Today is Kick Butts Day, a national day of youth advocacy on the tobacco issue run by the Campaign for Tobacco-Free Kids. The Campaign is asking youths throughout the country to "Stand Out, Speak Up, and Seize Control in the fight against Big Tobacco."
The Rest of the Story
While the Campaign's goal of encouraging youths to advocate for tobacco control policies seems laudable, surprises await for those who take the time to read what the Campaign is actually telling kids, and not telling them.
The online Kick Butts Day guidebook links youths to a Campaign for Tobacco-Free Kids web site that provides education and guidance about tobacco control activities in which youths are encouraged to take part. And one of those activities is advocacy in support of the Tobacco-Free Kids and Philip Morris-supported legislation to grant FDA authority to regulate tobacco products.
The web site tells kids that: "Tobacco products are deadly and addictive, yet they're almost completely unregulated by the government to protect our health and safety. That's because Congress has not granted the FDA, which regulates food and other consumer products, the authority to regulate tobacco. There are many actions that the FDA could take to better protect people from tobacco products and the tobacco industry's deceptive marketing. The Campaign for Tobacco-Free Kids has a special report on FDA regulation and a series of factsheets that summarize what effective FDA regulation of tobacco products means."
"How does effective FDA regulation help people? If effective FDA regulation becomes a law, the FDA could regulate how tobacco products are made, marketed and sold. Here are some examples of how:
• The FDA could require tobacco companies to take out some of the dangerous chemicals in tobacco products so they won't be as harmful or addictive.
• The FDA could stop marketing that targets youth.
• The FDA can crack down on stores that sell cigarettes to youth.
The Campaign for Tobacco-Free Kids goes on to tell youths to "Write, call or e-mail your U.S. Representatives and Senators and tell them you support FDA regulation of tobacco products. Send them information about effective regulation of tobacco. Tell them not to support any bill that protects the tobacco industry instead of our health," and to "Organize your community around the importance of FDA regulation."
Importantly, a March 17, 2005 report that the Campaign refers kids to states that: "The FDA’s authority to regulate tobacco products would be comparable to its existing authority for drugs, devices, and foods."
And most importantly, nowhere on any of the Campaign's youth web sites and in none of the reports or fact sheets to which the Campaign refers youth does the Campaign inform the kids they are trying to recruit to promote the FDA legislation of a critical piece of information: that Philip Morris, the nation's largest tobacco company, supports the very same FDA legislation, is actively lobbying for its passage, and has told its shareholders that the defeat of last year's FDA legislation was "a significant disappointment" and that passage of this year's legislation is "a key priority."
I believe that the Campaign for Tobacco-Free Kids' actions are unethical and inappropriate because it appears that the Campaign is manipulating kids to further its own legislative goal of enacting S. 666 and H.R. 1376. It certainly appears that the Campaign is being intentionally deceptive in its presentation of the critical issues regarding this legislation to the youths it is trying to recruit to promote these bills. There a number of elements of this deception:
First, the Campaign states that: "The FDA’s authority to regulate tobacco products would be comparable to its existing authority for drugs, devices, and foods." Presumably, this statement, released on March 17, 2005 (the date S. 666 and H.R. 1376 were introduced) refers to the FDA legislation that was introduced. Such a statement is grossly misleading, if not inaccurate and false.
The very first provision of the FDA legislation is that: "Tobacco products shall be regulated by the Secretary under this chapter and shall not be subject to the provisions of chapter V." So the very premise of the entire legislation is that tobacco products are not to be regulated under the same rules by which FDA regulates drugs and devices (and foods). In fact, FDA's authority to regulate tobacco products under the legislation is not at all comparable to its existing authority for drugs, devices, and foods. Far from it - the FDA's authority to regulate tobacco products is completely different from its authority to regulate drugs, devices, and foods.
Second, the Campaign is asking youths throughout the country to "Stand Out, Speak Up, and Seize Control in the fight against Big Tobacco." Is it not then only fair to inform these youths that Big Tobacco (at least in the form of its largest and most important and influential component - Philip Morris) - supports FDA regulation of tobacco products, supports the specific legislation that youths are being recruited to promote, viewed last year's defeat of the essentially identical FDA legislation as a signficant disappointment, and views the passage of the legislation this year as a key priority.
