Thursday, August 31, 2006

Massachusetts Report Finds Increase in Cigarette Nicotine Yields During Past Seven Years

A new report released this week by the Massachusetts Department of Health (MDPH) concludes that actual nicotine yields of cigarettes have increased by approximately 10% over the period 1998-2004.

The Massachusetts method for measuring nicotine yield is an improvement on the FTC-published methods, which do not adequately account for the actual way in which cigarettes are smoked. Limitations of the FTC method include inadequate puff duration and smoke inhalation and failure to block the filter ventilation holes. "The MDPH testing method better simulates the smoking behavior of the typical smoker under typical smoking conditions. Using the Massachusetts’ method, the amount of smoke inhaled with each puff is increased and the amount of time between puffs is reduced. In addition, 50% of the cigarette filter is covered. Testing for nicotine yield using the MDPH method revealed levels that are more than twice as high as those found by the historical method."

The major conclusion of the MDPH report was the following: "For all brands tested in both 1998 and 2004 (N = 116), the total amount of nicotine delivered to the smoker has increased significantly: 1.72 mg in 1998 compared to 1.89 mg in 2004. ... For each of the major manufacturers (i.e., Brown & Williamson, Lorillard, Phillip Morris, and RJ Reynolds), the increases in nicotine delivered were significant. ... With the exception of Winston cigarettes, all brands that were tested in both 1998 and 2004 had significant increases in nicotine delivered to the smoker. This includes Basic, Camel, Doral, Kool, Marlboro, and Newport cigarettes."

The MDPH press release accompanying the report stated: "“'This data is significant,' said DPH Commissioner Paul Cote, 'since is this is the first US release of information on nicotine yield in more than six years. We want health care providers to know that smokers are getting more nicotine than in the past, and they may need additional help in trying to quit.'

Increased levels of nicotine may make it more difficult for the average smoker to quit. Increased levels of nicotine consumed by pregnant women can lead to developmental delays in childhood as well as low birth weight infants. Nicotine changes the way that insulin works in the body. Smoking raises blood sugar levels, placing smokers at higher risk for developing diabetes and making it harder for those who already have diabetes to control blood sugar levels. Medications that treat depression and other mental illnesses can lose their effectiveness when combined with nicotine. Non-smokers, especially children, who are exposed to secondhand smoke can inhale up to seven times the amount of nicotine inhaled by a smoker."

A statement by the Campaign for Tobacco-Free Kids lamented: "The fact that the tobacco companies have been able to secretly increase nicotine levels in tobacco smoke occurred only because no federal or state agency currently has regulatory authority over cigarettes or what tobacco companies put in cigarettes. ... In light of ... the new report findings, it is critical that Congress enact legislation granting the U.S. Food and Drug Administration (FDA) authority over tobacco products that would require tobacco companies to disclose to the FDA and seek approval before making changes to their products that could make them more harmful or more addictive."

The Rest of the Story

While the methodology of the report appears to be solid and the results valid, the conclusions that are being drawn from it raise some important questions.

There is a "rest of the story" here. And that rest of the story is that you can't have it both ways. You can't argue (successfully) in federal court that "low-nicotine" and "light" cigarettes do not confer any health benefit because smokers simply compensate to achieve a steady delivery of nicotine, but then argue that if switched to higher nicotine yield cigarettes, smokers will not compensate by smoking less (or inhaling less deeply).

Is it not possible that the increased nicotine content of cigarettes may have resulted in decreases in cigarette consumption, reduced puff volume and intensity, reduced puffs per cigarette, and reduced time that the smoke is held in the lungs before exhaling?

In other words, is it not possible that despite the increased nicotine yield, the overall nicotine dose delivered to smokers remained essentially the same?

Just as the overall nicotine dose remains the same when low-yield nicotine cigarettes are smoked, why would the overall dose not remain about the same when higher-yield nicotine cigarettes are smoked?

The MDPH appears to conclude that overall nicotine dose has increased, but this conclusion is made in the absence of any evidence regarding actual nicotine doses to which smokers are exposed. The conclusion assumes no change in cigarette smoking behavior, which is an unreasonable assumption, it seems to me, given what we know about how smokers change their puffing and smoking behavior in response to changes in nicotine yield of their cigarettes.

While it seems undeniably true that cigarette companies have increased the nicotine yields of their cigarettes, it does not necessarily hold that this change has resulted in an increase in overall nicotine dose, and therefore in the resulting adverse health effects that MDPH posits are occurring.

In fact, it is quite possible that higher nicotine cigarettes are (marginally) less harmful, because they result in lower cigarette consumption. If the tar delivery is unchanged, then this will result in a lower dose of tar, and a subsequent (marginal) decline in cancer and other disease risk.

In fact, one possibility that has been considered by public health practitioners (and tobacco companies) is the production of a high-nicotine, low-tar cigarette that would allow smokers to obtain current amounts of nicotine through fewer cigarettes, and therefore with lower tar delivery.

The Campaign for Tobacco-Free Kids laments this finding of increased nicotine delivery and issues its usual whine about how this means that Congress must enact the Tobacco-Free Kids/Philip Morris FDA tobacco legislation. But the lament and whine are meaningless, because would the Campaign have stated anything different if the report had found that nicotine yields had significantly dropped over this time period?

Of course not. The Campaign would simply have argued that the decreased nicotine yields are meaningless because smokers simply smoked more. In fact, they probably would have argued that adverse health effects might have increased, since smokers would be compensating by increasing the intensity of their smoking.

What is the significance of the cigarette companies increasing nicotine yields? Probably very little, other than that they are ensuring that addiction levels are maintained given the widespread passage of smoking bans that are limiting opportunities and places for smokers to smoke and encouraging smokers to cut down on the amount they smoke.

Would the FDA legislation have prevented this occurrence, and if it did, would that have been a good thing? It's not clear that giving FDA the ability to regulate nicotine levels would do any good. If FDA required greatly reduced nicotine levels, it could be a public health disaster, as smokers would greatly increase their consumption and overall tar delivery would be much higher, leading to increased disease and death.

Possibly, FDA could do the most public health good by requiring increases in the nicotine/tar ratio in cigarettes, but it's not clear that they could do this given the language of the current legislation. Obviously, the only real public health good that could come from regulation of nicotine would be to get rid of it, but the legislation ties FDA's hands in that regard, and ensures that any regulatory decision to eliminate the nicotine rests squarely in the hands of Congress (i.e., politics), where the tobacco companies would surely use their influence to block action (or they would tie it up in the courts).

Frankly, the Campaign's lament and whining is little more than hot air.

Incidentally, unless I'm missing something, we may have our next fallacious claim by a tobacco control organization, as the claim that "Non-smokers, especially children, who are exposed to secondhand smoke can inhale up to seven times the amount of nicotine inhaled by a smoker" seems implausible to me. Nicotine is much more heavily concentrated in mainstream smoke than in sidestream smoke, so I don't see how it is possible for a nonsmoker to inhale more nicotine than a smoker.

Things cut both ways, and it just doesn't make sense to me to lament the increased nicotine delivery of cigarettes over time, when in the face of a decreased nicotine delivery over time, we responded by blasting the companies for increasing health risks by forcing smokers to compensate and smoke more.

I guess the companies are in a no-win situation. If they decrease their nicotine yields, we'll blast them because smokers will compensate, nicotine intake won't change, but tar delivery will be higher and there could be a net detriment to the public's health. Now that they increase nicotine yields, we blast them because nicotine intake will increase and cause more adverse health effects, making the assumption that compensation won't take place.

There is one detrimental effect of the increased nicotine yield, which is that smokers who are being forced to cut down, or voluntarily cutting down, due to decreased opportunities and environments to smoke thanks to smoking bans, will not see the reduced nicotine delivery and reduced addiction level that otherwise might occur. This is probably the reason why the cigarette companies are increasing the nicotine yields.

The biggest problem with the Campaign for Tobacco-Free Kids' emphasis on the small increase in nicotine yield of cigarettes and on the regulation of tobacco smoke constituents is that it obscures the real issue, which is that cigarettes are a deadly product. No amount of regulation of specific tobacco constituents is going to change that basic fact. And pretending that it will is misleading to the public and represents a disservice to the protection of the public's health.

(Thanks to Bill Godshall for the tip, and for providing a cogent analysis of the potential effects of higher nicotine-yield cigarettes on smoking behavior).

Wednesday, August 30, 2006

JAMA Article Brings Surgeon General's Misrepresentation of Secondhand Smoke Science to the Forefront

An article in the current issue of JAMA (Journal of the American Medical Association), reporting on the recent Surgeon General's review of the health effects of secondhand smoke, brings to the forefront the controversy over whether the Surgeon General misrepresented the science in his public communications surrounding the report's release (see: Kuehn BM. Report reviews secondhand smoke risks: some scientists question risk level. JAMA 2006; 296:922-923).

The controversy stems from the press release and other ancillary materials released by the Surgeon General to accompany the report itself.

Here is what those ancillary materials stated:

According to the Surgeon General's press release:

"Even brief exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and increases risk for heart disease and lung cancer, the report says."

