within a few days we received more than 200 personal stories sharing the devastating effects that tobacco use brings. E-champions described how loved ones' lives were tragically cut short because of deadly tobacco addictions. Grandparents and parents missed weddings, graduations and births due to tobacco-related deaths. Has your life been impacted by tobacco use? There's still time to add your voice! Click here to visit VoicesAgainstTobacco.org and share your story. Right now Congress is considering a bill that would give the Food and Drug Administration the authority to regulate tobacco products. Your stories are crucial to passing this life-saving legislation. Not only do these stories allow you to share your concern and outrage over Big Tobacco, but they also help our team on Capitol Hill. Hearing stories directly from their constituents help Members of Congress realize that tobacco hurts their own community. Please visit VoicesAgainstTobacco.org today and add your story to the hundreds who have already spoken against the harms of a deadly tobacco addiction. ... Help us fight Big Tobacco by sharing how tobacco has affected you."
The Rest of the Story
Once again, the Campaign for Tobacco-Free Kids has disseminated a deceptive communication which misleads its constituents about the FDA tobacco legislation. The Campaign is deceiving its constituents by suggesting that the legislation is uniformly opposed by Big Tobacco, when in fact the largest member of Big Tobacco - Philip Morris - actually supports the legislation.
This deceptive campaign is really getting out of control. One after another, the deceptive communications continue to roll out from the Campaign for Tobacco-Free Kids. The organization simply does not appear to be capable of telling the truth. It is now about as trustworthy as the very companies that it is claiming to be fighting in the halls of Congress.
Today I announce the Campaign for Tobacco-Free Kids Honesty Challenge Sweepstakes. Here's how it works:
I am challenging the Campaign for Tobacco-Free Kids to put out one - just one - honest communication that does not deceive its constituents and the public about the nature of the proposed FDA tobacco legislation. And I am offering a financial reward - a virtual sweepstakes - for a successful response to this challenge. Reaping in this money will be even easier than soliciting personal donations to support the YAYAs. All the Campaign has to do is tell the truth.
Here are the dollar amounts the Campaign will receive for being honest about various critical facts concerning the legislation:
If the Campaign tells the public that Philip Morris is supporting this bill, I will contribute (no questions asked) $25 to the Campaign.
If the Campaign tells the public that Philip Morris is supporting this bill and that they are supporting it because it will help the company's bottom line, I will contribute (no questions asked) $50 to the Campaign.
If the Campaign tells the public that Philip Morris is supporting the bill because it contains a number of specific provisions that were inserted to protect the company's profits, I will contribute (no questions asked) $100 to the Campaign.
If the Campaign tells the public that the bill was negotiated between itself and Philip Morris through Congressional intermediaries, I will contribute $250 to the Campaign.
If the Campaign tells the public that the bill was negotiated between itself and Philip Morris and that it contains specific provisions that weaken the FDA's ability to regulate tobacco products in order to protect Big Tobacco financial interests, I will contribute $350 to the Campaign.
If the Campaign tells the public that the bill was negotiated between itself and Philip Morris and that it contains specific provisions that weaken the FDA's ability to regulate tobacco products in order to protect Big Tobacco financial interests, and that these provisions were placed into the legislation and approved by the Campaign because it didn't want to risk losing Philip Morris' support, I will contribute $500 to the Campaign.
Here is the only caveat: the Campaign must be honest in the next communication that it sends out. This is a one-chance sweepstakes. If the next communication sent out by the Campaign related to this topic is dishonest, as its previous communications have been, I will find a different way to use the money that I have allocated to this sweepstakes.
Note: This offer is void where prohibited by law. Any sweepstakes contributions will be tax deductible to the maximum amount allowed by the law. No purchase necessary. Sweepstakes is offered only to the Campaign for Tobacco-Free Kids or its affiliated lobbying group - the Tobacco-Free Action Fund. Prize is non-transferable by winner. Sponsor reserves the right to disqualify the entrant if these Sweepstakes rules are not followed. By entering, you agree to comply with all applicable law and these Sweepstakes rules, and you agree to abide by all decisions of the Sponsor. Sweepstakes entrant may enter beginning July 5, 2007. Contest ends on August 5, 2007. All decisions of Sponsor are final. Sponsor is not responsible for the inability to contact winners resulting from incomplete, incorrect, incomprehensible, illegible, or out of service e-mail addresses or phone numbers provided by entrants.
Odds of Winning. If the entrant tells the truth, odds of winning are 100%. If the entrant is dishonest, misleading, or deceptive, the odds of winning are 0%.
Tuesday, July 03, 2007
Smokers Deemed Unsuitable for Employment at Cleveland Clinic
Beginning September 1, all applicants for jobs with the Cleveland Clinic - a health system that is Ohio's second largest employer - will be tested for cotinine and rejected for employment automatically if the test indicates that they smoke or use smokeless tobacco (article 1; article 2; article 3).
The non-hiring of smokers policy will apply to all Cleveland Clinic sites in Ohio and Florida, as well as to all vendors hired at these sites. The clinic has more than 36,000 employees. It now joins Medical Mutual and Scotts Miracle-Gro as a large Ohio company which refuses to hire smokers. The policy will apply only to new applicants.
According to the official new policy: "Beginning Sept. 1, the policy goes into full effect, and all applicants who test positive for cotinine will not be offered employment at Cleveland Clinic. This policy applies to all Cleveland Clinic campuses in Ohio and Florida (but not Canada). Applicants will be referred to a free tobacco cessation program paid for by Cleveland Clinic. After 90 days, those who have been successful in quitting will be encouraged to reapply."
The reason for this policy provided by Cleveland Clinic is as follows: "Cleveland Clinic has been a leader in preventative health and wellness. In 2005, we designated the entire health system smoke-free. Last fall, we supported the SmokeFreeOhio Initiative on ballots. Recently, trans fats were banned from all patient and cafeteria menus. Cleveland Clinic will join the World Health Organization, the American Cancer Society and more than 6,000 other employers in the United States who have chosen to advocate for healthier living. 'As a leading healthcare organization dedicated to fighting disease and advocating healthy living, our policies and procedures must reflect that commitment,' says Toby Cosgrove, M.D., President and CEO."
