Article in Nature Highlights Shoddy Science Behind Helena et al. Conclusions and 30 Minute Claims of Anti-Smoking Groups

An article by Dr. Kris Novak in this week's issue of Nature highlights my questioning of the validity of the conclusion of the Helena, Pueblo, Piedmont, and Bowling Green studies that smoking bans in those towns resulted in immediate, dramatic reductions in heart attacks. The article also highlights my questioning of the claim being made by many anti-smoking groups that 30 minutes of secondhand smoke causes clogged arteries and heart attacks among otherwise healthy nonsmokers.

According to the article:

"In principle, smoking bans provide a unique opportunity to study populations before and after reductions in second-hand smoke exposure. But if research into the incidence of heart attacks is any guide, the results of such studies are often far from clear and can cause more controversy. Glantz reported in 2004 that during a six-month smoking ban in Helena, Montana, the number of heart attacks dropped by 40% compared with the same months in other years. The study, cited in the surgeon general's report, was criticized for the small number of cases studied and the large month-to-month variations in incidence of heart attacks. Since the report, several studies have reported a drop in hospital admissions for heart attacks after smoking bans in the Piedmont region of Italy (11% drop), and in small cities in Colorado (27%) and Ohio (39%)."

"But not all epidemiologists are impressed. 'It's quite common to see major year-to-year changes in heart attacks, sometimes as much as a 50% increase or decrease,' says Michael Siegel, an epidemiologist at Boston University School of Public Health. Attributing such changes to a ban is impossible, he says. Worse, none of the studies recorded whether the changes occurred in non-smokers or in smokers, yet the effects of the ban are frequently attributed to reductions in second-hand smoke exposure. The lead author of the Ohio study agreed that a prospective study that collected data on groups of non-smokers and smokers in advance of a ban — and then followed them up for a few years after — would be ideal, but this would take longer and be costly." ...

Certainly, public-health officials seem convinced. Pechacek says that the general consensus in tobacco researchers is that the drop in heart attacks occurs mainly in non-smokers. Smokefree England suggests that just 30 minutes of breathing in second-hand smoke can raise your risk of having a heart attack. But can you really become ill just by sitting in a bar next to a smoker? 'Saying that just a little exposure is killing people is going overboard,' says Siegel, who worries that when researchers exaggerate their findings, they lose credibility with the public. 'I agree that second-hand smoke is a tremendous health hazard, but no one is going to have a heart attack from 30 minutes of exposure.'"

"Siegel thinks that banning smoking in outdoor places is going too far and risks losing support for smoking bans overall. Smoking has been banned on 25 California beaches, and this week the Beverly Hills City Council approved a ban in nearly all outdoor dining areas. 'We should focus efforts on the remaining areas in which workers are not protected,' he says. 'My biggest concern is for the waiters and bartenders who spend 40 hours each week in very smoky environments.' He's also worried about the health of smoking research itself, which he sees being compromised by methodological flaws and over-interpretation of results. And although prospective studies would be costly, Siegel argues that funding for a large prospective study of the effects of smoking bans on non-smokers is warranted. 'Although I wholeheartedly support smoking bans, I still believe that we must use solid science to advocate for such bans and that a noble end — improving public health — does not justify the compromise of our scientific principles.'"

The Rest of the Story

I don't have much to add to what Dr. Novak wrote. I'm just glad that the misrepresentation of the science by anti-smoking groups and the deterioration of the quality of the scientific conclusions being made in the movement are being highlighted in a scientific journal with the high quality and fine reputation of a journal like Nature. I hope this will force anti-smoking groups to re-examine their decisions to disseminate misleading, if not inaccurate, health information and encourage the tobacco control movement to take stock of the deterioration of its scientific integrity and take steps to restore it.

Unfortunately, I don't think either of these will happen, because frankly, I really don't think that the movement, as an entity, actually cares. As long as its political aims are being met, I don't think that scientific integrity really enters the picture.

30 Minutes of Secondhand Smoke Equals Clogged Arteries - Final Answer; TobaccoScam Decides to Stick with Deception

In response to my challenge to correct its misleading website (page 1; page 2), TobaccoScam has apparently decided not to do anything. The web pages remain the same, with no changes, corrections, documentation, or clarifications.

It appears, then, that it is TobaccoScam's intention to inform the public that:

• 30 minutes of secondhand smoke exposure causes clogged arteries;
• 30 minutes of secondhand smoke exposure cause arteries that are as damaged as an active smoker's;
• 30 minutes of secondhand smoke exposure increases the risk of an immediate heart attack; and
• 20 minutes of secondhand smoke exposure is the equivalent to actively smoking a pack of cigarettes per day.

The specific claims are as follows:

"30 minutes exposure = smoker's arteries"

"Thirty minutes of secondhand smoke compromises a non-smoker's coronary arteries to the same extent as in smokers."

"20 minutes exposure = smoking a pack a day"

"Twenty minutes of breathing secondhand smoke at levels similar to those measured in bars activates blood platelets involved in the clotting process as much as it does in pack-a-day smokers. These activated platelets increase the chances of heart attack or stroke."

"30 minutes exposure = stiffened, clogged arteries"

"All of these effects not only increase the long term risks of developing heart disease, but also increase the immediate risk of heart attack."

The Rest of the Story

I have been trying to give all the anti-smoking groups the benefit of the doubt for a long time now (at least 18 months), and despite the fact that there has been no response to my pointing out the many misleading scientific claims that are being made, I have clung to the hope that perhaps this misrepresentation of the science was just a series of innocent mistakes, oversights, or careless errors.

At this point however, it is impossible for me to any longer cling to that belief.

Instead, it appears to me that at least some of these claims are the result of a deliberate attempt to deceive people.

The fact that TobaccoScam and the other organizations that were informed earlier this week about the misleading nature of their claims about the acute cardiovascular effects of secondhand smoke apparently decided not to alter these claims suggests to me that they have made a conscious and deliberate decision to maintain the deception of the public. In other words, this is not just the result of a careless mistake or oversight, but instead, represents a deliberate attempt to convince the public that these specific scientific assertions are true.

That is - these groups actually want the public to believe that 30 minutes of secondhand smoke exposure clogs your arteries.

They actually want the public to believe that 30 minutes of secondhand smoke increases your immediate risk of a heart attack.

They actually want the public to believe that 20 minutes of secondhand smoke exposure is as damaging as actively smoking one pack of cigarettes per day.

It is thus my opinion that these groups actually want the public to believe scientific facts that are not true. That is, by definition, deception. And this is then, by definition, intentional deception of the public.

I apologize, but no more Mr. Nice Guy. Now it's time to play hard ball. Because these groups, by violating the most basic ethical principle of public health communication, are risking the credibility and reputation of the entire tobacco control movement.

Cartoon Draws Attention to Absurdity of Proposed FDA Tobacco Legislation

A cartoon created by cartoonist Matt Bors and commissioned by Dr. Alan Blum, director of the University of Alabama Center for the Study of Tobacco and Society, appeared in the opinion section of last Sunday's Birmingham News. The cartoon draws public attention to the absurdity of the proposal to place responsibility for the safety of cigarettes in the hands of the Food and Drug Administration (FDA). The cartoon also appears on the website of the Association of Public Health Physicians, which opposes the proposed FDA tobacco legislation.

The cartoon features a cancer patient apparently receiving chemotherapy in a hospital bed while smoking, with the header: "When you're dying, you can use FDA-approved cancer drugs." The smoking patient states: "It's a one-stop agency for everything I need."

