Saturday, December 31, 2011

Lessons Learned in 2011: Reflections on the Year in Tobacco Control

After reflecting on the events of 2011, here are the major lessons I've learned and their implications for public health:

1. Some anti-smoking groups really are lying to the public.

Previously, I was able to hold out hope that false statements being made by anti-smoking groups to the public were merely mistakes or oversights. It is now clear, however, that some anti-smoking groups really are lying to the public and the apparent intention is to mislead the public in some way.

For example, the American Cancer Society (winner of the 2011 Liar, Liar, Pants on Fire Award) lied to its constituents in telling them that the FDA Tobacco Act banned all flavored tobacco products. The ACS clearly understood that the legislation exempts menthol cigarettes because it was one of the groups that supported the legislation and was briefed on the bill by the Campaign for Tobacco-Free Kids, which negotiated the terms of the legislation. The false statement made by the ACS is therefore difficult to explain as a simple oversight.

Instead, it seems clear to me that the ACS is afraid to tell the public the truth - that while the bill bans all the flavorings in cigarette brands which are rarely used by youths - it exempts menthol, which is the chief flavoring present in the brands favored by 80% of African American youth smokers and 50% of all youth smokers. Telling the public the truth - that the bill exempted menthol - would be an embarrassing admission for the ACS, because it would reveal that the Tobacco Act is a scam, which allows health groups and politicians to boast about how they are fighting Big Tobacco but which actually failed to ban any flavored cigarettes manufactured by Big Tobacco and exempted the one flavoring in cigarettes which is favored by half of the nation's youth smokers.

As a second example, Americans for Nonsmokers' Rights (runner up for the 2011 Liar, Liar, Pants on Fire Award) lied to the public by stating that there are virtually no health disparities between active and passive smoking. This is clearly false, as there are many health disparities between the two. The apparent purpose of this lie is to mislead the public into thinking that secondhand smoke is more hazardous than it actually is. But of course, the adverse side effect of this is that it also misleads the public into thinking that active smoking is not as hazardous as they have been led to believe. Moreover, I discussed the issue with a staff member of ANR, explaining why the information is incorrect. That the organization apparently decided to retain the false claim suggests that this was an intentional decision rather than a mere oversight. It certainly does create a more alarming health scare: if secondhand smoke's health effects are every bit as severe as those of active smoking, then secondhand smoke is much more hazardous than even the scientific evidence demonstrates!

The implication of these lies for public health are that the anti-smoking movement is going to lose its public credibility. Like the "global warming movement," which has lost credibility (undeservedly) because of a few exaggerations, I fear that the tobacco control movement will similarly lose credibility because of its willingness to lie to the public. Eventually this is going to catch up with us. I don't want to see the tobacco control movement go the way of the global warming movement. But we risk that happening if we continue to lie to the public in this way.

2. The smoke-free aspect of the tobacco control movement has largely become an attack on smokers, rather than a battle against tobacco smoke.

Two trends that have picked up steam in 2011 are policies which ban smokers from potential employment and policies which ban smoking in large, wide-open outdoor areas such as Central Park or entire areas of a downtown. Both of these policies have left the realm of protecting the public from secondhand smoke to punishing smokers for their poor health behavior decisions. Banning smoking in the entirety of Central Park is obviously not necessary to protect the public from exposure to secondhand smoke. And banning smokers, rather than just tobacco smoke, from the workplace, is obviously not necessary to prevent exposure to tobacco smoke in the workplace.

These policies are instead intended to punish smokers by either: (1) making it more difficult for them to smoke outdoors; or (2) making it more difficult for them to find employment. The latter effect can be quite significant in communities in which a single hospital system is the major employer. If that hospital system refuses to consider applications from smokers, it truly does make it much more difficult for smokers to find employment. This is especially true with the job shortages we are facing today.

The implications of this development for public health is that we are now using employment discrimination as a strategy for health promotion. I find this a troubling development. In addition, we are now viewing smoking as a moral, rather than a health issue, and trying to protect people not only from tobacco smoke exposure, but from having to even see a smoker in public.

3. At a national level, the tobacco control movement has waged a war on smokers, rather than on the tobacco industry and its most hazardous products. It is working to help entrench the most risky existing tobacco products, protect existing cigarette market shares, and fend off Big Pharma from competition, all at the expense of the health of smokers.

The implementation of the FDA Tobacco Act has turned into a disaster because it has resulted in the protection and institutionalization of the most hazardous existing tobacco products - cigarettes - and the stifling of much safer alternatives such as electronic cigarettes, which could otherwise be helping many smokers who would not otherwise quit smoking to successfully discontinue smoking.

Rather than embrace products such as electronic cigarettes, which are being used successfully by thousands of ex-smokers to keep them off cigarettes, anti-smoking groups are making it difficult, if not impossible, for these products to compete with tobacco cigarettes. The recommendations of the Institute of Medicine committee reinforce this view. In fact, it is the very purpose of the FDA Tobacco Act.

The implication of this development for public health is that cigarettes now have the FDA seal of approval, while safer products - such as electronic cigarettes - have an almost insurmountable barrier in front of them if they want to promote themselves effectively in the marketplace (i.e., as safer alternatives to tobacco cigarettes).

The Rest of the Story

If this were a state-of-the-tobacco-control-movement address, I would be forced to give a quite negative report. The thrust of national tobacco control efforts is the exact opposite of what public health would call for: protection of the most hazardous products and the imposition of insurmountable barriers to much safer products that have the potential to save thousands of lives. At the local level, the goal of protecting the public from the hazards of secondhand smoke are being supplanted by policies designed to punish smokers. And for some reason, lying to the public has become an acceptable tactic that is supposedly justified based on the good ends which these lies are serving.

My hope is that 2012 will bring a re-examination of the public health practice of tobacco control and a return to the basic public health objectives that the movement is supposed to serve.

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