"As Cleveland Clinic helps move society from “sick” care to “health” care, it’s important to acknowledge these startling statistics: The treatment of chronic medical conditions comprises more than 75 percent of the nation’s $1.4 trillion medical expenditures. Chronic medical conditions account for 70 percent of all deaths in the United States. Smoking costs more than $75 billion annually in direct and indirect medical costs. These costs and statistics call for healthcare organizations to take the lead in promoting wellness and disease prevention, regardless of the tough choices that may be involved. By instituting this new hiring policy, Cleveland Clinic will play a role in reducing healthcare costs for patients, employers and the government by promoting prevention and wellness."
The Rest of the Story
Clearly, by its own reasoning, the Cleveland Clinic's policies and procedures do not reflect a commitment to advocating healthy living. While smoking may account for $75 billion in medical costs, obesity accounts for more than $78 billion (even more than smoking). Yet the Cleveland Clinic has not announced a policy to refuse to hire fat people. If the Cleveland Clinic were true to its word about adopting policies and procedures that reflect a consistent commitment to advocate healthy living, then surely they would institute a policy of refusing to hire people who are overweight or obese. As with smoking, such applicants could be referred to a weight loss program and encouraged to reapply after 90 days if they lose sufficient weight.
Similarly, the Cleveland Clinic doesn't appear to care about the alcohol problem that afflicts American society and causes a huge burden of chronic disease. While smokers need not apply, persons who drink too much alcohol are free to seek employment with this health system that considers itself a leader in "preventative" health and wellness. So are those who engage in unsafe sexual activities, eat far too much fat in their diets, consume high amounts of unhealthy trans-fats, or engage in a sedentary lifestyle and get absolutely no physical activity or exercise.
To be clear, what the Cleveland Clinic is doing is discriminating against smokers in employment. They are justifying this selective and targeted employment discrimination on the grounds that it is important to promote a healthy workforce. Yet they show no desire to actually promote a healthy workforce by making sure that prospective employees are actually healthy. They can be as unhealthy as they want to be, as long as they don't smoke.
Obesity - that's fine. Alcohol overuse - fine. An unhealthy diet - fine. High trans-fat intake - fine. High cholesterol intake - fine. No exercise at all - fine. The only thing that is not fine is smoking. You can't convince me that the Cleveland Clinic is solely motivated by a desire for a healthy workforce. Clearly, they don't give a particular damn about whether their new employees have a host of other health problems (which may be far more severe than smoking at their particular ages). They only care about whether they smoke or not.
Perhaps the Cleveland Clinic would argue that they do care about these other problems - that's why they have health and wellness programs at their facilities to address them. Great, then implement health and wellness programs to address smoking as well. You don't deal with these other health problems through corporate wellness programs and deal with smoking by throwing applicants' resumes in the trash can.
Sadly, the precise reasoning the Cleveland Clinic is using to support discrimination against smokers in employment also supports discrimination against obese and overweight people. If we are going to support the idea of excluding smokers from employment to save health care costs for employers and to promote a healthy workforce, then we must also support the idea of excluding fat people from employment.
If the Cleveland Clinic were taking a broad and consistent approach to hiring in terms of healthy lifestyles, and refusing to hire anyone who engages in a behavior that has serious long-term health implications, it would be one thing. Then I might take them seriously and believe that the health and economic concerns are really at the forefront of their action. But by discriminating only against smokers, I think they have exposed the true force beyond the policy: bigotry and intolerance of a large segment of the population whose personal and private lifestyle choices they are unwilling to accept.
I'm sorry, but employers have no business inside the homes of their employees, other than to ensure that they are not engaging in illegal behaviors or behaviors that directly impair their job performance. And employers certainly have no business getting inside the body fluids of their employees, except, again, to ensure that they are not using illegal substances. But when it comes to engaging in lawful behaviors in one's home that do not directly influence job performance, an employer has no business interfering with an employee's or potential employee's privacy.
Perhaps most disturbing is the degree to which the Cleveland Clinic appears willing to intrude into the privacy of employees' homes. I don't want my employer snooping around my house to see what I do in my own home on my own time. If they suspect me of illegal behavior and they want to pry on me, that's one thing. But if it's lawful behavior that's not in any way unprofessional, then they have no business controlling what I do in my home. And they have no business making employment decisions based on it.
This is what scares me most, because it suggests that anti-smoking groups have completely lost a sense of perspective. The only thing that matters is whether people smoke or not and how much we pay for smoking-related costs. We need to reduce smoking and these smoking-related costs at all cost. No matter how intrusive of our privacy, autonomy, or rights. There's nothing to stop us. Nothing to get in the way of our agenda.
The anti-smoking movement does not appear to understand or respect that what people do in their homes is their own business, as long as it is lawful and does not directly impair their job ability.
Even if the movement didn't respect the privacy and autonomy of individuals, it would still be more respectable in my eyes if it wanted to impose its intrusion systematically and consistently. So if these groups were calling on a workforce of non-smoking, physically active, thin (but not too thin), normocholesterolemic, non-hypertensive, non-hyperglycemic, and sexually non-promiscuous individuals, then I might believe that this is all motivated by a true concern for health and health care costs.
But the singling out of one particular risk factor suggests that there is something deeper going on, something beneath the surface. And I think what's underlying it is some sort of basic intolerance of smokers, and perhaps a desire to punish smokers and coerce them to change their behavior in a desired way.
Ohio needs a law to prevent this type of intrusion and discrimination. And it needs it now. As much as I hate to support the idea of government intervention to control this problem and protect people's privacy and rights, I don't see that the anti-smoking movement is going to back down.
This type of employment discrimination and bigotry is a terrible precedent, and it paves the way for even more serious discrimination. If we want to eliminate the most severe forms of discrimination from society, then I think we need to be concerned about the less egregious forms, which will otherwise open the door for, and pave the way for more serious breaches of personal rights, privacy, and autonomy.
The non-hiring of smokers policy will apply to all Cleveland Clinic sites in Ohio and Florida, as well as to all vendors hired at these sites. The clinic has more than 36,000 employees. It now joins Medical Mutual and Scotts Miracle-Gro as a large Ohio company which refuses to hire smokers. The policy will apply only to new applicants.
According to the official new policy: "Beginning Sept. 1, the policy goes into full effect, and all applicants who test positive for cotinine will not be offered employment at Cleveland Clinic. This policy applies to all Cleveland Clinic campuses in Ohio and Florida (but not Canada). Applicants will be referred to a free tobacco cessation program paid for by Cleveland Clinic. After 90 days, those who have been successful in quitting will be encouraged to reapply."