Bors states that: "we have a situation where people will be buying 'FDA approved' smokes while other brands are banned by arbitrary standards involving the packaging and marketing of the cigarettes instead of the actual result of using the products. Just to be clear, I am in favor of certain restrictions on Tobacco's claims and advertising--anyone who knows me is aware of my loathing f0r this product. This Bill is just misguided."

He adds: "Don't let anyone ever say that Democrats or Liberal leaning interest groups don't give bills deceitful titles: The Family Smoking Prevention and Tobacco Control Act. You see, by putting cigarettes under the FDA we will protect families from smoking. Not any individuals, single people, couples, or orphans. Families."

Bors concludes: "As Dr. Blum said in his testimony against this Bill to the Senate Committee on Health, Education, Labor, and Pensions: 'The proposed FDA bill will simply change who is committing consumer fraud. Currently, it’s still the tobacco companies, marketing reduced tar and nicotine cigarettes in a way that deceives consumers into believing that these products are safer. If the FDA bill is enacted, then the government will be doing the dirty work for the tobacco companies. Small wonder why Philip Morris embraces this bill, which will permit it to tell consumers that it is complying with strict product safety standards, making government-approved cigarettes.'"

The Rest of the Story

What a great job by Matt Bors (and a great idea of Dr. Blum's) to use humor to draw attention to the absurdity of this legislation. The image of a smoker receiving FDA-approved chemotherapy while smoking an FDA-approved cigarette says it all. Thank God for the FDA legislation. At least the cigarettes which will be causing cancer, disease, and death for literally thousands of Americans each month after the legislation is enacted will be FDA-approved products. We wouldn't want people dying from cigarettes which do not meet FDA's standards.

American Legacy Foundation Testifies that 390,000 Kids Start Smoking Each Year Due to Seeing Smoking in Movies

The American Legacy Foundation, in testimony at a special Congressional hearing on the topic of smoking in movies, claimed that one-third of all youth smoking initiation is due to smoking in movies. The Foundation also reiterated its call for an automatic R-rating for any movie depicting any smoking, with the exception of an accurate historical depiction or if the movie clearly reflects the dangers of tobacco use.

According to a Legacy press release: "Today on Capitol Hill, members of the U.S. Congress representing adults, parents and families across America convened for a hearing to discuss the negative impact that everyday images in media have on our nation's children. The American Legacy Foundation(R) was present to testify about important information on how images of smoking cause youth to start this dangerous and addictive behavior. ... Legacy specifically shared research that establishes a relationship between smoking in movies and on television and youth starting to smoke, finding that one-third of youth smoking initiation can be traced to what youth see on screen after controlling for all other factors, such as peer pressure, parental smoking and more. ... What research tells us, and what Congress heard today from us, is that the film industry -- by showing smoking on the silver screen -- recruits 390,000 new smokers each year. ... If the movie industry seriously intends to solve the problem of movie smoking, they would agree to our call for rating new smoking movies R, with the exception of the accurate representation of a historical figure or if the smoking clearly reflects the dangers of tobacco use."

The Rest of the Story

As I have explained, there are a number of reasons why one cannot validly conclude that on-screen smoking causes one-third of youth smoking initiation, even given the studies which have shown an association between exposure to smoking in movies and smoking behavior.

For one thing, parents who allow their kids to go out and see the types of movies that contain a lot of smoking are quite different from the parents who are more restrictive about what they allow their kids to be exposed to. In addition, the kids who go out to movies often are different from those kids who choose not to go out to these types of movies very often. It is very difficult to control for these major differences between these populations, which could well explain why one group is more likely to smoke. It is quite possible that it is not smoking in movies, but some other factor - related to WHY a parent allows their kids to spend hours and hours out with their friends watching these types of movies rather than forcing them to be home or in more controlled settings - that is the actual cause of increased smoking among this group.

Another serious methodologic problem with these studies is that there is most likely a severe measurement bias. Parents who are controlling enough not to allow their kids to go out to the movies are probably more likely to be listening in to or monitoring the phone call in which their childrens' smoking status is ascertained. It has been demonstrated that kids are significantly less likely to admit that they smoke when they believe a parent may be monitoring the phone call. This effect would create the appearance that kids who see more smoking in movies are more likely to smoke when the real effect has more to do with parental factors.

Even if the smoking in movies were contributing to the initiation of smoking, it is far too premature to make definitive quantitative conclusions about the specific proportion of kids who start smoking because of smoking depictions in movies. These definitive quantitative conclusions are, after all, based on only a handful of studies. If our science were loose enough to be willing to make these kind of quantitative conclusions based on such limited studies, we would have long ago been told that drinking coffee kills thousands of Americans every year from cancer and that if we all only write to Maxwell House, we could save thousands of lives a year.

Moreover, it is extremely unlikely that these studies are measuring an exclusive effect of seeing smoking in movies. Movies are just one source of exposure to depictions of smoking and to the formation of attitudes and social norms regarding smoking. Movies most certainly do contribute to these attitudes and norms, but to suggest that movies are the only such factor or that these studies are measuring an isolated effect of smoking in movies, is ridiculous and certainly not scientifically sound.

And to top it all off, even if we were to accept that smoking in movies does cause one-third of smoking initiation, there is no evidence to suggest that simply requiring an R-rating of movies that depict smoking would reduce kids' exposure. What might happen instead is that parents will stop paying as much attention to the movie ratings and that kids may be more likely to go to R-rated movies. An action like this one could undermine the ratings system to the point that parents don't pay much attention to it anymore. I don't know if that would be the effect or not, but neither do these anti-smoking organizations know that it wouldn't occur. My point is that even if smoking in the movies is as bad as these groups are claiming, it is inappropriate and not scientifically sound to state that the R-rating will save 60,000 lives per year.

What is not made clear in the American Legacy Foundation's press release is that the claim that requiring a R-rating for movies that depict smoking would result in 200,000 fewer kids starting to smoke each year rests on the assumption that such an intervention would eliminate exposure to smoking in movies for one-half of all kids who are currently exposed to smoking in movies.

But there is no evidence that requiring an R-rating for movies that depict smoking would eliminate exposure to smoking in movies.

In fact, research published by one of the very researchers mentioned above documented that only 16% of kids are restricted from watching R-rated movies. So requiring an R-rating for movies depicting smoking would eliminate exposure to smoking in movies for only 16%, not 50% of kids.

And this assumes that parents do not change their behavior if smoking in movies results in an automatic R-rating. Another possibility is that such a move would undermine the current rating system, leading parents not to worry so much about whether their kids view such movies, because they may figure that it might only be smoking to which their kids are being exposed. In other words, the R-rating could become much less meaningful to parents as a way of knowing the movies to which their kids should be restricted if smoking automatically triggers an R-rating.

It is possible, in fact, that such an intervention could actually increase kids' exposure to violence and sex in movies, as parents may be less likely to restrict their childrens' access to R-rated movies.

The important point, though, is that even if there is no change in parental behavior, a whopping 84% of kids are allowed to see R-rated movies anyway. Thus, requiring an R-rating for movies that depict smoking would be expected to have only a marginal impact on eliminating youths' exposure to these depictions.

The rest of the story is that the American Legacy Foundation's testimony amounts to an unsupported and implausible scientific assertion. In my expert opinion, Legacy is grossly overestimating the impact of smoking in movies. More importantly, Legacy is drawing unsound scientific conclusions. This is, in my view, an example of the shoddy science that has begun to surface in the tobacco control movement.