According to the Surgeon General's remarks to the media:

"Breathing secondhand smoke for even a short time can damage cells and set the cancer process in motion. Brief exposure can have immediate harmful effects on blood and blood vessels, potentially increasing the risk of a heart attack."

According to the Surgeon General's accompanying fact sheet:

"Breathing secondhand smoke for even a short time can have immediate adverse effects on the cardiovascular system, interfering with the normal functioning of the heart, blood, and vascular systems in ways that increase the risk of heart attack."

And according to the Surgeon General's accompanying brochure:

"Even a short time in a smoky room causes your blood platelets to stick together. Secondhand smoke also damages the lining of your blood vessels. In your heart, these bad changes can cause a deadly heart attack."

These claims are markedly different from those made in the Surgeon General's report itself, which concludes that chronic exposure to secondhand smoke increases the risk for heart disease, but does not conclude (or even present evidence that) a brief exposure to secondhand smoke can cause lung cancer, heart attacks, or heart disease.

The JAMA Medical News & Perspectives article highlighted the controversy over these claims that brief exposures to secondhand smoke are enough to cause heart attacks, heart disease, and lung cancer: "More controversial [than the claims regarding the effects of chronic exposure] was the surgeon general's emphasis on the immediate risks of exposure to tobacco smoke, particularly acute cardiovascular and lung cancer risks."

"Siegel questioned the surgeon general's comments and promotional materials from Carmona's office that emphasize the acute risks. 'It's very misleading to suggest to the public that you can walk down a street and breathe in a few whiffs of smoke and be at risk of developing heart disease or lung cancer,' he said. 'It takes many years for these chronic diseases to develop, and there's simply no evidence that a brief exposure is enough to cause chronic health problems.' He said he felt the publicity materials and coverage in the media distort the evidence laid out in the report itself."

The reporter apparently sought a response to my critique from a CDC official who co-authored a 2004 commentary which suggested that brief exposure to secondhand smoke might be capable of triggering a heart attack. According to the JAMA article, that official "maintains that the evidence is strong enough that physicians should urge patients with cardiovascular disease or respiratory problems to avoid all exposure to secondhand smoke. He noted that there a large number of individuals who are unaware of the status of their cardiovascular health and may be at risk. He also said that parents need to get the unequivocal message that they should not expose their children to secondhand smoke."

The article concludes: "But Siegel said he believes public health officials should be emphasizing the well-established risks faced by individuals exposed in the workplace or at home, instead of suggesting that everyone is at risk. 'We're really risking our credibility [as public health professionals or officials] by putting out rather absurd claims that you can be exposed briefly to secondhand smoke and you are going to come down with heart disease or cancer. People are going to look at that and say that's ridiculous.'"

The Rest of the Story

I applaud JAMA for the willingness to challenge anti-smoking movement dogma and bring this issue to the attention of the public and the medical community at large. I have become convinced that it is not until the public spotlight is shined upon the misleading claims that are being made that any action will be taken to correct the problem. And this prominent exposure will help, at least to make the public and the medical community aware of what is going on.

To me, the CDC response confirms my assertion that the science has been misrepresented. Apparently in response to my critique of the Surgeon General's public communications about the report, CDC was defensive, but only so far as to emphasize that patients with existing cardiovascular disease may be susceptible to severe health effects from a brief secondhand smoke exposure. The response completely ignored my primary assertion, which is that brief exposure will not cause heart disease and lung cancer in anyone, and will not cause a heart attack in anyone without severe existing coronary artery stenosis.

In other words, it appears that CDC agrees that it is preposterous to assert that a brief exposure poses any problem for a person who does not have severe coronary artery stenosis to begin with, and CDC is unwilling to defend the Surgeon General's misleading claims. At the same time, CDC is also apparently unwilling to suggest outright that the Surgeon General went too far in his press release, remarks, fact sheet, and brochure.

This is not surprising, because it would take a lot for CDC to openly criticize the Surgeon General. Nevertheless, CDC's unwillingness to back up the Surgeon General's health claims does lend support to the validity of my arguments.

I think it is important to continue to press this issue, because it is not until the issue receives widespread public attention that any real response will be forced. On its own, the tobacco control movement has demonstrated no interest in entertaining any scientific challenge to its dogma.

Tuesday, August 29, 2006

California Senate Passes Car Smoking Ban; Inaccurate Scientific Claims Spread to Policy Makers

It appears that the anti-smoking movement's widespread use of inaccurate scientific claims to promote smoking bans has spread to policy makers. In her efforts to promote a ban on smoking in cars with children, California state Senator Deborah Ortiz claimed that a child in a car with a smoker for one hour is effectively smoking 1 1/2 packs of cigarettes.

According to an article on the San Jose Mercury News web site: "Sen. Deborah Ortiz, D-Sacramento, said the Koretz bill was an attempt to 'protect the health of children who cannot protect themselves. We all know that secondhand smoke is hazardous,' she said, 'particularly for young children whose lungs are still developing. Children are effectively smoking a pack and a half a day for every hour they are exposed to smoke in a car.'"

The bill, which would prohibit smoking in any car with a child young enough to require a child safety seat (ages 6 and under or under 60 pounds), passed the Senate on a 23-14 vote and now moves to the state Assembly.

The Rest of the Story

While I oppose this legislation for reasons unrelated to the degree of risk posed by secondhand smoke, I think it is essential that public policy makers accurately present risk information to the public. While secondhand smoke exposure in a car may pose an increased risk for a child to develop upper respiratory infections, middle ear infections, and asthma, it is hardly the case that an hour of exposure is equivalent to that child actively smoking 1 1/2 packs of cigarettes.

There are a number of reasons why this claim is inaccurate, but to start with, the level of secondhand smoke in the car would have to be 8 times higher than the level in the smokiest bar for a one-hour exposure to yield the equivalent exposure as 1 1/2 packs of cigarettes to even the most heavily concentrated component of secondhand smoke compared to mainstream smoke: N-nitrosodimethylamine (NDMA).

While the NDMA exposure, under such conditions, would be equivalent to that from actively smoking 1 1/2 pack of cigarettes, the exposure to all the other chemicals in tobacco smoke would be far less. Thus, it would not be "effectively" the same as smoking 1 1/2 packs of cigarettes. To be accurate, one would have to clarify such a claim by stating that it refers specifically to one or two constituents of tobacco smoke.

More importantly, the exposure levels in cars vary widely and are highly dependent upon whether the windows are open or not. So even if the NDMA exposure levels are correct, in order to be accurate, one would have to clarify such a claim by stating that it refers specifically to driving with the windows closed. It is not sound scientifically to claim that anyone in a car for one hour under any conditions would have this exposure.

Is it just me, or does it not truly seem that nowadays, you can basically say anything you want about the hazards of secondhand smoke? You can claim that it will cause atherosclerosis in 30 minutes, that it will cause fatal arrhythmias, that just a brief exposure will set the cancer process in motion, that it contains asbestos, that it contains plutonium, and that one hour of exposure is equivalent to smoking 1 1/2 packs of cigarettes per day.

While Judge Kessler rejected the idea of having independent monitors to conduct surveillance on the activities of the tobacco companies to make sure that their actions were in line, I think that such a remedy may be required to ensure that anti-smoking groups do not deceive the public.

Back in the old days, we had to back up and support our scientific claims. It must be fun to be an anti-smoking practitioner today. You can basically say anything you want and you don't have to justify it or back it up. I think I entered the anti-smoking movement 20 years too early.

(Thanks to Just the Facts for the tip).

Thursday, August 24, 2006

San Francisco Chronicle Editorial Calls Out Fanaticism of Anti-Smoking Movement; Backlash May Be Starting

An editorial published yesterday in the San Francisco Chronicle lashes out at the anti-smoking movement, calling out its fanaticism and suggesting that we are going too far by promoting bans on smoking in wide open outdoor public places and in private cars.

The editorial states: "Here is a short list of the places Bay Area smokers have recently been declared persona non grata: Parks. Bus stops. Public squares. Train stations. Gardens. Cable-car stops. Playing fields. Their own backyards. Proposed laws would include banning smokers from their own cars if minors are present. So, for the privilege of hunkering down in a dark alley or, lighting the Weber grill to distract neighbors from the whiff of nicotine, Bay Area smokers continue to exercise the perfectly legal right to smoke. ...

We don't approve of smoking. ... But now that smokers have found themselves decidedly marginalized in California culture, sanctimonious non-smokers are attacking them with a vengeance verging on obsession. ... Does Assemblyman Paul Koretz, D-West Hollywood, really believe that the CHP has nothing better to do than hunt for smoking drivers with children in the backseat? Do the rest of us really want the societal headaches that come with this sort of lifestyle micromanagement? We don't. Enough of the nanny state. Leave these silly rules alone -- and leave the smokers alone with their nasty habit."

The Rest of the Story

The San Francisco Chronicle is not exactly a conservative newspaper. It has generally been supportive of anti-smoking measures over the years. The fact that it now chooses to lash out at the anti-smoking movement is, in my opinion, a sign that the backlash I predicted would happen has indeed begun.