The reason for this policy provided by Cleveland Clinic is as follows: "Cleveland Clinic has been a leader in preventative health and wellness. In 2005, we designated the entire health system smoke-free. Last fall, we supported the SmokeFreeOhio Initiative on ballots. Recently, trans fats were banned from all patient and cafeteria menus. Cleveland Clinic will join the World Health Organization, the American Cancer Society and more than 6,000 other employers in the United States who have chosen to advocate for healthier living. 'As a leading healthcare organization dedicated to fighting disease and advocating healthy living, our policies and procedures must reflect that commitment,' says Toby Cosgrove, M.D., President and CEO."
"As Cleveland Clinic helps move society from “sick” care to “health” care, it’s important to acknowledge these startling statistics: The treatment of chronic medical conditions comprises more than 75 percent of the nation’s $1.4 trillion medical expenditures. Chronic medical conditions account for 70 percent of all deaths in the United States. Smoking costs more than $75 billion annually in direct and indirect medical costs. These costs and statistics call for healthcare organizations to take the lead in promoting wellness and disease prevention, regardless of the tough choices that may be involved. By instituting this new hiring policy, Cleveland Clinic will play a role in reducing healthcare costs for patients, employers and the government by promoting prevention and wellness."
The Rest of the Story
Clearly, by its own reasoning, the Cleveland Clinic's policies and procedures do not reflect a commitment to advocating healthy living. While smoking may account for $75 billion in medical costs, obesity accounts for more than $78 billion (even more than smoking). Yet the Cleveland Clinic has not announced a policy to refuse to hire fat people. If the Cleveland Clinic were true to its word about adopting policies and procedures that reflect a consistent commitment to advocate healthy living, then surely they would institute a policy of refusing to hire people who are overweight or obese. As with smoking, such applicants could be referred to a weight loss program and encouraged to reapply after 90 days if they lose sufficient weight.
Similarly, the Cleveland Clinic doesn't appear to care about the alcohol problem that afflicts American society and causes a huge burden of chronic disease. While smokers need not apply, persons who drink too much alcohol are free to seek employment with this health system that considers itself a leader in "preventative" health and wellness. So are those who engage in unsafe sexual activities, eat far too much fat in their diets, consume high amounts of unhealthy trans-fats, or engage in a sedentary lifestyle and get absolutely no physical activity or exercise.
To be clear, what the Cleveland Clinic is doing is discriminating against smokers in employment. They are justifying this selective and targeted employment discrimination on the grounds that it is important to promote a healthy workforce. Yet they show no desire to actually promote a healthy workforce by making sure that prospective employees are actually healthy. They can be as unhealthy as they want to be, as long as they don't smoke.
Obesity - that's fine. Alcohol overuse - fine. An unhealthy diet - fine. High trans-fat intake - fine. High cholesterol intake - fine. No exercise at all - fine. The only thing that is not fine is smoking. You can't convince me that the Cleveland Clinic is solely motivated by a desire for a healthy workforce. Clearly, they don't give a particular damn about whether their new employees have a host of other health problems (which may be far more severe than smoking at their particular ages). They only care about whether they smoke or not.
Perhaps the Cleveland Clinic would argue that they do care about these other problems - that's why they have health and wellness programs at their facilities to address them. Great, then implement health and wellness programs to address smoking as well. You don't deal with these other health problems through corporate wellness programs and deal with smoking by throwing applicants' resumes in the trash can.
Sadly, the precise reasoning the Cleveland Clinic is using to support discrimination against smokers in employment also supports discrimination against obese and overweight people. If we are going to support the idea of excluding smokers from employment to save health care costs for employers and to promote a healthy workforce, then we must also support the idea of excluding fat people from employment.
If the Cleveland Clinic were taking a broad and consistent approach to hiring in terms of healthy lifestyles, and refusing to hire anyone who engages in a behavior that has serious long-term health implications, it would be one thing. Then I might take them seriously and believe that the health and economic concerns are really at the forefront of their action. But by discriminating only against smokers, I think they have exposed the true force beyond the policy: bigotry and intolerance of a large segment of the population whose personal and private lifestyle choices they are unwilling to accept.
I'm sorry, but employers have no business inside the homes of their employees, other than to ensure that they are not engaging in illegal behaviors or behaviors that directly impair their job performance. And employers certainly have no business getting inside the body fluids of their employees, except, again, to ensure that they are not using illegal substances. But when it comes to engaging in lawful behaviors in one's home that do not directly influence job performance, an employer has no business interfering with an employee's or potential employee's privacy.
Perhaps most disturbing is the degree to which the Cleveland Clinic appears willing to intrude into the privacy of employees' homes. I don't want my employer snooping around my house to see what I do in my own home on my own time. If they suspect me of illegal behavior and they want to pry on me, that's one thing. But if it's lawful behavior that's not in any way unprofessional, then they have no business controlling what I do in my home. And they have no business making employment decisions based on it.
This is what scares me most, because it suggests that anti-smoking groups have completely lost a sense of perspective. The only thing that matters is whether people smoke or not and how much we pay for smoking-related costs. We need to reduce smoking and these smoking-related costs at all cost. No matter how intrusive of our privacy, autonomy, or rights. There's nothing to stop us. Nothing to get in the way of our agenda.
The anti-smoking movement does not appear to understand or respect that what people do in their homes is their own business, as long as it is lawful and does not directly impair their job ability.
Even if the movement didn't respect the privacy and autonomy of individuals, it would still be more respectable in my eyes if it wanted to impose its intrusion systematically and consistently. So if these groups were calling on a workforce of non-smoking, physically active, thin (but not too thin), normocholesterolemic, non-hypertensive, non-hyperglycemic, and sexually non-promiscuous individuals, then I might believe that this is all motivated by a true concern for health and health care costs.
But the singling out of one particular risk factor suggests that there is something deeper going on, something beneath the surface. And I think what's underlying it is some sort of basic intolerance of smokers, and perhaps a desire to punish smokers and coerce them to change their behavior in a desired way.
Ohio needs a law to prevent this type of intrusion and discrimination. And it needs it now. As much as I hate to support the idea of government intervention to control this problem and protect people's privacy and rights, I don't see that the anti-smoking movement is going to back down.
This type of employment discrimination and bigotry is a terrible precedent, and it paves the way for even more serious discrimination. If we want to eliminate the most severe forms of discrimination from society, then I think we need to be concerned about the less egregious forms, which will otherwise open the door for, and pave the way for more serious breaches of personal rights, privacy, and autonomy.