Of course, the ultimate of all hypocrisy is that at the same time that the American Legacy Foundation is blaming the movie companies for killing 60,000 people each year, Legacy is partnering with the chief culprit - Warner Brothers. The American Legacy Foundation and Time Warner are corporate partners. If the problem is really so severe as Legacy testifies, then how can Legacy possibly defend its corporate partnership with Time Warner? That is hypocrisy if I've ever seen it.

It appears that Legacy wants to have it both ways. It wants to look good to the public by condemning smoking in movies. But it also appears not to want to do anything to possibly disturb the financial benefits it obtains from its lucrative partnership with Time Warner. So in an action that is not so apparent to the public and doesn't make the news headlines, Legacy continues to partner with Time Warner and refuses to take the single action that would do the most to put pressure on Time Warner to change its practices -- rescinding the partnership.

A public renouncement of the partnership would bring media attention to the issue and would make a statement that public health organizations cannot partner with media companies until they change their practice of exposing kids to millions of smoking images each year. Instead, Legacy appears to be making the statement: "We want to look like we are doing something about smoking in movies, but we don't want to lose our lucrative financial benefits from our partnership with Time Warner. Money is more important than public health, but since the public doesn't see our partnership in the news headlines, we don't have to worry about the public thinking that we are actually more concerned about money than health."

What I consider to be the insincerity of Legacy's actions is also evidenced by the exceptions to its proposed policy. Apparently, the issue is not youth exposure to smoking in movies after all. Because Legacy states that the historically accurate portrayal of smoking is not a problem. So it is actually the context in which the smoking occurs that is the problem, not the smoking itself.

Legacy also has no problem with showing smoking in movies as long as the movie clearly reflects the dangers of tobacco use. But what does that mean? Does it mean that if a smoker is shown coughing, it is acceptable to depict smoking? Does it mean that if a smoker is shown having few health problems until he reaches older age, that is acceptable (since that may reflect the nature of the health effects of smoking in some situations)?

I can tell you right now - it is going to be hard to beat out the American Legacy Foundation for the 2007 Anti-Smoking Hypocrisy Award.

TobaccoScam Fact Sheet Claims that Brief Exposure to Secondhand Smoke Caused 40% of Heart Attacks in Helena

The same "fact sheet" which claims that 30 minutes of secondhand smoke exposure clogs nonsmokers' arteries, gives them arteries with damage equivalent to that of a smoker, and puts them at increased risk of a heart attack or stroke also claims that brief exposure to secondhand smoke causes 40% of all heart attacks (or at least of all heart attacks in Helena, Montana).

According to the TobaccoScam fact sheet: "Breathing secondhand smoke for just twenty minutes has substantial, adverse effects on the heart, blood, and blood vessels. That's why making restaurants and bars (as well as workplaces) smokefree was associated with a 40% drop in hospital admissions for heart attacks when Helena, Montana, implemented a smokefree policy."

The Rest of the Story

What this fact sheet is claiming, then, is that brief exposure (20 minutes) to secondhand smoke causes a huge number of heart attacks. So huge, in fact, that when Helena banned smoking in bars and restaurants, the reduction in these brief exposures led to a 40% decrease in hospital admissions for heart attacks.

In other words, TobaccoScam is claiming that 40% of the heart attacks in Helena were attributable to brief exposures to secondhand smoke.

This claim seems implausible for three reasons:

First, it is scientifically unsound to conclude that the observed 40% decline in heart attack admissions in Helena over a six-month period was attributable to the smoking ban in the first place. It is highly likely that a substantial portion of this drop was due simply to random variation and that some of it was due to secular changes in heart attack admissions over time.

Second, even if the 40% decline in heart attack admissions were solely attributable to the smoking ban, it is scientifically unsound to conclude that these effects were due to reduced secondhand smoke exposure, rather than to lowered levels of active smoking (smoking cessation and reduced cigarette consumption). Certainly, it is not valid to conclude that all of the observed effect was due to reduced secondhand smoke exposure. The Helena study did not, in fact, measure the smoking status of those who suffered heart attacks, nor did it document changes in the smoking status or secondhand smoke exposure of city residents. So the study does not have the ability to determine whether any observed decline in heart attacks, even if due to the smoking ban, was due to changes in active smoking or changes in secondhand smoke exposure.

Third, it is implausible that a reduction in brief exposure to secondhand smoke could cause a 40% reduction in heart attacks. It has never been shown that brief exposure to secondhand smoke is a cause of heart attacks in the first place. Moreover, it is close to impossible that brief exposure to secondhand smoke explains 40% of all heart attacks. Smoking in its entirety is estimated to be responsible for only about 30% of heart attacks. So how could just brief exposure to secondhand smoke be responsible for 40%?

What I find most distressing about this claim is that it is unfounded. There is simply no evidence upon which to base an assertion that the 40% reduction in heart attacks in Helena was attributable solely to a reduction in secondhand smoke exposure, even if that reduction were indeed due to the smoking ban in the first place. The reduction, if due to the smoking ban, could just as easily (and probably more likely) be due to changes in active smoking. Recent evidence from New York City suggests that smoking bans can have substantial effects on active smoking rates and on cigarette consumption levels. These effects could just as easily explain any reductions in heart attacks. In fact, if I were forced to attribute any observed declines in their entirety to one factor or the other, I would choose active smoking reduction as an explanation long before I chose reduced secondhand smoke exposure resulting from the Helena smoking ban.

Readers unfamiliar with my latest commentary on the Helena-type studies may want to review it in order to understand why I do not believe any of these studies provide credible evidence that these smoking bans have resulted in drastic declines in heart attack admissions. In that post, I concluded that: "upon closer examination, the study which purports to demonstrate that a smoking ban in Bowling Green resulted in a massive decline in heart disease admissions demonstrated nothing of the sort, and possibly demonstrated that there was no significant decline in admissions attributable to the smoking ban. Like its predecessors (e.g., Helena and Pueblo), this is another example of shoddy science that apparently now passes as acceptable in tobacco control research."

Today's finding simply adds to the evidence I presented previously that the TobaccoScam fact sheet is misleading and needs to be corrected. In this case, it draws a conclusion that is not supported by any evidence and which is scientifically implausible anyway.

If public health officials in other cities that are enacting smoking bans are expecting to see immediate 40% reductions in heart attacks due to reduction in brief secondhand smoke exposures, I'm afraid they are going to be quite disappointed. There are undoubtedly health benefits to be realized from smoke-free laws; but this degree of an immediate reduction in heart attacks is probably not one of them.

As of now, the fact sheet remains unchanged. So I don't expect this particular point to be corrected, although I think it would be a great service to the public to do so. I'll report back later in the week on any changes on this site or the others I cited which are making exaggerated and deceptive claims about the acute cardiovascular effects of secondhand smoke.

TobaccoScam Says 30 Minutes of Secondhand Smoke Gives You "Smoker's Arteries"; So Why Should Any Smoker Quit?

According to the anti-smoking project TobaccoScam, if a nonsmoker is exposed to secondhand smoke for 30 minutes, he or she has "smoker's arteries" - arteries that are compromised to the same extent as those of an active smoker. This 30 minute exposure results in clogged arteries. As a result, the nonsmoker is at increased risk of suffering an immediate heart attack. Just 20 minutes of exposure to secondhand smoke is equivalent to actively smoking one pack of cigarettes per day.

Here are the specific claims being made by TobaccoScam:
Source 1: Secondhand Smoke - A Little is Dangerous
Source 2: Secondhand Smoke - A Little is Dangerous (PDF Version)

"30 minutes exposure = smoker's arteries"

"Thirty minutes of secondhand smoke compromises a non-smoker's coronary arteries to the same extent as in smokers."