In a way, this is actually encouraging news to me. Because it shows that while the anti-smoking movement seems to know no limits and to have no bounds of reason, perspective, science, or ethics, the public and the media do recognize some limits and may be willing to call the movement on at least some of them.

Here, the Chronicle makes note of the fact that anti-smoking groups in California do not seem to know when to stop. Instead of stopping at the prohibition of smoking in workplaces and outdoor places where nonsmokers cannot avoid secondhand smoke exposure, these groups have pushed for banning smoking in virtually all outdoor places (see my posts on the anti-smoking ordinance in Calabasas) and are now pushing for banning smoking in cars when children are present.

It's one thing when groups with libertarian leanings call the policies your movement is supporting an example of the nanny state, but when the San Francisco Chronicle uses this rhetoric, it's time for pause about whether maybe you are going too far.

To get some sense of the degree to which the Chronicle has, in the past, supported the anti-smoking agenda, remember that it came out in support of the whole SmokeFreeMovies initiative in 2002, writing that "Hollywood should not be sending a message that smoking is a glamorous habit that won't harm people's health."

The Chronicle is a strong supporter of public health in general; this May 2002 editorial demonstrates the paper's perspective on public health intervention.

Clearly, we're not talking about a paper that opposes rather intrusive anti-smoking measures or other public health interventions.

I do think that the backlash is beginning. Unfortunately, the tobacco control groups failed to listen when the fanaticism was called to their attention. They didn't want to hear about it and so they silenced me. They simply didn't want to hear about it. Now I'm afraid it may be too late. The movement is out of control and the consequences are going to gradually unfold.

This is just the beginning.

Wednesday, August 23, 2006

New Data Show Decline in M.I. Admissions in Smoke-Free States is Lagging Behind Decline for Nation; Casts Doubt on Helena/Pueblo/Saskatoon Claims

Data recently released by HCUPnet, a service of the Agency for Healthcare Research and Quality (AHRQ), show that there was a substantial decline (8.2%) in heart attack hospital admissions in the United States between 2003 and 2004. This followed a smaller decline of 2.8% between 2002 and 2003. Overall, the decline in heart attack admissions in the U.S. between 2002 and 2004 was 11%.

These sharp declines in heart attack admissions suggest that the conclusion of recent studies that smoking bans caused declines in heart attacks in Helena, Pueblo, and Saskatoon are highly suspect, as these studies fail to control for the fact that during the same period of time as these smoking bans went into effect, a secular change in heart attack admissions was occurring.

An analysis of heart attack trends in states that implemented smoking bans in recent years (but prior to 2004, which is the most recent year for which heart attack data are available) reveals that there is no evidence that smoking bans led to a decline in heart attack admissions in these states.

In New York, a smoking ban in all bars and restaurants was implemented in July, 2003. A similar ban in New York City had been implemented in March of that year. If smoking bans caused a drastic and immediate decline in heart attacks (40% in 6 months was claimed by the Helena study), then one would certainly expect to have seen a substantial decline in heart attack admissions in New York State in 2003 and 2004.

However, heart attack admissions in New York State dropped by only 0.5% in 2003, and by 3.2% in 2004, compared with the national declines of 2.8% and 8.2%, respectively. Overall, the decline in heart attack admissions in New York State from 2002 to 2004 was only 2.7%, compared to a 10.7% drop in the nation as a whole.

In Florida, a smoking ban in all restaurants was implemented in July, 2003. If smoking bans caused a drastic and immediate decline in heart attacks on the order of 40% (as claimed in Helena) or 27% (as claimed in Pueblo), then one would certainly expect to have seen a substantial decline in heart attack admissions in Florida in 2003 and 2004.

However, heart attack admissions in Florida dropped by only 0.7% in 2003, and by 2.0% in 2004, compared with the national declines of 2.8% and 8.2%, respectively. Overall, the decline in heart attack admissions in Florida from 2002 to 2004 was only 2.7%, compared to a 10.7% drop in the nation as a whole.

During the period 2003-2004, the precise period when smoking bans were implemented in New York and Florida, these states lagged substantially behind the rest of the nation in their observed rates of decline in heart attack admissions. Instead of seeing a 40%, or even 27% decline in heart attack admissions in these states, there was less than a 3% decline over two years, and this was in the face of a nearly 11% decline in the nation as a whole during the same period.

The Rest of the Story

Obviously, I am not concluding from this analysis that smoking bans cause heart attacks. But it is perhaps worth noting that the same methodology used by the Helena, Pueblo, and Saskatoon studies would lead to such a preposterous conclusion. This is the problem with attributing any observed changes in a health outcome to one particular change (i.e., a smoking ban) and ignoring all other possible changes that occurred, including random changes in the health outcome itself.

The problem is particularly troublesome in very small samples, such as those in Helena, Pueblo, and Saskatoon.

The bottom line is that there simply is not evidence to support the conclusions being disseminated by a large number of anti-smoking groups that smoking bans lead to dramatic decreases in heart attacks. This is an unsubstantiated health claim if I've ever heard one.

But the lack of evidence to substantiate the claim, as well as the lack of plausibility of the claim, do not appear to be stopping anti-smoking groups from making the claim, and from using this as propaganda in their efforts to promote smoking bans.

If you are going to be a credible scientist, you have to be willing to look at the data. I have done that, and I conclude that there is not evidence to support a contention that smoking bans will dramatically reduce heart attacks. If anything, the evidence suggests that this is not the case. Unfortunately, it doesn't appear to me that many anti-smoking researchers and groups are willing to even look at this evidence. Instead, they simply attack those calling this to their attention as being tobacco industry sympathists.

That is one thing I am not.

However, I am starting to sympathize with those who are getting sick and tired of seeing anti-smoking groups continue to spout propaganda that is unsupported by the science. Yes, I'm starting to feel your pain.

Monday, August 21, 2006

Campaign for Tobacco-Free Kids Again Suggests that Big Tobacco Opposes FDA Tobacco Legislation; Misleading and Deceptive Propaganda is Unethical

In a press release issued Monday, the Campaign for Tobacco-Free Kids (TFK) publicly implies that Big Tobacco is blocking the FDA tobacco legislation (and therefore, that Big Tobacco opposes this legislation), when in fact, the largest company of Big Tobacco - Philip Morris - supports the legislation and is putting its lobbying resources behind the promotion of the passage of these bills currently before Congress.

According to the TFK press release: "It is mind-boggling that the rogue industry described by Judge Kessler and its deadly and addictive products are exempt from basic health and safety regulations that apply to other consumable products and their manufacturers. The main reason is the millions of dollars the industry spends every year on campaign contributions and lobbying. It is time for Congress to finally end the special protection accorded the tobacco industry and pass this legislation... ."

The Rest of the Story

At least part of the rogue industry described by TFK above supports the legislation that, according to TFK, has not been enacted by Congress because of "the millions of dollars the industry spends every year on campaign contributions and lobbying."

The rest of the story is that the bulk of that tobacco industry money spent on campaign contributions and Congressional lobbying is being spent to support enactment of the FDA tobacco legislation. This is because Philip Morris is by far the greatest source of campaign contributions and lobbying expenditures and Philip Morris is lobbying in support of the legislation.

It is, in my opinion, grossly deceptive to suggest to the American public that the main reason why FDA tobacco legislation was not enacted is that the tobacco companies spent millions of dollars lobbying against this legislation. The truth is that most of the money spent by the industry was spent in support of this legislation. Philip Morris, which dominates the campaign contributions and lobbying, obviously was not successful in promoting the FDA tobacco legislation. So obviously, it is despite the tobacco industry campaign contributions and lobbying, not because of it, that the FDA tobacco legislation failed to be enacted by Congress.

TFK's statement is misleading and deceptive because it implies that Big Tobacco, as a whole, is opposed to legislation giving FDA the authority to regulate tobacco products. But the truth is that the largest and most dominant company - Philip Morris (which controls about half of the domestic cigarette market) - supports and is in fact behind the FDA legislation.

What I believe is happening here is that TFK is using this misleading and deceptive propaganda in an effort to promote the FDA legislation. In other words, this is a public relations lobbying ploy on the part of TFK. And in my opinion, to be deceptive on a critical point like this with the public relating to a federal policy initiative with huge public health implications is unethical.

What I find particularly ironic is that in the press release, TFK spends an inordinate amount of time criticizing the tobacco companies for all of their deception of the public over the years. But apparently, while it's wrong for the tobacco industry to deceive the public, there's nothing wrong with one of the nation's leading anti-smoking groups doing the same thing, as long as it's in the support of a policy that this group thinks is a good one.

I hate to tell my friends at TFK this, but deception is wrong in my opinion, no matter who is doing the deception. What makes it wrong is not that the tobacco industry - apparently a "rogue" industry - is doing it. What makes it wrong is that it is wrong to deceive the public, period. It is no more justified to deceive the public when you are working to protect the children then when your products are killing them.

