Monday, October 17, 2005

Who I Am: Thoughts on the Anti-Smoking Movement and Public Health

It has reached a point where I need to clarify who I am. A number of interesting theories have circulated. One is that I am being funded by the Republican Party. Another is that I am now working on the side of the tobacco companies. Anti-smoking advocates are questioning whether I am a "good guy" or a "bad guy" (those are their terms, not mine). An email from a colleague just this past weekend questioned whether I am working for the tobacco companies. And this is from someone who is familiar with my work, not with someone just happening upon the blog without any knowledge of who I am (although I thought I made that clear in my profile).

Before answering the question (I am a good guy), let me comment on how unfortunate it is that I even have to address this. I have spent my professional life working to reduce the morbidity and mortality from tobacco-related diseases. I have worked for 21 years to help prevent kids from smoking and to help existing smokers to quit. I have worked for 21 years to protect the public from secondhand smoke exposure in workplaces and was partly responsible for the re-framing of the issue of clean indoor air protection from one of protecting customers to one of protecting bar and restaurant workers. I have testified in more than 100 different cities and towns in support of legislation to protect bar and restaurant workers from secondhand smoke exposure.

I have testified in no less than 7 trials against the tobacco companies. I was a key witness in the Engle case, which resulted in a $145 billion verdict against the industry, a verdict that might have forced the industry into bankruptcy had it not been for a last-minute move by the Florida legislature to reduce the amount of the appeal bond that the industry had to pay in order to appeal the decision. I was also a key witness in the Broin case, which resulted in a $350 million settlement and established the largest foundation dedicated to research to prevent and/or treat diseases associated with tobacco smoke.

I have worked to reduce the toll of tobacco on people's lives since I was 20 years old. Although I have other interests in medicine and public health, I have never focused on any area other than tobacco control. I sat on the board of Americans for Nonsmokers' Rights for several years. I spent two years working at the Office on Smoking and Health at CDC. And I now serve as a methodologic/statistical editor for Tobacco Control, one of the only two journals dedicated to tobacco control in the world.

So I find the fact that I have to now defend myself appalling.

It demonstrates, I think, the truth of one of my challenging dogma posts: that if you challenge the party line in the anti-smoking movement, you must not be a part of the movement. Immediately, the speculation begins - are you funded by the industry? Are you a closet conservative? Have you simply gone off your rocker?

Rather than dealing with the arguments that I have been raising for six months, the movement is attacking me. The criticisms I am hearing are not about my arguments, but about me and what I am doing. I'm a relatively good sport and I'll live with the attacks, but it would be nice if my writings over the past six months could start a dialogue about the issues, rather than about me.

Interestingly, my most stringent critics within the anti-smoking movement have specifically not expressed disagreement with most, if any, of my arguments. They have simply tried to silence me because they felt that what I was doing was going to hurt the "cause." Or that I should find better things to do with my time than to criticize organizations that are, after all, doing good things and are on the correct side of the issue.

Because I have been courageous enough to criticize what I feel is unethical, inappropriate, or irresponsible conduct on the part of anti-smoking organizations, I am now being attacked personally and my own career is threatened. I have to defend myself against these attacks. I will do it, but not without sadness that it has come to this.

The Rest of the Story

First and foremost, I am a physician. And although I no longer treat patients, I have treated enough patients to know that I am going to dedicate my career to trying to reduce suffering caused by tobacco-related diseases. It is for the smokers who I treated during my clinical experience that I am working today. I have made the decision to dedicate my career to preventing disease rather than waiting until it is too late. So first, I am a preventive medicine physician and the focus of my career has been, and will continue to be, preventing smoking-related morbidity and mortality.

Second, I am a public health researcher, practitioner, and advocate. While I have a broad range of interests in public health, one cannot escape the fact that tobacco is the leading preventable cause of death and disease. So I think all public health efforts, and particularly my own, should logically begin with trying to reduce suffering caused by smoking-related disease and death. So my interests as a preventive medicine physician and a public health researcher, practitioner, and advocate converge.

Who am I? I am no different than I have been for the past 21 years: a physician and public health researcher and practitioner who is dedicating my career to trying to improve the public's health by reducing morbidity and mortality from tobacco-related disease.

As I stated in my profile (which, incidentally, is visible on every page on my blog): "I am a physician who specialized in preventive medicine and public health. I am now a professor in the Social and Behavioral Sciences Department, Boston University School of Public Health. I have 20 years of experience in tobacco control, primarily as a researcher. My areas of research interest include the health effects of secondhand smoke, policy aspects of regulating smoking in public places, effects of cigarette marketing on youth smoking behavior, and the evaluation of tobacco control program and policy interventions."

I am still doing research on the policy aspects of regulating smoking in public places and on the evaluation of tobacco control program and policy interventions, I am still advocating for smoke-free workplace policies, I am still testifying in tobacco litigation, I am still a statistical editor for Tobacco Control.

So I have not changed at all.

What has changed is the anti-smoking movement.

It has changed from a true, grassroots social movement run largely by volunteers to a highly centralized, professional movement, dominated by a few major, well-funded organizations that have coopted the entire movement, taken things into their own hands, and set us in a direction that I think is contrary to the basic goals I have been working for during my 21 years in public health.