"20 minutes exposure = smoking a pack a day"

"Twenty minutes of breathing secondhand smoke at levels similar to those measured in bars activates blood platelets involved in the clotting process as much as it does in pack-a-day smokers. These activated platelets increase the chances of heart attack or stroke."

"30 minutes exposure = stiffened, clogged arteries"

"All of these effects not only increase the long term risks of developing heart disease, but also increase the immediate risk of heart attack."

The Rest of the Story

These fact sheets are very deceptive for the following reasons.

"30 minutes exposure = smoker's arteries"

While it is true that 30 minutes of secondhand smoke exposure has been found to cause endothelial dysfunction in coronary arteries that is equivalent to that observed among active smokers, it is deceptive to suggest that 30 minutes of exposure is equivalent to a smoker's arteries. An active smoker may well have narrowed and clogged coronary arteries due to years of active smoking. In contrast, a nonsmoker who is just exposed to secondhand smoke for 30 minutes will not have any narrowing or clogging of the arteries due to that brief exposure. Claiming that a 30 minute exposure is equivalent to a smoker's arteries implies that a brief secondhand smoke exposure causes the kind of chronic damage that is seen among active smokers. This is not the case. Perhaps 30 years of exposure could result in smoker's arteries; but not 30 minutes.

"Thirty minutes of secondhand smoke compromises a non-smoker's coronary arteries to the same extent as in smokers."

In terms of coronary flow velocity reserve, it is true that 30 minutes of secondhand smoke compromises a nonsmoker's coronary arteries to the same extent as in smokers. However, in every other sense, it is not true. A brief exposure does not compromise the arteries in terms of the clogging, narrowing, plaque formation, thrombus formation, and atherosclerosis that is seen in smokers.

"20 minutes exposure = smoking a pack a day"

While platelet activation levels may be similar in smokers as in nonsmokers exposed to secondhand smoke for 20 minutes, it is certainly not the case that 20 minutes of secondhand smoke exposure is equivalent to smoking a pack of cigarettes per day. In an otherwise healthy person, a single 20 minute exposure to secondhand smoke causes no clinically significant damage. In contrast, smoking a pack a day can certainly cause clinically significant damage. To claim that the two are equivalent is deceptive.

"Twenty minutes of breathing secondhand smoke at levels similar to those measured in bars activates blood platelets involved in the clotting process as much as it does in pack-a-day smokers. These activated platelets increase the chances of heart attack or stroke."

While it is true that 20 minutes of secondhand smoke activates blood platelets to the same extent as in pack-a-day smokers, it is not true that this platelet activation increases the chance of a heart attack or stroke. A mere 20 minute exposure to secondhand smoke cannot possibly cause a heart attack or stroke in a nonsmoker who does not already have severe pre-existing coronary or cerebrovascular artery stenosis. It is deceptive to claim that the platelet activation observed in healthy nonsmokers who are exposed to secondhand smoke for 20 minutes increases their risk of a heart attack or stroke.

"30 minutes exposure = stiffened, clogged arteries"

It is true that 30 minutes of exposure decreases the ability of the coronary arteries to dilate (a short-term, transient effect), but it is not true that a 30 minute exposure causes clogged arteries. The arteries cannot clog that quickly. It takes more like 30 years for the arteries to clog, not 30 minutes.

"All of these effects not only increase the long term risks of developing heart disease, but also increase the immediate risk of heart attack."

A mere 20 or 30 minutes of exposure to secondhand smoke does not increase the long-term risk of developing heart disease. To develop heart disease, one would need chronic exposure - exposure for many years. It is preposterous to assert that a mere 30 minutes of exposure is enough to cause heart disease. It is equally absurd to claim that a mere 30 minutes of exposure can cause a heart attack in anyone other than an individual who already has severe, pre-existing coronary artery stenosis.

In many ways, these fact sheets are deceptive to the public. They misrepresent the science in a way that is likely to mislead people into believing things that are not true. I view it as unethical to deceive the public in this way about scientific facts.

But what is perhaps even more disturbing are the implications of the misrepresentation of the science. If a reader actually believes these assertions, then the implication is that there is really no reason to quit smoking if you are going to be exposed, even briefly, to secondhand smoke. If it is truly the case that a mere 30 minute exposure to secondhand smoke is going to give you the arteries of an active smoker, then why should a smoker bother to quit? If that smoker is exposed to tobacco smoke for 30 minutes, he is going to have the arteries of an active smoker anyway. So what reason is there for him to bother quitting?

By implying that active smoking is no worse than a brief secondhand smoke exposure, this fact sheet actually undermines the public's appreciation of the severe hazards of smoking. The message - albeit unintended - is that smoking is much less hazardous than previously thought. It is, after all, only as bad as breathing in drifting tobacco smoke for a half hour or so.

I hope that TobaccoScam will re-examine and correct these fact sheets, which have been widely copied and disseminated by many anti-smoking organizations throughout the country. It is important not only because of the principle of accurate communication of science to the public, but also because the web site is undermining years of effort by tobacco control groups to educate the public about the severe hazards of active smoking.

It wouldn't take a lot to correct these fact sheets, and frankly, I don't see what the harm would be in doing so. How could it possibly hurt to clarify the fact sheets and ensure that they are not only accurate, but also that they are not misleading?

I will be keeping on eye on these fact sheets and will report next week on whether any changes are made to them. The decision about whether or not to correct these "fact sheets" will go a long way toward shaping my impression about whether these inaccuracies are simple mistakes or oversights or whether there is an intentional effort to deceive the public by overstating the health effects of brief secondhand smoke exposure.

Many Anti-Smoking Groups Continue to Claim that 30 Minutes of Secondhand Smoke Exposure Causes Clogged Arteries

Did you know that your arteries can become clogged from a mere 30 minutes of exposure to secondhand smoke?

That is the assertion that a number of anti-smoking groups continue to make to the public.

The claim, while false, is important because it sensationalizes the health effects of secondhand smoke and leads people to believe that even a brief exposure for a healthy person can result in a clogged artery, and therefore a severe or fatal consequence such as a heart attack or stroke.

The claim also implies that brief secondhand smoke exposure is as harmful for the arteries as chronic active smoking.

This claim is certainly misleading and deceptive, but even more it is just plain untruthful. You cannot develop a clogged artery from a mere 30 minutes of exposure to secondhand smoke. Even in active smokers, it takes years and years of exposure (usually at least 20-30 years) before clogged arteries develop. So how can a nonsmoker possibly develop a clogged artery in just 30 minutes?

Here is a list of some of the groups which are currently making this claim, headlined by the American Heart Association:

American Heart Association: "30 minutes exposure = stiffened, clogged arteries"

Smoke Free Catawba: "30 Minutes of Exposure = Stiffened, Clogged Arteries"

University of North Carolina School of Medicine Department of Family Medicine: "30 minutes of exposure = stiffened, clogged arteries"

DuPage County Health Department: "30 minutes exposure = stiffened, clogged arteries"

Iowa Department of Public Health: "30 minutes of secondhand smoke exposure results in stiffened, clogged arteries"

Tobacco Free Washington: "30 minutes exposure = stiffened, clogged arteries"

Heart and Stroke Foundation South Africa: "Only 30 minutes of exposure can damage a non-smoker’s heart and increases the risk of heart disease by 30%."

TobaccoScam: "30 minutes exposure = smoker's arteries"

The Rest of the Story

I am truly discouraged by the fact that while it is now June 2007 - a full 18 months after I first reported the inaccurate claim being made by many anti-smoking groups that 30 minutes of secondhand smoke exposure causes hardening of the arteries, clogged arteries, heart attacks, and heart disease - anti-smoking groups are still widely disseminating this false and misleading information to the public.