OK - well maybe it's not quite so sinister. But it's still wrong. And that's the basis for my opinion that what the Campaign for Tobacco-Free Kids is doing here, and throughout its campaign of deception on the FDA tobacco legislation, is unethical.

Sunday, August 20, 2006

European Anti-Smoking Groups Condemn Employment Discrimination Against Smokers; Why are U.S. Groups Afraid to Speak Out?

According to an article on, two European anti-smoking organizations have condemned the idea of refusing to hire smokers or firing existing smoking employees. The statements of these two groups comes in response to a European Commission announcement that the European Union (EU) anti-discrimination policy does not apply to employers refusing to hire smokers. The Commission had issued that declaration in response to an inquiry after an Irish company issued a job announcement making it clear that smokers need not apply.

The head of a French anti-smoking association and a Belgian anti-smoking foundation spoke out strongly against these policies, noting that although they may be legal, they are misguided and wrong.

According to the article: "Even the commission's usual allies in the fight against smoking were left dazed by its position, with some anti-smoking campaigners calling it counterproductive. Professor Gerard Dubois, who heads a French anti-smoking association: 'We never asked for it, it's ridiculous and totally useless in the fight against smoking. Smokers are victims of addiction and they have to be helped,' Dubois added. 'What happens if somebody starts smoking, takes it up again, are they going to be fired,' he stressed.

Doctor Luc Joris, who heads the Belgian anti-smoking foundation, said that denying a smoker a job was the wrong approach to helping the person give up tobacco. 'I'm for a tobacco-free society, but once a smoker is addicted it's complicated,' he said. 'We can't put him in a situation where he can't work. That's going a bit far, afterwards are we going to ask beer and champagne drinkers not to apply,' Joris said."

[Apparently, this quote was misattributed to Dr. Joris and a Belgian anti-smoking foundation, and should have been attributed to Luk Joossens with the Foundation against Cancer.]

The Rest of the Story

It is nice to see anti-smoking groups standing up and speaking out publicly against employmnet discrimination directed at smokers. It is reassuring to see anti-smoking groups that recognize that this is not in any way a public health intervention, but a discriminatory, undue intrusion into employee privacy and autonomy.

Unfortunately, one has to go all the way to Europe to find any good reason in the tobacco control community on this issue. Or at least any that is publicly expressed. I am now aware of 4 anti-smoking groups that have spoken out publicly against employment discrimination directed at smokers: these groups are all outside the U.S. (Great Britain, Australia, Belgium, and France). To the best of my knowledge, not a single U.S. anti-smoking group or advocate (other than me) has publicly condemned the unwarranted intrusion into privacy and unjustified discrimination that these policies represent.

And the silence of the U.S. tobacco control community holds not only for policies by which employers refuse to hire smokers, but also for policies by which employers fire existing employees who smoke.

Let me focus the issue by noting that I am not talking about the legality of these discriminatory policies. In most of the states, and in most other countries, these policies are perfectly legal. But that doesn't make the policies right, and anti-smoking groups should make it clear to the public that these policies are not justified.

It's not clear to me why U.S. anti-smoking groups are afraid to speak out. Do they really support this kind of discrimination, or are they simply afraid to speak out because of the McCarthyistic-like mindset that leads to attacks on anyone within the movement who dissents from the extremist agenda?

It's probably a little bit of both, but either way, I think it's an embarrassment for us.

Friday, August 18, 2006

Special Friday Edition: DOJ Tobacco Case Commentaries and Focus on a College Complete Smoking Ban

Today I feature a 3-part commentary on yesterday's DOJ tobacco case ruling by Judge Gladys Kessler of the D.C. District Court. The first part (the bottom-most commentary) provides an overview of the decision and analysis of its overall implications. The second part comments on one anti-smoking group's response to the decision. The third part (the top-most and most recent commentary) comments on the implications of the decision in terms of the actions of former Associate Attorney General Robert McCallum and anti-smoking groups attacks against him for destroying the DOJ's case.

In the midst of these DOJ case commentaries, don't miss the bottom-most post of the day, which addresses the proposal by McHenry County College (Crystal Lake, IL) to ban all tobacco product use on this college campus.

DOJ Tobacco Ruling Demonstrates that McCallum Did Not Destroy or Undermine Government's Case; Anti-Smoking Groups Were Wrong

Contrary to what the Campaign for Tobacco-Free Kids (TFK), Americans for Nonsmokers' Rights (ANR), and other anti-smoking groups claimed, former Associate Attorney General Robert McCallum did not in fact destroy or undermine the government's case in the DOJ tobacco lawsuit.

As demonstrated by yesterday's ruling by the D.C. District Court, McCallum's decision to substitute a $10 billion smoking cessation remedy for a $130 billion smoking cessation remedy had no impact whatsoever on the case, because as Judge Gladys Kessler ruled, $0 of smoking cessation remedy was allowable under the D.C. Appeals Court's interpretation of the RICO statute.

As I predicted months ago, Kessler refused to order any of the three monetary remedies sought by the Department of Justice and by anti-smoking group intervenors (including TFK and ANR).

Smoking Cessation Remedy: Kessler ruled that "Adoption of such a national smoking cessation program would unquestionably serve the public interest. However, under the narrow standard for §1964(a) remedies articulated in Judge Sentelle’s Opinion, the Court cannot enter such a remedy because it is not specifically aimed at preventing and restraining future RICO violations."

Public Education and Counter-Marketing Remedy: Kessler ruled that "Adoption of such a public education and countermarketing campaign would unquestionably serve the public interest. However, under the narrow standard for §1964(a) remedies articulated in Judge Sentelle’s Opinion, the Court cannot enter such a remedy because it is not specifically aimed at preventing and restraining future RICO violations."

Youth Smoking Reduction Targets Remedy: Kessler ruled that "Youth smoking rates may increase or decrease due to input factors beyond Defendants’ control. Accordingly, because the targets are aimed at reducing the public health consequences of marketing to youth and are not narrowly tailored to prevent and restrain Defendants’ future RICO violations, the Government’s proposed remedy cannot be entered by this Court."

The Rest of the Story

Those who have followed The Rest of the Story will see that Kessler's ruling with respect to each of these three remedies is what I predicted months ago. I opined that the smoking cessation and counter-advertising remedies would be denied because they are not designed to prevent and restrain future RICO violations. And I opined that the youth smoking reduction targets remedy would be denied because there was not a direct enough connection between youth smoking prevalence and RICO violations (too many other factors, other than RICO violations, can affect youth smoking rates).

Unfortunately, the legal analysis and judgment of the anti-smoking organizations that are actually leading the movement and making the decisions is not so good. These groups pinned their entire intervention on the premise that the government had let down the public by not pursuing the $130 billion smoking cessation remedy and that the multi-billion dollar public education and counter-marketing and youth smoking prevalence target remedies were the be-all and end-all of the case.

These groups also staked their reputations and credibility on the claim, which I thought was premature at the time, that McCallum destroyed the government's case by altering the $130 billion remedy. These anti-smoking groups went so far as to publicly attack McCallum and accuse him of ethical wrongdoing, without having any evidence to support their claims.

Now that the Court has ruled, it is clear that McCallum did not in fact destroy or undermine the government's case in any way. His action was irrelevant, as no smoking cessation remedy would have been allowable by Judge Kessler, given the appellate court ruling which she is obligated to follow.

The smoking cessation remedy is a backwards-looking remedy designed to remedy past wrongdoing, not to directly prevent and restrain future RICO violations. Thus, it is not allowable under the RICO statute, at least as interpreted by the D.C. Appeals Court.

Barring a surprise reversal of the appellate court ruling by the U.S. Supreme Court, the issue of whether McCallum undermined or destroyed the government's case is now closed. Given this fact, it should be only a matter of hours or perhaps days before TFK, ANR, and other anti-smoking groups and leaders apologize for their unwarranted attacks on McCallum and for their inaccurate claim to the public that he destroyed the DOJ's case. Retractions and apologies will be forthcoming, I am sure, given the high ethical standards and integrity of these anti-smoking organizations.

Thursday, August 17, 2006

Campaign for Tobacco-Free Kids Decries Lack of Money for Anti-Smoking Programs; Still Doesn't Seem to Get It

In a press release issued in response to the D.C. District Court's ruling in the DOJ tobacco case, the Campaign for Tobacco-Free Kids bemoans the failure of the Court to impose any of the monetary remedies, which would have provided anti-smoking groups with millions of dollars to run their cessation, education, and counter-advertising programs. The Campaign states that the remedies "fail to protect" the "American people," and therefore "must be appealed."

According to the press release: "We are deeply disappointed, however, that Judge Gladys Kessler felt constrained in the remedies she could impose by misguided appellate court rulings. Given the overwhelming scope of the industry’s wrongdoing found by the judge, much of which continues today, the Bush Administration has an obligation to appeal the remedies in this case to protect the American people and especially our children."

The Rest of the Story

You can just feel the air being let out of the Campaign's tires in that press release as they watch the opportunity to get their hands on billions of dollars go sailing away into the distance. It really does appear to be all about the money, and little about the law, for this group.

