In an editorial today, the Boston Globe states that despite its vigorous support for all sorts of anti-smoking policies, it thinks the anti-smoking movement has gone too far. Specifically, the Globe takes issue with the recently-announced policy of the World Health Organization not to hire smokers:
"This newspaper proudly supports all sorts of policies to combat the use of tobacco. We are for smoke-free workplaces, raising the cigarette tax, toughening sanctions on sales to minors, prohibiting sales through vending machines, and protecting state and federal funds for smoking cessation programs from budget cutbacks. But the World Health Organization's recently announced policy to deny jobs to smokers goes too far.
We deplore smoking, too, but there is an important distinction to be made between an action and an individual. The WHO policy conflates the two in a worrisome way, aiming not just at smoking but at smokers.
Smokers are modern-day pariahs and an easy target. But just as free speech rights must extend to the most unpopular views, so, too, should unsound -- but private -- activities such as smoking, drinking, or eating Twinkies be protected from raids by the lifestyle police."
The Rest of the Story
When the Boston Globe starts complaining about anti-smoking policies as being "raids from the lifestyle police," then you know that the movement has gone too far, and that the backlash perhaps has begun.
The importance of this story to tobacco control groups and advocates is, I think, not about how the Boston Globe is opposed to employment discrimination in the form of policies by which employers refuse to hire smokers.
Instead, the story is about how quickly a public health movement can lose its public perception as a legitimate, health-oriented, well-reasoned movement and be publicly cast as illegitimate - as a "raid" from the "lifestyle police."
In other words, the backlash does not merely have implications for the specific issue at hand. It has implications for the very way in which the entire movement and its practitioners are perceived.
And this is why I have been going to such great lengths to try to warn the movement about this impending backlash, to question policies that I think are just going too far, and to try to make sure that we as public health and tobacco control practitioners ensure that our proposed policies are justified and consistent with ethical principles of public health conduct.
It is not just employment policies that are at stake here (and my hope is that the idea of making smoking a condition of employment does go by the wayside); it is the very legitimacy, credibility, and public perception of our movement that is threatened, and this is the precise reason why The Rest of the Story exists.
Monday, December 12, 2005
Anti-Smoking Groups Fail to Respond to Double Challenge; Show that they are Talking Out of Both Sides of their Mouths
So far, I have failed to see any evidence that either the Campaign for Tobacco-Free Kids or Ignite have responded to my double challenge, challenging them to call for strengthening of the proposed FDA tobacco legislation so that it does not provide unprecedented special protections for the tobacco industry, something which both groups claim is the very reason why legislation is needed in the first place.
Let me make it very clear that I do not support the idea of FDA regulation of tobacco products right now. I do not believe that such regulation would be in the best interests of the public's health, especially given the dreadful record of the FDA in regulating non-tobacco products and the current political environment that is undermining the Agency's regulatory ability. I do not believe that federal regulation is the answer to all of our public health problems, and it is certainly not, at the present time, the solution to the tobacco problem.
Nevertheless, even if one were to accept the fact that the absence of federal regulation of tobacco products is a national tragedy, as the Campaign for Tobacco-Free Kids and Ignite seem to suggest, and that we must end the special protection for the tobacco industry by regulating tobacco products in the same way as food and drugs, then I think one would have to agree that the FDA legislation being supported by these groups fails to do that.
In contrast, it provides even more special protections for the tobacco industry, through a series of truck-size loopholes that, among other things, provide immunity for the industry against most litigation, allow the industry to market reduced exposure products without any legal repercussions (even if their claims which imply reduced health risk are false), and give Congress nearly unprecedented oversight and institutionalized veto power over the actions of the FDA to regulate tobacco products.
What is most troubling to me is not whether or not groups are supporting the idea of FDA legislation, which is a strategic judgment, but whether or not groups are consistent in their public propaganda. And by failing to call for removal of these loopholes which provide special protections for the tobacco industry, I think both the Campaign for Tobacco-Free Kids and Ignite are being inconsistent and hypocritical in their actions.
What could possibly be lost by calling for a strengthening of this legislation? One thing only, and that is Philip Morris' support for the legislation. Why? Because the legislation, with the loopholes it currently contains, provides the special protection that Philip Morris deems it needs in order to conduct business as usual.
So essentially what we have is a situation where the Campaign for Tobacco-Free Kids and Ignite are lobbying to provide Philip Morris with the precise special protections that it most desires, while at the same time, decrying the influence of the tobacco companies and their campaign contributions on federal policy makers providing special protections for the tobacco industry.
These groups are talking out of both sides of their mouths. This is hypocrisy at its worst.
And the shame of it all is that it undermines everything else that these groups are saying. Because if they demonstrate that they don't really mean what they say in the first place, then what reason do we have to believe anything that they say?
Let me make it very clear that I do not support the idea of FDA regulation of tobacco products right now. I do not believe that such regulation would be in the best interests of the public's health, especially given the dreadful record of the FDA in regulating non-tobacco products and the current political environment that is undermining the Agency's regulatory ability. I do not believe that federal regulation is the answer to all of our public health problems, and it is certainly not, at the present time, the solution to the tobacco problem.
Nevertheless, even if one were to accept the fact that the absence of federal regulation of tobacco products is a national tragedy, as the Campaign for Tobacco-Free Kids and Ignite seem to suggest, and that we must end the special protection for the tobacco industry by regulating tobacco products in the same way as food and drugs, then I think one would have to agree that the FDA legislation being supported by these groups fails to do that.
In contrast, it provides even more special protections for the tobacco industry, through a series of truck-size loopholes that, among other things, provide immunity for the industry against most litigation, allow the industry to market reduced exposure products without any legal repercussions (even if their claims which imply reduced health risk are false), and give Congress nearly unprecedented oversight and institutionalized veto power over the actions of the FDA to regulate tobacco products.
What is most troubling to me is not whether or not groups are supporting the idea of FDA legislation, which is a strategic judgment, but whether or not groups are consistent in their public propaganda. And by failing to call for removal of these loopholes which provide special protections for the tobacco industry, I think both the Campaign for Tobacco-Free Kids and Ignite are being inconsistent and hypocritical in their actions.
What could possibly be lost by calling for a strengthening of this legislation? One thing only, and that is Philip Morris' support for the legislation. Why? Because the legislation, with the loopholes it currently contains, provides the special protection that Philip Morris deems it needs in order to conduct business as usual.
So essentially what we have is a situation where the Campaign for Tobacco-Free Kids and Ignite are lobbying to provide Philip Morris with the precise special protections that it most desires, while at the same time, decrying the influence of the tobacco companies and their campaign contributions on federal policy makers providing special protections for the tobacco industry.
These groups are talking out of both sides of their mouths. This is hypocrisy at its worst.
And the shame of it all is that it undermines everything else that these groups are saying. Because if they demonstrate that they don't really mean what they say in the first place, then what reason do we have to believe anything that they say?
New Study Shows Proposed FDA Legislation is Philip Morris' Dream Come True
A study in the current issue of the Journal of Public Health Policy provides an analysis of the proposed FDA tobacco legislation supported by Philip Morris and by a coalition of public health groups, headlined by the Campaign for Tobacco-Free Kids, in light of the core principles for desired FDA legislation that Philip Morris outlined (see: Givel M. Philip Morris' FDA gambit: good for the public health? Journal of Public Health Policy 2005;26:450-468).
The study reports that the proposed FDA legislation "is compatible with almost all of Philip Morris' core principles on FDA regulation."
This result has two important implications:
First, it demonstrates that the FDA legislation, as proposed, would "ensure regulatory and economic stability in contrast to the past uncertainty of FDA regulating tobacco products as a drug and delivery device. This economic stability would have been maintained because the FDA policy and legislative approach advocated by Philip Morris and many health groups ensured that tobacco products would not be banned and that nicotine would not be removed from tobacco products ensuring a steady adult market into the foreseeable future. This approach, of course, would quite likely have also blocked any future attempts by FDA to treat tobacco products and nicotine as a drug and drug delivery device ... which would have greatly restricted the supply and marketability of tobacco products."
Second, it demonstrates that the proposed FDA legislation would "have meant that adult tobacco use including associated illnesses and deaths would have, using optimistic scenarios, been reduced to a certain extent and then stabilized and institutionalized at the federal level. This is contrary to the goals of the major health groups supporting this legislation, who generally have called for reducing tobacco use for the entire population as much as is feasible or possible ... probably for the long-term, this meant that progress toward reducing tobacco use and tobacco-related disease as much as possible through FDA regulation would have been stalled."
The author concludes that: "The crucial policy message and lesson ... is to be extremely vigilant and do not be drawn in by an apparent willingness of the industry to 'change its ways.'"
The Rest of the Story
Dr. Givel has meticulously demonstrated that the FDA legislation being supported by the Campaign for Tobacco-Free Kids and other public health groups is not compatible with the actual stated goals of these organizations, but instead, is fully compatible with the profit-making and market-dominating goals of Philip Morris, the nation's leading tobacco company.
Dr. Givel has shown, I think, that in negotiating this legislation, the Campaign for Tobacco-Free Kids conceded almost all of the critical points that Philip Morris required in order for this legislation to represent a policy that would institutionalize tobacco use and its resulting disease and death into our society, and with the sanctioning and support of the federal government.
Givel suggests that the Campaign for Tobacco-Free Kids was drawn in and fooled by the apparent willingness of the nation's leading tobacco company to change its ways, but I think it is more likely that the Campaign knew exactly what it was facing, and made a concerted decision to agree to the compromise provisions contained in the legislation because it viewed Philip Morris' support as critical to enactment of the legislation.
In other words, in order to give itself any chance of building the house, the Campaign gave away everything but the kitchen sink. Now, they are left in a position where the legislation they are supporting and claiming to be a house is nothing more than a kitchen sink.
The key effects of this legislation that Givel points out are economic and legal (litigation and legislation) stability for the industry, federal institutionalization and sanctioning of tobacco production, marketing, sale, and use, and stabilization of the tobacco market. Combined with the likelihood that Philip Morris is the best-positioned of the tobacco companies to take advantage of the liability-free reduced exposure product opportunities provided by the FDA legislation, all of this would have meant that Philip Morris would be provided with a complete market dominance.
What is surprising to me is not so much that the Campaign for Tobacco-Free Kids was willing to concede critical public health principles in negotiating this bill, but that it has been so widely successful in misleading other anti-smoking and public health groups into believing that this legislation is in the best interests of the public's health.
In many ways, the campaign is pulling the wool over the eyes of the public much more than Philip Morris is. While Philip Morris claims it is acting because of a sincere interest in social responsibility, the public is not so naive to think that any corporation would not be looking out to protect its own best interests. Their actions are not, I think, really fooling anyone.
But the Campaign for Tobacco-Free Kids, I believe, has been successful in fooling much of the public health community into believing that Philip Morris has truly changed its ways and is now supporting legislation that is in the best interests of the public's health.
In other words, Philip Morris doesn't need to conduct its own public relations anymore to improve its public image. The Campaign for Tobacco-Free Kids is doing Philip Morris' public relations for it. The Campaign is, I think, doing more to improve the public image of Philip Morris than the company could do on its own.
For that, I think Philip Morris should be credited with devising a brilliant scheme, especially in knowing that they could draw a group like the Campaign for Tobacco-Free Kids in, because of the Campaign's expressed and apparent zeal to pass federal legislation at almost any cost.
The rest of the story suggests that the FDA legislation, and even more, the promotion of that legislation by the Campaign for Tobacco-Free Kids, is truly a dream come true for the nation's leading tobacco company.
The study reports that the proposed FDA legislation "is compatible with almost all of Philip Morris' core principles on FDA regulation."
This result has two important implications:
First, it demonstrates that the FDA legislation, as proposed, would "ensure regulatory and economic stability in contrast to the past uncertainty of FDA regulating tobacco products as a drug and delivery device. This economic stability would have been maintained because the FDA policy and legislative approach advocated by Philip Morris and many health groups ensured that tobacco products would not be banned and that nicotine would not be removed from tobacco products ensuring a steady adult market into the foreseeable future. This approach, of course, would quite likely have also blocked any future attempts by FDA to treat tobacco products and nicotine as a drug and drug delivery device ... which would have greatly restricted the supply and marketability of tobacco products."
Second, it demonstrates that the proposed FDA legislation would "have meant that adult tobacco use including associated illnesses and deaths would have, using optimistic scenarios, been reduced to a certain extent and then stabilized and institutionalized at the federal level. This is contrary to the goals of the major health groups supporting this legislation, who generally have called for reducing tobacco use for the entire population as much as is feasible or possible ... probably for the long-term, this meant that progress toward reducing tobacco use and tobacco-related disease as much as possible through FDA regulation would have been stalled."
The author concludes that: "The crucial policy message and lesson ... is to be extremely vigilant and do not be drawn in by an apparent willingness of the industry to 'change its ways.'"
The Rest of the Story
Dr. Givel has meticulously demonstrated that the FDA legislation being supported by the Campaign for Tobacco-Free Kids and other public health groups is not compatible with the actual stated goals of these organizations, but instead, is fully compatible with the profit-making and market-dominating goals of Philip Morris, the nation's leading tobacco company.
Dr. Givel has shown, I think, that in negotiating this legislation, the Campaign for Tobacco-Free Kids conceded almost all of the critical points that Philip Morris required in order for this legislation to represent a policy that would institutionalize tobacco use and its resulting disease and death into our society, and with the sanctioning and support of the federal government.
Givel suggests that the Campaign for Tobacco-Free Kids was drawn in and fooled by the apparent willingness of the nation's leading tobacco company to change its ways, but I think it is more likely that the Campaign knew exactly what it was facing, and made a concerted decision to agree to the compromise provisions contained in the legislation because it viewed Philip Morris' support as critical to enactment of the legislation.
In other words, in order to give itself any chance of building the house, the Campaign gave away everything but the kitchen sink. Now, they are left in a position where the legislation they are supporting and claiming to be a house is nothing more than a kitchen sink.
The key effects of this legislation that Givel points out are economic and legal (litigation and legislation) stability for the industry, federal institutionalization and sanctioning of tobacco production, marketing, sale, and use, and stabilization of the tobacco market. Combined with the likelihood that Philip Morris is the best-positioned of the tobacco companies to take advantage of the liability-free reduced exposure product opportunities provided by the FDA legislation, all of this would have meant that Philip Morris would be provided with a complete market dominance.
What is surprising to me is not so much that the Campaign for Tobacco-Free Kids was willing to concede critical public health principles in negotiating this bill, but that it has been so widely successful in misleading other anti-smoking and public health groups into believing that this legislation is in the best interests of the public's health.
In many ways, the campaign is pulling the wool over the eyes of the public much more than Philip Morris is. While Philip Morris claims it is acting because of a sincere interest in social responsibility, the public is not so naive to think that any corporation would not be looking out to protect its own best interests. Their actions are not, I think, really fooling anyone.