Friday, June 29, 2007
Article in Nature Highlights Shoddy Science Behind Helena et al. Conclusions and 30 Minute Claims of Anti-Smoking Groups
An article by Dr. Kris Novak in this week's issue of Nature highlights my questioning of the validity of the conclusion of the Helena, Pueblo, Piedmont, and Bowling Green studies that smoking bans in those towns resulted in immediate, dramatic reductions in heart attacks. The article also highlights my questioning of the claim being made by many anti-smoking groups that 30 minutes of secondhand smoke causes clogged arteries and heart attacks among otherwise healthy nonsmokers.
According to the article:
"In principle, smoking bans provide a unique opportunity to study populations before and after reductions in second-hand smoke exposure. But if research into the incidence of heart attacks is any guide, the results of such studies are often far from clear and can cause more controversy. Glantz reported in 2004 that during a six-month smoking ban in Helena, Montana, the number of heart attacks dropped by 40% compared with the same months in other years. The study, cited in the surgeon general's report, was criticized for the small number of cases studied and the large month-to-month variations in incidence of heart attacks. Since the report, several studies have reported a drop in hospital admissions for heart attacks after smoking bans in the Piedmont region of Italy (11% drop), and in small cities in Colorado (27%) and Ohio (39%)."
"But not all epidemiologists are impressed. 'It's quite common to see major year-to-year changes in heart attacks, sometimes as much as a 50% increase or decrease,' says Michael Siegel, an epidemiologist at Boston University School of Public Health. Attributing such changes to a ban is impossible, he says. Worse, none of the studies recorded whether the changes occurred in non-smokers or in smokers, yet the effects of the ban are frequently attributed to reductions in second-hand smoke exposure. The lead author of the Ohio study agreed that a prospective study that collected data on groups of non-smokers and smokers in advance of a ban — and then followed them up for a few years after — would be ideal, but this would take longer and be costly." ...
Certainly, public-health officials seem convinced. Pechacek says that the general consensus in tobacco researchers is that the drop in heart attacks occurs mainly in non-smokers. Smokefree England suggests that just 30 minutes of breathing in second-hand smoke can raise your risk of having a heart attack. But can you really become ill just by sitting in a bar next to a smoker? 'Saying that just a little exposure is killing people is going overboard,' says Siegel, who worries that when researchers exaggerate their findings, they lose credibility with the public. 'I agree that second-hand smoke is a tremendous health hazard, but no one is going to have a heart attack from 30 minutes of exposure.'"
"Siegel thinks that banning smoking in outdoor places is going too far and risks losing support for smoking bans overall. Smoking has been banned on 25 California beaches, and this week the Beverly Hills City Council approved a ban in nearly all outdoor dining areas. 'We should focus efforts on the remaining areas in which workers are not protected,' he says. 'My biggest concern is for the waiters and bartenders who spend 40 hours each week in very smoky environments.' He's also worried about the health of smoking research itself, which he sees being compromised by methodological flaws and over-interpretation of results. And although prospective studies would be costly, Siegel argues that funding for a large prospective study of the effects of smoking bans on non-smokers is warranted. 'Although I wholeheartedly support smoking bans, I still believe that we must use solid science to advocate for such bans and that a noble end — improving public health — does not justify the compromise of our scientific principles.'"
The Rest of the Story
I don't have much to add to what Dr. Novak wrote. I'm just glad that the misrepresentation of the science by anti-smoking groups and the deterioration of the quality of the scientific conclusions being made in the movement are being highlighted in a scientific journal with the high quality and fine reputation of a journal like Nature. I hope this will force anti-smoking groups to re-examine their decisions to disseminate misleading, if not inaccurate, health information and encourage the tobacco control movement to take stock of the deterioration of its scientific integrity and take steps to restore it.
Unfortunately, I don't think either of these will happen, because frankly, I really don't think that the movement, as an entity, actually cares. As long as its political aims are being met, I don't think that scientific integrity really enters the picture.
According to the article:
"In principle, smoking bans provide a unique opportunity to study populations before and after reductions in second-hand smoke exposure. But if research into the incidence of heart attacks is any guide, the results of such studies are often far from clear and can cause more controversy. Glantz reported in 2004 that during a six-month smoking ban in Helena, Montana, the number of heart attacks dropped by 40% compared with the same months in other years. The study, cited in the surgeon general's report, was criticized for the small number of cases studied and the large month-to-month variations in incidence of heart attacks. Since the report, several studies have reported a drop in hospital admissions for heart attacks after smoking bans in the Piedmont region of Italy (11% drop), and in small cities in Colorado (27%) and Ohio (39%)."
"But not all epidemiologists are impressed. 'It's quite common to see major year-to-year changes in heart attacks, sometimes as much as a 50% increase or decrease,' says Michael Siegel, an epidemiologist at Boston University School of Public Health. Attributing such changes to a ban is impossible, he says. Worse, none of the studies recorded whether the changes occurred in non-smokers or in smokers, yet the effects of the ban are frequently attributed to reductions in second-hand smoke exposure. The lead author of the Ohio study agreed that a prospective study that collected data on groups of non-smokers and smokers in advance of a ban — and then followed them up for a few years after — would be ideal, but this would take longer and be costly." ...
Certainly, public-health officials seem convinced. Pechacek says that the general consensus in tobacco researchers is that the drop in heart attacks occurs mainly in non-smokers. Smokefree England suggests that just 30 minutes of breathing in second-hand smoke can raise your risk of having a heart attack. But can you really become ill just by sitting in a bar next to a smoker? 'Saying that just a little exposure is killing people is going overboard,' says Siegel, who worries that when researchers exaggerate their findings, they lose credibility with the public. 'I agree that second-hand smoke is a tremendous health hazard, but no one is going to have a heart attack from 30 minutes of exposure.'"
"Siegel thinks that banning smoking in outdoor places is going too far and risks losing support for smoking bans overall. Smoking has been banned on 25 California beaches, and this week the Beverly Hills City Council approved a ban in nearly all outdoor dining areas. 'We should focus efforts on the remaining areas in which workers are not protected,' he says. 'My biggest concern is for the waiters and bartenders who spend 40 hours each week in very smoky environments.' He's also worried about the health of smoking research itself, which he sees being compromised by methodological flaws and over-interpretation of results. And although prospective studies would be costly, Siegel argues that funding for a large prospective study of the effects of smoking bans on non-smokers is warranted. 'Although I wholeheartedly support smoking bans, I still believe that we must use solid science to advocate for such bans and that a noble end — improving public health — does not justify the compromise of our scientific principles.'"