So the remedies fail to protect the American people. I suppose that's true. But the purpose of the remedies is not to "protect the American people." The purpose of the remedies is to prevent and restrain future RICO violations as appropriate under the law. A failure to protect the American people from the harms of smoking is not grounds for appeal of the case.

What would be grounds for appeal is if the appellate court misinterpreted the RICO statute's civil remedies provisions by ruling that remedies must be (as the statute states) designed to prevent and restrain future RICO violations, rather than remedy the effects of past violations. Unless the Campaign can provide some solid reasoning for how the appellate court was wrong about what seems to be quite clear and straightforward language in the RICO statute, then it has little credibility in issuing propaganda like this.

The practice of tobacco control is not all about trying to extract money from the industry by urging courts to alter the interpretation of the nation's laws to unfairly deprive cigarette companies of the benefits of the law's protections in order to serve the public's health, no matter how noble that public health cause may be.

As tobacco control and public health practitioners, we must work within the law. That's something which the Campaign, along with the other intervenors in the case, seem to fail to realize.

I have no problem with the government appealing the appellate court's ruling to the U.S. Supreme Court. If I were DOJ, I might well appeal it. But the grounds for appeal is not that the remedy does not provide enough money to anti-smoking groups or that it does not provide the $130 billion that a certain government witness said was necessary or that it does not adequately protect the public. The grounds for appeal is that there is something substantively wrong with the legal reasoning used in arriving at the appellate court's ruling. The reason to appeal it is the belief that the ruling is in error.

To suggest otherwise only creates the perception (at least in my mind) that it is really the money for all the anti-smoking programs that is the chief concern. It certainly has the appearance that the prospect of billions of dollars is clouding the clear legal thinking and appreciation of the law that we as public health practitioners should have.

Tobacco Companies Found Guilty of Racketeering But are Spared by Judge's Denial of Any Monetary Remedies

In what can at once be called a great victory for the government as well as Big Tobacco, the major cigarette companies were today found guilty of violating the Racketeer Influenced and Corrupt Organizations (RICO) statute of the U.S. Criminal Code and ordered to undertake a series of remedies including ceasing to use health descriptors in their marketing, disseminating corrective communications, and making millions of industry documents available to the public.

Despite the general ruling in favor of the government and the imposition of these remedies, however, the D.C. District Court (Judge Gladys Kessler) failed to impose the remedies most highly sought by the government and by the anti-smoking group intervenors: the monetary remedies, which would have required tobacco companies to pay billions of dollars for a national smoking cessation program, a national counter-advertising campaign, and a youth smoking reduction target program.

The remedies imposed by Judge Kessler include:
  • the enjoinment of Defendants from using health descriptors in their marketing, including the terms "low tar," "light," "ultra light," "mild," and "natural."
  • the requirement that Defendants make a series of corrective statements regarding the health effects of smoking, the addictiveness of smoking, the lack of health benefits from low-tar or light cigarettes, the cigarette companies manipulation of nicotine levels in their products to maintain or enhance addiction, and the adverse health effects of secondhand smoke;
  • disclosure of tobacco industry documents in depositories and on websites; and
  • the disclosure to the government of disaggregated (i.e., brand-specific) marketing data.
The corrective messages are to be not only included in cigarette package inserts, but also disseminated through full-page newspaper advertisements in Sunday editions of the largest newspapers and through 15-second television commercials on the three largest broadcast networks. These corrective communications would run over approximately a two-year period.

The cigarette companies have already announced that they plan to appeal Kessler's ruling. It is likely that the government will appeal the appellate court ruling that disallowed disgorgement as a remedy. Thus, none of this is final. It is possible that the finding of violation of racketeering laws could be overturned and at the opposite extreme, it is possible that the appellate court's disallowing of disgorgement could be overturned, opening the door to huge monetary remedies.

The Rest of the Story

Without a doubt, the finding that the cigarette companies are guilty of racketeering is a significant one, and it probably closes out this phase of the history of these companies in appropriate fashion. That the cigarette companies deceived the public for many years about the health hazards and addictive nature of smoking probably does not come as a surprise to too many in 2006. But it is important, from both a historical and from a public image and public knowledge standpoint, to have this federal court finding. It takes any final guesswork out of the picture and makes it clear to all for all time the true history of what the tobacco companies did to undermine the health of the American people for decades.

This finding is likely to have some impact on the public image of the companies, but I suspect it will be a small one. I think the public is largely aware already of the nature of what the companies have done, and it's not clear that this finding will have a huge impact.

Of the remedies that were imposed, the most significant, by far, is the ban on the use of health descriptors. This will (if sustained on appeal) have the practical effect of requiring cigarette companies to re-name brands such as Marlboro Lights, Winston Lights, and many others. It would also require a change in the advertising of these products, as words such as "light," "mild," and "low-tar" could no longer be used.

The corrective statements remedy is probably going to have less of an impact than it might appear. If sustained, these statements will likely blend into the existing public relations campaign of the industry, in which it is trying to alter its image as being a more responsible corporate citizen. If the industry plays its cards right, the negative impact of these statements on its public image could be mitigated by the promotion of a public perception that the industry is changing its ways. Ultimately, I don't see the impact of any such statements as being particularly substantial.

The document disclosure remedy does not seem all that huge, since there are already millions of documents out there and it is not clear what more we will find out that we don't already know.

The marketing data disclosure remedy also does not seem too huge, since there is already apparently sufficient data to convince a federal judge that the industry targeted youths in its marketing.

Ultimately, then, I see the actual effects of the remedies as being marginal at best. The biggest impact would be on the marketing of light cigarettes. I'm sure cigarette companies could find another way of effectively marketing such products.

What it comes down to is that this represents an important victory for public health and a kind of penultimate acknowledgment of the wrongdoing that the tobacco companies committed for decades. But the remedy allowable under RICO is little more than a slap on the wrist for these cigarette companies.

The remedies that could potentially have really hurt the companies - the monetary ones - have been all but eliminated.

And the only other remedy that could have been truly problematic - the appointment of industry monitors - was also nixed by Judge Kessler, on the grounds that it violates the Constitution by impermissibly delegating judicial authority to the independent hearing officers and monitors.

A few comments on the strength of potential appeals in the case.

I do not see much of a chance of the government succeeding in its attempt to have the U.S. Supreme Court overturn the D.C. Appeals Court's ruling that backwards-looking remedies are not allowable under RICO. That ruling seems to be consistent with the clear intent and meaning of the statute.

The defendants' success in reversing the finding of guilt will rest primarily on whether they can convince the appellate body that there is not a signficant likelihood of future RICO violations due to major structural changes in the industry (including the Master Settlement Agreement). My opinions on the MSA are clear, so I don't think it likely that the industry will be successful in this regard.

I think there is a moderate likelihood that an appeals body could find some Constitutional problems with a few of the corrective statement remedies. As Judge Kessler pointed out, the D.C. Court of Appeals has already ruled that corrective statements do not present a First Amendment problem if they are necessary to prevent continuing deception of the public, so it's hard to see how there would be a problem with the health effects of smoking and addictiveness of smoking corrective statements. However, it's not clear why the "low tar" corrective statement would be necessary since health descriptors are being banned, it's not clear why the nicotine manipulation statement is necessary if it is acknowledged that smoking is addictive, and one simply doesn't know what the court would find with respect to the need to put out secondhand smoke corrective statements. This latter area is the one where I think an appeals court might tamper most with the ruling.

At the end of the day, this does stand as an important victory for the government. But it is a victory more of historical than practical significance. It is a victory that had to, at some point, be forthcoming. But the end result is little more than a slap on the wrist for the tobacco companies. There is little threat to their long-term viability and no meaningful long-term institutional changes that will change the fundamental nature of the public health problem of tobacco use.

So when all is said and done, it is really the tobacco companies which come away with a victory they had to have.

McHenry County College Poised to Ban Tobacco Use Entirely on Campus; From Public Health to Moralizing and Paternalism

The Board of Trustees Policy Committee of McHenry County College (Crystal Lake, IL) has proposed a new non-smoking policy which would completely prohibit the use of tobacco products anywhere on the college campus. This includes both smoking and the use of smokeless tobacco. This would replace the current policy, under which smoking is restricted to outdoor areas on campus.

The proposed policy, which would go into effect in August 2007, reads as follows:

College-owned buildings, grounds, and vehicles shall be a tobacco-free environment for all, including but not limited to employees, students, and visitors. This includes the smoking of any tobacco product and the use of smokeless or "spit" tobacco.

The new policy was developed by a committee which worked closely with a number of anti-smoking groups, including the McHenry County Health Department, the American Cancer Society, the American Heart Association, and the American Lung Association.

The Rest of the Story

Anyone familiar with my research or my career's work knows that I am a strong proponent of indoor and workplace smoking bans and that I have advocated for banning smoking in all indoor areas of college campuses. In brief, I support the policy that McHenry County College currently has in place, which restricts smoking to outdoor areas and protects nonsmokers from any substantial exposure to secondhand smoke and the resulting health effects.

However, I think this proposed policy goes too far.