But the Campaign for Tobacco-Free Kids, I believe, has been successful in fooling much of the public health community into believing that Philip Morris has truly changed its ways and is now supporting legislation that is in the best interests of the public's health.
In other words, Philip Morris doesn't need to conduct its own public relations anymore to improve its public image. The Campaign for Tobacco-Free Kids is doing Philip Morris' public relations for it. The Campaign is, I think, doing more to improve the public image of Philip Morris than the company could do on its own.
For that, I think Philip Morris should be credited with devising a brilliant scheme, especially in knowing that they could draw a group like the Campaign for Tobacco-Free Kids in, because of the Campaign's expressed and apparent zeal to pass federal legislation at almost any cost.
The rest of the story suggests that the FDA legislation, and even more, the promotion of that legislation by the Campaign for Tobacco-Free Kids, is truly a dream come true for the nation's leading tobacco company.
Saturday, December 10, 2005
Scotts Miracle-Gro to Begin Firing Smokers
Scotts Miracle-Gro, based in Marysville, Ohio, has announced plans to begin firing smokers in an effort to reduce health care costs for the company. Smokers have been given one year to quit smoking or else lose their jobs. Employees of the company who smoke will be fired, even if they smoke only in their own home.
According to the article: "Scotts took dramatic action because it wants to hold down health-insurance costs by 'helping people live healthy lifestyles,' said James Hagedorn, chairman and chief executive. The Marysville company pays for medical claims using its own funds, 'so why would we admit someone into this environment when they'’re passing risk along to everyone else?' he asked. 'Our view is we shouldn'’t and we won'’t.'"
The Rest of the Story
If Scotts Miracle-Gro is serious about keeping its health insurance costs down by helping people live healthy lifestyles and not passing along any risk by admitting someone who has increased health risks, then it would certainly follow up this announcement with its decision to fire any employees who have a body mass index greater than 30, a level that puts them at significantly increased risk of chronic disease.
Obesity is clearly a problem that results in greatly increased medical costs for employers and admitting obese workers into the Scotts Miracle-Gro environment certainly passes along risk of increased health costs to other employees of the company. Since the company's view is that it shouldn't and it won't pass along this risk, there is no reason why it should not begin firing obese people next year as well as smokers.
The company will also want to give out dietary questionnaires and fire anyone who consumes excessive fat and not enough fiber and anti-oxidants, since poor nutrition is, next to smoking, probably the greatest risk factor for cancer, heart disease, and other chronic diseases.
And the company will also be remiss if it doesn't start firing employees who do not report engaging in sufficient physical activity.
One reason I am highlighting this story is because it demonstrates that workplace discrimination against smokers is not just an isolated (that is, Weyco) incident, but that it is now a bona fide trend and I think it truly threatens to make it difficult for smokers to seek and obtain meaningful employment.
Scotts is apparently one of the major employers in Marysville, and with a town population of only 15,942, eliminating Scotts as a potential job site for smokers severely limits their ability to seek gainful employment. If Honda, which has a large plant near Marysville, also decides to implement such a policy, then there is almost no question that smokers in Marysville will have an extremely difficult time finding employment in the area.
Although tobacco control groups are not necessarily promoting these policies, I think it is encumbent upon us, as tobacco control professionals, to speak out unequivocally against these policies. It is, I think, the social climate of stigmatization of smokers that anti-smoking groups have helped to create that is contributing, at least in part, to the enactment of these policies, and therefore I think we have an obligation to condemn them in no uncertain terms.
According to the article: "Scotts took dramatic action because it wants to hold down health-insurance costs by 'helping people live healthy lifestyles,' said James Hagedorn, chairman and chief executive. The Marysville company pays for medical claims using its own funds, 'so why would we admit someone into this environment when they'’re passing risk along to everyone else?' he asked. 'Our view is we shouldn'’t and we won'’t.'"
The Rest of the Story
If Scotts Miracle-Gro is serious about keeping its health insurance costs down by helping people live healthy lifestyles and not passing along any risk by admitting someone who has increased health risks, then it would certainly follow up this announcement with its decision to fire any employees who have a body mass index greater than 30, a level that puts them at significantly increased risk of chronic disease.
Obesity is clearly a problem that results in greatly increased medical costs for employers and admitting obese workers into the Scotts Miracle-Gro environment certainly passes along risk of increased health costs to other employees of the company. Since the company's view is that it shouldn't and it won't pass along this risk, there is no reason why it should not begin firing obese people next year as well as smokers.
The company will also want to give out dietary questionnaires and fire anyone who consumes excessive fat and not enough fiber and anti-oxidants, since poor nutrition is, next to smoking, probably the greatest risk factor for cancer, heart disease, and other chronic diseases.
And the company will also be remiss if it doesn't start firing employees who do not report engaging in sufficient physical activity.
One reason I am highlighting this story is because it demonstrates that workplace discrimination against smokers is not just an isolated (that is, Weyco) incident, but that it is now a bona fide trend and I think it truly threatens to make it difficult for smokers to seek and obtain meaningful employment.
Scotts is apparently one of the major employers in Marysville, and with a town population of only 15,942, eliminating Scotts as a potential job site for smokers severely limits their ability to seek gainful employment. If Honda, which has a large plant near Marysville, also decides to implement such a policy, then there is almost no question that smokers in Marysville will have an extremely difficult time finding employment in the area.
Although tobacco control groups are not necessarily promoting these policies, I think it is encumbent upon us, as tobacco control professionals, to speak out unequivocally against these policies. It is, I think, the social climate of stigmatization of smokers that anti-smoking groups have helped to create that is contributing, at least in part, to the enactment of these policies, and therefore I think we have an obligation to condemn them in no uncertain terms.
Friday, December 09, 2005
Tobacco Control Leader Speaks Out Against WHO's Discriminatory Employment Policy
In an op-ed commentary in today's Sydney Morning Herald, Dr. Simon Chapman, Professor at the School of Public Health at the University of Sydney and editor of the journal Tobacco Control, questions the justification for the policy announced earlier this week by which the World Health Organization will refuse to hire anyone who smokes.
Dr. Chapman evaluates two potential arguments that could justify such a policy: "employers' rights to optimise their selection of staff (smokers are likely to take more sick leave and breaks) and enlightened paternalism."
He reasons that "The first argument fails because, while it is true that smokers, as a class, are less productive through their absences, many smokers do not take extra sick leave or smoking breaks. By the same logic, employers might just as well refuse to hire younger women because they might get pregnant and take maternity leave, and might later take more time off than men to look after sick children."
Dr. Chapman evaluates two potential arguments that could justify such a policy: "employers' rights to optimise their selection of staff (smokers are likely to take more sick leave and breaks) and enlightened paternalism."
He reasons that "The first argument fails because, while it is true that smokers, as a class, are less productive through their absences, many smokers do not take extra sick leave or smoking breaks. By the same logic, employers might just as well refuse to hire younger women because they might get pregnant and take maternity leave, and might later take more time off than men to look after sick children."
In terms of the second argument - enlightened paternalism - he argues: "There are some acts where governments decide that the exercise of free will is so dangerous that individuals should be protected from their poor judgements. Mandatory use of seatbelts and motorcycle helmets are good examples. ... The World Health Organisation would argue that its policy of quit or reduce your chances of employment is founded on similar enlightened paternalism. The comparisons are questionable. Seatbelt and helmet laws represent trivial intrusions on liberty and cannot be compared with demands to stop smoking - something that about 20 per cent of smokers want to continue doing."
"By the same paternalistic precepts, employers might consult their insurance companies about dangerous leisure activities and interrogate employees as to whether they engage in risky sports, ride motorcycles or like lone ocean sailing. Many would find this an odious development that diminished tolerance. There is not much of a step from arguing, out of paternalism, that smokers should not be employed (in anything but tobacco companies), to arguing that they should be prosecuted for their own good. We don't need this."
The Rest of the Story
Dr. Chapman is to be congratulated for having the courage as well as insight to question this discriminatory, unwarranted, and intrusive employment practice that serves no public health principle, despite the fact that his opinion goes against the grain of the tobacco control movement (as least in the United States - as I noted earlier, the British anti-smoking group ASH condemned this action).
It will be interesting to see if any of the U.S. anti-smoking groups or advocates will follow the lead of their British (and now Australian) counterparts.
Weyco Announces Plan to Charge Employees if their Spouses Smoke
In a CNN interview broadcast online yesterday, the president of Okemos, Michigan-based Weyco, Inc. announced his plan to implement a $1,000 charge for employees who report that their spouses smoke. Weyco reached national fame earlier this year when it implemented a policy by which any employees who smoke were given one year to quit, or be fired. Three employees who failed to quit smoking were indeed fired earlier this year.
According to the interview, employees are not only asked whether they smoke, but Breathalyzer-type tests are administered to confirm that they do not smoke.
It appears that the reporter was jokingly asking if Weyco would begin requiring spouses of employees not to smoke, and he was quite surprised when the Weyco president responded: "Yes." He explained that such employees would not be fired, but that they would be assessed a $1,000 penalty for their spouse smoking.
The Rest of the Story
This is absolutely insane.
I have already condemned the policy of firing employees who smoke or not hiring smokers as a policy, but even for those anti-smoking groups or advocates who support those policies, this has got to be viewed as being ridiculously inappropriate.
Now, we are not only going to interfere with the privacy of individual's lawful, off-the-job behavior but we are going to interfere into the personal lives of their spouses.
I think it will be interesting to see if anti-smoking groups come out and condemn this degree of intrusion into individual privacy.
Given the extent of employment discrimination and privacy intrusion against smokers that is going on (see yesterday's post about the WHO's policy of no longer hiring smokers), I have come to the decision that, despite my extreme reluctance to support a legislative approach to regulate employment policies, it is now necessary to intervene to protect these types of unwarranted intrusions into individual employee's privacy and this extent of employment discrimination.
For this reason, I now actively support SB381, legislation introduced into the Michigan legislature by state Senator Verg Bernero, which would prevent employers from making off-the-job legal behavior a condition of employment, except in cases where that behavior directly affects job performance or relates to the mission of a company. That bill has been stalled in committee, but I hope that the WHO story and the continuing Weyco saga bring it out for active debate.
And I hope that anti-smoking groups in Michigan will either support that legislation, or unequivocally condemn the policies of Weyco, which represent exactly the kind of employment discrimination that we have worked for decades to try to prevent.
According to the interview, employees are not only asked whether they smoke, but Breathalyzer-type tests are administered to confirm that they do not smoke.
It appears that the reporter was jokingly asking if Weyco would begin requiring spouses of employees not to smoke, and he was quite surprised when the Weyco president responded: "Yes." He explained that such employees would not be fired, but that they would be assessed a $1,000 penalty for their spouse smoking.
The Rest of the Story
This is absolutely insane.
I have already condemned the policy of firing employees who smoke or not hiring smokers as a policy, but even for those anti-smoking groups or advocates who support those policies, this has got to be viewed as being ridiculously inappropriate.
Now, we are not only going to interfere with the privacy of individual's lawful, off-the-job behavior but we are going to interfere into the personal lives of their spouses.
I think it will be interesting to see if anti-smoking groups come out and condemn this degree of intrusion into individual privacy.
Given the extent of employment discrimination and privacy intrusion against smokers that is going on (see yesterday's post about the WHO's policy of no longer hiring smokers), I have come to the decision that, despite my extreme reluctance to support a legislative approach to regulate employment policies, it is now necessary to intervene to protect these types of unwarranted intrusions into individual employee's privacy and this extent of employment discrimination.
For this reason, I now actively support SB381, legislation introduced into the Michigan legislature by state Senator Verg Bernero, which would prevent employers from making off-the-job legal behavior a condition of employment, except in cases where that behavior directly affects job performance or relates to the mission of a company. That bill has been stalled in committee, but I hope that the WHO story and the continuing Weyco saga bring it out for active debate.
And I hope that anti-smoking groups in Michigan will either support that legislation, or unequivocally condemn the policies of Weyco, which represent exactly the kind of employment discrimination that we have worked for decades to try to prevent.
Trends in Heart Attacks in Lewis and Clark County Show Prematurity of Helena Study Conclusions
In a rapid response to the original BMJ study which concluded that a 40% decline in heart attack hospital admissions in Helena, Montana was attributable to the city's smoking ban, Drs. Brad Rodu and Philip Cole of the University of Alabama at Birmingham presented historical data on trends in the heart attack mortality rate for Lewis and Clark County (which includes Helena) for the years 1979-2001.
These data demonstrate that there is significant random variation in heart attack mortality trends (which suggests that there is also substantial random variation in heart attack incidence trends) in Helena, since 85% of the county population lives in Helena. This random variation is so marked that the observed heart attack mortality in several years is dramatically lower than, or higher than, the trend in preceding years.
As the authors point out: "The variability is most clearly illustrated by two periods: 1989-1993 and 1997-2001 (the bars for these periods are yellow). The latter period is notable because of the year 2000, in which the mortality rate was 110, about 50% higher than the mean for the other years in the period. The former period includes 1992, in which the mortality rate was 40% lower than the mean for the other years in the period. In addition, 1992 follows three years of increasing AMI mortality. In isolation, this period presents a picture very similar to that described by Sargent et al from 1998 to 2003."
The authors conclude that random variation cannot be ruled out as an explanation for the observed 40% decline in heart attack admissions in Helena coincident with the city's smoking ban.
In response, the authors of the original study wrote: "Rodu and Cole are following a well-established tobacco industry strategy of trying to shift the focus away from our actual observations."
The Rest of the Story
Rodu and Cole have, I think, convincingly illustrated the dangers in drawing a causal conclusion from an association between one specific factor and a single observed change in a complex phenomenon such as heart attack admissions, especially when there is tremendous baseline variation and substantial secular changes in that phenomenon and when one looks only at a small slice of the overall secular trend.
Using the same methodology as in the original Helena study, the authors could have concluded that there was a significant decline in heart attacks in Helena in 1992 (it seems quite obvious from the data that there was a drop in heart attacks in 1992 and if one was looking only at the period 1989-1992, one could easily conclude that something happened in 1992 to bring down the heart attack rate).
Does this mean that the 40% decline in heart attacks in 1992 was due to the absence of a smoking ban? Or to the election of Bill Clinton as president of the United States? Or to the Toronto Blue Jays having won the World Series? Or to the Pittsburgh Penguins winning the Stanley Cup?
Of course not. The point is that in order to truly have a picture of the underlying secular trend and random variation in a phenomenon as variable as heart attack admissions in a small city, one has to go back many years. Examining an isolated five-year period runs a huge risk of interpreting what is really random variation as being a significant annual change.
And this is precisely what I think is the fundamental flaw of the Sargent et al. analysis.
Given this serious flaw, I do not suggest that the paper does not provide any evidence that heart attack admissions may have fallen in response to the smoking ban. But I think the flaw is serious enough so that one cannot credibly conclude that the smoking ban was the cause of the observed reduction in heart attacks.