The Rest of the Story
I don't have much to add to what Dr. Novak wrote. I'm just glad that the misrepresentation of the science by anti-smoking groups and the deterioration of the quality of the scientific conclusions being made in the movement are being highlighted in a scientific journal with the high quality and fine reputation of a journal like Nature. I hope this will force anti-smoking groups to re-examine their decisions to disseminate misleading, if not inaccurate, health information and encourage the tobacco control movement to take stock of the deterioration of its scientific integrity and take steps to restore it.
Unfortunately, I don't think either of these will happen, because frankly, I really don't think that the movement, as an entity, actually cares. As long as its political aims are being met, I don't think that scientific integrity really enters the picture.
Thursday, June 28, 2007
30 Minutes of Secondhand Smoke Equals Clogged Arteries - Final Answer; TobaccoScam Decides to Stick with Deception
In response to my challenge to correct its misleading website (page 1; page 2), TobaccoScam has apparently decided not to do anything. The web pages remain the same, with no changes, corrections, documentation, or clarifications.
It appears, then, that it is TobaccoScam's intention to inform the public that:
"30 minutes exposure = smoker's arteries"
"Thirty minutes of secondhand smoke compromises a non-smoker's coronary arteries to the same extent as in smokers."
"20 minutes exposure = smoking a pack a day"
"Twenty minutes of breathing secondhand smoke at levels similar to those measured in bars activates blood platelets involved in the clotting process as much as it does in pack-a-day smokers. These activated platelets increase the chances of heart attack or stroke."
"30 minutes exposure = stiffened, clogged arteries"
"All of these effects not only increase the long term risks of developing heart disease, but also increase the immediate risk of heart attack."
The Rest of the Story
I have been trying to give all the anti-smoking groups the benefit of the doubt for a long time now (at least 18 months), and despite the fact that there has been no response to my pointing out the many misleading scientific claims that are being made, I have clung to the hope that perhaps this misrepresentation of the science was just a series of innocent mistakes, oversights, or careless errors.
At this point however, it is impossible for me to any longer cling to that belief.
Instead, it appears to me that at least some of these claims are the result of a deliberate attempt to deceive people.
The fact that TobaccoScam and the other organizations that were informed earlier this week about the misleading nature of their claims about the acute cardiovascular effects of secondhand smoke apparently decided not to alter these claims suggests to me that they have made a conscious and deliberate decision to maintain the deception of the public. In other words, this is not just the result of a careless mistake or oversight, but instead, represents a deliberate attempt to convince the public that these specific scientific assertions are true.
That is - these groups actually want the public to believe that 30 minutes of secondhand smoke exposure clogs your arteries.
They actually want the public to believe that 30 minutes of secondhand smoke increases your immediate risk of a heart attack.
They actually want the public to believe that 20 minutes of secondhand smoke exposure is as damaging as actively smoking one pack of cigarettes per day.
It is thus my opinion that these groups actually want the public to believe scientific facts that are not true. That is, by definition, deception. And this is then, by definition, intentional deception of the public.
I apologize, but no more Mr. Nice Guy. Now it's time to play hard ball. Because these groups, by violating the most basic ethical principle of public health communication, are risking the credibility and reputation of the entire tobacco control movement.
It appears, then, that it is TobaccoScam's intention to inform the public that:
- 30 minutes of secondhand smoke exposure causes clogged arteries;
- 30 minutes of secondhand smoke exposure cause arteries that are as damaged as an active smoker's;
- 30 minutes of secondhand smoke exposure increases the risk of an immediate heart attack; and
- 20 minutes of secondhand smoke exposure is the equivalent to actively smoking a pack of cigarettes per day.
"30 minutes exposure = smoker's arteries"
"Thirty minutes of secondhand smoke compromises a non-smoker's coronary arteries to the same extent as in smokers."
"20 minutes exposure = smoking a pack a day"
"Twenty minutes of breathing secondhand smoke at levels similar to those measured in bars activates blood platelets involved in the clotting process as much as it does in pack-a-day smokers. These activated platelets increase the chances of heart attack or stroke."
"30 minutes exposure = stiffened, clogged arteries"
"All of these effects not only increase the long term risks of developing heart disease, but also increase the immediate risk of heart attack."
The Rest of the Story
I have been trying to give all the anti-smoking groups the benefit of the doubt for a long time now (at least 18 months), and despite the fact that there has been no response to my pointing out the many misleading scientific claims that are being made, I have clung to the hope that perhaps this misrepresentation of the science was just a series of innocent mistakes, oversights, or careless errors.
At this point however, it is impossible for me to any longer cling to that belief.
Instead, it appears to me that at least some of these claims are the result of a deliberate attempt to deceive people.
The fact that TobaccoScam and the other organizations that were informed earlier this week about the misleading nature of their claims about the acute cardiovascular effects of secondhand smoke apparently decided not to alter these claims suggests to me that they have made a conscious and deliberate decision to maintain the deception of the public. In other words, this is not just the result of a careless mistake or oversight, but instead, represents a deliberate attempt to convince the public that these specific scientific assertions are true.
That is - these groups actually want the public to believe that 30 minutes of secondhand smoke exposure clogs your arteries.
They actually want the public to believe that 30 minutes of secondhand smoke increases your immediate risk of a heart attack.
They actually want the public to believe that 20 minutes of secondhand smoke exposure is as damaging as actively smoking one pack of cigarettes per day.
It is thus my opinion that these groups actually want the public to believe scientific facts that are not true. That is, by definition, deception. And this is then, by definition, intentional deception of the public.
I apologize, but no more Mr. Nice Guy. Now it's time to play hard ball. Because these groups, by violating the most basic ethical principle of public health communication, are risking the credibility and reputation of the entire tobacco control movement.
Tuesday, June 26, 2007
Cartoon Draws Attention to Absurdity of Proposed FDA Tobacco Legislation
A cartoon created by cartoonist Matt Bors and commissioned by Dr. Alan Blum, director of the University of Alabama Center for the Study of Tobacco and Society, appeared in the opinion section of last Sunday's Birmingham News. The cartoon draws public attention to the absurdity of the proposal to place responsibility for the safety of cigarettes in the hands of the Food and Drug Administration (FDA). The cartoon also appears on the website of the Association of Public Health Physicians, which opposes the proposed FDA tobacco legislation.