It is clearly not necessary to ban smoking on the entire college campus in order to protect nonsmokers from substantial exposure to secondhand smoke. Certainly, restricting smoking to designated outdoor areas can be done in a way that prevents nonsmokers from having to breathe in any significant quantity of secondhand smoke. There is no reason why if a student is smoking in their car in a parking lot, for example, nonsmoking students or employees will be unable to avoid exposure to his or her smoke.

You can't tell me that if a student lights up for a few minutes in the remote area of parking lot F, she is going to cause involuntary exposure to secondhand smoke to anyone who wishes to avoid that smoke by not hanging out in that area of the parking lot.

And how about a smoker who crosses Ring Road and lights up during a break over by the soccer fields if no one is around? How exactly does that represent a major public health threat?

The answer is simple. It doesn't. This policy is clearly not intended to protect the health of nonsmokers from the dangers of secondhand smoke. Instead, the policy is intended to impose moral values on a specific health behavior decision. It is a clear example of moralizing and paternalism masquerading as a public health policy.

If the policy were about protecting nonsmokers from tobacco smoke exposure, then there would be no reason to ban smokeless tobacco use from the campus, since that doesn't produce secondhand smoke. Clearly, there is something else going on.

The problem, as being defined by the Board, isn't exposure to secondhand smoke, it's tobacco use itself.

Which is fine - since tobacco use is a public health problem. But the response to that problem is inappropriate. Public health practitioners on college campuses try to use educational and support programs to discourage tobacco use and encourage tobacco users to quit. If we on college campuses are truly concerned about the problem of tobacco use, we will develop smoking cessation programs and incentives to help smokers and smokeless tobacco users quit.

But imposing health behaviors that do not affect others on the college community is not appropriate from a public health perspective. Not to mention how inconsistent this approach is.

If McHenry County College is truly concerned about imposing healthy behaviors on its community members, then probably the first thing it should do is prohibit the consumption of fatty foods on its premises. Obesity and poor nutrition are huge public health problems and are linked with heart disease, hypertension, stroke, and cancer. If the college doesn't want to allow people to risk slowly killing themselves by smoking, then how could the college possibly allow people to risk slowly killing themselves by eating high quantities of fat (quantities which have, by the way, been demonstrated to cause exactly the same kind of endothelial dysfunction caused by smoking)?

Perhaps the first thing to go should be the fried chicken. What business did the MCC Cafeteria have serving a Soul Food menu, with fat-laden fried chicken, to the college community? If MCC is truly concerned about the health of its community members, then that event should certainly be canceled for this year, or else the menu should be changed. And how can MCC justify serving greens, corn bread, fried chicken, and much more at the regular lunch entree prices? Doesn't that simply encourage excessive food intake and contribute to the obesity problem? Shouldn't some greens, a piece of corn bread, and a leg or breast be enough? Why would you need much more to eat than that? And how irresponsible it is of the college to promote that kind of irresponsible diet and unhealthy eating behavior.

And shouldn't the college end its irresponsible and most unhealthy program of providing a free cup of coffee every day as a benefit for those who buy an Alumni Benefits Card? That level of consumption of caffeine is associated, unequivocally, with cardiac arrhythmias, even more serious than those seen with 2 hours of secondhand smoke exposure.

The MCC Conference Center catering menu would certainly have to change. How does serving scrambled eggs with hash browns and sausage, cheese eggs, an omelet with ham or bacon and hash browns, or sausage gravy promote a healthy diet among the campus community? And what about the roast beef and beef sirloin tips entrees? You really can't do much worse than that if you're looking to find a meal with a healthy level of fat. Eat like that for long and you'll be in the same hospital ward as all the smokers who will soon be dodging the traffic on Highway 14 to find a place where they can smoke.

If the Board of Trustees of the College approves this policy, it will be giving a moral value to smoking that it does not give to any other legal health behavior. And that's why, ultimately, I find the proposed policy to be unjustified on public health grounds. There should not be a moral value attached to smoking among adults. Yes, it is a dangerous and risky behavior. But so are many other behaviors that so many of us engage in. What business do we have telling other people that their unhealthy behaviors are not to be tolerated, but our unhealthy behaviors are just fine?

Ultimately, there's a double standard at work here. And so what it comes down to is downright hypocrisy. Maybe it's no surprise that there are anti-smoking groups at least partially behind this proposal. The hypocrisy had to come from somewhere.

Finally, I should add that I don't seriously think that this policy, if imposed, would result in smokers quitting. If anything, I think it will alienate the smokers and solidify their smoking behavior, make them less motivated to quit. This is not health promotion; it's imposition of values on a community in a hypocritical, inconsistent, and intolerant way.

Wednesday, August 16, 2006

California Legislature Considering Bill to Ban Smoking in Cars with Young Children; Arguments Supporting Bill Reveal Flawed Justification for Policy

The California state legislature is considering legislation (Assembly Bill 379) which would prohibit smoking in cars with children under 6 or below 60 pounds. If it enacts the legislation, California would become the third state to ban smoking in cars with children present. According to the Sacramento Bee article about the bill: "Violators would be subject to a base fine of up to $100, which could rise to more than $350 through penalty assessments for courts, jails, trauma centers and other programs."

The chief legislative supporter of the bill - Assemblyman Paul Koretz - revealed the reasoning behind the proposed policy: "If you're too stupid to recognize that [secondhand smoke is dangerous] on your own, then we have to pass a law to tell you, 'Don't be an idiot, don't smoke with your small kid in the car with you.'"

The only organization mentioned in the article which is apparently supporting the bill is the American Lung Association, which was quoted as stating: "Think of the image. Young children, strapped into a child safety seat, unable to roll down a window or really control their environment at all -- and they're being exposed to harmful levels of air pollution."

According to the articles, two of the major tobacco companies have taken no position on AB379: "The R.J. Reynolds Tobacco Co. and Philip Morris USA, two of the nation's largest cigarette companies, have taken no position on AB 379. John Singleton, a spokesman for R.J. Reynolds, said the company opposes smoking around children but that legislating such a ban can 'present some enforcement challenges.' 'I think it just puts an additional burden on law enforcement to make judgments when they already have, most people would say, a pretty full plate,' Singleton said."

The Rest of the Story

If there was any solid policy justification for imposing car smoking bans, supporters of such a policy have destroyed it by revealing the poor reasoning behind their support for it. The purpose of the law, apparently, is to legislate against people being stupid idiots and smoking in a car in the presence of children under age 6.

This is flawed reasoning.

If it is stupid to smoke in a car with children present and this stupidity needs to be banned, then it is even more stupid to smoke in a home with children present and that stupidity would certainly need to be banned. Children are exposed to secondhand smoke for many more hours in the home than they are in a car. By Koretz' reasoning, it's far more stupid to smoke at home around your children than in your car. So the legislature should be banning smoking not only in cars with children, but in all homes and apartments as well. How could the legislature possibly allow such stupid, idiotic behavior?

Moreover, if it is stupid to smoke in a car with children under age 6 present, then isn't it also stupid to smoke with a child of age 6 present? How could you be a stupid idiot because you fail to wait until your child reaches age 6 before you smoke in a car? Or, alternatively, how could you be a stupid idiot for smoking in your car if you have a 5-year-old, but be a reasonably smart citizen for smoking in your car with a 6-year-old?

And if we're going to legislate against idiocy that puts children at risk, there are a host of other things that we should probably outlaw even before smoking in cars. How about drinking, for starters? Or screaming at kids? Using curse words or foul language in front of them? Having an extra-marital affair?

As much as I may loathe the American Lung Association's description of the young child, strapped in the car safety seat, who cannot escape the smoke, this hardly justifies a policy of banning smoking in cars when children age 6 and under are present. The image, while compelling, is not particularly meaningful. If the child weren't strapped in the safety seat, would she be any less trapped in the car. What is she supposed to do? Jump out of the car if the parent starts smoking?

And how is a young child in a home any less trapped? Is a 2-year-old supposed to know enough to walk out of the house if his parent starts smoking? And what is a poor 9-month old supposed to do? Crawl their way over to the door and wait for someone to open it so she can crawl out and have an escape?

I'm sorry, but the reasoning in support of this policy just doesn't add up. It's flawed, and I don't see a way that it can be repaired.

The most important aspect of the rest of the story, however, is not the flawed reasoning that has been revealed in supporting car smoking bans. It is the way that smokers are being seen by legislators. Clearly, they are being seen as stupid idiots.

Smokers are stupid idiots because they expose their children to an increased risk of ear infections, respiratory infections, or asthma. But are parents who don't wear a seat belt stupid idiots for increasing the risk that they will leave their children parentless? Are parents who drink alcohol excessively stupid idiots? What about parents who don't remove the lead paint from their apartment?

If you really analyze each of us, you'll find that all of us parents are indeed stupid idiots. We all do things that knowingly put our children at increased risk of adverse health effects or other adverse consequences. By this reasoning, we are a nation of stupid idiots. It's just the smokers who are being singled out. Because smoking is true idiocy. But all the other vices, addictions, and poor health behaviors are smart ones.