Perhaps most disturbing in this story, however, is the original authors' response to the very appropriate and enlightening analysis by Rodu and Cole. Instead of addressing the criticism on its scientific merits, the authors accuse Rodu and Cole of using some sort of tobacco industry strategy. And they accuse them of trying to shift the focus away from the observations, when in fact they are doing an excellent job of trying to spotlight the observations and show how they are within the overall range of random variation observed in heart attacks in Helena over time.
Sargent et al. seem to be following what is a common tobacco control strategy of failing to address the scientific merits of an argument by instead issuing an ad hominem attack on the messenger - in this case, accusing them of using tobacco industry tactics.
The rest of the story is that the underlying random variation in heart attacks in Helena seems to be high enough to fully explain the 40% drop in heart attacks observed in association with the implementation of a smoking ban. This doesn't mean that the observed decline could not be due to the smoking ban, but it does suggest, to me at least, that it is premature to conclude that the heart attack decline was caused by the smoking ban, as opposed to simply representing random variation.
More importantly, the rest of the story reveals the use of what I have recently come to learn is a common tobacco control strategy in responding to scientific criticism - deflecting the merits of that criticism by attacking its messenger.
These data demonstrate that there is significant random variation in heart attack mortality trends (which suggests that there is also substantial random variation in heart attack incidence trends) in Helena, since 85% of the county population lives in Helena. This random variation is so marked that the observed heart attack mortality in several years is dramatically lower than, or higher than, the trend in preceding years.
As the authors point out: "The variability is most clearly illustrated by two periods: 1989-1993 and 1997-2001 (the bars for these periods are yellow). The latter period is notable because of the year 2000, in which the mortality rate was 110, about 50% higher than the mean for the other years in the period. The former period includes 1992, in which the mortality rate was 40% lower than the mean for the other years in the period. In addition, 1992 follows three years of increasing AMI mortality. In isolation, this period presents a picture very similar to that described by Sargent et al from 1998 to 2003."
The authors conclude that random variation cannot be ruled out as an explanation for the observed 40% decline in heart attack admissions in Helena coincident with the city's smoking ban.
In response, the authors of the original study wrote: "Rodu and Cole are following a well-established tobacco industry strategy of trying to shift the focus away from our actual observations."
The Rest of the Story
Rodu and Cole have, I think, convincingly illustrated the dangers in drawing a causal conclusion from an association between one specific factor and a single observed change in a complex phenomenon such as heart attack admissions, especially when there is tremendous baseline variation and substantial secular changes in that phenomenon and when one looks only at a small slice of the overall secular trend.
Using the same methodology as in the original Helena study, the authors could have concluded that there was a significant decline in heart attacks in Helena in 1992 (it seems quite obvious from the data that there was a drop in heart attacks in 1992 and if one was looking only at the period 1989-1992, one could easily conclude that something happened in 1992 to bring down the heart attack rate).
Does this mean that the 40% decline in heart attacks in 1992 was due to the absence of a smoking ban? Or to the election of Bill Clinton as president of the United States? Or to the Toronto Blue Jays having won the World Series? Or to the Pittsburgh Penguins winning the Stanley Cup?
Of course not. The point is that in order to truly have a picture of the underlying secular trend and random variation in a phenomenon as variable as heart attack admissions in a small city, one has to go back many years. Examining an isolated five-year period runs a huge risk of interpreting what is really random variation as being a significant annual change.
And this is precisely what I think is the fundamental flaw of the Sargent et al. analysis.
Given this serious flaw, I do not suggest that the paper does not provide any evidence that heart attack admissions may have fallen in response to the smoking ban. But I think the flaw is serious enough so that one cannot credibly conclude that the smoking ban was the cause of the observed reduction in heart attacks.
Perhaps most disturbing in this story, however, is the original authors' response to the very appropriate and enlightening analysis by Rodu and Cole. Instead of addressing the criticism on its scientific merits, the authors accuse Rodu and Cole of using some sort of tobacco industry strategy. And they accuse them of trying to shift the focus away from the observations, when in fact they are doing an excellent job of trying to spotlight the observations and show how they are within the overall range of random variation observed in heart attacks in Helena over time.
Sargent et al. seem to be following what is a common tobacco control strategy of failing to address the scientific merits of an argument by instead issuing an ad hominem attack on the messenger - in this case, accusing them of using tobacco industry tactics.
The rest of the story is that the underlying random variation in heart attacks in Helena seems to be high enough to fully explain the 40% drop in heart attacks observed in association with the implementation of a smoking ban. This doesn't mean that the observed decline could not be due to the smoking ban, but it does suggest, to me at least, that it is premature to conclude that the heart attack decline was caused by the smoking ban, as opposed to simply representing random variation.
More importantly, the rest of the story reveals the use of what I have recently come to learn is a common tobacco control strategy in responding to scientific criticism - deflecting the merits of that criticism by attacking its messenger.
Thursday, December 08, 2005
The Tobacco Control Movement: Why the Unique Distaste for Scientific Discussion and Challenge?
As a public health researcher and practitioner in a School of Public Health, I have had fairly broad exposure to a number of fields of public health research and practice. Over the past months, it has begun to strike me that the field of tobacco control is unique in its seeming distaste for, or lack of interest in, true scientific discussion and challenge to the science, which has become almost like a set of unassailable religious tenets of the movement.
I'm curious to hear from public health practioners in other fields whether they have observed anything similar, but from my discussions with a wide range of colleagues in public health, this phenomenon appears to be unique to tobacco control.
I'm not saying that there is no scientific discussion that takes place. It most certainly does. But what has become evident is that any scientific discussion seems to be confined to the scholarly journals and that the organizations and leaders who set the agenda have little interest in scientific inquiry. It seems, instead, that they are interested in finding science to use to support their agenda and in attacking any science (or the messengers of scientific findings) that runs counter to the agenda.
Perhaps the best example I can think of is the lack of debate over the assertion that smoking bans result in an immediate and drastic reduction in heart attacks. Here you have a study with essentially two data points - one before and one after a law. You have very little basis upon which to establish a secular baseline and a clear idea of the baseline variability in heart attack admission rates. You have two or three very small towns that have been examined. And you have very limited comparison groups. And what does all of this produce? Press releases and media claims that smoking bans are going to reduce heart attacks by 27% or 40%, depending on which small city you want to look at.
But what's even more surprising to me is that there is little or no discussion of the limitations of these studies in the literature or in the discourse of the movement. I made one attempt at trying to introduce such a discussion and was promptly and resoundingly beaten back and censored.
And those who have tried to introduce data to examine the research question more systematically have also bean beaten back; unlike me, they have been discredited before they even began because of the suspicion that they are tobacco fronts and have nothing of merit that they could possibly say.
This all comes as a great disappointment to me. Because I am in this field, in part, because I am trained as a scientist and a researcher and I trained under a paradigm in which the science dictates the agenda, and not the reverse.
It is leading me to question the importance of my own research. If the science doesn't really matter in the first place, then what is the need for me to continue my own research efforts? If the findings are going to be ignored (unless they support the prevailing dogma), then is there any point of actually doing the research?
I am not ready or prepared to throw in the towel yet, but I have to say that this is making me seriously think about my own research program and its importance, as well as the importance of any tobacco control research to begin with.
My research has been of great interest, it seems, among tobacco control practitioners. But is the reason for that because my research was of scientific value, or because my findings supported the prevailing agenda? Now I am beginning to doubt whether there is any true appreciation in the movement for good science, or whether the appreciation is simply for science that supports the dogma and supports the agenda.
It will be interesting to see how things unfold as time goes on, but for now, let me just say that I think the tobacco control field seems peculiarly unique in its seeming disinterest in scientific challenge and discussion. And it comes as a huge disappointment for me.
I'm curious to hear from public health practioners in other fields whether they have observed anything similar, but from my discussions with a wide range of colleagues in public health, this phenomenon appears to be unique to tobacco control.
I'm not saying that there is no scientific discussion that takes place. It most certainly does. But what has become evident is that any scientific discussion seems to be confined to the scholarly journals and that the organizations and leaders who set the agenda have little interest in scientific inquiry. It seems, instead, that they are interested in finding science to use to support their agenda and in attacking any science (or the messengers of scientific findings) that runs counter to the agenda.
Perhaps the best example I can think of is the lack of debate over the assertion that smoking bans result in an immediate and drastic reduction in heart attacks. Here you have a study with essentially two data points - one before and one after a law. You have very little basis upon which to establish a secular baseline and a clear idea of the baseline variability in heart attack admission rates. You have two or three very small towns that have been examined. And you have very limited comparison groups. And what does all of this produce? Press releases and media claims that smoking bans are going to reduce heart attacks by 27% or 40%, depending on which small city you want to look at.
But what's even more surprising to me is that there is little or no discussion of the limitations of these studies in the literature or in the discourse of the movement. I made one attempt at trying to introduce such a discussion and was promptly and resoundingly beaten back and censored.
And those who have tried to introduce data to examine the research question more systematically have also bean beaten back; unlike me, they have been discredited before they even began because of the suspicion that they are tobacco fronts and have nothing of merit that they could possibly say.
This all comes as a great disappointment to me. Because I am in this field, in part, because I am trained as a scientist and a researcher and I trained under a paradigm in which the science dictates the agenda, and not the reverse.
It is leading me to question the importance of my own research. If the science doesn't really matter in the first place, then what is the need for me to continue my own research efforts? If the findings are going to be ignored (unless they support the prevailing dogma), then is there any point of actually doing the research?
I am not ready or prepared to throw in the towel yet, but I have to say that this is making me seriously think about my own research program and its importance, as well as the importance of any tobacco control research to begin with.
My research has been of great interest, it seems, among tobacco control practitioners. But is the reason for that because my research was of scientific value, or because my findings supported the prevailing agenda? Now I am beginning to doubt whether there is any true appreciation in the movement for good science, or whether the appreciation is simply for science that supports the dogma and supports the agenda.
It will be interesting to see how things unfold as time goes on, but for now, let me just say that I think the tobacco control field seems peculiarly unique in its seeming disinterest in scientific challenge and discussion. And it comes as a huge disappointment for me.
Parental Presence During Interviews Could Explain Connection Between Movies and Smoking
In an online rapid response letter published in the journal Pediatrics, Dr. Joel Moskowitz, Director of the Center for Family and Community Health at the UC Berkeley School of Public Health, suggests an alternative explanation for the observed association between exposure to smoking in movies and smoking initiation among adolescents.
Dr. Moskowitz reports in the letter the results of studies he has done showing that children tend to under-report smoking in telephone surveys when a parent is listening to, or present during, the interview. Among children ages 12-14 years, 57% reported that a parent heard them being interviewed. The self-reported prevalence of ever smoking/puffing was only 9% for those who reported that a parent heard the entire interview but was 20% for those who reported a parent being home but not hearing the interview and was 27% for those who did not have a parent home during the interview.
The importance of this result for the present study is that children whose parents are protective to the extent that they do not allow their children to see R-rated movies (which have higher numbers of smoking portrayals) may also be protective to the extent that they are present during the interview of their children:
"The interpretation of results from the authors' studies of exposure to smoking in movies is of particular concern because children who reported low exposure to smoking in movies (i.e., those whose parents did not allow them to see R-rated movies) may have more protective parents who are more likely to be present during their child's telephone interview compared to children who reported high exposure to smoking in movies. If this were true, and if parental presence during the interview caused these children to under-report smoking initiation, then the results of the authors' studies could be explained by this confounding."
The Rest of the Story
This seems to be an important potential threat to the validity of the conclusion of the studies linking exposure to smoking in movies with a higher risk of smoking initiation. Under-reporting of smoking due to parental presence is indeed a plausible confounder because it is clearly associated with the outcome (self-reported smoking) and is likely associated with the exposure (being "allowed" by parents to see R-rated movies which contain more smoking), and because the magnitude of the reported effect on self-reported smoking behavior is so large.
The presence of a potential confounder does not negate or render invalid the conclusions of the study; it merely suggests a potential alternative explanation for the study findings that must be considered. Hopefully, this potential explanation can be addressed in future research.
I can't help but add that another potential confounding factor is differences in parental protectiveness itself, independent of any effect of protectiveness on interview presence. Parents who allow their kids to see R-rated movies would certainly seem to have a different level of protectiveness and might not this factor itself be related in some way to smoking initiation?
One potential mediator for this relationship is the association between protectiveness and perceived parental disapproval of smoking, which was shown to be a significant inhibitor of smoking initiation by the same researchers who reported the movie exposure - smoking initiation link.
Of note, the original research paper did indeed control for parenting style (using an authoritative parenting index); however, it is unclear to me whether this measure truly can account adequately for the range of differences in parenting between parents of kids who are allowed or not allowed to view R-rated movies.
The rest of the story is not that there is anything wrong with the conclusion that exposure to smoking in movies seems to be a risk factor for smoking initiation. Instead, my conclusion is that there are some plausible alternative explanations for this observed association, and because of this, it seems premature to draw a definitive conclusion. But far more importantly, it seems premature, for sure, to be providing precise quantitative estimates of the number of kids who start smoking due to seeing smoking in movies. I think a little more respect for the science, and a little less urgency to support an agenda, is in order.
Dr. Moskowitz reports in the letter the results of studies he has done showing that children tend to under-report smoking in telephone surveys when a parent is listening to, or present during, the interview. Among children ages 12-14 years, 57% reported that a parent heard them being interviewed. The self-reported prevalence of ever smoking/puffing was only 9% for those who reported that a parent heard the entire interview but was 20% for those who reported a parent being home but not hearing the interview and was 27% for those who did not have a parent home during the interview.
The importance of this result for the present study is that children whose parents are protective to the extent that they do not allow their children to see R-rated movies (which have higher numbers of smoking portrayals) may also be protective to the extent that they are present during the interview of their children:
"The interpretation of results from the authors' studies of exposure to smoking in movies is of particular concern because children who reported low exposure to smoking in movies (i.e., those whose parents did not allow them to see R-rated movies) may have more protective parents who are more likely to be present during their child's telephone interview compared to children who reported high exposure to smoking in movies. If this were true, and if parental presence during the interview caused these children to under-report smoking initiation, then the results of the authors' studies could be explained by this confounding."
The Rest of the Story
This seems to be an important potential threat to the validity of the conclusion of the studies linking exposure to smoking in movies with a higher risk of smoking initiation. Under-reporting of smoking due to parental presence is indeed a plausible confounder because it is clearly associated with the outcome (self-reported smoking) and is likely associated with the exposure (being "allowed" by parents to see R-rated movies which contain more smoking), and because the magnitude of the reported effect on self-reported smoking behavior is so large.
The presence of a potential confounder does not negate or render invalid the conclusions of the study; it merely suggests a potential alternative explanation for the study findings that must be considered. Hopefully, this potential explanation can be addressed in future research.
I can't help but add that another potential confounding factor is differences in parental protectiveness itself, independent of any effect of protectiveness on interview presence. Parents who allow their kids to see R-rated movies would certainly seem to have a different level of protectiveness and might not this factor itself be related in some way to smoking initiation?