The cartoon features a cancer patient apparently receiving chemotherapy in a hospital bed while smoking, with the header: "When you're dying, you can use FDA-approved cancer drugs." The smoking patient states: "It's a one-stop agency for everything I need."
Bors states that: "we have a situation where people will be buying 'FDA approved' smokes while other brands are banned by arbitrary standards involving the packaging and marketing of the cigarettes instead of the actual result of using the products. Just to be clear, I am in favor of certain restrictions on Tobacco's claims and advertising--anyone who knows me is aware of my loathing f0r this product. This Bill is just misguided."
He adds: "Don't let anyone ever say that Democrats or Liberal leaning interest groups don't give bills deceitful titles: The Family Smoking Prevention and Tobacco Control Act. You see, by putting cigarettes under the FDA we will protect families from smoking. Not any individuals, single people, couples, or orphans. Families."
Bors concludes: "As Dr. Blum said in his testimony against this Bill to the Senate Committee on Health, Education, Labor, and Pensions: 'The proposed FDA bill will simply change who is committing consumer fraud. Currently, it’s still the tobacco companies, marketing reduced tar and nicotine cigarettes in a way that deceives consumers into believing that these products are safer. If the FDA bill is enacted, then the government will be doing the dirty work for the tobacco companies. Small wonder why Philip Morris embraces this bill, which will permit it to tell consumers that it is complying with strict product safety standards, making government-approved cigarettes.'"
The Rest of the Story
What a great job by Matt Bors (and a great idea of Dr. Blum's) to use humor to draw attention to the absurdity of this legislation. The image of a smoker receiving FDA-approved chemotherapy while smoking an FDA-approved cigarette says it all. Thank God for the FDA legislation. At least the cigarettes which will be causing cancer, disease, and death for literally thousands of Americans each month after the legislation is enacted will be FDA-approved products. We wouldn't want people dying from cigarettes which do not meet FDA's standards.
The cartoon features a cancer patient apparently receiving chemotherapy in a hospital bed while smoking, with the header: "When you're dying, you can use FDA-approved cancer drugs." The smoking patient states: "It's a one-stop agency for everything I need."
Bors states that: "we have a situation where people will be buying 'FDA approved' smokes while other brands are banned by arbitrary standards involving the packaging and marketing of the cigarettes instead of the actual result of using the products. Just to be clear, I am in favor of certain restrictions on Tobacco's claims and advertising--anyone who knows me is aware of my loathing f0r this product. This Bill is just misguided."
He adds: "Don't let anyone ever say that Democrats or Liberal leaning interest groups don't give bills deceitful titles: The Family Smoking Prevention and Tobacco Control Act. You see, by putting cigarettes under the FDA we will protect families from smoking. Not any individuals, single people, couples, or orphans. Families."
Bors concludes: "As Dr. Blum said in his testimony against this Bill to the Senate Committee on Health, Education, Labor, and Pensions: 'The proposed FDA bill will simply change who is committing consumer fraud. Currently, it’s still the tobacco companies, marketing reduced tar and nicotine cigarettes in a way that deceives consumers into believing that these products are safer. If the FDA bill is enacted, then the government will be doing the dirty work for the tobacco companies. Small wonder why Philip Morris embraces this bill, which will permit it to tell consumers that it is complying with strict product safety standards, making government-approved cigarettes.'"
The Rest of the Story
What a great job by Matt Bors (and a great idea of Dr. Blum's) to use humor to draw attention to the absurdity of this legislation. The image of a smoker receiving FDA-approved chemotherapy while smoking an FDA-approved cigarette says it all. Thank God for the FDA legislation. At least the cigarettes which will be causing cancer, disease, and death for literally thousands of Americans each month after the legislation is enacted will be FDA-approved products. We wouldn't want people dying from cigarettes which do not meet FDA's standards.
American Legacy Foundation Testifies that 390,000 Kids Start Smoking Each Year Due to Seeing Smoking in Movies
The American Legacy Foundation, in testimony at a special Congressional hearing on the topic of smoking in movies, claimed that one-third of all youth smoking initiation is due to smoking in movies. The Foundation also reiterated its call for an automatic R-rating for any movie depicting any smoking, with the exception of an accurate historical depiction or if the movie clearly reflects the dangers of tobacco use.
According to a Legacy press release: "Today on Capitol Hill, members of the U.S. Congress representing adults, parents and families across America convened for a hearing to discuss the negative impact that everyday images in media have on our nation's children. The American Legacy Foundation(R) was present to testify about important information on how images of smoking cause youth to start this dangerous and addictive behavior. ... Legacy specifically shared research that establishes a relationship between smoking in movies and on television and youth starting to smoke, finding that one-third of youth smoking initiation can be traced to what youth see on screen after controlling for all other factors, such as peer pressure, parental smoking and more. ... What research tells us, and what Congress heard today from us, is that the film industry -- by showing smoking on the silver screen -- recruits 390,000 new smokers each year. ... If the movie industry seriously intends to solve the problem of movie smoking, they would agree to our call for rating new smoking movies R, with the exception of the accurate representation of a historical figure or if the smoking clearly reflects the dangers of tobacco use."
The Rest of the Story
As I have explained, there are a number of reasons why one cannot validly conclude that on-screen smoking causes one-third of youth smoking initiation, even given the studies which have shown an association between exposure to smoking in movies and smoking behavior.
For one thing, parents who allow their kids to go out and see the types of movies that contain a lot of smoking are quite different from the parents who are more restrictive about what they allow their kids to be exposed to. In addition, the kids who go out to movies often are different from those kids who choose not to go out to these types of movies very often. It is very difficult to control for these major differences between these populations, which could well explain why one group is more likely to smoke. It is quite possible that it is not smoking in movies, but some other factor - related to WHY a parent allows their kids to spend hours and hours out with their friends watching these types of movies rather than forcing them to be home or in more controlled settings - that is the actual cause of increased smoking among this group.
Another serious methodologic problem with these studies is that there is most likely a severe measurement bias. Parents who are controlling enough not to allow their kids to go out to the movies are probably more likely to be listening in to or monitoring the phone call in which their childrens' smoking status is ascertained. It has been demonstrated that kids are significantly less likely to admit that they smoke when they believe a parent may be monitoring the phone call. This effect would create the appearance that kids who see more smoking in movies are more likely to smoke when the real effect has more to do with parental factors.