It seems to me that if you are going to try to recruit kids to support FDA legislation, then they at very least have the right to know that Philip Morris is vigorously supporting and lobbying for that legislation. To omit this critical piece of information is deceptive, and it is hard to imagine that it is anything other than intentional deception, since it's difficult to believe that it represents a simple oversight on the Campaign's part. The Campaign obviously made a deliberate decision not to include this information in its recruitment package provided to the kids.
Third, the Campaign instructs youths to tell their Congresspersons not to support any bill that protects the tobacco industry instead of health. But the Campaign fails to inform youths that there are a number of provisions in the legislation that are there specifically to protect the tobacco industry and that have no health protection purpose. The Campaign itself has admitted that these are compromises; there is no disagreement that these provisions are specifically there to protect the tobacco industry.
Fourth, the Campaign leads kids to believe that by taking out "some of the dangerous chemicals in tobacco products," these products will not be "as harmful." Is the Campaign not aware that such an assertion is misleading, since the Campaign itself, on the very same Kick Butts web site, empasizes to kids that "There are over 4000 chemicals in a single puff of cigarette smoke, and 69 of them are known carcinogens." Is the Campaign ready to make a public statement that removing just some of these 4000 chemicals and 69 carcinogens will produce a safer cigarette? Is it not hypocritical to suggest such a fact to kids on the one hand, and then on the other hand, to complain about how terrible it is that cigarette companies may make even mild claims (such as that a product reduces exposure to a given substance) without having solid documentation of the reduced risk?
As the Campaign itself has stated: "These bills would prohibit tobacco companies from making any explicit or implicit health claims, such as reduced risk of disease or reduced exposure to specific toxins, without first proving to the FDA that the scientific evidence is adequate to conclude BOTH 1) that the product as actually used by consumers will significantly reduce the risk of disease to individual consumers AND 2) that the product as marketed will benefit the health of the population as a whole." Is it unacceptable for tobacco companies to make health claims without incontrovertible evidence but somehow acceptable for the Campaign for Tobacco-Free Kids to make just about the very same contention to kids, but without any solid documentation?
Finally, is it not deceptive to tell kids that the FDA legislation will allow the Agency to "stop marketing that targets youth" when the Campaign knows full well that the Supreme Court of the United States has overturned even far less restrictive advertising laws on the grounds that they are too sweeping to satisfy the requirements of the First Amendment of the Constitution?
Manipulation is defined as "influencing or managing shrewdly or deviously," and devious as "not straightforward...misleading...deceptive." It certainly seems to me that the Campaign for Tobacco-Free Kids is influencing kids to promote FDA legislation, and that the Campaign is doing so in a devious way - a way that is not straightforward, but rather is quite misleading and quite deceptive.
I find the Campaign's manipulation of kids to be not only highly inappropriate, but also unethical, because it violates accepted standards of professional public health conduct that require public health organizations to provide the public with full and accurate information that is necessary to make decisions on policies. This is what the APHA Public Health Code of Ethics calls the "community-level" equivalent of the individual-level ethical principle of informed consent:
"Public health institutions should provide communities with the information they have that is needed for decisions on policies or programs and should obtain the community’s consent for their implementation. ... there is a moral obligation in some instances to share what is known. For example, active and informed participation in policy-making processes requires access to relevant information. ...Such processes depend upon an informed community. The information obtained by public health institutions is to be considered public property and made available to the public."
I think that the obligation to share the information relevant to the decision whether to support a public health policy is particularly important when it is children that are being recruited to promote such a policy. This is because kids are far less able to find out the necessary, relevant information on their own, and they are more susceptible to the possibility of manipulation of their attitudes.
The rest of the story reveals that the Campaign for Tobacco-Free Kids is manipulating kids to promote FDA tobacco legislation by presenting them with incomplete and misleading information about that legislation. These actions, I think, violate established standards of ethical public health practice. This story should once again underscore to tobacco control and public health practitioners the obligation for us to use appropriate and ethical means to pursue our intended ends, regardless of how noble and important we think those ends might be.