Monday, August 14, 2006

Another Youth Anti-Smoking Group Supporting Special Protections for Philip Morris; Unethical Tactics of Campaign for Tobacco-Free Kids At Work?

Another youth anti-smoking group (in addition to Ignite) is supporting proposed FDA tobacco legislation that would provide Philip Morris with special protections designed to keep major tobacco regulatory decisions in the hands of politicians and subject to tobacco legislative influence, rather than in the hands of scientists and subject only to science and public health concerns.

The Ohio group – Stand Online – held a protest Wednesday at the office of Ohio Congressman John Boehner to call attention to Boehner’s failure to support proposed legislation that would give FDA severely limited regulatory authority over tobacco products. According to the group’s web site, it supports the proposed FDA tobacco legislation and is “doing our part here in Ohio to support FDA legislation by hosting events.”

The Rest of the Story

The rest of the story is that little do these young people appear to know that what they are supporting is a watered down version of legislation which contains gaping loopholes introduced solely in order to achieve Philip Morris’ support for the bill – loopholes which provide special protections for the tobacco companies not enjoyed by any other companies whose products are regulated by FDA.

It seems very unlikely this group of young people would want to support legislation that would help Philip Morris achieve its chief legislative goal. It seems inconsistent with the mission of these youths for them to support a system of special protection for an industry that it is supposedly attacking.

So the question arises: do the youths really understand how the specific provisions of this bill came about? Do they understand that the legislation was written by, or with the assistance and input of, Philip Morris? Do they understand that it was the result of a negotiation that involved Philip Morris and which resulted in substantial public health compromises in order to appease the nation’s leading cigarette manufacturer? Are they aware that there is substantial opposition to this legislation in the anti-smoking community? Are they aware that the Campaign for Tobacco-Free Kids basically agreed to this deal with Philip Morris, knowing that the concessions that were made would compromise the protection of the public’s health in order to appease Big Tobacco? Is this what these young people are really all about?

I doubt it.

I’ve learned from my recent experience in tobacco control that whenever you see youths parading around and “hosting events” in a state of apparent oblivion to the complex realities of the politics of tobacco product regulation, you can pretty much guess that the Campaign for Tobacco-Free Kids is in some way behind it. And so I question whether the Campaign really set these youths up for this.

In fact, upon closer reading of the article, we find out that these youths did have substantial interaction with the Campaign, as they were named as Tobacco-Free Kids’ youth advocates of the year. I seriously doubt that the Campaign provided these youths with the full information that is necessary for them to make an informed decision about their position on the proposed FDA tobacco bailout for Philip Morris. It certainly doesn’t appear, from the group’s propaganda (which is highly reminiscent of the propaganda put out by the Campaign), that they have been informed about the most critical issues.

If this is the case, then I view it as an ethical violation by the Campaign, because I don’t view it as being ethical to use youths for our own purposes in this way, especially engaging them in advocacy efforts without providing a mechanism for full informed consent. You cannot have informed consent without informing the youths of these important details regarding the legislation.

And I’m not just talking about varying interpretations of the effect of the legislation. I’m talking about facts – the basic facts about how the legislation came to be, what the provisions are, how these provisions were arrived at, who were the players at the table, and why the specific provisions that compromise public health protection were included in the legislation and why it is apparently essential that these loopholes not be removed from the bill.

If the youths still want to support the legislation after being fully informed about all of these facts, then that’s fine. But they’d certainly have to change some of their rhetoric.

I really hate to see youths used in this way. While I think that getting kids involved in legislative advocacy is a good idea in general, this is certainly not the way to do it. It’s a shame that these youths are being indoctrinated directly into the hypocrisy of the modern anti-smoking movement.

Thursday, August 10, 2006

It Must Be the Plutonium: Anti-Smoking Group Provides Explanation for How 30 Minutes of Secondhand Smoke Exposure Could Be So Deadly

The Tobacco Prevention Center at the St. Louis University has finally answered my question as to how it could be plausible that a mere 30 minutes of exposure to secondhand smoke could be so deadly, as claimed by more than 80 anti-smoking groups and by the former United States Surgeon General.

The answer, it turns out, is quite simple: secondhand smoke contains plutonium.

According to this anti-smoking group: "Arsenic, benzene, carbon monoxide, Plutonium 210 and a host of other poisons are in secondhand smoke."

The Rest of the Story

The presence of the chief raw material for nuclear weapons in secondhand smoke definitely provides a plausible explanation for how, as the Surgeon General claimed, even a brief exposure to secondhand smoke can cause lung cancer. Even micrograms of fine plutonium particles are known to cause lung cancer. Thus, even a brief exposure to secondhand smoke, with its plutonium, would be expected to cause lung cancer.

Now while I thought I had reason to question even the claim that 30 minutes of secondhand smoke exposure causes heart attacks in people with existing heart disease, I suspect that there is a logical explanation for why it can break down the coronary arteries even of those who are perfectly healthy and strong.

In addition to plutonium, secondhand smoke probably contains kryptonite as well. This element has been documented to pose a danger even to the strongest and most powerful individuals out there with completely healthy and in fact, superhuman, cardiovascular systems.

This provides an obvious explanation for why just 5 minutes of exposure to secondhand smoke reduces the ability of the heart to pump, as claimed by many anti-smoking groups, even among the healthiest of individuals.

Of course, the variety of kryptonite in secondhand smoke would have to be either green, red, or gold to exhibit this toxicity to individuals with super-human strength.

Not only is there no safe level of exposure, but no one is safe. No matter how much of a super hero you think you are, you are powerless against a brief whiff of secondhand smoke.

But there's good news on the horizon. Philip Morris, along with the Campaign for Tobacco-Free Kids, are supporting Congressional legislation that would ban red, gold, blue, and white kryptonite from tobacco smoke, although The Rest of the Story has opposed this legislation because it would still allow the most toxic form - green - to remain present in existing cigarettes already on the market. No green kryptonite would be allowed in new cigarettes, however.

Another important implication of the presence of plutonium and possibly kryptonite in secondhand smoke is that it provides an alternative explanation for why cigarette companies might be adding ammonia to cigarettes (other than to enhance the addictiveness by increasing the presence of the more readily absorbed form of nicotine).

It may be that cigarette companies are aware that kryptonite easily breaks down in an acid environment, making it essential for them to maintain a higher pH. So in addition to providing anti-smoking groups with increased ammunition to use in their efforts to freak out the public about the astounding immediate dangers of small amounts of secondhand smoke, this new information may also provide cigarette companies with a new defense in tobacco litigation.

Already, a number of pharmaceutical company-funded anti-smoking groups are touting KRT (kryptonite replacement therapy) as the new basis for a national smoking cessation plan, and suggesting that DOJ amend its requested remedy in the landmark case against Big Tobacco to include a $130 billion KRT program. KRT has been shown to be twice as effective as quitting smoking with the use of a placebo; however, the effectiveness of the blinding in these clinical trials has been questioned, since the white kryptonite used in these trials cause immediate disintegration of any plants in the homes of subjects who are receiving non-placebo.

Wednesday, August 09, 2006

My Idea for a New "Truth" Campaign Commercial

Here’s my offering of a 30-second television commercial for the “truth” campaign. It is modeled after the current campaign in which tobacco executives are shown sitting around a board room table trying to think of ways to entice young people to smoke. Different executives present various ideas, all taken from tobacco industry documents, and a laugh track follows each of these seemingly crazy and funny ideas (like “how about putting chocolate in the cigarettes?”).

Here, however, the “executives” are anti-smoking advocates sitting around a conference room table trying to figure out how to convince the public of the dangers of secondhand smoke and the need to ban it in public places.

The Rest of the Story: Proposed Script for a “Truth” Commercial

Advocate 1: So here’s the problem. People just aren’t paying attention to all this talk about secondhand smoke being harmful. All this talk about the hazards of chronic exposure, the benzene, radioactive polonium, and hydrogen cyanide just aren’t cutting it. We need something worse – much, much worse – that can grab people’s attention. Something quicker, more potent. Any ideas?

Advocate 2: Yeah – how about saying that it kills instantaneously.

(laugh track)

Advocate 3: Well, people won’t believe that. But, let’s say…. 30 minutes. Yeah, 30 minutes. It causes hardening of the arteries. Just 30 minutes of exposure.

(laugh track)

Advocate 4: And fatal cardiac arrhythmias.

(laugh track)

Advocate 3: Oooh. That sounds nasty.

Advocate 5: How about this? Just 20 minutes of exposure can clog your arteries?

(laugh track)

Advocate 2: Yeah. That’s good. Clogging sounds good.

Advocate 1: Can we get anything quicker than that? Five minutes perhaps? Anybody?

(laugh track)

Advocate 6: Hey, I’ve got it. Just 5 minutes of exposure causes the aorta to stiffen and makes it harder for the heart to pump.

(laugh track)

Advocate 1: Nice. These plumbing analogies are going to fly with the public.

(laugh track)

Advocate 1: But we still need something nasty in the secondhand smoke. And I mean really nasty.

Advocate 2: I’ve got it. Sardines. Spoiled sardines.

