Tuesday, July 05, 2005

Some Anti-Smoking Advocates Viewing Ethics (and this Blog) as a Distraction to their Work

The Rest of the Story, its author, and the serious ethical concerns that it has expressed about the tactics being used by many anti-smoking organizations are apparently being viewed as a distraction to the important work being done by anti-smoking advocates and organizations.

I have received a number of comments from anti-smoking advocates protesting my recent posts and calling them a distraction to the movement, but this personal comment was perhaps the most telling:

"This is really getting old. There are so many really important substantial issues we could be talking about and actions we could be considering, if we were not mired down addressing Michael's BLOG editorial comments critical of our allies in the tobacco control community. ... We are being diverted away from our right and proper focus."

The Rest of the Story

I am sorry that ethical concerns are apparently viewed by some as a distraction and diversion from the important substantial issues of the anti-smoking movement.

And I'm sorry that this blog is apparently hindering public health practitioners from talking about and taking action on such issues.

Actually, one of my purposes in creating this tobacco control blog was to stimulate discussion on issues that I feel are most substantial and most important in the movement. And right now, I can think of nothing that takes precedence in its importance over the way in which tobacco control practitioners practice public health, especially the responsibility to conduct their practices ethically.

The ethical practice of tobacco control and public health is in fact our right and proper focus.

It is perhaps fitting that the lead editorial in this month's American Journal of Public Health is entitled: "The Challenges and Opportunities of Ethics" (see: Dickens BM. The Challenges and Opportunities of Ethics. Am J Public Health 2005; 95:1094).

The editorial emphasizes "the responsibility of public health practitioners and scientists to conduct their practices ethically."

Specifically, the editorial suggests that the kind of ethical concerns that apply to individual research with human subjects should also apply at the collective level, and not only to research, but to the very practice of public health. Because of this assertion, I view this as an important piece in the public health literature.

It is easy to see why it would be unethical to mislead an individual subject in a public health intervention about the reasons for such an intervention. But perhaps it is not as easy to see why it might also be considered unethical for a public health organization to mislead a community of individuals (e.g., the public) about the underlying facts regarding the development of a public health policy proposal, or about the facts regarding certain individuals who are involved in public health policy debates.

But the principle of informed consent, if viewed to apply to communities as well as individuals, dictates that the same level of care and scrutiny that is given to communications to individual human subjects also be given to public communications that are attempting to influence the public's perception of an individual or of a public policy debate, and especially if those communications are designed to stir the public to political action.

My previous discussion of APHA's code of ethical practice discusses the "community-level" equivalent of the individual-level ethical principle of informed consent.

Rather than being a distraction to the public health practice of tobacco control, I view the issues being raised in The Rest of the Story as being the "right and proper focus" of tobacco control and public health practice.

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