What is disturbing is that these claims above are not simply exaggerations. They are factually inaccurate, I would argue. It is simply not true that 30 minutes of secondhand smoke exposure causes clogged arteries.

Obviously that is not true. If it were, you would see all kinds of people around you suffering strokes and heart attacks from being exposed briefly to secondhand smoke.

What I don't understand is this: how can these anti-smoking groups continue to make such claims, even when the claims are blatantly false on their face? Even when the claims belie common sense and the bounds of medical and scientific plausibility? Even when making such claims destroys the scientific credibility of the organization putting the assertion forward?

Why would these groups want to risk their scientific credibility like this?

Don't these groups have any ethical principles? Is telling the truth to the public not important to these groups?

Are the groups truly not aware that their claims are ridiculous? Can they actually defend themselves by arguing that they didn't realize that 30 minutes of secondhand smoke exposure does not cause people's arteries to clog? And if they did realize that it is completely impossible that 30 minutes of exposure could cause an artery to clog (that was not already severely compromised), then aren't these untruthful communications deliberate lies?

Do the groups realize that they are disseminating untruthful information to the public? Are they doing this deliberately?

The questions continue to pile up for me. But I have to say that the longer this goes on without any response, the more inclined I am to believe that these actions are deliberate and not just some sort of very serious, but inadvertent mistake.

For my own conscience, although I strongly support workplace smoking laws, I have to distance myself from the organizations which are making these false statements and completely misrepresenting the science to the public.

If these were my websites, I could not sleep at night knowing that I was wildly deceiving the public. Fortunately, they are not my sites; however, I don't know that I can any longer say that I consider myself a part of the movement made up of the groups whose sites these are.

How can I, with any conscience or scientific integrity, consider myself to be a part of a movement which is putting out ridiculous, false statements like this, deceiving or possibly lying to the public, and completely misrepresenting the science???

On Parental Smoking, Child Abuse, and Heelys

What does parental smoking have to do with child abuse? Several anti-smoking groups and many tobacco control advocates consider smoking in the presence of children to be a form of child abuse and want this behavior to be banned, fined, and otherwise treated similarly to recognized forms of child abuse.

What does parental smoking have to do with allowing one's child to use heelys? Both are parental decisions - behaviors - that expose their kids to health risks. Secondhand smoke increases the risk for ear and respiratory infections as well as asthma and asthma exacerbation. And new research published in the journal Pediatrics reveals that allowing your kids to wear heelys places them at significant risk of "broken wrists, arms and ankles; dislocated elbows and even cracked skulls."

What does allowing one's child to use heelys have to do with child abuse? Absolutely nothing, I'm sure almost everyone would agree.

The Rest of the Story

The problem is, however, that according to the reasoning being used by anti-smoking groups to support classifying smoking around children as child abuse, allowing children to wear heelys is also a form of child abuse.

By arguing that smoking around children - a behavior that increases a child's risk for certain health complications - is child abuse, anti-smoking groups are advancing the argument (whether they realize it or not) that exposing children to increased health risks constitutes child abuse. Thus, according to the new research, allowing a child to wear heelys, which has now been documented to increase the risk of injuries ranging from broken wrists to broken skulls, would also constitute child abuse. But we all recognize that assertion to be ridiculous.

Equally ridiculous, therefore, is the assertion that smoking around children, except in some rare circumstances, is child abuse.

Why is it, then, that some anti-smoking groups appear eager to single out smoking as the one parental behavior that increases health risks that is to be considered a form of child abuse, while excusing all other parental behaviors and decisions that put children at significant risk of injury, illness, or disease?

I can contemplate several possible explanations.

One possibility is that these anti-smoking groups are so narrow-minded in their thinking and perspective that they simply cannot think beyond secondhand smoke as a threat to childrens' health. Smoking is the only thing that is harming children; thus, it is the only parental behavior that needs to be considered as child abuse.

A second possibility is that anti-smoking groups are aware that there are many other risks to which parents expose their children, but that for some reason, smoking is a unique risk and the only one that constitutes child abuse. While the reasons for such a perspective are not clear to me, it is plausible that these groups have such a disdain for the idea of smoking around children that this is clouding their thinking. But I have to question whether having such a narrow and specific disdain for smoking around children is reflecting some sort of underlying hatred of smokers - a hatred that does not exist toward parents who expose their kids to all kinds of other significant and sometimes even more severe health risks.

I also wonder whether this seemingly unique disdain toward parents who smoke reflects to some extent a view of social class inferiority. Could it be that smokers are considered to be a lower social class, and thus that they carry less respect and more disapproval as a class?

Either way, it seems to me that anti-smoking groups are in a major conundrum. Either they are so narrow-minded that they have lost their sense of perspective on child health and welfare such that they are no longer qualified to be able to make reasonable policy recommendations, or they are participating (albeit unconsciously) in class discrimination and possibly social injustice.

Most disturbing to me is the fact that none of the anti-smoking groups or advocates supporting the idea of treating smoking around children as child abuse have yet responded - substantively - to my arguments. It appears that they have no interest in defending the consistency or integrity of their views and proposals.

In other words, this is a crusade.

Unfortunately, it is a crusade that is increasingly losing its public health and social justice grounding. It is a crusade that increasingly is coming to conflict with basic principles of public health and social justice. It is a crusade that is beginning to embrace the ideas of class inferiority and outright class discrimination.

It is a crusade that I can no longer be a part of.

Campaign for Tobacco-Free Kids Again Deceives Constituents About Philip Morris' Support for FDA Tobacco Legislation; Is TFK Even Capable of Honesty?

In a communication sent to its constituents on Friday, the Campaign for Tobacco-Free Kids again deceived citizens around the nation in order to entice them to support the proposed FDA tobacco legislation. The communication implored citizens to contribute money to help youth advocates promote the FDA tobacco legislation and indicated that this money was necessary because those advocates would need to fight Big Tobacco in the halls of Congress. The constituents were informed that Big Tobacco is a staunch opponent of the legislation.

According to the email: "This summer Youth Advocates from across the country will stand up for kids and take a stand against Big Tobacco's outrageous marketing. Will you help support these Youth Advocates as they take the battle against Big Tobacco right to Capitol Hill? ... These youth will insist Congress pass legislation allowing the FDA to regulate tobacco products and sinister tobacco marketing campaigns like Camel No.9. Your contribution to the Action Fund will aid our efforts to provide vital training and resources so these Youth Advocates succeed. The Youth Advocates are taking on a wealthy and powerful opponent. It's up to you and me to make sure they're armed with the tools they need to fight Big Tobacco in the halls of Congress - and win. Please support the Youth Advocates with a gift to the Tobacco-Free Kids Action Fund. ... Help us empower the leaders of tomorrow today by supporting the Youth Advocates' efforts to fight Big Tobacco and pass life-saving FDA legislation. Thank you!"

The Rest of the Story

The truth is that the wealthiest and most powerful of the tobacco companies - Philip Morris - is not an opponent of the legislation at all. Philip Morris will not in fact be taking on the Youth Advocates, but will instead be helping them to try to win passage of the bill. The Youth Advocates will not be fighting Big Tobacco, at least not the largest of the tobacco companies. The largest and most dominant of the companies will be joining the Youth Advocates in trying to secure passage of this legislation.

By informing its constituents that the Youth Advocates wil be fighting Big Tobacco in order to promote the FDA legislation and that these advocates are taking on a wealthy and powerful opponent, the Campaign for Tobacco-Free Kids is misleading citizens throughout the nation into believing that Big Tobacco is uniformly opposed to the proposed legislation. This, in my view, is outright deception. It is untruthful and dishonest. It is unethical.