One potential mediator for this relationship is the association between protectiveness and perceived parental disapproval of smoking, which was shown to be a significant inhibitor of smoking initiation by the same researchers who reported the movie exposure - smoking initiation link.
Of note, the original research paper did indeed control for parenting style (using an authoritative parenting index); however, it is unclear to me whether this measure truly can account adequately for the range of differences in parenting between parents of kids who are allowed or not allowed to view R-rated movies.
The rest of the story is not that there is anything wrong with the conclusion that exposure to smoking in movies seems to be a risk factor for smoking initiation. Instead, my conclusion is that there are some plausible alternative explanations for this observed association, and because of this, it seems premature to draw a definitive conclusion. But far more importantly, it seems premature, for sure, to be providing precise quantitative estimates of the number of kids who start smoking due to seeing smoking in movies. I think a little more respect for the science, and a little less urgency to support an agenda, is in order.
Wednesday, December 07, 2005
Americans for Nonsmokers' Rights Refuses to Accede to Author's Demand to Remove Article from Website
In a letter to Americans for Nonsmokers' Rights (ANR), I demanded to have an article which I authored removed from their website. My article remains on their site, and it appears clear that ANR is not going to honor my authorship of this article by complying with my demand to remove my article from the site.
As I explained earlier, this is an article for which I never granted ANR permission to post on its website and which I demanded be removed from the website in the past. ANR has now repeatedly rejected my requests to take the article off its site and it appears that it has no respect for my authorship of this article. It has apparently subsumed authorship of the article from me.
Why? Quite simple. Because, in the words of ANR:
"There is a strong consensus that we do not want to post ANYTHING on our web page that can be construed as an apology or as backtracking from the position taken in the paper you wrote. More specifically, XXXXXX has convinced me that, given Levy's long history of attacking ETS science, it would be a mistake to state anything that would give him credence. ... I realize that your views on the matter are heart-felt and sincere, and that mere removal of your name from the paper, without more, will not be entirely satisfactory to you. But at this point ANR must put its political credibility ahead of what you consider to be your scientific credibility."
The Rest of the Story
In other words, ANR has no interest in accurately portraying the facts, communicating messages to the public in the clearest possible way, or suggesting, in any possible way, that someone affiliated with the tobacco industry in any way has any merit whatsoever.
And by suggesting otherwise, I apparently lost my authorship of the article.
Even if one could justify ANR's action in refusing to comply with my earlier request to remove the article, it is beyond me why they would not agree to honor my authorship of the article at this time. What purpose could it possibly serve to steal an article from a tobacco control researcher and refuse to allow him to dictate the terms of its publication on a public site?
I think the answer is clear. The purpose is apparently to take advantage of an opportunity to slam and slur someone with any tobacco-related affiliation. The fact that ANR used me as the hatchet man to deliver this attack is bad enough, but when I came to my senses and realized the error of my ways, their refusal to allow me to remove the attack was inexcusable.
Looking back at the article, I realize how hoodwinked I was by the dogma of the tobacco control movement. Here I was arguing that we don't really need to look at the science behind an article, we need only see that it is authored by someone with some tobacco affiliation and we can discredit it. I'm ashamed of having written that, but it goes a long way to show the kind of brainwashing that takes place in the tobacco control movement.
Anyone familiar with my writing in the past months knows that I feel it is critical to examine the science behind any article, no matter who authored it. This doesn't mean that we shouldn't be on the lookout for potential bias caused by an article being written by someone with a tobacco affiliation or funding, but it also doesn't mean that such an article needs to be discredited outright by virtue of that affiliation.
It's clear to me that scientific integrity takes second place to politics in the tobacco control movement. And here is ANR spelling that out directly for everyone to see: ANR must put its political credibility ahead of what you consider to be your scientific credibility.
Unfortunately, ANR's approach is doomed to fail. While in the short run, it might have helped maintain its political credibility, in the long run, it's only a matter of time before the public comes to understand what ANR is all about and what their tactics really amount to. And that is, I believe, going to hurt their long-term political credibility far more than it would have to change a couple of words in an article, or better yet, to accede to an author's request to discontinue publication of his article.
As I explained earlier, this is an article for which I never granted ANR permission to post on its website and which I demanded be removed from the website in the past. ANR has now repeatedly rejected my requests to take the article off its site and it appears that it has no respect for my authorship of this article. It has apparently subsumed authorship of the article from me.
Why? Quite simple. Because, in the words of ANR:
"There is a strong consensus that we do not want to post ANYTHING on our web page that can be construed as an apology or as backtracking from the position taken in the paper you wrote. More specifically, XXXXXX has convinced me that, given Levy's long history of attacking ETS science, it would be a mistake to state anything that would give him credence. ... I realize that your views on the matter are heart-felt and sincere, and that mere removal of your name from the paper, without more, will not be entirely satisfactory to you. But at this point ANR must put its political credibility ahead of what you consider to be your scientific credibility."
The Rest of the Story
In other words, ANR has no interest in accurately portraying the facts, communicating messages to the public in the clearest possible way, or suggesting, in any possible way, that someone affiliated with the tobacco industry in any way has any merit whatsoever.
And by suggesting otherwise, I apparently lost my authorship of the article.
Even if one could justify ANR's action in refusing to comply with my earlier request to remove the article, it is beyond me why they would not agree to honor my authorship of the article at this time. What purpose could it possibly serve to steal an article from a tobacco control researcher and refuse to allow him to dictate the terms of its publication on a public site?
I think the answer is clear. The purpose is apparently to take advantage of an opportunity to slam and slur someone with any tobacco-related affiliation. The fact that ANR used me as the hatchet man to deliver this attack is bad enough, but when I came to my senses and realized the error of my ways, their refusal to allow me to remove the attack was inexcusable.
Looking back at the article, I realize how hoodwinked I was by the dogma of the tobacco control movement. Here I was arguing that we don't really need to look at the science behind an article, we need only see that it is authored by someone with some tobacco affiliation and we can discredit it. I'm ashamed of having written that, but it goes a long way to show the kind of brainwashing that takes place in the tobacco control movement.
Anyone familiar with my writing in the past months knows that I feel it is critical to examine the science behind any article, no matter who authored it. This doesn't mean that we shouldn't be on the lookout for potential bias caused by an article being written by someone with a tobacco affiliation or funding, but it also doesn't mean that such an article needs to be discredited outright by virtue of that affiliation.
It's clear to me that scientific integrity takes second place to politics in the tobacco control movement. And here is ANR spelling that out directly for everyone to see: ANR must put its political credibility ahead of what you consider to be your scientific credibility.
Unfortunately, ANR's approach is doomed to fail. While in the short run, it might have helped maintain its political credibility, in the long run, it's only a matter of time before the public comes to understand what ANR is all about and what their tactics really amount to. And that is, I believe, going to hurt their long-term political credibility far more than it would have to change a couple of words in an article, or better yet, to accede to an author's request to discontinue publication of his article.
Tuesday, December 06, 2005
Coke Next Item on Agenda for Anti-Tobacco Lawyers
According to articles in the Washington Post and Beverage World Online, a coalition of lawyers that was previously successful in suing Big Tobacco is now close to filing a class-action lawsuit against soft drink companies for selling sodas in schools.
The lawsuit will apparently rely on a number of potential legal arguments:
Another of the lawyers was said to suggest that "selling drinks in schools can hook kids on something that can eventually lead to diabetes." He was quoted as stating that the combination of caffeine and sugar in soft drinks is a "toxic cocktail that children cannot easily refuse."
The Rest of the Story
Not only do I fail to see any legal merit in this litigation, but I think it makes a mockery of public health in general, and of tobacco litigation in particular.
By putting Marlboro on the same plane as Coca-Cola, these attorneys are I think undermining the very litigation that they themselves helped establish.
The argument that caffeine is addictive and is used to hook children on soft drinks I think undermines the basic argument that is critical to almost every tobacco case out there: that nicotine is a highly addictive drug and that cigarette companies have intentionally manipulated levels of nicotine in order to addict their customers, but without their customers' knowledge.
In fact, this is an argument that cigarette company lawyers have repeatedly made in tobacco trials in an attempt to convince juries that nicotine is not addictive in any serious sense - it is only mildly addictive in the same way that soda or chocolate are addictive.
I vehemently disagree with the contention that caffeine has anything like the addictive power of nicotine, and I think there is simply no comparison. I spent years of my career trying to help patients overcome a nicotine addiction, but not once did I have a patient whose problem was not being able to stop drinking Coca-Cola. I've had a lot of patients who were chain smokers, but none who were "chain Cokers."
To suggest that soft drinks are a "toxic cocktail" is not only grossly inaccurate, but I think it does an injustice to legitimate public health attempts to protect the public from toxic substances - like tobacco. If the public is led to believe that any product that may possibly, if consumed in gross excess, lead to health problems is "toxic," then the public's appreciation of the very real risks of something like tobacco use will be greatly undermined. Eventually, I think the public is just going to get sick of listening to all this banter, and they will just give up.
Public health practitioners need to be consistent in their messages to the public, and telling the public that soft drinks are a toxic cocktail is simply not a message that is consistent with what I think the public health message should be.
In fact, soft drinks are not toxic. They are not even dangerous. It is only the over-consumption of soft drinks, combined with the under-consumption of other foods, that is a health risk. There is, after all, nothing inherently dangerous in drinking a Coke or a Pepsi. To call a soda machine a "dangerous object" makes a farce out of public health, in my opinion.
The legal theories make even less sense. If having a Coke machine in a school is akin to having a swimming pool on one's property without a fence, then doesn't that mean that any Coke machine in a public location must have a fence around it, or some other mechanism to keep kids out? Aren't store owners who sell Coke to kids liable for damages if Coke is really that dangerous and toxic a cocktail? And what about serving Coke to kids at parties? Shouldn't we have lawsuits against parents who serve Coke to their kids' friends without the consent of those kids' parents? After all, it may be less egregious than serving alcohol to kids, but it is still egregious, is it not?
And why leave the coffee makers out of this? Coffee often has a lot more caffeine in it than soda. Shouldn't Maxwell House be on the witness stand for selling caffeine-laden products to kids without requiring identification to prove that the kids were adults and capable of making a decision to ingest a toxic and dangerous substance on their own?
And what about chocolate makers? Chocolate is laden with caffeine, as many nursing mothers know after their first experience eating chocolate as an evening snack and then wondering why their baby is having trouble sleeping that night. Doesn't Hershey deserve a place on the defendant's bench along with Coke, Pepsi, and Maxwell House?
If it is unfair to offer kids soft drinks in an environment where parents have no control, then isn't it also unfair for teachers to give out chocolates to school children on Valentine's Day or other special occasions? Perhaps these irresponsible teachers should be marched into the courtroom for contributing to the addiction of kids to caffeine, the over-consumption of sugar, and raising the risk of children developing diabetes and obesity.
And don't even get me started on the high-fat foods that school cafeterias tend to serve: pizza, sloppy Joe's, meatloaf, Salisbury steak. Isn't that an injustice? Shouldn't the companies which manufacture those products be paraded into the courtroom as well for inflicting their toxic products on kids?
Don't get me wrong - I think childhood obesity is a major public health problem, food manufacturers and fast food companies and their advertising play a major role, and society needs to find solutions that involve these corporations - some of these solutions may involve legislation. But taking these companies to court is not only frivolous, but it makes a mockery of what public health is supposed to be about.
Ultimately, I think it undermines the public health practice of tobacco control to insist that Coke stand behind Marlboro in the line for plaintiffs lawyers to try to extract monetary gain. A Coke is not a Marlboro, and we shouldn't pretend that it is.
The lawsuit will apparently rely on a number of potential legal arguments:
- "Part of the strategy is to claim that soft drink companies use caffeine, a mildly addictive substance, to hook children on a product that is dangerous because of its empty calories."
- Attorneys may also argue "that school vending machines are a nuisance because they give kids access to something that is both tempting and dangerous, the same argument that would be used in the case of a swimming pool without a fence."
- Another potential argument is that "it is unfair to offer kids soft drinks in an environment where parents have no control."
- And yet another potential argument is deceptive advertising - that "by putting vending machines in schools, companies are implicitly telling kids the drinks are good for them."
Another of the lawyers was said to suggest that "selling drinks in schools can hook kids on something that can eventually lead to diabetes." He was quoted as stating that the combination of caffeine and sugar in soft drinks is a "toxic cocktail that children cannot easily refuse."
The Rest of the Story
Not only do I fail to see any legal merit in this litigation, but I think it makes a mockery of public health in general, and of tobacco litigation in particular.
By putting Marlboro on the same plane as Coca-Cola, these attorneys are I think undermining the very litigation that they themselves helped establish.
The argument that caffeine is addictive and is used to hook children on soft drinks I think undermines the basic argument that is critical to almost every tobacco case out there: that nicotine is a highly addictive drug and that cigarette companies have intentionally manipulated levels of nicotine in order to addict their customers, but without their customers' knowledge.
In fact, this is an argument that cigarette company lawyers have repeatedly made in tobacco trials in an attempt to convince juries that nicotine is not addictive in any serious sense - it is only mildly addictive in the same way that soda or chocolate are addictive.
I vehemently disagree with the contention that caffeine has anything like the addictive power of nicotine, and I think there is simply no comparison. I spent years of my career trying to help patients overcome a nicotine addiction, but not once did I have a patient whose problem was not being able to stop drinking Coca-Cola. I've had a lot of patients who were chain smokers, but none who were "chain Cokers."
To suggest that soft drinks are a "toxic cocktail" is not only grossly inaccurate, but I think it does an injustice to legitimate public health attempts to protect the public from toxic substances - like tobacco. If the public is led to believe that any product that may possibly, if consumed in gross excess, lead to health problems is "toxic," then the public's appreciation of the very real risks of something like tobacco use will be greatly undermined. Eventually, I think the public is just going to get sick of listening to all this banter, and they will just give up.
Public health practitioners need to be consistent in their messages to the public, and telling the public that soft drinks are a toxic cocktail is simply not a message that is consistent with what I think the public health message should be.
In fact, soft drinks are not toxic. They are not even dangerous. It is only the over-consumption of soft drinks, combined with the under-consumption of other foods, that is a health risk. There is, after all, nothing inherently dangerous in drinking a Coke or a Pepsi. To call a soda machine a "dangerous object" makes a farce out of public health, in my opinion.
The legal theories make even less sense. If having a Coke machine in a school is akin to having a swimming pool on one's property without a fence, then doesn't that mean that any Coke machine in a public location must have a fence around it, or some other mechanism to keep kids out? Aren't store owners who sell Coke to kids liable for damages if Coke is really that dangerous and toxic a cocktail? And what about serving Coke to kids at parties? Shouldn't we have lawsuits against parents who serve Coke to their kids' friends without the consent of those kids' parents? After all, it may be less egregious than serving alcohol to kids, but it is still egregious, is it not?
