Thursday, January 12, 2006

On the Value of Critical Discussion of Issues in Tobacco Control

My experience over the past few days with the discussion prompted by my criticism of the Lung Cancer Alliance for criticizing a proclamation on lung cancer for emphasizing smoking too much has been enlightening to me. It has really driven home the value of engaging in critical discussion of issues, especially in a public form where a diversity of perspectives may be contributed and considered.

While I of course hope that members of the Lung Cancer Alliance came to at least appreciate my perspective on the issue, I can certify that I certainly came to appreciate and understand the Lung Cancer Alliance's perspective and that I came away from the discussion from a lot more than I went into it with. And that new perspective and awareness will affect my future efforts in this area.

But I want to emphasize that it was the willingness of the thoughtful folks from the Lung Cancer Alliance that made this all possible.

The Rest of the Story

Now contrast this with the reaction of many tobacco control organizations and advocates to my attempts to promote a discussion of what I feel are some critical issues in the field.

The typical reaction has been, in sharp contrast to the response of the Lung Cancer Alliance, either:
  1. An attempt to discredit me by insulting or attacking me; or
  2. Ignoring the issue altogether; or
  3. Arguing that discussion of the issue is inappropriate and/or that it detracts from the important work we need to do.
There are far too many examples to explore here, but hopefully a few will suffice to illustrate the point.

One such example is the Campaign for Tobacco-Free Kids, which it seems to me absolutely refuses to enter into any meaningful discussion of the proposed FDA tobacco legislation that it and Philip Morris are lobbying for. Specifically, the Campaign has repeatedly refused to take part in any discussion of what many have claimed are severe flaws in the bill. I can attest to the fact that there has been little meaningful discussion in the tobacco control community of what this legislation would do in terms of protecting the public's health and saving lives. There has been about 100% propaganda from the Campaign and 0% discussion of the issues involved in this complex legislative proposal.

In particular, it seems to me that the Campaign has refused to answer questions from public health advocates, including questions about the details of how the bill was negotiated, how the compromise provisions came about, and the reasons for the numerous flaws in the proposed bills. I think that public health advocates (and the public) certainly have the right to know how this legislation came to be. Knowing that is essential in order to make an informed decision about the legislation. And the Campaign has stooped even lower by engaging youths to spread their deceptive propaganda for them, in the absence of any possibility of having these youths be fully informed about the details of the legislation and able to analyze its potential effects on the public's health.

A more timely example is the response of anti-smoking advocates to my questioning of the plausibility of the claim that a smoking ban in Helena (or anywhere) could reduce heart attacks by 40%. Instead of directly addressing the issue, which is, quite simply: is it even possible that a smoking ban could reduce heart attacks by 40%, when if all smoking were eliminated, it would reduce heart attacks by no more than 50%, the response attempts to discredit me, to indirectly tie me to tobacco money, and to distract attention from the question by focusing on unrelated issues: namely, the data from the studies.

The data from the studies are not going to answer the question of whether it is plausible that a smoking ban could cause a 40% drop in heart attacks. Only a reasoned analysis of the issue could yield a meaningful answer to that question. But there appears to be no reasoned analysis of the issue possible in the current anti-smoking movement.

Even worse was the response to my attempt to initiate a discussion of why, if smoking bans reduce heart attacks by 40%, one doesn't see any evidence of a decline in heart attacks in states like California, New York, Massachusetts, or Florida, where statewide smoking bans or widespread local bans went into effect. Instead of leading to a meaningful discussion of the scientific issues, this led to, among other attacks, a claim from one anti-smoking advocate that I was simply lying.

A third example is my attempt to engage the tobacco control groups in a discussion of the justification for broad bans on outdoor smoking, even in areas where people are not at all confined. One of the typical responses was: leave us alone, we have important work to do, we don't have time to discuss whether these policies are justified. Of course, another response (to my attempts to stimulate discussion of critical issues in tobacco control in general) was to expel me from a tobacco control list-serve in order to censor me. This was perhaps the most blatant example of the lack of interest of tobacco control groups and advocates to enter into any meaningful critical discussion of the "proclaimed" agenda.


Ignoring issues doesn't make them go away. Being unwilling to even talk about critical issues serves no purpose that I can understand. We should always be willing to talk, to discuss, to be asked questions, and to try to answer them as best as we can.

Most readers of this blog will know that I am always willing to discuss issues, even when the issue relates to the validity of my own scientific work. Just a few weeks ago, we had a protracted discussion about my study linking secondhand smoke to increased lung cancer among food service workers and there were lots of excellent comments critical of my work and lots of questions, which I tried to answer and respond to as best I could. The discussion was useful, and no damage was done. The world did not end because I entered into a discussion about an issue that is considered dogma by the tobacco control movement.

There seems to be a perception out there (in the tobacco control movement) that if we discuss any issue, we run the risk of some terrible catastrophe happening. Well you know what? By not discussing the issue, a terrible catastrophe has happened.

The tobacco control movement has turned into a McCarthyism-like movement where you can't even question the justification for what we are doing or question any of the data we are spewing out or you will be attacked, discredited, defamed, or even worse (a.k.a. accused of being funded by the tobacco industry, as occurred last week for the first time in my career - the "worst thing" that could happen to any tobacco control advocate!!!).

The Lung Cancer Alliance's willingness to enter into a meaningful discussion of issues therefore comes as a breath of fresh air to me. And I do hope that the tobacco control organizations and the movement as a whole will learn something from it.

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