The Campaign for Tobacco-Free Kids appears to have turned into a pure propaganda machine. The organization, in my view, has lost its legitimacy as a public health advocacy organization because it does not respect the basic public health ethical principle of informed consent.

This ethical principle, which the Campaign for Tobacco-Free Kids is consistently violating, is the community-level equivalent of the principle of informed consent, which is spelled out in the American Public Health Association Code of ethics. Just as public health organizations must provide individuals with full and accurate information before enrolling these individuals in research studies, public health organizations must also provide the public with full and accurate information that is necessary to make decisions on policies that affect them:

"Public health institutions should provide communities with the information they have that is needed for decisions on policies or programs and should obtain the community's consent for their implementation. ... there is a moral obligation in some instances to share what is known. For example, active and informed participation in policy-making processes requires access to relevant information. ...Such processes depend upon an informed community. The information obtained by public health institutions is to be considered public property and made available to the public."

I don't think that the Campaign for Tobacco-Free Kids (nor other groups supporting this legislation) have made available to their constituents the relevant information needed for them to be able to make an informed decision about the proposed policy, and about whether or not to donate money to this cause.

If I, as a citizen, am approached by a public health group asking for my financial support to send some youth advocates to Washington to fight Big Tobacco, I am very likely to open up my pocket book and write out a check. It sounds like a great cause. How could it not be?

However, if instead, I am told the truth and am informed that I am being asked for my financial support to send some youth advocates to Washington to help Philip Morris encourage policy makers to enact legislation, it doesn't sound like such a great cause anymore. It certainly adds a critical "nuance" to my understanding of the plea for financial help if I am told that while the smaller tobacco companies oppose the bill, the largest company supports it. This still might not deter me from contributing money, but at least I am given the opportunity to make my own informed decision. Such an opportunity is not being afforded to citizens whose money is being elicited from the Campaign for Tobacco-Free Kids' communication. Their constituents are not being provided with the opportunity for informed consent.

While informed consent would be important even if the sole purpose of the communication was to enlist citizens' support for the legislation, informing them of the truth about the tobacco companies' position on the legislation seems even more critical when the purpose of the communication is to ask for our money.

How would financial contributors feel if they found out they were solicited on false grounds: that in fact the largest company of Big Tobacco and its huge financial resources are backing the bill in the halls of Congress? I'm sure that many contributors would be quite angry, and this could quickly become a scandal.

I condemn these unethical tactics and I think it is time that some semblance of integrity be restored to the tobacco control movement.

Reynolds American Tells Campaign for Tobacco-Free Kids: Stick to the Facts

In a press release issued Wednesday, Reynolds American (parent of R.J. Reynolds Tobacco Company) instructed the Campaign for Tobacco-Free Kids to "Stick to the Facts."

The Rest of the Story

Reynolds American - I feel your pain.

I've been saying the same thing now for the past two years or so. And no changes were forthcoming.

I have documented, for example, an entire campaign of deception being waged by the Campaign for Tobacco-Free Kids in favor of the proposed FDA tobacco legislation. This campaign has been based not on sticking to the facts, but on wild speculation, exaggerated propaganda, unsupported claims, and outright deception. The Campaign for Tobacco-Free Kids, unfortunately, continues to use the same deceptive tactics and has not changed its approach in the two years that I have been writing about its unethical and inappropriate behavior.

The Campaign for Tobacco-Free Kids continues to hide Philip Morris' vigorous support for the legislation, to conceal the process that led to the legislation and to its specific provisions, and to misrepresent what the legislation does. In addition, the Campaign continues to misuse youths, using them as pawns in a political game without informing them of the facts about the legislation. Its entire campaign for the legislation is based on a withholding of facts, rather than sticking to the facts.

To Reynolds American I can only wish that you get a better response than I have obtained. As I think you will realize, asking the Campaign for Tobacco-Free Kids to stick to the facts is like banging your head against a brick wall.

American Cancer Society Apparently Lacks the Goods; Fails to Respond with Evidence or Explanation of Accusation Against Big Tobacco

In response to my challenge to provide evidence that Big Tobacco is lying about the ingredients in cigarettes or to remove the accusation from its website, the American Cancer Society has apparently done nothing at all. They have not removed the accusation. They have failed to explain how tobacco companies are lying about the ingredients in their products. They have opted not to clarify this claim. They have provided no additional evidence to support their claim.

The only "evidence" that the ACS has in fact provided is the following, which is listed on its fact sheet, entitled "Stop Big Tobacco From Lying About Their Ingredients," which purports to explain "how Big Tobacco is lying about their ingredients":

"Cigarette smoke contains more than 4,000 chemicals, including at least 69 that cause cancer. These dangerous chemicals include arsenic, formaldehyde, ammonia and radioactive Polonium-210. Yet most Americans don’t know what’s really in a cigarette because tobacco companies are not required to disclose the contents of their products or to remove dangerous ingredients. This legislation would force the tobacco companies to disclose what is in their products, to take out dangerous chemicals and to stop marketing these deadly and addictive products to our kids."

The Rest of the Story

As it stands, the American Cancer Society's argument appears to be that tobacco companies are lying about the ingredients in their cigarettes because they are failing to disclose the contents of their products. But that destroys their contention that the companies are lying. If the companies are refusing to disclose what is in their products, then they are in fact not lying about their ingredients; they are simply not disclosing those ingredients. It seems to me like the American Cancer Society has pretty much destroyed its own argument.

I have to confess that I really don't understand the reasoning here. The tobacco companies are not telling the public what is in their cigarettes - therefore, they are lying. It doesn't make sense to me. If they are not making claims about what is in their products, then they are in fact not lying. They just aren't telling. You can't lie if you keep your mouth shut.

Unfortunately, I'm afraid that the ACS is going to undermine not only its own credibility, but that of the entire tobacco control movement. And this is significant, because if we are making a baseless accusation that the tobacco companies are lying, then what credibility do we have in asserting that the companies are lying when they really are?

I have no problem with requiring the tobacco companies to disclose the ingredients in their products, but I think it's time that we require the American Cancer Society to disclose their evidence that Big Tobacco is lying about the ingredients of their products. If we're going to require full disclosure, then let's go ahead and require full disclosure.

It's looking more and more like the American Cancer Society has joined the Campaign for Tobacco-Free Kids in descending to the lowest level of behavior in promoting the FDA tobacco legislation.

Are they really that desperate that they have to resort to this? The bill must be pretty darn bad if you have to turn to dishonesty and deception in order to promote it.

American Cancer Society Continues to Accuse Big Tobacco of Lying About Cigarette Ingredients; Challenge Issued -- Prove It or Remove It

On its website devoted to promoting the Philip Morris-supported FDA tobacco legislation currently before Congress, the American Cancer Society continues to accuse Big Tobacco of lying about the ingredients in cigarettes (click here for my original account of this story).

The American Cancer Society titles its page: "Stop Big Tobacco from Lying About Their Ingredients."

The ACS implores readers to support the proposed FDA legislation because: "It’s time to Stop Big Tobacco from Lying About Their Ingredients!"

The page states: "Read our talking points about how Big Tobacco is lying about their ingredients," and links to this page.

However, the "talking points" page about how Big Tobacco is lying about their ingredients does not say anything about how Big Tobacco is lying about their ingredients. It merely points out that consumers are largely unaware of the ingredients because there is no requirement that these ingredients be disclosed. It also mentions that the tobacco companies are deceiving consumers by marketing products with terms such as "low-tar," which imply some degree of health benefit.