And why leave the coffee makers out of this? Coffee often has a lot more caffeine in it than soda. Shouldn't Maxwell House be on the witness stand for selling caffeine-laden products to kids without requiring identification to prove that the kids were adults and capable of making a decision to ingest a toxic and dangerous substance on their own?
And what about chocolate makers? Chocolate is laden with caffeine, as many nursing mothers know after their first experience eating chocolate as an evening snack and then wondering why their baby is having trouble sleeping that night. Doesn't Hershey deserve a place on the defendant's bench along with Coke, Pepsi, and Maxwell House?
If it is unfair to offer kids soft drinks in an environment where parents have no control, then isn't it also unfair for teachers to give out chocolates to school children on Valentine's Day or other special occasions? Perhaps these irresponsible teachers should be marched into the courtroom for contributing to the addiction of kids to caffeine, the over-consumption of sugar, and raising the risk of children developing diabetes and obesity.
And don't even get me started on the high-fat foods that school cafeterias tend to serve: pizza, sloppy Joe's, meatloaf, Salisbury steak. Isn't that an injustice? Shouldn't the companies which manufacture those products be paraded into the courtroom as well for inflicting their toxic products on kids?
Don't get me wrong - I think childhood obesity is a major public health problem, food manufacturers and fast food companies and their advertising play a major role, and society needs to find solutions that involve these corporations - some of these solutions may involve legislation. But taking these companies to court is not only frivolous, but it makes a mockery of what public health is supposed to be about.
Ultimately, I think it undermines the public health practice of tobacco control to insist that Coke stand behind Marlboro in the line for plaintiffs lawyers to try to extract monetary gain. A Coke is not a Marlboro, and we shouldn't pretend that it is.
British Health Secretary Defends Exemption of Private Clubs from Smoking Ban
According to an article in The Publican, British Health Secretary Patricia Hewitt defended the government's exemption of private clubs from the proposed smoking ban, stating that private clubs should have the choice whether or not to allow smoking:
"“Those clubs are non-profit-making organisations in which the members make the decisions, just as people make their own decisions in their own homes. It is therefore right to exempt membership clubs."”
The Rest of the Story
Hewitt may not realize it, but I think she has pretty much destroyed the government's justification for the entire proposed smoking regulation. By her reasoning, it would be just as easy to argue that the decisions about whether smoking should be allowed in bars and restaurants should be made by the patrons of those establishments. If private clubs are beyond the scope of government regulation of occupational health, then so are bars and restaurants.
There is no rational reason why occupational health can be regulated for bar and restaurant employees, but not for employees of private clubs. The exemption makes no public health sense, and in trying to defend it, the Health Secretary has made it clear that the government has no consistent public health rationale for its proposed legislation.
I find it quite hypocritical for the Health Secretary to imply that health conditions are so bad that smoking must be eliminated in bars and restaurants, but not so bad that employees in private clubs need to be protected.
In my view, there is only one real reason why public health practitioners have often exempted private clubs from smoking regulations: politics. They perceive that there will be less political support for such a proposal. When will they have the integrity to simply admit that is the reason for the inconsistency in their proposed policies?
"“Those clubs are non-profit-making organisations in which the members make the decisions, just as people make their own decisions in their own homes. It is therefore right to exempt membership clubs."”
The Rest of the Story
Hewitt may not realize it, but I think she has pretty much destroyed the government's justification for the entire proposed smoking regulation. By her reasoning, it would be just as easy to argue that the decisions about whether smoking should be allowed in bars and restaurants should be made by the patrons of those establishments. If private clubs are beyond the scope of government regulation of occupational health, then so are bars and restaurants.
There is no rational reason why occupational health can be regulated for bar and restaurant employees, but not for employees of private clubs. The exemption makes no public health sense, and in trying to defend it, the Health Secretary has made it clear that the government has no consistent public health rationale for its proposed legislation.
I find it quite hypocritical for the Health Secretary to imply that health conditions are so bad that smoking must be eliminated in bars and restaurants, but not so bad that employees in private clubs need to be protected.
In my view, there is only one real reason why public health practitioners have often exempted private clubs from smoking regulations: politics. They perceive that there will be less political support for such a proposal. When will they have the integrity to simply admit that is the reason for the inconsistency in their proposed policies?
Monday, December 05, 2005
Rest of the Story Author Expelled from Tobacco Control List-Serve; Dissent is Met with Censorship
The author of this blog was expelled from the tobacco control list-serve tp-talk (which stands for tobacco policy talk) Friday. In a message sent to all tp-talk members, but not to me, the list-serve administrator stated (and this is the message in its entirety):
The Rest of the Story
Actually, the list-serve administrator is wrong. He is not going to be the subject of a blog posting. The subject of this blog posting, instead, is about the anti-smoking movement and what is has come to.
After all, the real issue here isn't the list-serve. The real issue is the fact that the tobacco control movement simply cannot tolerate any dissent. And that in response to speaking out to suggest that perhaps some of the things we are doing are not appropriate, the movement resorts to attacking the messenger, and now censoring that individual's free expression of opinion.
In some previous comments, a colleague of mine from UC Berkeley criticized my claims that there were attempts to censor my expression of my opinions because there was no outright censorship. Well here it is. Censorship - alive and well in the tobacco control movement.
The reason provided for my expulsion is quite interesting: my messages have apparently "interfered with the quality of the listserv." What is really being said is that I disagreed with some of the dogmatic views of the movement. In this case, that's what interference means: disagreeing with the mentality of the movement.
There clearly is no room for dissent in the tobacco control movement, and dissent is met not only with personal attacks, but now, with outright censorship.
There's a tinge of McCarthyism here. Perhaps more than just a tinge.
Fascinating to me is the fact that the final blow leading to my expulsion was my scientific analysis of heart attack trends in 12 states and in the nation as a whole. Had those trends showed a significant effect of smoking bans on heart attacks, I would not be writing this post today. It is the data - and what the data suggests about the anti-smoking agenda - that led to the need to disallow me from expressing my opinions. It was simply too much of a challenge to the dogma of the movement.
The economist John Maynard Keynes once said: "Sir, when the facts change, I change my mind. What do you do?"
I've been in the tobacco control movement for 21 years and I have extensive experience in the field at the national, state, and local levels. I have over 60 peer-reviewed publications in tobacco control and have testified as an expert witness in at least 7 tobacco trials. What has guided me throughout my career is an attempt to bring sound scientific and sound policy analysis to the problem of tobacco use. And I'm not going to stop doing that now.
When the facts change, I change my mind. What does the tobacco control movement do? It's clear: censor the individual so that the movement does not become aware that the facts may have changed. There is no room to challenge the received wisdom and canons of tobacco control.
To borrow a few words and wisdom from a dear colleague of mine, I think there is a need for, and a value to provocation, challenge, and scrutiny of long-held assumptions. This is the motor of progress and renewal. And what is its opposite?
"I made the dictatorial (but perhaps benevolent) decision to remove Mike Siegel from tp-talk today. I felt that his posts lately have interfered with the quality of the listserv messages. I suspect I'll be the subject of a blog posting about how he's been kicked off a tobacco control listserv, but I can deal with that."
I found out about my expulsion from this tobacco policy discussion group, of which I have been a part for the past 5 years, from a colleague's email.
I found out about my expulsion from this tobacco policy discussion group, of which I have been a part for the past 5 years, from a colleague's email.
The Rest of the Story
Actually, the list-serve administrator is wrong. He is not going to be the subject of a blog posting. The subject of this blog posting, instead, is about the anti-smoking movement and what is has come to.
After all, the real issue here isn't the list-serve. The real issue is the fact that the tobacco control movement simply cannot tolerate any dissent. And that in response to speaking out to suggest that perhaps some of the things we are doing are not appropriate, the movement resorts to attacking the messenger, and now censoring that individual's free expression of opinion.
In some previous comments, a colleague of mine from UC Berkeley criticized my claims that there were attempts to censor my expression of my opinions because there was no outright censorship. Well here it is. Censorship - alive and well in the tobacco control movement.
The reason provided for my expulsion is quite interesting: my messages have apparently "interfered with the quality of the listserv." What is really being said is that I disagreed with some of the dogmatic views of the movement. In this case, that's what interference means: disagreeing with the mentality of the movement.
There clearly is no room for dissent in the tobacco control movement, and dissent is met not only with personal attacks, but now, with outright censorship.
There's a tinge of McCarthyism here. Perhaps more than just a tinge.
Fascinating to me is the fact that the final blow leading to my expulsion was my scientific analysis of heart attack trends in 12 states and in the nation as a whole. Had those trends showed a significant effect of smoking bans on heart attacks, I would not be writing this post today. It is the data - and what the data suggests about the anti-smoking agenda - that led to the need to disallow me from expressing my opinions. It was simply too much of a challenge to the dogma of the movement.
The economist John Maynard Keynes once said: "Sir, when the facts change, I change my mind. What do you do?"
I've been in the tobacco control movement for 21 years and I have extensive experience in the field at the national, state, and local levels. I have over 60 peer-reviewed publications in tobacco control and have testified as an expert witness in at least 7 tobacco trials. What has guided me throughout my career is an attempt to bring sound scientific and sound policy analysis to the problem of tobacco use. And I'm not going to stop doing that now.
When the facts change, I change my mind. What does the tobacco control movement do? It's clear: censor the individual so that the movement does not become aware that the facts may have changed. There is no room to challenge the received wisdom and canons of tobacco control.
To borrow a few words and wisdom from a dear colleague of mine, I think there is a need for, and a value to provocation, challenge, and scrutiny of long-held assumptions. This is the motor of progress and renewal. And what is its opposite?
World Health Organization Will Not Hire Smokers
According to an Associated Press article Friday, the World Health Organization (WHO) will no longer hire smokers.
According to the article: "Applicants are asked if they smoke or use other tobacco products, and if they answer 'yes,' the application process is terminated."
A WHO spokesperson described the reason behind the new employment policy as follows: "WHO has taken a very public lead in the fight against tobacco use. As a matter of principle, WHO does not want to recruit smokers."
Another WHO spokesperson made it clear that WHO's principled concern about the health of its employees was specific to smoking: "When asked whether WHO would soon stop hiring obese people or those drinking alcohol, spokeswoman Fadela Chaib said the agency was aware that its new rules 'may seem discriminatory or even politically incorrect' to some. But she stressed that WHO needs to align its own employment practices with its principles."
The Rest of the Story
Apparently, it is the principle of the World Health Organization that smokers are not entitled to have a career in public health, no matter how committed they may be to the cause, how qualified they may be for such a position, how much training, education, and experience they have in public health, or how dedicated they are to the effort to protect the public's health.
The astute question put forth by the reporter revealed, I think, that this policy is not about health at all. It is really about a distaste for smokers and an attempt to socially engineer changes in a specific health behavior by discriminating against and penalizing a population of law-abiding citizens.
The WHO's rationalization for discriminating against smokers in hiring could just as easily be made for a policy to refuse to hire obese people, people who eat a high-fat diet, people who don't exercise, or people who engage in unsafe sex. It is outright discrimination, and in addition, I think it is an unwarranted intrusion into the privacy of potential employees.
It's not like WHO is specifically an anti-smoking organization, where they might legitimately view hiring a smoker as being opposed to the mission of their organization (I don't agree with that view - I'm just pointing out that it isn't even the case here). WHO is a public health organization, and unless an individual is somehow opposed to the principle of improving the public's health, then I don't see how hiring them violates any "principle" of a public health agency.
Perhaps it is the principle of the WHO that smokers should become second class citizens who are not provided with an opportunity to pursue employment. How this policy advances any public health principle is beyond me.
To its credit, a British anti-smoking organization (ASH - Action on Smoking and Health) condemned the new policy: "We think this is rather foolish. We should not be persecuting people smoking but encouraging them to give up [smoking]."
I think the U.S. anti-smoking groups have a lot to learn from their British counterparts. When will they follow ASH-UK's lead and similarly condemn this discriminatory and intrusive policy?
According to the article: "Applicants are asked if they smoke or use other tobacco products, and if they answer 'yes,' the application process is terminated."
A WHO spokesperson described the reason behind the new employment policy as follows: "WHO has taken a very public lead in the fight against tobacco use. As a matter of principle, WHO does not want to recruit smokers."
Another WHO spokesperson made it clear that WHO's principled concern about the health of its employees was specific to smoking: "When asked whether WHO would soon stop hiring obese people or those drinking alcohol, spokeswoman Fadela Chaib said the agency was aware that its new rules 'may seem discriminatory or even politically incorrect' to some. But she stressed that WHO needs to align its own employment practices with its principles."
The Rest of the Story
Apparently, it is the principle of the World Health Organization that smokers are not entitled to have a career in public health, no matter how committed they may be to the cause, how qualified they may be for such a position, how much training, education, and experience they have in public health, or how dedicated they are to the effort to protect the public's health.
The astute question put forth by the reporter revealed, I think, that this policy is not about health at all. It is really about a distaste for smokers and an attempt to socially engineer changes in a specific health behavior by discriminating against and penalizing a population of law-abiding citizens.
The WHO's rationalization for discriminating against smokers in hiring could just as easily be made for a policy to refuse to hire obese people, people who eat a high-fat diet, people who don't exercise, or people who engage in unsafe sex. It is outright discrimination, and in addition, I think it is an unwarranted intrusion into the privacy of potential employees.
It's not like WHO is specifically an anti-smoking organization, where they might legitimately view hiring a smoker as being opposed to the mission of their organization (I don't agree with that view - I'm just pointing out that it isn't even the case here). WHO is a public health organization, and unless an individual is somehow opposed to the principle of improving the public's health, then I don't see how hiring them violates any "principle" of a public health agency.
Perhaps it is the principle of the WHO that smokers should become second class citizens who are not provided with an opportunity to pursue employment. How this policy advances any public health principle is beyond me.
To its credit, a British anti-smoking organization (ASH - Action on Smoking and Health) condemned the new policy: "We think this is rather foolish. We should not be persecuting people smoking but encouraging them to give up [smoking]."
I think the U.S. anti-smoking groups have a lot to learn from their British counterparts. When will they follow ASH-UK's lead and similarly condemn this discriminatory and intrusive policy?
Don't Like the Direction the Program is Going
It seems to me that whenever a coach of a collegiate or professional sports team is fired, the reason provided is that the general manager or athletic director "doesn't like the direction the program is going." "It's now time to take the program in a new direction" is the rallying cry for a web site devoted to promoting the firing of Oregon State head football coach Mike Riley and seems to be the sole criterion used to defend the firing or hiring of head coaches.
Based on the direction in which the tobacco control program is going in this country, I think it may be time for some new coaching.
Here's how I rate the program's national leadership:
Agenda: C-
The national agenda, largely set by the direction the Campaign for Tobacco-Free Kids is trying to take the program, is obsessively focused on the attempt to achieve federal regulation of tobacco products. It is a focus that is seemingly ignorant of the long history of dismal failures of federal tobacco policymaking, including the disastrous Federal Cigarette Labeling and Advertising Act of 1970, the equally disastrous Master Settlement Agreement, and what came close to being the catastrophic global tobacco bailout of 1998.