Even if the smoking in movies were contributing to the initiation of smoking, it is far too premature to make definitive quantitative conclusions about the specific proportion of kids who start smoking because of smoking depictions in movies. These definitive quantitative conclusions are, after all, based on only a handful of studies. If our science were loose enough to be willing to make these kind of quantitative conclusions based on such limited studies, we would have long ago been told that drinking coffee kills thousands of Americans every year from cancer and that if we all only write to Maxwell House, we could save thousands of lives a year.
Moreover, it is extremely unlikely that these studies are measuring an exclusive effect of seeing smoking in movies. Movies are just one source of exposure to depictions of smoking and to the formation of attitudes and social norms regarding smoking. Movies most certainly do contribute to these attitudes and norms, but to suggest that movies are the only such factor or that these studies are measuring an isolated effect of smoking in movies, is ridiculous and certainly not scientifically sound.
And to top it all off, even if we were to accept that smoking in movies does cause one-third of smoking initiation, there is no evidence to suggest that simply requiring an R-rating of movies that depict smoking would reduce kids' exposure. What might happen instead is that parents will stop paying as much attention to the movie ratings and that kids may be more likely to go to R-rated movies. An action like this one could undermine the ratings system to the point that parents don't pay much attention to it anymore. I don't know if that would be the effect or not, but neither do these anti-smoking organizations know that it wouldn't occur. My point is that even if smoking in the movies is as bad as these groups are claiming, it is inappropriate and not scientifically sound to state that the R-rating will save 60,000 lives per year.
What is not made clear in the American Legacy Foundation's press release is that the claim that requiring a R-rating for movies that depict smoking would result in 200,000 fewer kids starting to smoke each year rests on the assumption that such an intervention would eliminate exposure to smoking in movies for one-half of all kids who are currently exposed to smoking in movies.
But there is no evidence that requiring an R-rating for movies that depict smoking would eliminate exposure to smoking in movies.
In fact, research published by one of the very researchers mentioned above documented that only 16% of kids are restricted from watching R-rated movies. So requiring an R-rating for movies depicting smoking would eliminate exposure to smoking in movies for only 16%, not 50% of kids.
And this assumes that parents do not change their behavior if smoking in movies results in an automatic R-rating. Another possibility is that such a move would undermine the current rating system, leading parents not to worry so much about whether their kids view such movies, because they may figure that it might only be smoking to which their kids are being exposed. In other words, the R-rating could become much less meaningful to parents as a way of knowing the movies to which their kids should be restricted if smoking automatically triggers an R-rating.
It is possible, in fact, that such an intervention could actually increase kids' exposure to violence and sex in movies, as parents may be less likely to restrict their childrens' access to R-rated movies.
The important point, though, is that even if there is no change in parental behavior, a whopping 84% of kids are allowed to see R-rated movies anyway. Thus, requiring an R-rating for movies that depict smoking would be expected to have only a marginal impact on eliminating youths' exposure to these depictions.
The rest of the story is that the American Legacy Foundation's testimony amounts to an unsupported and implausible scientific assertion. In my expert opinion, Legacy is grossly overestimating the impact of smoking in movies. More importantly, Legacy is drawing unsound scientific conclusions. This is, in my view, an example of the shoddy science that has begun to surface in the tobacco control movement.
Of course, the ultimate of all hypocrisy is that at the same time that the American Legacy Foundation is blaming the movie companies for killing 60,000 people each year, Legacy is partnering with the chief culprit - Warner Brothers. The American Legacy Foundation and Time Warner are corporate partners. If the problem is really so severe as Legacy testifies, then how can Legacy possibly defend its corporate partnership with Time Warner? That is hypocrisy if I've ever seen it.
It appears that Legacy wants to have it both ways. It wants to look good to the public by condemning smoking in movies. But it also appears not to want to do anything to possibly disturb the financial benefits it obtains from its lucrative partnership with Time Warner. So in an action that is not so apparent to the public and doesn't make the news headlines, Legacy continues to partner with Time Warner and refuses to take the single action that would do the most to put pressure on Time Warner to change its practices -- rescinding the partnership.
A public renouncement of the partnership would bring media attention to the issue and would make a statement that public health organizations cannot partner with media companies until they change their practice of exposing kids to millions of smoking images each year. Instead, Legacy appears to be making the statement: "We want to look like we are doing something about smoking in movies, but we don't want to lose our lucrative financial benefits from our partnership with Time Warner. Money is more important than public health, but since the public doesn't see our partnership in the news headlines, we don't have to worry about the public thinking that we are actually more concerned about money than health."
What I consider to be the insincerity of Legacy's actions is also evidenced by the exceptions to its proposed policy. Apparently, the issue is not youth exposure to smoking in movies after all. Because Legacy states that the historically accurate portrayal of smoking is not a problem. So it is actually the context in which the smoking occurs that is the problem, not the smoking itself.
Legacy also has no problem with showing smoking in movies as long as the movie clearly reflects the dangers of tobacco use. But what does that mean? Does it mean that if a smoker is shown coughing, it is acceptable to depict smoking? Does it mean that if a smoker is shown having few health problems until he reaches older age, that is acceptable (since that may reflect the nature of the health effects of smoking in some situations)?
I can tell you right now - it is going to be hard to beat out the American Legacy Foundation for the 2007 Anti-Smoking Hypocrisy Award.
According to a Legacy press release: "Today on Capitol Hill, members of the U.S. Congress representing adults, parents and families across America convened for a hearing to discuss the negative impact that everyday images in media have on our nation's children. The American Legacy Foundation(R) was present to testify about important information on how images of smoking cause youth to start this dangerous and addictive behavior. ... Legacy specifically shared research that establishes a relationship between smoking in movies and on television and youth starting to smoke, finding that one-third of youth smoking initiation can be traced to what youth see on screen after controlling for all other factors, such as peer pressure, parental smoking and more. ... What research tells us, and what Congress heard today from us, is that the film industry -- by showing smoking on the silver screen -- recruits 390,000 new smokers each year. ... If the movie industry seriously intends to solve the problem of movie smoking, they would agree to our call for rating new smoking movies R, with the exception of the accurate representation of a historical figure or if the smoking clearly reflects the dangers of tobacco use."
The Rest of the Story
As I have explained, there are a number of reasons why one cannot validly conclude that on-screen smoking causes one-third of youth smoking initiation, even given the studies which have shown an association between exposure to smoking in movies and smoking behavior.