The Rest of the Story

The rest of the story is that the American Cancer Society is publicly accusing the tobacco companies of lying about the ingredients in cigarettes, but is putting forward not a shred of evidence to support that accusation. In fact, the talking points page which claims to show "how Big Tobacco is lying about their ingredients" provides no evidence whatsoever that the tobacco companies are lying about their ingredients. This is a completely unsubstantiated public accusation.

I must emphasize the seriousness of this accusation. The American Cancer Society is claiming that the tobacco companies are "lying" to the American public about the ingredients of their products -- not just misleading people, but outright lying. If true, this would represent consumer fraud. It would likely represent a continued violation of the RICO statute. It would make the tobacco companies liable in court for consumer fraud, would open the door to literally thousands of lawsuits, including class action suits, and could potentially cost the companies billions of dollars.

Given that attorneys for smokers are now suing the tobacco companies simply for marketing their products to their clients, there must be a pool of attorneys who would love to get their hands on the proof that the American Cancer Society has that the tobacco companies are committing widespread consumer fraud by lying to their customers about the ingredients in cigarettes.

What the American Cancer Society is accusing the tobacco companies of doing, if true, would represent perhaps the most egregious conduct ever on the part of the industry. Most of the inappropriate behavior that I cited in my testimony against tobacco companies refers to misleading the public, deceiving consumers, making false implications, or hiding information. There are few, if any, examples of outright factual misrepresentation of information, such as the actual ingredients of cigarettes.

In fact, I remember being asked by a tobacco industry attorney in one of my depositions if I could give any examples of a material (factual) misrepresentation of information, rather than merely a misleading or deceptive representation, or concealment, of that information. I explained that the way the tobacco companies had operated was not necessarily to outright lie, but to undermine the public's appreciation of the health hazards and addictiveness of cigarettes by misleading and deceiving people. It certainly would have helped my testimony tremendously to have this apparently new information about how the tobacco companies are lying to the public about cigarette ingredients.

The second reason why this accusation is critically important is because it is an accusation not about behavior in the past, but about current behavior. The American Cancer Society is not saying: "Prevent Big Tobacco From Ever Lying Again About Their Ingredients"; the claim is in the present tense: "Big Tobacco is lying about their ingredients."

This has rather massive implications for an industry that is trying to demonstrate in courtrooms around the country that its behavior has changed and that there is therefore no need to award high punitive damages. The accusation also has massive implications for the DOJ tobacco lawsuit - under appeal - in which the fact of continuing lying by the industry would wipe out its primary argument in the appeal: that the DOJ, while it might have demonstrated fraud in the past, has failed to prove continuing violation of the RICO statute.

Frankly, it is surprising to me that the cigarette companies have not called the American Cancer Society on this accusation.

One possible reason they have not is that perhaps they realize that the ACS is making such a ridiculous claim that no one will believe it anyway. Perhaps the tobacco companies are relying upon the fact that the credibility of the ACS is falling due to its continued misrepresentations. And if the tobacco companies are relying upon the lack of credibility of the ACS, then maybe it is time for the American Cancer Society to start taking notice.

While the tobacco companies may not call the ACS on their accusation, I do.

I'd like to see the documentation that the tobacco companies are lying about their ingredients, or else I think it is only appropriate that the ACS retract its accusation.

Such information - relating to continued lies by the tobacco industry - is critically important in lawsuits throughout the nation, including the DOJ case appeal. It should not be withheld by the American Cancer Society.

Unless of course the ACS is just blowing smoke. In which case, it's not so clear to me on what grounds the ACS can stand before the public and complain about the tobacco companies deceiving the public. How is deception by the tobacco companies wrong, but an outright false accusation of ethical wrongdoing by an anti-smoking group appropriate?

So as far as the ACS' accusation that the tobacco companies are lying about their ingredients goes, I today call on the Cancer Society to either prove it or remove it.

Anti-Smoking Group Supports Denial of Surgery to Smokers

According to an article published Wednesday by Medical News Today, a major U.S. anti-smoking group appears to support the denial of surgery to current smokers; only ex-smokers would be eligible for surgery under the policy supported by the group: Action on Smoking and Health (ASH). According to a policy being considered by the Leicester City Primary Care Trust, smokers will be denied surgery unless they quit smoking for at least four weeks and their abstinence is confirmed via a cotinine blood test.

According to the article: "Medical research shows that smokers take far longer, on the average, to recover from operations, and are far more likely to suffer serious medical complications. This not only greatly increases the cost of providing surgery to smokers, but also ties up beds and hospital facilities urgently needed by other patients. ... Professor John Banzhaf, Executive Director of ASH, notes that some physicians in the US have refused to perform operations on smokers, and that potential recipients may be denied life-saving organ transplants if they smoke, just like patients who abuse alcohol or use recreational drugs. 'Smoking not only causes many very serious and very expensive diseases, but also exacerbates many existing medical problems and complicates recovery from virtually all operations. Thus a smoker who sufferers a broken leg while skiing -- a condition obviously not caused by his smoking -- is much more likely to suffer respiratory complications and/or infections as a result of the surgery, and to take far longer to heal,' says Banzhaf.'"

"'Generally, since most health insurance companies charge smokers the same rates and provide them with the same benefits, these added costs and delays in providing services to others are absorbed by the great majority of patients who are nonsmokers. This is manifestly unfair. One remedy is to charge smokers more for their health insurance, a policy the federal government recently recommended and approved. Another is to deny smokers certain services, especially if their smoking is likely to impair their outcome.'"

The Rest of the Story

It's hard to believe that it has come to this. A prominent anti-smoking group is actually supporting the denial of appropriate and necessary medical care to smokers solely on the basis of a somewhat higher rate of complications. It is critical to understand that the patients' smoking is but one of a myriad of factors that influences post-operative recovery time and complication rates. The majority of smokers do not necessarily suffer complications and the increased recovery time is a statistical phenomenon that may not apply to an individual patient. Thus, categorically denying surgery to smokers represents blatant discrimination, and from a medical perspective, it is unethical.

I'll tell you another thing that increases post-operative recovery time and complications, and perhaps even more than smoking: obesity. Like smoking, patients who are overweight cost the health care system more because they "are far more likely to suffer serious medical complications. This not only greatly increases the cost of providing surgery to overweight people, but also ties up beds and hospital facilities urgently needed by other patients." Wound healing is much prolonged in people who are obese; respiratory complications are much more likely; overall recovery time is prolonged.

The same reasoning by which ASH is supporting the denial of surgery to smokers applies just as well to denying surgery to fat people until they lose weight. Why not deny surgery to fat people until they undergo at least four weeks of a rigorous weight loss program and their successful weight loss is confirmed by stepping on a scale?

If you substitute obesity for smoking, then ASH's statement reads: "Generally, since most health insurance companies charge fat people the same rates and provide them with the same benefits, these added costs and delays in providing services to others are absorbed by the great majority of patients who are not obese. This is manifestly unfair. One remedy is to ... deny fat people certain services, especially if their obesity is likely to impair their outcome."

My colleague at the Boston University School of Public Health - Professor Leonard Glantz - wrote in a January BMJ column: "The suggestion that we should deprive smokers of surgery indicates that the medical and public health communities have created an underclass of people against whom discrimination is not only tolerated but encouraged. When the World Health Organization announced that it would no longer employ anyone who smokes, public health and medical communities did not respond to this act of blatant bigotry. Similarly, it is shameful for doctors to be willing to treat everybody but smokers in a society that is supposed to be pluralistic and tolerant. Depriving smokers of surgery that would clearly enhance their wellbeing is not just wrong - —it is mean."