It has changed from a movement that prided itself, and distinguished itself from the tobacco industry, on the truth to one that doesn't seem to care whether its public statements are factual, so long as the ultimate goal of achieving its desired legislation is supported.

It has changed from a movement with some integrity to one that doesn't seem to care about the means, only the ends. As long as the end we are working for is a good one, we can do pretty much anything we need to in order to get there, even if that means issuing unwarranted and untruthful personal attacks against individuals or groups, lying to the public, misleading people in our public communications, and throwing ethics aside in order to achieve our goals.

It has changed from a movement that was trying to help smokers to one that is trying to penalize them. The movement is supporting ever-increasing cigarette taxes to balance state budgets as well as policies that would essentially result in smokers becoming second class citizens by not being able to be employed due to worker policies that deny employment to individuals who smoke.

It has changed from a movement that was backed up by science to one that is pursuing its ends regardless of the science. The movement is increasingly supporting policies that ban smoking not only indoors, but outdoors, in wide open areas where there simply is not evidence of any substantial health effects. The movement is also supporting policies that create an unlevel playing field of health protection, offering protection to some workers but denying it to others.

It has changed from a movement that used the law as a vehicle to advance appropriate legal interests to one that is trying to use the law as a free-for-all to gain any number of public health goals that are simply not supported by the law.

It has changed from a movement that spoke out against tobacco advertising to one that now gives awards to groups that expose millions of kids to tobacco advertising.

It has changed from a movement that spoke out against front groups that allowed Big Tobacco to hide behind the scenes while paying to support efforts to promote its interests, to one that now uses front groups itself.

And it has changed from a movement that was once fighting Big Tobacco to one that is now standing shoulder to shoulder with the largest cigarette manufacturer in the world, on the verge of helping it to achieve legislation that will serve to basically destroy my ability to continue working to prevent tobacco-related disease and death. And it is being promoted with unethical means, deceptive communications, and with the inappropriate recruitment of youths to advance this narrow-minded and misguided cause. And it is being done without the appropriate input of the public health community, especially the individuals working at the grassroots who know best the types of interventions that are most effective in reducing tobacco use.

It's been breaking my heart every day watching the movement go in this direction.

And there's only one way that I know of to try to change things and restore the movement to a more ethical, responsible, appropriate, and effective path. And that's to speak out for what I believe is right and to write about, chronicle, document, and expose what is happening to the movement.

And that's what this blog is about - nothing more and nothing less.

So if anti-smoking advocates want to characterize what I am doing as helping out the tobacco industry, that's their right. But if they would open their eyes for just a few minutes and read what I've actually written, I think they would see that in the long run, it is not the industry that will be helped by having a strong, respectable tobacco control movement that has credibility among the public because it represents everything that the tobacco industry does not - especially honesty and integrity. It is the public health cause, not tobacco profits, that stand to gain. If what I'm doing is playing into the hands of the industry, then it is my critics who have gone off the deep end, not me.

If anti-smoking advocates want to characterize what I'm doing as dividing the tobacco control community and breaking its solidarity, that's their right. But if they would open their eyes for just a few minutes, I think they would see that it is not me who decided to negotiate a bill with Philip Morris, it is not me who decided to award the nation's leading carrier of tobacco ads that reach children, it is not me who forged a partnership with the corporation that is exposing the most children to smoking in movies, it is not me who made a unilateral decision to support legislation that would essentially provide immunity to the tobacco industry.

I am simply reacting to what the leading organizations in tobacco control have done to destroy this movement that I have been a part of. If there is now a lack of solidarity, it's their fault, not mine. I'm not lobbying Congress to help Philip Morris achieve its chief legislative priority - they are.

I write this blog every day because every day I wake up, my heart is broken thinking about what I cannot do because of what the anti-smoking movement has become.

It truly breaks my heart to realize that the grassroots social movement that we once were has been taken over by a few organizations, that, in their zeal to achieve gains for which they can claim credit are on the verge of undoing everything I have been working for during my last 21 years in public health.

And you know what? Seeing what is going on in the anti-smoking movement, I cannot wake up each day as a member of that movement and look at myself in the mirror and have any sense of pride. How can I consider myself to be in the anti-smoking movement when I know that very movement is lobbying for legislation that will help Philip Morris achieve a monopoly and allow it to continue selling its deadly products with virtual immunity?

How can I consider myself to be in the anti-smoking movement when by virtue of one organization's actions, I become a partner with a corporation that is responsible for millions of kids being exposed to cigarette advertising in magazines and movies?

How can I consider myself to be in the anti-smoking movement when I check out the web site of a leading anti-smoking organization and find that with no evidence whatsoever (and an admission that there is no evidence), a group is being attacked as being a tobacco industry front group when I know for a fact that group is representing the interests of its members, not those of Big Tobacco?

How can I consider myself to be in the anti-smoking movement when I look at the web site of a major anti-smoking organization and see that it is essentially lying in order to pursue its particular legislative goals - goals that I think are completely misguided?

What I think has happened is that the anti-smoking movement has departed from public health. This is not what public health is supposed to be about. There are ethical codes of conduct that public health practitioners follow. And I am going to follow them. And I won't be part of any movement that doesn't.

So while I consider myself to be a public health researcher, practitioner and advocate who specializes in trying to prevent and reduce suffering from tobacco-related disease, I no longer consider myself to be part of the anti-smoking movement.

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