(laugh track)

(long pause)

Advocate 3: Rat poison?

Advocate 1: Already been used.

Advocate 4: Toilet bowl cleaner?

Advocate 6: Used.

Advocate 7: Cockroach dander.

Advocate 1: Not believable.

Advocate 8: Asbestos?

(laugh track)

Advocate 1: Now we’re cooking. Nasty stuff. Brings up images of that stuff flaking off of insulation in old houses. Millions of dollars spent trying to get rid of the fibers.

Advocate 4: Won’t people question how those fibers could have gotten into the smoke?

Advocate 8: Who do you think the public is? We’re not putting out this stuff for scientists.

(laugh track)

Advocate 4: What if the tobacco companies call us on this?

Advocate 2: Bruce – it’s 2006 now. Wake up. The tobacco companies haven’t challenged anything we’ve said in the past four years. All we have to worry about is that crazy Mike Siegel’s blog.

(extended laugh track)

Eating Carrot Cake and a Milk Shake May Be As Bad As 30 Minutes of Secondhand Smoke

New research out of the Heart Research Institute in Sydney shows that eating a piece of carrot cake prepared with saturated fat along with a milk shake causes endothelial dysfunction as measured by a reduction in coronary reserve flow velocity. The same changes did not take place when the carrot cake was prepared with polyunsaturated fat.

According to the Associated Press article about the study: “The researchers, led by Dr. Stephen Nicholls, a cardiologist now at the Cleveland Clinic, found that three hours after eating the saturated-fat cake and shake, the lining of the arteries was hindered from expanding to increase blood flow. And after six hours, the anti-inflammatory qualities of the good cholesterol were reduced.”

The changes observed with carrot cake are similar to those seen after a 30-minute exposure to secondhand smoke – changes which are being used by anti-smoking groups to support claims that a brief exposure to secondhand smoke is enough to cause heart attacks, narrowed and clogged arteries, atherosclerosis, and death.

Unlike anti-smoking groups, health advocates commenting on these findings to the public did not claim that eating a piece of carrot cake can cause a heart attack, that imbibing a single milk shake can narrow and clog arteries, or that a single high-fat meal can cause hardening of the arteries.

Instead, the researchers accurately pointed out that chronic ingestion of saturated fat over many years could lead to heart disease and that people should therefore aim to reduce their saturated fat intake: “Dr. Nicholls said ‘the take-home, public-health message is this: It's further evidence to support the need to aggressively reduce the amount of saturated fat consumed in the diet.’”

Nevertheless, at least one cardiologist who commented on the study did suggest that even a single meal might be too much for the body to handle: “Even one meal of a double cheeseburger with fries and a Coke will mess up your system… .”

The Rest of the Story

What this study shows, in my opinion, is that eating a piece of carrot cake prepared with saturated fat in a restaurant that contains secondhand smoke is a recipe for almost certain death.

Poor carrot cake. Like it really needs this bad rap.

Tuesday, August 08, 2006

Anti-Smoking Group Does Claim that Secondhand Smoke Contains Asbestos

A Missouri anti-smoking group has publicly claimed that secondhand smoke contains asbestos.

On Monday, I reported that the St. Louis University Tobacco Prevention Center had made such a claim, according to a KMOV news story. Some readers questioned whether I was perhaps jumping the gun and making something out of nothing, since it was possible that this was simply a reporter's mistake in communicating the quote from the Tobacco Prevention Center spokesperson.

However, the actual footage from the KMOV news segment has been pointed out to me, and confirms that this was not a mistake.

The anti-smoking group has indeed claimed that secondhand smoke contains asbestos. Here is the quote:

"Why would you want to inhale lethal substances? We're not made to do that kind of thing. And when asbestos was declared lethal, it was eliminated. There's asbestos in second hand smoke."

The Rest of the Story

Once again, this is a completely fallacious claim. Secondhand smoke does not contain asbestos.

It appears that the truth is not enough. We in tobacco control apparently need to deceive the public and make up things that aren't true in order to scare the public enough to support our agenda.

I guess you can add this group to the 80+ other anti-smoking groups which continue to make fallacious scientific claims to the public about secondhand smoke.

And I still have the $100 that I offered, to no avail, to the first group that corrected their fallacious claim and apologized. So that offer now extends to the St. Louis University Tobacco Prevention Center.

Should I put the money in a safe place, or is it safe for me to spend it? I'm thinking about a couple of box seats for the next Red Sox home game. Do I pull the trigger, or is there even a chance that an anti-smoking group will admit that they have deceived the public and apologize for it?

Michigan-Ohio State Matchup May Have Less Deception than SmokeFree vs. SmokeLess Ohio

NBC Nightly News revealed last night that petitioners for a SmokeLessOhio-supported ballot initiative are using deception of the public to try to obtain signatures for an initiative that would protect smoking in public places and wipe out local smoking restrictions, all under the guise of protecting nonsmokers.

I have already revealed that SmokeFreeOhio, the chief supporter of the competing initiative which would ban smoking in most public places, is also using deception of the public to promote its initiative. The group is making fallacious scientific claims about secondhand smoke to the public to try to increase the emotional appeal of its message about how terribly and acutely hazardous secondhand smoke is to the masses.

Citizens in Ohio who want to see a battle played out with some integrity and not merely trickery may have to wait until November 18, when the Wolverines and Buckeyes fight it out in Columbus for a possible Big Ten championship. You won't see much deception or many trick plays in that game, just hard-nosed, in-the-trenches football. Maybe someone should take SmokeFreeOhio and SmokeLess Ohio to the game and show them what a battle fought with some integrity looks like.

Monday, August 07, 2006

Anti-Smoking Group Quoted as Stating that Secondhand Smoke Contains Asbestos: The Newest Fallacious Scientific Claim

According to an article on the KMOV (St. Louis) website, a Missouri anti-smoking group has informed the public that secondhand smoke contains asbestos.

According to the article, Pat Lindsey, director of the St. Louis University Tobacco Prevention Center, stated: "Why would you want to inhale lethal substances? We're not made to do that kind of thing. And when asbestos was declared lethal, it was eliminated. There's asbestos in second hand smoke."

The Rest of the Story

The rest of the story is that there is no asbestos in secondhand smoke.

I've reviewed reports of hundreds of the chemicals in secondhand smoke. I've testified about the chemicals present in secondhand smoke. I've even been in the same room as the safe that contained the secret list of additives in cigarettes (which is now public). And nowhere have I seen any support for the contention that secondhand smoke contains asbestos.

That is a fallacious claim if I've ever seen one.

Now let me say that I think there are enough nasty things in secondhand smoke that we certainly don't have to resort to deceiving the public about what's in it in order to promote our agenda.

Apparently, it's not enough any more for anti-smoking groups to simply report the scientific truth. We now have to exaggerate and distort it in order to create the maximum possible emotional appeal. And if the actual list of components of tobacco smoke isn't scary enough, then we can just embellish it a little to frighten people.

After all, secondhand smoke is bad for you. So what does it matter whether we stretch the truth a little by making people think that it contains asbestos? No harm is done.

Unfortunately, there is harm done. The harm is that the anti-smoking movement is quickly losing its scientific credibility. This is the story of the Boy Who Cried Wolf. Eventually, the public will not believe what we are stating, even when it is true and we need the public to trust us in order to take the appropriate action.

Not surprisingly, when I examined the St. Louis University Tobacco Prevention Center website, I found that it is yet another one of the 80+ anti-smoking organizations that are making misleading and fallacious scientific claims to the public about the acute cardiovascular hazards of secondhand smoke.

According to a "fact sheet" on the site written by a number of Missouri anti-smoking groups: "Even half an hour of secondhand smoke exposure causes heart damage similar to that of habitual smokers."

This so-called "fact sheet" is suggesting to the public that just 30 minutes of secondhand smoke exposure causes the same heart damage to a nonsmoker as it does to someone who actively smokes day in and day out for many years.

What rubbish!

First of all, a 30-minute exposure to secondhand smoke was not found to do any "heart damage" in the study that is cited to support this claim. What the brief exposure did was cause transient endothelial dysfunction, which in and of itself did not cause any damage to the heart.

But in an active smoker, the heart damage can be severe. Chronic active smoking can cause atherosclerosis, which can completely block coronary arteries and cause heart attacks that virtually destroy the heart muscle, making it unable to pump blood and sustain life.

I don't think that 30 minutes of exposure to secondhand smoke can do that!

What the Tobacco Prevention Center's (and other Missouri anti-smoking groups') claim suggests is that there is no reason for smokers to quit. If just being exposed once for 30 minutes is going to cause the same amount of damage to their heart as years of smoking, then what possible incentive is there for people to quit smoking?

We in tobacco control accuse the tobacco companies of a lot of wrongdoing. We certainly accuse them of lying and distorting the truth. But seldom do we find blatant examples of absolutely fallacious factual misrepresentations. Usually it is more on the line of misleading or deceptive statements.

Well here is an example of an outright factual misrepresentation. Unfortunately, it is coming not from the tobacco companies, but from our own camp.