In order to achieve Philip Morris' support for federal regulation, which is apparently seen as necessary to enact this legislation, the health groups have had to accept compromises that have resulted in truck-size loopholes in the legislation which would provide unprecedented special protections for the tobacco companies, especially for the industry leader. The major health groups are now standing shoulder to shoulder with Philip Morris promoting this legislation, but at the same time, attacking Philip Morris for demanding special protections and for making campaign contributions to try to promote enactment of this bill which will "protect children" and "save lives." It has become a hypocrisy-laden circus and would certainly be the priority for the new coaching staff to straighten out.
At the same time, the national tobacco control program, again largely under the direction of the Campaign for Tobacco-Free Kids, seems to have become obsessed with increasing cigarette taxes to support virtually any government program under the sun. I view these taxes as discriminatory policies that serve to balance the state budgets on the backs of smokers, and what they are essentially doing is avoiding the more politically difficult decision to increase taxes on the wealthiest citizens and corporations in order to provide funds that the government should already be devoting to essential services. In addition, from a strategic viewpoint, the enactment of these taxes is making state governments dependent on tobacco consumption for essential services and is therefore removing any incentive to enact tobacco policies that will reduce cigarette use. Finally, the over-promotion of these taxes is making it difficult to promote what I think is perhaps the most important tobacco control intervention - the use of cigarette taxes to directly benefit smokers, through support for disease treatment, smoking cessation, and prevention.
Another problem with the agenda is the focus on penalizing, stigmatizing, and discriminating against smokers in order to try to change their behavior. This is seen most notably by efforts to promote or support employment policies by which smokers are fired from their jobs, assessed "health impact fees," or precluded from employment in the first place. While the national tobacco control leadership is ostensibly not to blame, their silence in the face of these discriminatory actions which are attempting to make smokers second-class citizens, unable to obtain employment, is I think enabling this aspect of the agenda.
Finally, the increasing trend of banning smoking in open, non-enclosed outdoors areas where people can move freely about is troubling, since there is no solid scientific evidence I am aware of which suggests that this is causing substantial morbidity. If anything, I think these efforts are going to undermine legitimate efforts to promote smoke-free workplaces by creating a backlash and by exposing the lack of a public health justification for anti-smoking groups' efforts. Not every national tobacco control group is promoting these measures, but Americans for Nonsmokers' Rights appears to be playing a significant role.
Tactics: D
It's difficult not to give failing marks to a national tobacco control leadership that is using a campaign of deception to promote a piece of legislation that is Philip Morris' dream, that misled its constituents into thinking that Big Tobacco wholeheartedly supported the FDA legislation, that misled the public into thinking that Associate Attorney General Robert McCallum, who represented the government in the DOJ tobacco lawsuit, previously represented R.J. Reynolds in litigation, and which is giving awards and providing corporate partnerships to companies that are the leading causes of youth exposure to cigarette advertising and movie portrayals of cigarette smoking.
In addition, I don't like the direction the program is going in terms of its attacks on individuals and organizations, especially the undocumented claims that a number of groups which oppose tobacco control measures are tobacco industry front groups. This is seen most notably in the Americans for Nonsmokers' Rights hit list-like catalog of Big Tobacco front groups and allies, some of which ANR itself admits have no documented funding from any tobacco company.
No - I don't like the direction this program is going, and I think it may be time for a coaching change. Charlie Weis - are you available?
Based on the direction in which the tobacco control program is going in this country, I think it may be time for some new coaching.
Here's how I rate the program's national leadership:
Agenda: C-
The national agenda, largely set by the direction the Campaign for Tobacco-Free Kids is trying to take the program, is obsessively focused on the attempt to achieve federal regulation of tobacco products. It is a focus that is seemingly ignorant of the long history of dismal failures of federal tobacco policymaking, including the disastrous Federal Cigarette Labeling and Advertising Act of 1970, the equally disastrous Master Settlement Agreement, and what came close to being the catastrophic global tobacco bailout of 1998.
In order to achieve Philip Morris' support for federal regulation, which is apparently seen as necessary to enact this legislation, the health groups have had to accept compromises that have resulted in truck-size loopholes in the legislation which would provide unprecedented special protections for the tobacco companies, especially for the industry leader. The major health groups are now standing shoulder to shoulder with Philip Morris promoting this legislation, but at the same time, attacking Philip Morris for demanding special protections and for making campaign contributions to try to promote enactment of this bill which will "protect children" and "save lives." It has become a hypocrisy-laden circus and would certainly be the priority for the new coaching staff to straighten out.
At the same time, the national tobacco control program, again largely under the direction of the Campaign for Tobacco-Free Kids, seems to have become obsessed with increasing cigarette taxes to support virtually any government program under the sun. I view these taxes as discriminatory policies that serve to balance the state budgets on the backs of smokers, and what they are essentially doing is avoiding the more politically difficult decision to increase taxes on the wealthiest citizens and corporations in order to provide funds that the government should already be devoting to essential services. In addition, from a strategic viewpoint, the enactment of these taxes is making state governments dependent on tobacco consumption for essential services and is therefore removing any incentive to enact tobacco policies that will reduce cigarette use. Finally, the over-promotion of these taxes is making it difficult to promote what I think is perhaps the most important tobacco control intervention - the use of cigarette taxes to directly benefit smokers, through support for disease treatment, smoking cessation, and prevention.
Another problem with the agenda is the focus on penalizing, stigmatizing, and discriminating against smokers in order to try to change their behavior. This is seen most notably by efforts to promote or support employment policies by which smokers are fired from their jobs, assessed "health impact fees," or precluded from employment in the first place. While the national tobacco control leadership is ostensibly not to blame, their silence in the face of these discriminatory actions which are attempting to make smokers second-class citizens, unable to obtain employment, is I think enabling this aspect of the agenda.
Finally, the increasing trend of banning smoking in open, non-enclosed outdoors areas where people can move freely about is troubling, since there is no solid scientific evidence I am aware of which suggests that this is causing substantial morbidity. If anything, I think these efforts are going to undermine legitimate efforts to promote smoke-free workplaces by creating a backlash and by exposing the lack of a public health justification for anti-smoking groups' efforts. Not every national tobacco control group is promoting these measures, but Americans for Nonsmokers' Rights appears to be playing a significant role.
Tactics: D
It's difficult not to give failing marks to a national tobacco control leadership that is using a campaign of deception to promote a piece of legislation that is Philip Morris' dream, that misled its constituents into thinking that Big Tobacco wholeheartedly supported the FDA legislation, that misled the public into thinking that Associate Attorney General Robert McCallum, who represented the government in the DOJ tobacco lawsuit, previously represented R.J. Reynolds in litigation, and which is giving awards and providing corporate partnerships to companies that are the leading causes of youth exposure to cigarette advertising and movie portrayals of cigarette smoking.
In addition, I don't like the direction the program is going in terms of its attacks on individuals and organizations, especially the undocumented claims that a number of groups which oppose tobacco control measures are tobacco industry front groups. This is seen most notably in the Americans for Nonsmokers' Rights hit list-like catalog of Big Tobacco front groups and allies, some of which ANR itself admits have no documented funding from any tobacco company.
No - I don't like the direction this program is going, and I think it may be time for a coaching change. Charlie Weis - are you available?
Saturday, December 03, 2005
Comment Policy
Given what I've been through in the past couple of weeks on the receiving end of personal attacks in public forums, I want to make sure that this blog does not become a place where personal attacks are encouraged or tolerated. I love comments, I love dialogue, but please try to keep it to the issues and avoid personal attacks. I will be actively monitoring comments and will be forced to delete comments that cross the line from discussion of the issues into personal attacks.
Friday, December 02, 2005
Anti-Smoking Advocate Calls for Censorship of this Blog
In an email sent directly to me, an anti-smoking advocate has called for censorship of my expression of my opinions - in the form of a peer-review process for my blog articles before I post them.
I believe a slightly different approach in your work would serve you well. First, you could hold your criticism until after the proponents of matters of concern to you are given time for explanation or corrective action. This would enable you to carry out your work without creating public disputes, unduly burdening everyone's reading needs, or risking unintended support for tobacco.
"While I pass no judgment on the accuracy of anything you say--I do not have the time to review every detail, I am concerned about your work for a different reason than scientific accuracy. ... Many who look to your site for information ... are not able to devote the whole of their day to detailed analysis of as many tobacco related studies/matters as you devour and critique, nor are they able to respond to all your thoughts... However, each time your written views raise the slightest doubt about the appropriateness of some tobacco control activity/ position, or the accuracy/integrity of tobacco research, you cause serious pause. With your postings available to the public, your work can easily send a message that harms tobacco control efforts even if you do not intend this.
I believe a slightly different approach in your work would serve you well. First, you could hold your criticism until after the proponents of matters of concern to you are given time for explanation or corrective action. This would enable you to carry out your work without creating public disputes, unduly burdening everyone's reading needs, or risking unintended support for tobacco.
Second, you could invite a peer review before posting your thoughts on your blog."
The Rest of the Story
What's most interesting to me about this charming note is the reason why this advocate suggests that the expression of my views need to be censored or otherwise controlled. It's not that my views are inappropriate, inaccurate, or scientifically unsound, it's simply that:
I have heard of a fair number of attacks on bloggers, including some pretty harsh criticism of their work, but this is the first I've heard of someone suggesting that a blog needs to be peer-reviewed before it is published.
Apparently, the need for peer review is there even when I raise "the slightest doubt" about what the tobacco control movement, or any particular group within it, is doing.
Now I can't even have slight doubts about what we are doing in tobacco control without having to be controlled and the expression of my opinions suppressed or regulated.
I thought that tobacco control was supposed to be about regulating tobacco products, not regulating free speech and free expression of one's opinions.
I'm glad to hear that my blog articles are causing serious pause, because I think they should, given what I see going on in the tobacco control field. But the appropriate response is not to ask for me to withhold my opinions; I think the appropriate response would be to do something about it.
One option is to try to change the way things are being done, if the advocate finds my arguments compelling. Another option is to completely ignore me. Yet another is to vigorously disagree and express opposition to my opinions. But censorship of my expression of my opinions is not a valid option, at least not in this country.
The suggestion about holding my opinions to myself until after the actions in question can be explained to me is particularly charming. I guess I should also hold back my opinions about the war in Iraq until after it is resolved and the President has a chance to explain why we needed to sacrifice all those American lives.
Or more directly, I guess I should have waited for the Attorney General to call me on the phone to discuss why the Department of Justice changed its proposed smoking cessation remedy before I posted my opinion about the change in that remedy.
God forbid I should ever have the desire to criticize federal tobacco policy. I'll be waiting by the telephone for years before President Bush has the decency to call me so that I can then go ahead and post on my blog.
Actually, I kind of like the idea of a peer review process for my blog. It would make it the first blog to be peer-reviewed and maybe I could advertise it that way. Any volunteers to serve on the peer review committee?
The Rest of the Story
What's most interesting to me about this charming note is the reason why this advocate suggests that the expression of my views need to be censored or otherwise controlled. It's not that my views are inappropriate, inaccurate, or scientifically unsound, it's simply that:
- they run counter to his or her opinions;
- he or she doesn't want to take the time to actually read what I have to say; and therefore
- a roadblock needs to be set up to block me from expressing my opinions until some sort of control system or review can be put in place.
I have heard of a fair number of attacks on bloggers, including some pretty harsh criticism of their work, but this is the first I've heard of someone suggesting that a blog needs to be peer-reviewed before it is published.
Apparently, the need for peer review is there even when I raise "the slightest doubt" about what the tobacco control movement, or any particular group within it, is doing.
Now I can't even have slight doubts about what we are doing in tobacco control without having to be controlled and the expression of my opinions suppressed or regulated.
I thought that tobacco control was supposed to be about regulating tobacco products, not regulating free speech and free expression of one's opinions.
I'm glad to hear that my blog articles are causing serious pause, because I think they should, given what I see going on in the tobacco control field. But the appropriate response is not to ask for me to withhold my opinions; I think the appropriate response would be to do something about it.
One option is to try to change the way things are being done, if the advocate finds my arguments compelling. Another option is to completely ignore me. Yet another is to vigorously disagree and express opposition to my opinions. But censorship of my expression of my opinions is not a valid option, at least not in this country.
The suggestion about holding my opinions to myself until after the actions in question can be explained to me is particularly charming. I guess I should also hold back my opinions about the war in Iraq until after it is resolved and the President has a chance to explain why we needed to sacrifice all those American lives.
Or more directly, I guess I should have waited for the Attorney General to call me on the phone to discuss why the Department of Justice changed its proposed smoking cessation remedy before I posted my opinion about the change in that remedy.
God forbid I should ever have the desire to criticize federal tobacco policy. I'll be waiting by the telephone for years before President Bush has the decency to call me so that I can then go ahead and post on my blog.
Actually, I kind of like the idea of a peer review process for my blog. It would make it the first blog to be peer-reviewed and maybe I could advertise it that way. Any volunteers to serve on the peer review committee?
What A Scientific Response (Rather than a Personal Attack) to My Helena/Pueblo Analysis Might Look Like
Dr. Siegel:
I read with interest your analysis which failed to show any immediate, substantial decline in hospital admissions for heart attacks in states that implemented smoke-free restaurant and/or bar smoking bans. The scientific evaluation of this issue is of great interest to me since as a public health practitioner, I feel it is important to be very careful about the claims that we make to the public and to be sure that the data fully supports our claims before we disseminate them widely to the media.
Unfortunately, I do not find your argument to be compelling for the following reason. Generally, when states implement smoking bans, they are not going from a state of widespread secondhand smoke exposure in bars and restaurants to a state of no exposure. The usual pattern is that a large number of cities and towns within those states first enact smoke-free laws; this occurs gradually over a period of time and only after years of local enactment of policies is a statewide ban put in place.
This is certainly the pattern in California, where localities began passing smoke-free restaurant and bar laws in large numbers during the late 1980s and early 1990s - a pattern which continued until the ultimate statewide implementation of smoking bans in restaurants in 1995 and in bars in 1998.
For this reason, one might not expect to see the dramatic decline in acute cardiovascular morbidity that was observed in Helena and Pueblo, cities where no smoking ban existed prior to the implemented law, and therefore, cities in which the reduction in secondhand smoke exposure was truly from an extremely high level to an extremely low one. In California, since many cities and towns had already enacted smoke-free bar and restaurant laws prior to the statewide bans, the change in secondhand smoke exposure in these venues was probably not dramatic enough to expect to see the kinds of effects that would be observed at the city-level, especially in a city that had no prior regulation of smoking in its establishments.
While your thought of looking at statewide trends in myocardial infarction admissions to see if an impact of statewide smoking bans can be observed is an interesting one, ultimately it fails because the reduction in secondhand smoke associated with the regulation of smoking in bars and restaurants is a trend that happens gradually over time, even in states where a statewide law is implemented. This type of analysis is therefore not sensitive enough to pick up the smaller and more incremental changes in cardiovascular morbidity that might be attributable to this gradual trend in reduction in secondhand smoke exposure.
