Tuesday, November 01, 2005

IN MY VIEW: Public Health Reform in Tobacco Control Should Start with New Priorities for the Campaign for Tobacco-Free Kids

As I have stated repeatedly over the past few months, I think the Master Settlement Agreement (MSA) was the worst public health blunder of my lifetime. It created a partnership between the states and Big Tobacco which has, and will continue to undermine tobacco control for years to come.

I blame the Attorneys General who signed the agreement for this blunder. However, I also think that the tobacco control leadership at the time, which failed to kill the deal by refusing to speak out against it, is also partly to blame. And the tobacco control leadership at the time (and at the current time) is chiefly the Campaign for Tobacco-Free Kids (TFK).

While I was previously aware that TFK did not actively oppose the Master Settlement Agreement, I was not aware that this organization actually supported the MSA.

But today, I learned (and am now sharing with my readers) that TFK admits that it (or at least that its president, who I think it is fair to say represents the organization as a whole) supported the MSA publicly when it was announced:

Q: Did you support the MSA policy when it was announced?

A: Yes.

I don't think it bodes well for the tobacco control movement as a whole when the leadership of the movement (i.e., its leading organization) actively supported a policy which is the worst public health blunder of recent history and which has severely undermined the entire movement and will continue to do so for years to come.

And why did TFK support this disastrous public health policy? In the words of TFK's president: "I knew that the MSA was weaker than the Proposed Resolution; but I made a decision that we would have the greatest impact on our public health goals by working with the State attorneys general to vigorously enforce the MSA rather than pointing out the areas not covered by the agreement."

The most important word in that answer is the first one: "I." "I" made the decision. With a public health policy of this magnitude, that would certainly affect the very future of the entire tobacco control movement, don't you think that perhaps the decision for the public health establishment to support or oppose the MSA should have been made by more than a single individual?

It would have been one thing if the entire public health and tobacco control movements were bamboozled by the tobacco attorneys and the movement as a whole had supported the deal. Then, I would basically have to fault everyone, including myself, for the blunder.

But the fact is that a huge number of tobacco control organizations, prominent researchers, and advocates vigorously opposed the MSA.

Even if the meaning of the testimony was that TFK supported the enforcement of the MSA, rather than the deal itself, I still think TFK is partly to blame because it is the only organization that I believe had the power to kill the deal. They were intimately involved in the deal's predecessor - the global tobacco settlement. They had the connections and they had the ear of the Attorneys General. Vigorous opposition to the deal could have killed it. But they failed to do it.

Unfortunately, this is not the most troubling revelation of the day.

The most troubling revelation, to me, is my discovery that TFK (or at least its president, who again, I believe fairly represents the organization) admitted that its reluctant support of the Gregg amendment to the proposed (but failed) global tobacco settlement was a mistake:

The TFK president stated that he and TFK "reluctantly supported the Gregg amendment to maintain unity, but I believed then and still believe that its passage doomed the bill. Secretly, I hoped it would fail. ... frankly, I don't think we did the right thing." (see: Pertschuk M. Smoke in Their Eyes: Lessons in Movement Leadership from the Tobacco Wars. Nashville, TN: Vanderbilt University Press, 2001, p. 230).

The Gregg amendment was the measure that removed immunity from the global tobacco settlement. Without that amendment, the McCain bill would have provided effective immunity for tobacco companies from litigation by severely limiting the award and payment of punitive damages in wrongful death tobacco cases.

So you mean to tell me that TFK joined the rest of the public health movement in opposing the idea that the legal rights of private citizens should be taken away in order to protect the tobacco companies profits only because of the fear of how they would have looked if they acted as they really wanted to? That they actually were secretly hoping that the amendment would fail? And that after the fact, they regretted that they supported the amendment?

You've got to be absolutely kidding me.

How can we possibly endure tobacco control leadership of this nature? Leadership that would have gladly seen liability caps placed on tobacco cases in order to protect the profits of an industry that produces a product resulting in more than 400,000 deaths a year. Leadership that apparently didn't respect the overwhelming sentiment of the public health and tobacco control grassroots movement and went along only to avoid criticism, and that after the fact, regrets that it supported the idea that the tobacco industry should not receive special protection.

And leadership that now, after having tried unsuccessfully to give the industry special protection from litigation, is publicly whining about the need not to give the industry special protection. Its basic reason for supporting FDA legislation, is in fact that it wants to "end this special protection for the tobacco industry."

That hypocrisy is simply too much to believe.

The Rest of the Story

Unfortunately, this story does not end with the global tobacco settlement or with the Master Settlement Agreement. It is an ongoing story, that continues today with TFK's efforts to secure passage of legislation that, in my analysis, would provide very special protection for the tobacco industry by providing it with a large measure of immunity (both real and de facto) from the most threatening lawsuits (both existing and future).

It certainly seems to me that the priority of the Campaign for Tobacco-Free Kids is to use the legal rights of American citizens as a bargaining tool to try to achieve what it alone (without a broad public health consensus) views as public health gains.

That's what I think TFK did in supporting the global settlement agreement; that's what I think TFK did in supporting (or at least not vigorously opposing) the Master Settlement Agreement; and that's what I think TFK is doing today in supporting the FDA legislation as currently crafted and agreed to by itself and Philip Morris.

I'm not saying that if there were a broad public health consensus that we should sacrifice the legal rights of American citizens in order to obtain public health gains, I would join that chorus, or that I would then view it as acceptable to trade away those rights and provide special and unprecedented protection to the tobacco industry. But you would tend to think that a leading public health organization, before supporting a policy that provides such incredible legal protection for the industry that it is supposedly fighting against, would at least seek the broad approval of the public health community before agreeing to such a deal with Philip Morris and/or its Congressional negotiators.

I suggest here that the priorities of the Campaign for Tobacco-Free Kids (and therefore, of the leadership of the tobacco control movement) are inappropriate. There seems to be an overwhelming priority of achieving a broad federal "solution" to the tobacco problem, and that desire seems so strong that virtually anything can be given away to achieve it - even legal rights of supposedly "free" and "independent" American citizens.

But as I will soon show (see my next post), the success of tobacco control depends not upon any federal "solution," but on the restoration and preservation of the grassroots tobacco control movement that brought us to where we are today.

If we are going to restore the movement, then priority one, I believe, is changing the priorities of the tobacco control leadership. I think they need to start looking outside of the Beltway for any meaningful solutions to this public health problem. After all, that's where we are, the grassroots public health practitioners who can make it happen. As I'll soon try to show, the FDA legislation, as currently crafted, would take that all away.

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