I have already discussed a number of reasons why I think the idea of refusing medical treatment to smokers is inappropriate, unfair, discriminatory, and in conflict with the basic principles of medical practice. The rest of the story is that for the first time of which I am aware, a prominent anti-smoking group is actually publicly supporting such policies.

What a far cry from why I became involved in tobacco control in the first place. I decided to devote my career to tobacco control because I saw the suffering of many of my patients who were smokers and wanted to act out of compassion for these smokers. Today, the anti-smoking movement seems more motivated by a desire to overtly discriminate against and punish smokers. Instead of compassion, we seem to be motivated now primarily by hate, intolerance, or as Professor Glantz suggests - just plain meanness.

Campaign for Tobacco-Free Kids Again Deceives Constituents about Philip Morris Support for FDA Legislation

According to an electronic communication sent to its constituents on Monday, the Campaign for Tobacco-Free Kids is once again implying that Big Tobacco is opposing the proposed FDA tobacco legislation. This advocacy message, which urges constituents to contribute money to help train youth advocates to lobby for the FDA legislation, tries to entice people to contribute by making them think that this is a battle between public health groups and "Big Tobacco."

The message sent to advocates throughout the country states: "Help Kathy and the Youth Advocates fight the good fight in Washington. Your contribution will help the Action Fund provide advocacy training for the YAYAs and empower them to take on Big Tobacco by lobbying for the passage of life-saving FDA legislation. ... Please support the YAYA's mission with a gift to the Tobacco-Free Kids Action Fund. Your generosity will help kids stand up for kids and win this critical battle against Big Tobacco. I hope we can count on you to help!"

The Rest of the Story

It is very deceptive to claim that the advocacy training of the YAYAs is going to empower them to take on Big Tobacco by lobbying for the FDA legislation. Such a claim implies that Big Tobacco is opposed to the legislation and is itself lobbying against the legislation. That claim, of course, is untrue. Philip Morris, the largest company within Big Tobacco, is actively supporting the legislation and lobbying for its passage.

By then stating that this is a critical battle against Big Tobacco, the Campaign for Tobacco-Free Kids is implying, for a second time, that the battle to enact the FDA legislation is a battle against Big Tobacco. This is hardly the case, when the staunchest supporter of the legislation is none other than Philip Morris itself.

I think that the Campaign for Tobacco-Free Kids' constituents have a right to be informed of the truth. This massive deception of the public, in order to try to entice them to support a bill under false pretenses, is highly unethical in my opinion.

Of course, as someone who is well-versed in the legislation, I know that this is nothing more than deceptive propaganda. But for many advocates reading this email, they are likely to be tricked into thinking that Big Tobacco is indeed against the legislation and that this is therefore a true fight against Big Tobacco.

Ironically, the email urges the public to support the FDA legislation because it will put an end to "deceptive marketing" by the tobacco companies. Well what about the deceptive propaganda by the Campaign for Tobacco-Free Kids? Is there something I can sign to put an end to that?

Campaign for Tobacco-Free Kids Misusing Youth Advocates for Political Purposes, and Asking Constituents to Pay for their Political Training

In a message sent to its constituents, the Campaign for Tobacco-Free Kids is asking public health advocates to financially support its "training" of youth anti-tobacco advocates.

But when you read through to the bottom line, you find out that the training is in fact more like brainwashing. It is a one-sided recruitment of these youth advocates to lobby for the proposed FDA tobacco legislation - a bill that is strongly supported by Philip Morris. There is no indication that the youth advocates are given any choice other than to support the legislation, nor that they are given the opportunity to join hundreds of tobacco control and public health advocates throughout the nation in a campaign to vigorously oppose this legislation.

The funds to support these advocates are begin solicited under the guise of training these young people how to get rid of cigarette advertising in magazines. The solicitation message states:

"Vogue apparently doesn't care that 178,000 women die every year due to lung cancer and other smoking-related disease. Their latest response to your faxes about "light and luscious" Camel No. 9s -- "Could you stop? You're killing trees." R.J. Reynolds doesn't care either. Death is literally being marketed - and sold - to our daughters, mothers, and sisters through Camel No.9 ad campaigns. That's why our Youth Advocates of the Year - the YAYAs - are taking the fight against Big Tobacco and Camel No.9 straight to Washington, DC. Will you help the YAYAs wage this most important battle on Capitol Hill and sponsor their training at this summer's Youth Advocacy Symposium? At the six-day symposium, YAYAs from across the country will learn how to lobby our nation's lawmakers for passage of life-saving FDA legislation that will spell the end for pretty and pink Camel No.9 ads and other sinister marketing that attracts youth. ... Your gift will give the YAYAs the tools and training they need to influence lawmakers and impact life-saving FDA legislation."

If you click on the link to donate money, you are directed to a web page which states: "Youth are the very best advocates for their own tobacco-free futures. Please help our Youth Advocates of the Year - the YAYAs - fight back against marketing ploys like Camel No.9 that threaten to lure kids and teens into a lifetime of addiction, disease and death. Your gift today to the Tobacco-Free Kids Action Fund will provide critical advocacy training to the YAYAs at the Youth Advocacy Symposium this summer. With your help, we can give these dedicated young people the tools they need to meet our nation's lawmakers and fight for the passage of life-saving FDA legislation."

You are then invited to contribute $25 per each hour of training you wish to cover for a youth advocate.

The Rest of the Story

What should be made very clear is that this is not public health training. Nor is it even really primarily youth advocacy training. What it is, most ostensibly, is simply a sleazy tactic on the part of the Campaign for Tobacco-Free Kids to indoctrinate youth leaders with their philosophy and use these young people --taking advantage of them -- to do its bidding on Capitol Hill.

Why do I say that it is not public health training? Because true public health training would teach these young people how to analyze a public health problem and come up with their own analysis of a public policy proposal designed to address the problem. Thus, such a training could never be couched in terms of using these young people to fight for the FDA legislation. It would have to, instead, be couched as giving them the tools to analyze the legislation and then to make their own determination as to the appropriate action. For some of these youths, it is quite possible they would conclude that the FDA legislation is not an effective way of protecting the public's health.

If part of the training is lobbying for the FDA legislation, then youths are apparently not being given the opportunity to make their own decisions about whether to support or oppose Philip Morris. They are essentially given no choice but to help Philip Morris do its legislative bidding. That seems to run counter to what most youths would intuitively believe. Thus, it likely goes against most young people's thinking. But the training apparently is not so much of a training as it is an indoctrination. An indoctrination into supporting this singular view of tobacco control policy and learning how to support it. Not questioning it or making your own mind up about it.

This is why I say that it basically amounts to brainwashing. It is a systematic indoctrination. It essentially forces a youth to go against what would almost universally be a gut feeling of standing against the nation's leading cigarette company.

I could just as easily run a youth advocacy training and train young people to fight against the FDA legislation. But I wouldn't do that. The reason I wouldn't do that is because I have some ethical principles. I wouldn't use young people in that way. I would allow them to make their own informed decision about the legislation. If I were not prepared for them to take the opposite viewpoint, then I would not offer such a training.

What the Campaign for Tobacco-Free Kids is doing is not education, it's indoctrination.

I find it unethical and as such, it taints the perceived integrity of every one of us in tobacco control. Shame on the Campaign for doing that to us.

If the Campaign for Tobacco-Free Kids wishes to promote the FDA legislation, it is free to do that. But to use young people -- youth advocates -- as pawns in their political game is completely inappropriate.