Even if it is the case that the primary effect of smoking bans on acute cardiovascular morbidity is attributable to reductions in active smoking (as opposed to decreases in secondhand smoke exposure), the changes in active smoking due to the implementation of smoking bans is something that would be expected to occur gradually over time.
The Rest of the Story
Because of the concerns I raise about my own analysis, I specifically do not think that this analysis demonstrates that smoking bans are not associated with immediate and drastic declines in acute cardiovascular morbidity. As I was careful to state in my original commentary: "I am not concluding here that smoking bans do not reduce heart attacks. I am not even concluding that smoking bans did not reduce heart attacks in Helena or Pueblo."
All that I am suggesting is that this is a complex area of inquiry, and that more research is necessary before we can draw definitive and generalized conclusions about the effects of smoking bans on acute cardiovascular morbidity.
Looking at trends over time in a phenomenon as complex as hospital admissions for heart attacks, and having just an 18-month period (and essentially one data point) before the law and an 18-month period (and essentially one data point) after the law is a very tough research design to draw causal conclusions about the effects of a smoking ban. With two data points, it is simply impossible (or perhaps slightly less than impossible) to determine the baseline underlying secular trend and extent of variability in that trend to evaluate, with confidence, the degree to which the observed change from one data point to the second represents a truly significant difference from the underlying variability in this statistic. Moreover, even if an effect were to be real, it is unclear how generalizable the finding would be to all other communities.
What the examination of state and national trends in hospital heart attack admissions adds is simply that it makes it clear that there is no obvious, dramatic, and immediate decline in heart attacks from smoking bans, sufficient to conclude definitively that public policy makers can expect a 27% to 40% decline in heart attacks in their cities if they ban smoking in bars and restaurants.
I read with interest your analysis which failed to show any immediate, substantial decline in hospital admissions for heart attacks in states that implemented smoke-free restaurant and/or bar smoking bans. The scientific evaluation of this issue is of great interest to me since as a public health practitioner, I feel it is important to be very careful about the claims that we make to the public and to be sure that the data fully supports our claims before we disseminate them widely to the media.
Unfortunately, I do not find your argument to be compelling for the following reason. Generally, when states implement smoking bans, they are not going from a state of widespread secondhand smoke exposure in bars and restaurants to a state of no exposure. The usual pattern is that a large number of cities and towns within those states first enact smoke-free laws; this occurs gradually over a period of time and only after years of local enactment of policies is a statewide ban put in place.
This is certainly the pattern in California, where localities began passing smoke-free restaurant and bar laws in large numbers during the late 1980s and early 1990s - a pattern which continued until the ultimate statewide implementation of smoking bans in restaurants in 1995 and in bars in 1998.
For this reason, one might not expect to see the dramatic decline in acute cardiovascular morbidity that was observed in Helena and Pueblo, cities where no smoking ban existed prior to the implemented law, and therefore, cities in which the reduction in secondhand smoke exposure was truly from an extremely high level to an extremely low one. In California, since many cities and towns had already enacted smoke-free bar and restaurant laws prior to the statewide bans, the change in secondhand smoke exposure in these venues was probably not dramatic enough to expect to see the kinds of effects that would be observed at the city-level, especially in a city that had no prior regulation of smoking in its establishments.
While your thought of looking at statewide trends in myocardial infarction admissions to see if an impact of statewide smoking bans can be observed is an interesting one, ultimately it fails because the reduction in secondhand smoke associated with the regulation of smoking in bars and restaurants is a trend that happens gradually over time, even in states where a statewide law is implemented. This type of analysis is therefore not sensitive enough to pick up the smaller and more incremental changes in cardiovascular morbidity that might be attributable to this gradual trend in reduction in secondhand smoke exposure.
Even if it is the case that the primary effect of smoking bans on acute cardiovascular morbidity is attributable to reductions in active smoking (as opposed to decreases in secondhand smoke exposure), the changes in active smoking due to the implementation of smoking bans is something that would be expected to occur gradually over time.
The Rest of the Story
Because of the concerns I raise about my own analysis, I specifically do not think that this analysis demonstrates that smoking bans are not associated with immediate and drastic declines in acute cardiovascular morbidity. As I was careful to state in my original commentary: "I am not concluding here that smoking bans do not reduce heart attacks. I am not even concluding that smoking bans did not reduce heart attacks in Helena or Pueblo."
All that I am suggesting is that this is a complex area of inquiry, and that more research is necessary before we can draw definitive and generalized conclusions about the effects of smoking bans on acute cardiovascular morbidity.
Looking at trends over time in a phenomenon as complex as hospital admissions for heart attacks, and having just an 18-month period (and essentially one data point) before the law and an 18-month period (and essentially one data point) after the law is a very tough research design to draw causal conclusions about the effects of a smoking ban. With two data points, it is simply impossible (or perhaps slightly less than impossible) to determine the baseline underlying secular trend and extent of variability in that trend to evaluate, with confidence, the degree to which the observed change from one data point to the second represents a truly significant difference from the underlying variability in this statistic. Moreover, even if an effect were to be real, it is unclear how generalizable the finding would be to all other communities.
What the examination of state and national trends in hospital heart attack admissions adds is simply that it makes it clear that there is no obvious, dramatic, and immediate decline in heart attacks from smoking bans, sufficient to conclude definitively that public policy makers can expect a 27% to 40% decline in heart attacks in their cities if they ban smoking in bars and restaurants.
Disrespect in the Tobacco Control Movement: For Individuals and for the Science
I want to comment today on two areas of disrespect that I have recently noted in the anti-smoking movement that I hope will be corrected in order to preserve the integrity of the movement.
First is disrespect for persons who offer an opinion or analysis that may run counter to the traditional dogma of the movement.
I have to honestly say that never in my years of testifying in tobacco litigation have I ever been treated with as much disrespect as has been shown to me by several tobacco control advocates who apparently are intent on assassinating the character of anyone who disagrees with their opinions, rather than engaging in any intelligent discussion of the scientific issues.
Even tobacco industry lawyers have always treated me with respect and dignity - nothing like the lack of respect I have been shown by a number of anti-smoking advocates in the past few days.
If, ten years ago, someone had told me that I was going to be accused of lying, falsifying information, and presenting analyses and opinions only to satisfy my ego, and had asked me who I thought would be the perpetrators of such insults - tobacco industry-affiliated persons or colleagues in the public health community, I would have guessed tobacco industry-affiliated persons. And I guess I would have been quite wrong.
Frankly, I am appalled by the way I have been treated in the tobacco control community because of my willingness to tell it like it is and challenge the dogma of the movement. Even if I am dead wrong in my analysis and commentary, there is no reason for colleagues to attack and insult me and treat me with disrespect. I would never do that to another person, no matter how much I disagreed with their opinions.
The second thing I'd like to comment on is disrespect for the science. I am incredulous as to what it was that precipitated this flurry of personal attacks and insults. All I did was perform an analysis of heart attack admission trends in states with and without statewide smoking bans for the years 1997-2003 and reported the results of this analysis and my conclusions based on the findings. That's it!
A simple analysis of heart attack trends over time, conducted in order to try to elucidate the relationship between smoking bans and acute cardiovascular morbidity should result in public attacks and insults by colleagues?
What this showed me is that the science doesn't really matter. It's the agenda that matters. Had my very same analysis turned out to show a decline in heart attack admissions in states with smoking bans, I would most likely have been praised by the very same colleagues who attacked me and the results would have been widely disseminated by now. It is clear to me that it is not my analysis which offended a number of my colleagues - it is the results that did.
I think we need to have a little more respect for, and interest in the science behind tobacco control. I see too much dismissal of scientific evidence simply because it does not support our position or because an author of a study once wrote a letter to a tobacco company. As public servants, I think it is our obligation to examine the science and evaluate it. Ultimately, our own credibility is at stake. And ultimately, disrespect for persons and for science is going to hurt the tobacco control movement far more than it is going to help.
First is disrespect for persons who offer an opinion or analysis that may run counter to the traditional dogma of the movement.
I have to honestly say that never in my years of testifying in tobacco litigation have I ever been treated with as much disrespect as has been shown to me by several tobacco control advocates who apparently are intent on assassinating the character of anyone who disagrees with their opinions, rather than engaging in any intelligent discussion of the scientific issues.
Even tobacco industry lawyers have always treated me with respect and dignity - nothing like the lack of respect I have been shown by a number of anti-smoking advocates in the past few days.
If, ten years ago, someone had told me that I was going to be accused of lying, falsifying information, and presenting analyses and opinions only to satisfy my ego, and had asked me who I thought would be the perpetrators of such insults - tobacco industry-affiliated persons or colleagues in the public health community, I would have guessed tobacco industry-affiliated persons. And I guess I would have been quite wrong.
Frankly, I am appalled by the way I have been treated in the tobacco control community because of my willingness to tell it like it is and challenge the dogma of the movement. Even if I am dead wrong in my analysis and commentary, there is no reason for colleagues to attack and insult me and treat me with disrespect. I would never do that to another person, no matter how much I disagreed with their opinions.
The second thing I'd like to comment on is disrespect for the science. I am incredulous as to what it was that precipitated this flurry of personal attacks and insults. All I did was perform an analysis of heart attack admission trends in states with and without statewide smoking bans for the years 1997-2003 and reported the results of this analysis and my conclusions based on the findings. That's it!
A simple analysis of heart attack trends over time, conducted in order to try to elucidate the relationship between smoking bans and acute cardiovascular morbidity should result in public attacks and insults by colleagues?
What this showed me is that the science doesn't really matter. It's the agenda that matters. Had my very same analysis turned out to show a decline in heart attack admissions in states with smoking bans, I would most likely have been praised by the very same colleagues who attacked me and the results would have been widely disseminated by now. It is clear to me that it is not my analysis which offended a number of my colleagues - it is the results that did.
I think we need to have a little more respect for, and interest in the science behind tobacco control. I see too much dismissal of scientific evidence simply because it does not support our position or because an author of a study once wrote a letter to a tobacco company. As public servants, I think it is our obligation to examine the science and evaluate it. Ultimately, our own credibility is at stake. And ultimately, disrespect for persons and for science is going to hurt the tobacco control movement far more than it is going to help.
Thursday, December 01, 2005
This is the Anti-Smoking Movement???
Is this what the anti-smoking movement is all about?
In response to my post yesterday which provided a detailed analysis questioning the claim that smoking bans lead to immediate and drastic reductions in heart attacks, yet another anti-smoking advocate publicly attacked me as follows:
"I find your comments intrusive and divisive... please look at the impacts of your comments and consider in a larger way what you are up to. It is a disservice to the larger community if what you are saying is about your ego, and an even larger disservice if it is intentionally dishonest."
The Rest of the Story
I can't help but start my commentary with the obviously inappropriate and possibly defamatory accusation that I am intentionally lying. I didn't include the advocate's entire comment, but I can certify that there was not a single specific fact mentioned in the response that I had purportedly lied about. If I am lying about something, I'd like to know what it is so I can correct it. But more importantly, I don't think it is appropriate to accuse me publicly of lying in front of a broad audience of my colleagues, and without even the decency of pointing out the specific fact or claim in question so that I have an opportunity to provide documentation (or correct the claim, if need be).
Second, the attack based on my ego is completely unwarranted. I can certify that the personal attacks I have been receiving since having the gall to suggest that maybe, just maybe, the claim of a 40% immediate drop in heart attacks due to a smoking ban was an exaggeration are not doing wonders for my ego. But even if they were, this has nothing to do with the basic matter at hand, which is the scientific evidence behind the evaluation of the impact of smoking bans on acute cardiovascular events.
Third, the substantive message behind this advocate's comments appears to be not that my arguments are scientifically invalid, but that I should muzzle myself because by challenging the dogma of the movement, I am being divisive.
And, more interestingly, that it is actually an intrusion upon anti-smoking advocates for them to have to listen to an opinion which doesn't coincide with their own. Expressing my opinion is apparently intrusive because of what my opinion happens to be. If I had conducted exactly the same analysis, but found a significant decline in heart attack admissions associated with smoking bans, then my comments would not have represented a divisive intrusion.
The lesson I am learning, and it is being driven home repeatedly now (this is not just an isolated case of one or two inappropriate and misguided actions), is that for many anti-smoking groups and advocates, the science and the facts are really not of interest. Unless they support the pre-conceived agenda, in which case they are of great interest.
But if the science doesn't support the agenda, then the messenger must be attacked, discredited, and silenced. Even defamed if that is necessary.
The sad thing is that many of these anti-smoking groups or practitioners do not seem to be willing to even look at the evidence. If they know it doesn't support the agenda and the claims that are being made, then it must be discredited before even examining it.
I find it quite interesting that over the past two days since I published my analysis and commentary, there has been literally zero discussion of the scientific issues behind the evaluation of the impact of smoking bans on acute cardiovascular morbidity. Instead, the discussion has been entirely focused on attacking me as well as the authors of the original study.
I can't help but make note of what FORCES' Gian Turci termed the Fourth Amendment of the tobacco control movement:
"The antitobacco movement is inherently right, just and true – thus, it is heresy to disagree with its goals and methods."
Honestly, when I first read that I thought it was a bunch of crap. But now I'm beginning to see that perhaps there is some serious truth to it. And it greatly saddens me.
In response to my post yesterday which provided a detailed analysis questioning the claim that smoking bans lead to immediate and drastic reductions in heart attacks, yet another anti-smoking advocate publicly attacked me as follows:
"I find your comments intrusive and divisive... please look at the impacts of your comments and consider in a larger way what you are up to. It is a disservice to the larger community if what you are saying is about your ego, and an even larger disservice if it is intentionally dishonest."
The Rest of the Story
I can't help but start my commentary with the obviously inappropriate and possibly defamatory accusation that I am intentionally lying. I didn't include the advocate's entire comment, but I can certify that there was not a single specific fact mentioned in the response that I had purportedly lied about. If I am lying about something, I'd like to know what it is so I can correct it. But more importantly, I don't think it is appropriate to accuse me publicly of lying in front of a broad audience of my colleagues, and without even the decency of pointing out the specific fact or claim in question so that I have an opportunity to provide documentation (or correct the claim, if need be).
Second, the attack based on my ego is completely unwarranted. I can certify that the personal attacks I have been receiving since having the gall to suggest that maybe, just maybe, the claim of a 40% immediate drop in heart attacks due to a smoking ban was an exaggeration are not doing wonders for my ego. But even if they were, this has nothing to do with the basic matter at hand, which is the scientific evidence behind the evaluation of the impact of smoking bans on acute cardiovascular events.
Third, the substantive message behind this advocate's comments appears to be not that my arguments are scientifically invalid, but that I should muzzle myself because by challenging the dogma of the movement, I am being divisive.
