Thursday, September 14, 2006

IN MY VIEW: It's Time to Talk; Tobacco Control Movement Must Open Itself Up for Discussion with Critics

If there's one thing that both good science and sound policy require it's openness to challenge. In fact, I would define the process of scientific advancement as one in which existing paradigms are subject to criticism, challenged, examined systematically, and then either supported or refuted. And I would argue that the process of policy development entails the consideration of a wide range of policy options followed by a systematic examination of each. In both the science and the policy domains, openness to challenge is an essential element for the advancement of the field and a requirement to achieve excellence.

Unfortunately, as I've revealed in The Rest of the Story over the past months, the tobacco control movement has become increasingly insular, blindly dogmatic, and incessantly closed to questioning of both its scientific claims and its policy prescriptions.

It has reached the point where the movement is not even willing to respond substantively to its critics (even if such a critic is one of their own). Any questioning of the established dogma is disallowed, and is met with ad hominem attacks on the critic. Any questioning means, ipso facto, that the questioner has allied himself with the tobacco industry's side and maybe even receives tobacco money. The cause is so noble that the means to the ends are not subject to challenge.

Without realizing it, we have become what Foucault called a truth regime.

The Rest of the Story

A fascinating article in the journal Public Understanding of Science suggests that the anti-smoking movement has become so partisan in its ideology and actions that it is no longer capable of carrying on scientific inquiry (see: Ungar S, Bray D. Silencing science: partisanship and the career of a publication disputing the dangers of secondhand smoke. Public Understanding of Science 2005;14:5-23).

Ungar and Bray write: "We use the term partisan to describe those trying to mute the reporting or circulation of scientific claims. Partisan is a felicitous metaphor, as it encompasses two levels -- ideas and actions. At the first level, a partisan is a firm adherent to a belief or cause; the partisan tends to have an unreasoned allegiance to this, and not to truth. This contravenes, of course, the normative complex surrounding openness in science."

By this definition, the anti-smoking movement is decidedly partisan. While there is nothing wrong with a firm adherence to a belief or cause (it is quite an admirable quality), we cross the line from scientific-based advocacy to unreasoned allegiance when we ally ourselves with the cause (the agenda) and not to truth.

This is precisely what has occurred in our movement. Our firmest alliance is to the agenda, not to truth. One need only scroll through The Rest of the Story briefly to see numerous examples of how anti-smoking groups are not letting the scientific facts get in the way of their desire to make the most dramatic claims, especially about the effects of acute secondhand smoke exposure and the health benefits of smoking bans. The allegiance to the agenda over the truth has infiltrated the entire movement, from the smallest, local grassroots organization all the way up to the Surgeon General himself.

Ungar and Bray continue: "At the second level, a partisan is a member of a ... band harrassing an enemy. For our purposes then, partisanship involves not only a dogmatic adherence to a belief, but also the use of a wide range of tactics to silence opponents of that belief in any arena in which it is presented, reported or used. Partisans seek not only to authoritatively lay down their (scientific) position, but to shield it by engaging in silencing skirmishes that can include, among other things, intimidation, slander and discredit...".

There is nothing wrong with the tobacco control movement laying down its position, even in an authoritative manner. However, shielding it from challenge by silencing critics through intimidation and personal attack puts it into the realm of Foucault's truth regimes. Yet that is exactly what we are doing. Kicking someone off of a list-serve because you do not like the opinions they are expressing is a quite literal form of silencing critics. But this happened to me twice in a matter of months. I did experience intimidation, slanderous attacks, and attempts to discredit me personally.

I should note here that the primary mechanism by which the tobacco control movement silences its critics is what Ungar and Bray term "self-silencing." In most cases, overt intimidation and discrediting is not necessary. The fear of retaliation is so great that most members of the movement, finding themselves in a position of disagreeing with the dogma, will choose to silence themselves rather than to risk their reputations and their careers by speaking out.

Ungar and Bray, in describing self-silencing, appear to have an insightful understanding of the current nature of the tobacco control movement: "Indeed, the ideal form of silencing approaches Foucault's concept of truth regimes: specifically, 'self-silencing,' which is likely to occur when forms of discourse seem so patently obvious and sanctioned by leading institutions that they are presented as givens and are difficult or impossible to challenge. Here competing ideas are ignored because they are not only unbelievable, but they do not fit with the prevailing forms of talk institutionalized in the speech community."

The danger of scientific partisanship is that it represents the antithesis of science. By definition, it precludes sound science. Or as Ungar and Bray put it: "If fully realized, scientific partisanship entails, as noted above, closure, intimidation, and silencing, rendering science impossible."

Here is how Foucault describes his regimes of truth: "Each society has its regime of truth, its 'general politic' of truth: that is, the types of discourse which it accepts and makes function as true; the mechanisms and instances which enable one to distinguish true and false statements, the means by which each is sanctioned; the techniques and procedures accorded value in the acquisition of truth; the status of those who are charged with saying what counts as true." (from: Foucault M. Power/Knowledge: Selected Interviews and Other Writings. 1972-77. New York: Pantheon, 1980).

The anti-smoking movement has a simple mechanism for distinguishing true and false statements: simply determine whether the statement supports or opposes the tobacco control agenda. And it has a simple way of according value to the acquisition of truth: give value to anything that provides data which support the agenda and discredit or devalue anything that does not support the agenda.

A perfect example of this is my own research. When I produced research showing that secondhand smoke poses a serious occupational health hazard for bar and restaurant workers, I was widely praised by the tobacco control movement, was considered an important leader in the field, had my work widely cited, and my comments (even if judged repetitive) were welcomed without hesitation in all tobacco control discussion forums.

However, when I produced research showing that the claims about the reduction of heart attacks attributable to smoking bans were premature, that anti-smoking groups' claims about the acute cardiovascular effects of secondhand smoke were untrue, or that refusing to hire smokers represents employment discrimination, I was immediately dismissed from the list-serves, branded as a traitor, and condemned by my colleagues.

The tobacco control movement has become a regime of truth. A regime that cannot be challenged, even from within. Neither the agenda nor the science purported to support that agenda is subject to challenge. There is no legitimate discourse about the justification for anti-smoking groups' claims, statements, or actions.

I have responded to the development of this regime of truth in the only way I know how: by writing about it and bringing it to public attention. The regime cannot be toppled by bringing it to the attention of the tobacco control community. That type of challenge is heresy. But the public may be willing to listen. I know that you, my readers, are. For that, I am ever grateful.

Note: For purposes of full disclosure, I must mention that it has been a long-term dream of mine to one day bring Foucault into the discussion of tobacco control. Mission accomplished.

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