For one thing, parents who allow their kids to go out and see the types of movies that contain a lot of smoking are quite different from the parents who are more restrictive about what they allow their kids to be exposed to. In addition, the kids who go out to movies often are different from those kids who choose not to go out to these types of movies very often. It is very difficult to control for these major differences between these populations, which could well explain why one group is more likely to smoke. It is quite possible that it is not smoking in movies, but some other factor - related to WHY a parent allows their kids to spend hours and hours out with their friends watching these types of movies rather than forcing them to be home or in more controlled settings - that is the actual cause of increased smoking among this group.
Another serious methodologic problem with these studies is that there is most likely a severe measurement bias. Parents who are controlling enough not to allow their kids to go out to the movies are probably more likely to be listening in to or monitoring the phone call in which their childrens' smoking status is ascertained. It has been demonstrated that kids are significantly less likely to admit that they smoke when they believe a parent may be monitoring the phone call. This effect would create the appearance that kids who see more smoking in movies are more likely to smoke when the real effect has more to do with parental factors.
Even if the smoking in movies were contributing to the initiation of smoking, it is far too premature to make definitive quantitative conclusions about the specific proportion of kids who start smoking because of smoking depictions in movies. These definitive quantitative conclusions are, after all, based on only a handful of studies. If our science were loose enough to be willing to make these kind of quantitative conclusions based on such limited studies, we would have long ago been told that drinking coffee kills thousands of Americans every year from cancer and that if we all only write to Maxwell House, we could save thousands of lives a year.
Moreover, it is extremely unlikely that these studies are measuring an exclusive effect of seeing smoking in movies. Movies are just one source of exposure to depictions of smoking and to the formation of attitudes and social norms regarding smoking. Movies most certainly do contribute to these attitudes and norms, but to suggest that movies are the only such factor or that these studies are measuring an isolated effect of smoking in movies, is ridiculous and certainly not scientifically sound.
And to top it all off, even if we were to accept that smoking in movies does cause one-third of smoking initiation, there is no evidence to suggest that simply requiring an R-rating of movies that depict smoking would reduce kids' exposure. What might happen instead is that parents will stop paying as much attention to the movie ratings and that kids may be more likely to go to R-rated movies. An action like this one could undermine the ratings system to the point that parents don't pay much attention to it anymore. I don't know if that would be the effect or not, but neither do these anti-smoking organizations know that it wouldn't occur. My point is that even if smoking in the movies is as bad as these groups are claiming, it is inappropriate and not scientifically sound to state that the R-rating will save 60,000 lives per year.
What is not made clear in the American Legacy Foundation's press release is that the claim that requiring a R-rating for movies that depict smoking would result in 200,000 fewer kids starting to smoke each year rests on the assumption that such an intervention would eliminate exposure to smoking in movies for one-half of all kids who are currently exposed to smoking in movies.
But there is no evidence that requiring an R-rating for movies that depict smoking would eliminate exposure to smoking in movies.
In fact, research published by one of the very researchers mentioned above documented that only 16% of kids are restricted from watching R-rated movies. So requiring an R-rating for movies depicting smoking would eliminate exposure to smoking in movies for only 16%, not 50% of kids.
And this assumes that parents do not change their behavior if smoking in movies results in an automatic R-rating. Another possibility is that such a move would undermine the current rating system, leading parents not to worry so much about whether their kids view such movies, because they may figure that it might only be smoking to which their kids are being exposed. In other words, the R-rating could become much less meaningful to parents as a way of knowing the movies to which their kids should be restricted if smoking automatically triggers an R-rating.
It is possible, in fact, that such an intervention could actually increase kids' exposure to violence and sex in movies, as parents may be less likely to restrict their childrens' access to R-rated movies.
The important point, though, is that even if there is no change in parental behavior, a whopping 84% of kids are allowed to see R-rated movies anyway. Thus, requiring an R-rating for movies that depict smoking would be expected to have only a marginal impact on eliminating youths' exposure to these depictions.
The rest of the story is that the American Legacy Foundation's testimony amounts to an unsupported and implausible scientific assertion. In my expert opinion, Legacy is grossly overestimating the impact of smoking in movies. More importantly, Legacy is drawing unsound scientific conclusions. This is, in my view, an example of the shoddy science that has begun to surface in the tobacco control movement.
Of course, the ultimate of all hypocrisy is that at the same time that the American Legacy Foundation is blaming the movie companies for killing 60,000 people each year, Legacy is partnering with the chief culprit - Warner Brothers. The American Legacy Foundation and Time Warner are corporate partners. If the problem is really so severe as Legacy testifies, then how can Legacy possibly defend its corporate partnership with Time Warner? That is hypocrisy if I've ever seen it.
It appears that Legacy wants to have it both ways. It wants to look good to the public by condemning smoking in movies. But it also appears not to want to do anything to possibly disturb the financial benefits it obtains from its lucrative partnership with Time Warner. So in an action that is not so apparent to the public and doesn't make the news headlines, Legacy continues to partner with Time Warner and refuses to take the single action that would do the most to put pressure on Time Warner to change its practices -- rescinding the partnership.
A public renouncement of the partnership would bring media attention to the issue and would make a statement that public health organizations cannot partner with media companies until they change their practice of exposing kids to millions of smoking images each year. Instead, Legacy appears to be making the statement: "We want to look like we are doing something about smoking in movies, but we don't want to lose our lucrative financial benefits from our partnership with Time Warner. Money is more important than public health, but since the public doesn't see our partnership in the news headlines, we don't have to worry about the public thinking that we are actually more concerned about money than health."
What I consider to be the insincerity of Legacy's actions is also evidenced by the exceptions to its proposed policy. Apparently, the issue is not youth exposure to smoking in movies after all. Because Legacy states that the historically accurate portrayal of smoking is not a problem. So it is actually the context in which the smoking occurs that is the problem, not the smoking itself.
Legacy also has no problem with showing smoking in movies as long as the movie clearly reflects the dangers of tobacco use. But what does that mean? Does it mean that if a smoker is shown coughing, it is acceptable to depict smoking? Does it mean that if a smoker is shown having few health problems until he reaches older age, that is acceptable (since that may reflect the nature of the health effects of smoking in some situations)?
I can tell you right now - it is going to be hard to beat out the American Legacy Foundation for the 2007 Anti-Smoking Hypocrisy Award.
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