And, more interestingly, that it is actually an intrusion upon anti-smoking advocates for them to have to listen to an opinion which doesn't coincide with their own. Expressing my opinion is apparently intrusive because of what my opinion happens to be. If I had conducted exactly the same analysis, but found a significant decline in heart attack admissions associated with smoking bans, then my comments would not have represented a divisive intrusion.
The lesson I am learning, and it is being driven home repeatedly now (this is not just an isolated case of one or two inappropriate and misguided actions), is that for many anti-smoking groups and advocates, the science and the facts are really not of interest. Unless they support the pre-conceived agenda, in which case they are of great interest.
But if the science doesn't support the agenda, then the messenger must be attacked, discredited, and silenced. Even defamed if that is necessary.
The sad thing is that many of these anti-smoking groups or practitioners do not seem to be willing to even look at the evidence. If they know it doesn't support the agenda and the claims that are being made, then it must be discredited before even examining it.
I find it quite interesting that over the past two days since I published my analysis and commentary, there has been literally zero discussion of the scientific issues behind the evaluation of the impact of smoking bans on acute cardiovascular morbidity. Instead, the discussion has been entirely focused on attacking me as well as the authors of the original study.
I can't help but make note of what FORCES' Gian Turci termed the Fourth Amendment of the tobacco control movement:
"The antitobacco movement is inherently right, just and true – thus, it is heresy to disagree with its goals and methods."
Honestly, when I first read that I thought it was a bunch of crap. But now I'm beginning to see that perhaps there is some serious truth to it. And it greatly saddens me.
Anti-Smoking Advocates Have No Interest in Even Discussing the Science; The Agenda Cannot Be Challenged
In response to my post yesterday which provided a detailed analysis questioning the claim that smoking bans lead to immediate and drastic reductions in heart attacks, another anti-smoking advocate (different from the one whose attack and insult I discussed in my previous post) publicly attacked me as follows:
He called me a "contrarian gadfly," stating that "every group needs one--it's rather like a corpse at an Irish wake, and nobody pays much attention."
In response to my suggestion that it was inappropriate to insult me personally, rather than to actually attempt to discuss the scientific issues involved in the determination of the effects of smoking bans, yet another anti-smoking advocate stated:
"Michael McFadden is a personal insult, to me and (at least) several other people who read this list. Take it somewhere else."
The Rest of the Story
First of all, I am a good sport and don't mind being called a "contrarian gadfly." It actually has kind of a nice ring to it, and the advocate who attacked me as such has every right to opine that I am such. However, what is disturbing to me is the suggestion that we don't need to pay attention to opinions that differ from the dogma of the anti-smoking movement.
In other words, that in the anti-smoking movement, we have selective attention. We pay attention to, and consider the studies that support our agenda. However, if a study or analysis doesn't support our agenda, then we don't need to pay attention. We can just ignore it.
I view my role in public health as being a public servant. That's always how I have viewed my career as a physician and now as a public health professional. And I think we owe it to the public, who are essentially our clients, to be willing to examine all of the evidence before we make public claims.
Now this doesn't mean that we have to accept the evidence. It just means that we have to be willing to at least examine it. It may well be that an analysis is invalid or scientifically flawed. That's fine, and the study can then be trashed, but I think it needs to be trashed based on the lack of scientific merit, not based on the fact that it tends not to support the anti-smoking agenda.
Even studies that are produced by the tobacco industry or industry-paid consultants require our attention. Again, it may be that there are heavily biased and therefore laden with serious flaws, but it is our responsibility, I think, to examine the evidence and point out those flaws rather than simply to trash the study and ignore it because the author has a tobacco industry affiliation.
The danger here is that we are starting to do exactly what some have accused the anti-smoking movement of doing for a long time - cherry-picking the information that supports our cause. That's precisely what I think is going on here.
The truth of the matter is that while many tobacco control groups or advocates may not care enough about the science to pay attention, many individuals outside of the tobacco control movement are paying attention. Certainly, the thousands of readers who read my blog are paying attention. Certainly, those who read Reason Online's Hit&Run blog are paying attention. The readers at the Smokers' Club web site are paying attention. And the readers at FORCES are paying attention. And you can bet that my readers from the three leading tobacco companies are eagerly paying attention.
We are public servants. I think it's about time that we start paying attention.
Second, the fact that one individual advocate happens to be insulted by the mention of the name of one of the authors of a study does not in any way justify an attack and insult against me. What is happening here is classic guilt-by-association.
Frankly, this is really scary to me. I have heard certain smokers' rights groups talk about McCarthyism in the anti-smoking movement, and I honestly thought that was a bunch of crap, but now I am beginning to question whether or not there might be some truth to it after all. My experience during the past 24 hours certainly hasn't helped to dispel that notion.
The rest of the story is that it is becoming quite clear to me that many tobacco control advocates really are not interested in discussing the science behind their public claims. If the science doesn't support the agenda, then the messenger of that bad news needs to be attacked. This is a truly sad state of affairs.
He called me a "contrarian gadfly," stating that "every group needs one--it's rather like a corpse at an Irish wake, and nobody pays much attention."
In response to my suggestion that it was inappropriate to insult me personally, rather than to actually attempt to discuss the scientific issues involved in the determination of the effects of smoking bans, yet another anti-smoking advocate stated:
"Michael McFadden is a personal insult, to me and (at least) several other people who read this list. Take it somewhere else."
The Rest of the Story
First of all, I am a good sport and don't mind being called a "contrarian gadfly." It actually has kind of a nice ring to it, and the advocate who attacked me as such has every right to opine that I am such. However, what is disturbing to me is the suggestion that we don't need to pay attention to opinions that differ from the dogma of the anti-smoking movement.
In other words, that in the anti-smoking movement, we have selective attention. We pay attention to, and consider the studies that support our agenda. However, if a study or analysis doesn't support our agenda, then we don't need to pay attention. We can just ignore it.
I view my role in public health as being a public servant. That's always how I have viewed my career as a physician and now as a public health professional. And I think we owe it to the public, who are essentially our clients, to be willing to examine all of the evidence before we make public claims.
Now this doesn't mean that we have to accept the evidence. It just means that we have to be willing to at least examine it. It may well be that an analysis is invalid or scientifically flawed. That's fine, and the study can then be trashed, but I think it needs to be trashed based on the lack of scientific merit, not based on the fact that it tends not to support the anti-smoking agenda.
Even studies that are produced by the tobacco industry or industry-paid consultants require our attention. Again, it may be that there are heavily biased and therefore laden with serious flaws, but it is our responsibility, I think, to examine the evidence and point out those flaws rather than simply to trash the study and ignore it because the author has a tobacco industry affiliation.
The danger here is that we are starting to do exactly what some have accused the anti-smoking movement of doing for a long time - cherry-picking the information that supports our cause. That's precisely what I think is going on here.
The truth of the matter is that while many tobacco control groups or advocates may not care enough about the science to pay attention, many individuals outside of the tobacco control movement are paying attention. Certainly, the thousands of readers who read my blog are paying attention. Certainly, those who read Reason Online's Hit&Run blog are paying attention. The readers at the Smokers' Club web site are paying attention. And the readers at FORCES are paying attention. And you can bet that my readers from the three leading tobacco companies are eagerly paying attention.
We are public servants. I think it's about time that we start paying attention.
Second, the fact that one individual advocate happens to be insulted by the mention of the name of one of the authors of a study does not in any way justify an attack and insult against me. What is happening here is classic guilt-by-association.
Frankly, this is really scary to me. I have heard certain smokers' rights groups talk about McCarthyism in the anti-smoking movement, and I honestly thought that was a bunch of crap, but now I am beginning to question whether or not there might be some truth to it after all. My experience during the past 24 hours certainly hasn't helped to dispel that notion.
The rest of the story is that it is becoming quite clear to me that many tobacco control advocates really are not interested in discussing the science behind their public claims. If the science doesn't support the agenda, then the messenger of that bad news needs to be attacked. This is a truly sad state of affairs.
Wednesday, November 30, 2005
When You Don't Like What You Hear, Attack the Messenger - But Don't Discuss the Issues
In response to my post yesterday which provided a detailed analysis questioning the claim that smoking bans lead to immediate and drastic reductions in heart attacks, a prominent anti-smoking advocate publicly attacked me as follows:
"My general approach has been to ignore Michael Siegel, but his latest "analysis" is just too strange. He is publicising a "study" on the "Smokers' Club" web site. This "study" does not even account for population growth and there are no controls ... but only Mike can tell real quality."
The Rest of the Story
First of all, had the advocate taken the time to actually read and think about what I wrote instead of simply publicly attacking me, he or she would have noted that I was not relying upon the Smokers' Club web site study, but that I analyzed the data myself. It is my analysis (and not just what Michael McFadden and David Kuneman did) that suggests that there has been no observable (or at least no substantial) decline in heart attack admissions due to state-wide smoking bans. Even if I had relied upon the Kuneman-McFadden study without performing my own analysis, I would argue that it isn't invalidated because of who the authors are, but that it needs to be examined based on the actual data it presents. But this analysis is not going to be shot down on the basis of its authors being affiliated with the Smoker's Club, because I stand by the analysis, I think it is entirely an appropriate one (certainly with my extensions that extended the baseline period and used two comparison groups), and I think it demonstrates that there simply was not a dramatic decline in hospital admissions following the implementation of state-wide smoking bans.
Second of all, there is simply no way that population growth can account for the failure to observe a 27% to 40% decline in heart attack admissions (or even half of that) if one existed. Plus, if population growth were explaining the failure to detect such an effect, then there would have had to be basically at least a 13% difference in population growth between the smoking ban and comparison states and that difference would have had to be systematically different between the two groups.
Third of all, had the advocate read and thought about my comments before attacking me, he or she would have noted that I did employ 2 comparison groups - first, all of the states in the HCUP database in which a smoking ban was not implemented during the study period; and second, the entire country. If the entire country does not qualify as a comparison group, then I don't know what does.
Look - I am not claiming that this analysis is perfect or even that it suggests that smoking bans do not have a significant effect on heart attacks. My only point is that I think it is simply premature to be publicly claiming that smoking bans will produce a 27%-40% reduction in heart attack admissions. That's it.
Most importantly, I think I am bringing to light an important issue that deserves careful attention and further scientific analysis. I think that it deserves consideration. But attacking and insulting the person who makes such a suggestion without even attempting to read the entire piece or to discuss the scientific issues intelligently is just not appropriate.
And what it suggests to me, honestly, is that there is something missing. And what I think is missing is a sincere interest in discussing the science and in considering the different possibilities for what might explain the observed findings in the existing literature. This is precisely why it suggests to me that for some in the anti-smoking movement, the agenda seems to be driving the interpretation of the science rather than the science driving the agenda.
This has been a true learning experience for me. Never did I dream that some day, after 21 years of experience in tobacco policy research, as a statistical editor of perhaps the top tobacco control journal, and with over 50 peer-reviewed publications in top public health and medical journals, I would present a reasonably detailed scientific analysis of a tobacco control policy issue and then be publicly attacked and insulted for having the courage to present my opinions.
But because they apparently go against the anti-smoking agenda, I have now been publicly attacked and insulted. That's a shame.
But what's even more of a shame is that this issue really has nothing to do with the anti-smoking agenda. The issue of smoking bans should be decided based on the evidence regarding the health effects of secondhand smoke on bar and restaurant workers. It really doesn't matter, in my mind, whether smoking bans reduce heart attacks or not. The justification for such bans does not rest on such a determination. What does seem to depend on it, however, is the political ammunition that some anti-smoking groups and advocates seem to desire.
Finally, there are a lot of people who have expressed their scientific opinions on issues in tobacco control who I disagree with. But I would never attack and insult any of them, privately or publicly, for expressing their views. I think there has got to be a better way to practice public health and tobacco control.
The Rest of the Story
First of all, had the advocate taken the time to actually read and think about what I wrote instead of simply publicly attacking me, he or she would have noted that I was not relying upon the Smokers' Club web site study, but that I analyzed the data myself. It is my analysis (and not just what Michael McFadden and David Kuneman did) that suggests that there has been no observable (or at least no substantial) decline in heart attack admissions due to state-wide smoking bans. Even if I had relied upon the Kuneman-McFadden study without performing my own analysis, I would argue that it isn't invalidated because of who the authors are, but that it needs to be examined based on the actual data it presents. But this analysis is not going to be shot down on the basis of its authors being affiliated with the Smoker's Club, because I stand by the analysis, I think it is entirely an appropriate one (certainly with my extensions that extended the baseline period and used two comparison groups), and I think it demonstrates that there simply was not a dramatic decline in hospital admissions following the implementation of state-wide smoking bans.
Second of all, there is simply no way that population growth can account for the failure to observe a 27% to 40% decline in heart attack admissions (or even half of that) if one existed. Plus, if population growth were explaining the failure to detect such an effect, then there would have had to be basically at least a 13% difference in population growth between the smoking ban and comparison states and that difference would have had to be systematically different between the two groups.
Third of all, had the advocate read and thought about my comments before attacking me, he or she would have noted that I did employ 2 comparison groups - first, all of the states in the HCUP database in which a smoking ban was not implemented during the study period; and second, the entire country. If the entire country does not qualify as a comparison group, then I don't know what does.
Look - I am not claiming that this analysis is perfect or even that it suggests that smoking bans do not have a significant effect on heart attacks. My only point is that I think it is simply premature to be publicly claiming that smoking bans will produce a 27%-40% reduction in heart attack admissions. That's it.
Most importantly, I think I am bringing to light an important issue that deserves careful attention and further scientific analysis. I think that it deserves consideration. But attacking and insulting the person who makes such a suggestion without even attempting to read the entire piece or to discuss the scientific issues intelligently is just not appropriate.
And what it suggests to me, honestly, is that there is something missing. And what I think is missing is a sincere interest in discussing the science and in considering the different possibilities for what might explain the observed findings in the existing literature. This is precisely why it suggests to me that for some in the anti-smoking movement, the agenda seems to be driving the interpretation of the science rather than the science driving the agenda.
This has been a true learning experience for me. Never did I dream that some day, after 21 years of experience in tobacco policy research, as a statistical editor of perhaps the top tobacco control journal, and with over 50 peer-reviewed publications in top public health and medical journals, I would present a reasonably detailed scientific analysis of a tobacco control policy issue and then be publicly attacked and insulted for having the courage to present my opinions.
But because they apparently go against the anti-smoking agenda, I have now been publicly attacked and insulted. That's a shame.
But what's even more of a shame is that this issue really has nothing to do with the anti-smoking agenda. The issue of smoking bans should be decided based on the evidence regarding the health effects of secondhand smoke on bar and restaurant workers. It really doesn't matter, in my mind, whether smoking bans reduce heart attacks or not. The justification for such bans does not rest on such a determination. What does seem to depend on it, however, is the political ammunition that some anti-smoking groups and advocates seem to desire.
Finally, there are a lot of people who have expressed their scientific opinions on issues in tobacco control who I disagree with. But I would never attack and insult any of them, privately or publicly, for expressing their views. I think there has got to be a better way to practice public health and tobacco control.
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