In past weeks, I have exposed the story of anti-smoking groups widely disseminating completely false information about the effects of secondhand smoke (ASH fallacious claims; SmokeFreeOhio fallacious claims; ANR fallacious claims; 25 more anti-smoking groups' claims; 16 more groups' claims; British Heart Foundation fallacious claim).
Here I address the question of why it is that the tobacco control movement seems to have lost its ability to screen out inaccurate and misleading public communications about the scientific issues underlying their efforts to promote smoke-free policies.
The Rest of the Story
I think the fundamental reason for the loss of the movement's ability to ensure the scientific integrity of its communications is that it has been overcome by a mentality that has destroyed its internal gatekeeping ability.
Let me explain.
In most areas of public health in which I have been involved, there is a strong system of "checks and balances" by which scientific communications are screened internally both before and after they are made.
Before they are made, health claims of potentially extreme consequence are screened by experts in the field to make sure that they are valid and that there is sufficient documentation to back them up. After they are made, experts in the field feel comfortable refuting the statements if they view them to be false. Thus, there is a constant pressure on advocates to ensure that their statements are accurate before they make them.
This is the situation that I believe existed in the tobacco control movement (and I observed and took part in its existence) up until the past few years. In the past, when I have worked with tobacco control groups, I have observed an extreme level of care and concern in developing public communication materials. Everything had to be well-documented and the mentality was one by which we could not take chances, because the tobacco industry was out there "waiting for us" and would refute any undocumented claims that we made. Everyone seemed to be scared of saying anything that might be inaccurate for fear that the tobacco industry would pounce on us and discredit us.
In fact, in many situations, I felt that the degree of scrutiny was far too strong and that a number of statements that I thought should be made were "toned down" because of fear of a slight possibility of misinterpretation, and therefore attack by the tobacco industry. The fear of being discredited publicly was a paramount concern in everyone's mind.
In addition, most of the people working at the organizations with which I collaborated were life-long advocates, mostly unpaid volunteers. They were not particularly skilled at (or slick) public relations, and therefore, almost all potential communications were reviewed by experts in the field before they went public.
But three major changes have taken place in recent years.
The first is the tobacco industry's fall from grace and loss of its ability to effectively discredit tobacco control groups. Largely due to its own legal problems and the fact that it started losing tobacco lawsuits and was forced to release millions of damning internal documents, the tobacco companies were put on the public relations defensive, rather than the offensive, and the threat of being discredited by tobacco companies was all but removed from the picture. In addition, I believe the tobacco companies have made a decision to be far less aggressive in intimidating and threatening tobacco control groups and have largely been leaving groups to conduct their business without interference.
The second major change is the conversion of the movement from a grassroots (and largely volunteer), social movement to a highly institutionalized, heavily-funded, and overly centralized establishment. Our public relations capacity greatly increased and we now have professional (and slick) public communications expertise. The focus has thus shifted from the integrity of the science to the impact of the potential communications. The priority is to put out the most dramatic, striking, and impactful communication rather than the most accurate, sound, and unassailable scientific statements.
The third change, and the most important in my opinion, is the development of a new mentality - one by which dissent is not allowed and there is no room to disagree with or challenge any of the established dogma of the movement. But what constitutes the "established dogma" of the movement is simply anything that any tobacco control group has stated. If even one group makes a health claim, that becomes the "established dogma" and it cannot be challenged internally.
There is truly no room for any dissent. Anyone who challenges the established dogma is instantly accused of being a tobacco industry mole, a traitor, or a lunatic who has gone over to the "dark side." Advocates are afraid of speaking out to voice any criticism or disagreement with the dogma of the movement specifically because they are afraid they will be viewed negatively. And their fear is probably a well-founded one, based on my own experience.
In this way, the movement has lost its internal gatekeeping mechanism. You can't have an internal gatekeeping ability or any semblance of checks and balances when it is literally impossible for anyone within the movement to challenge a public statement once it has been made.
I cannot tell you how many times advocates have responded to my challenging of inaccurate scientific claims not by discussing the validity of those claims, but by castigating me personally for bringing the truth to the attention of the public. Apparently, the appropriate procedure in the movement is to quietly, secretly, and individually send a note to the relevant groups (even though that would take no less than 45 different letters I'd have to write) to suggest that perhaps they might have made a slight overexaggeration, and then to forget about it and move on to more important things. And that's the response I get from those who do not accuse me of being a traitor or tobacco stooge or having "changed" or gone to the dark side, or being a discredit to the movement.
The internal gatekeeping function of a movement is lost when there can be no internal challenge to the doctrine. Because criticizing a group within the movement is viewed as being traitorous, all it takes for a particular health claim to become doctrine is to make the claim publicly once. Thus, when one group of researchers made the absurd and completely implausible claim that a smoking ban reduced heart attacks by 40% within 6 months, that instantaneously became the prevailing wisdom of the movement, and any challenge to that wisdom instantly became prima faciae evidence of disloyalty to the movement.
Similarly, when a couple of anti-smoking groups completely botched the interpretation of the Otsuka study and mistakenly claimed that it showed that 30 minutes of secondhand smoke exposure could cause atherosclerosis and heart attacks in healthy nonsmokers, this claim became the dogma of the movement, and no longer subject to questioning from within.
I believe that the combination of these three factors has led to the near complete destruction of the tobacco control movement's ability to regulate its own scientific claims.
Whereas the threat of being discredited by the tobacco industry was previously a strong force helping to ensure accuracy in our communications, that force is now all but gone. And there is no threat of being discredited from within because the movement has removed that threat by creating a climate in which no dissent can be expressed from inside the movement without severe repercussions. The only check remaining in the system is the possibility that some external group might put up a fuss, but that's hardly a problem since that group will simply be dismissed as a tobacco industry front group anyway.
The end result: there is really nothing to keep the system in check. It is basically a free for all. Groups can say just about anything they like and they are essentially protected from being held responsible for any inaccuracies, due to an intricate, yet well-functioning system of group-think by which there cannot be any internal wrongdoing (or if there is, it can just be dismissed and the attack will be re-directed towards the individual making the claim of inaccuracy).
Something needs to be done to fix this system. While my priority right now is to try to get groups to correct the inaccurate claims and apologize for misleading the public, in order to save the credibility of the movement, my hope is that some critical attention will be given to reforming the mentality of the movement and confronting the factors that have made this breach of the public's trust possible.
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