IN MY VIEW: American Legacy Foundation's Call for R-Rating for Any Movie that Depicts Smoking Non-Historically is Hypocritical and Misguided

The Motion Picture Association of America (MPAA) yesterday announced a new policy to address the depiction of smoking in movies viewed by children and adolescents. From now on, smoking in movies will be considered as a factor, along with sex and violence, in rating movies. Previously, only underage smoking was considered, not adult smoking. In particular, the ratings board will focus on whether smoking is glamorized, whether it is pervasive, and whether there is any mitigating factor such as historical context. The film ratings will include reference to the depiction of smoking, such as "glamorized smoking" or "pervasive smoking" to provide specific information to parents.

According to the MPAA press release: "the rating board chaired by Joan Graves will now consider smoking as a factor—among many other factors, including violence, sexual situations and language—in the rating of films. Clearly, smoking is increasingly an unacceptable behavior in our society. There is broad awareness of smoking as a unique public health concern due to nicotine’s highly addictive nature, and no parent wants their child to take up the habit. The appropriate response of the rating system is to give more information to parents on this issue. This action is an extension of our current practice of factoring under-age smoking into the rating of films. Now, all smoking will be a consideration in the rating process. Three questions will have particular weight for our rating board when considering smoking in a film: Is the smoking pervasive? Does the film glamorize smoking? And, is there an historic or other mitigating context? Additionally, when a film’s rating is affected by the depiction of smoking, that rating will now include phrases such as ‘glamorized smoking’ or ‘pervasive smoking.’ This ensures specific information is front and center for parents as they make decisions for their kids."

Despite the MPAA's historic announcement, anti-smoking groups were not pleased. They had demanded that all movies with any non-historical depiction of smoking be automatically given an R-rating.

The American Legacy Foundation called the MPAA's action "an anemic response." According to a Legacy Foundation statement: "'This announcement is wholly inadequate and will cost countless lives,' said Legacy’s President and CEO Cheryl Healton, DrPH. 'Since more than 80 percent of smokers start before turning 18, youth exposure to smoking in youth rated movies is a vital concern for our nation's health.'"

Anti-smoking groups such as the American Legacy Foundation and the SmokeFreeMovies campaign as well as researchers from the Harvard School of Public Health had called for an automatic R rating for any depiction of smoking in films, unless that smoking was in a historical context or if it clearly showed the adverse health effects of smoking. The SmokeFreeMovies campaign stated the exception for the automatic R rating as follows: "when the presentation of tobacco...is necessary to represent the smoking of a historical figure."

The Campaign for Tobacco-Free Kids responded to the MPAA announcement as follows: "We are deeply disappointed that the movie ratings policy announced today by the Motion Picture Association of America (MPAA) falls short of the real change needed to reduce youth exposure to smoking in the movies. This policy fails to implement the recommendation by numerous public health organizations that any new movie with non-historical smoking be rated R."

The Rest of the Story

I see four major problems with the anti-smoking groups' demands and their disappointed response to the MPAA announcement: (1) hypocrisy; (2) inconsistency between the demand and its stated purpose; (3) exaggeration and narrow-mindedness; and (4) more hypocrisy.

1. Hypocrisy

First, for the purposes of argument, let us stipulate that the anti-smoking groups are correct and that exposure to smoking in non-R rated movies causes 38% of smoking initiation in the country, making it the leading known cause of youth smoking. Let us stipulate that smoking depiction in non-R movies is therefore responsible for about 200,000 new youth smokers each year. Let us stipulate further that the anti-smoking groups are therefore correct in stating that failing to require an R-rating "will cost countless lives."

As I have argued, I do not believe for a moment that these stipulations are correct. I do not think that the scientific evidence is sufficient to conclude that exposure to smoking in non-R rated movies causes 200,000 kids to start smoking each year. But indulge me for the sake of making my argument.

If it is indeed true that depiction of smoking in movies is going to result in killing people (as the American Legacy Foundation has put it), then what possible justification is there for allowing kids to be exposed to any depiction of smoking, whether it is historically correct or not?

Who cares if a smoking depiction is historically correct if it is going to cause kids to become addicted to smoking and ultimately, for many of them to die because of it? If a depiction of smoking in a movie is going to result in disease and premature death among many of those in the audience, then how can we possibly allow an exemption for movies that depict smoking in a historically correct manner? Who cares if the person actually smoked or not? It is the smoking depiction that is killing kids, not the historical accuracy or inaccuracy of that depiction.

I find it extremely hypocritical for anti-smoking groups to suggest that smoking in movies is so bad that we need to remove any shred of it from any movies which kids may view, but that it is not so bad that we need to remove the historical depiction of smoking.

Need I remind anyone that the "historical" depiction of smoking need not refer to old movies or to ancient historical figures. A movie about a modern-day individual who smokes could be considered to be a historically correct depiction of smoking, and would be exempt under the anti-smoking groups' proposed policy. So too, I could argue, would be any live filming of people in which they are smoking. After all, if I film people and they are smoking, then that depiction is historically correct. They were smoking at the time I filmed them. As long as the smoking is not staged, it is could be interpreted as being a historically correct depiction. And what about a character in a novel? If that character smoked, even if it is a piece of fiction, is it not "historically" correct to then depict that character smoking in my movie?

I find the hypocrisy to be so severe in this case that in my view, it destroys the very argument that the anti-smoking groups are making. You cannot convince me that a problem is so serious that we need to remove every shred of smoking from any movie seen by a kid, but then tell me that you support the idea of allowing smoking to be depicted in movies, so long as it is historically correct. That argument just won't fly with me. It's loaded with hypocrisy and it loses its ability to compel me.

2. Inconsistency Between the Demand and Its Stated Purpose

The stated purpose of the proposed automatic R-rating policy is to stop kids from starting to smoke by reducing their exposure to the depiction of smoking in movies. The premise is that any depiction of smoking in movies causes kids to start smoking, unless the adverse health effects are shown. A policy derived from such an intent would therefore demand that smoking be eliminated from all movies unless adverse effects are shown - period.

The fact that the policy demanded by anti-smoking groups would allow the widespread depiction of smoking in movies as long as it is historically correct completely obscures, and is inconsistent with, the stated purpose of the policy.

If one analyzes the policy proposed by anti-smoking groups, the primary concern seems to be one of historical correctness. In other words, the actual policy that the groups propose is based primarily on a concern for integrity in artistic expression. The implied concern is that there is something wrong with smoking that is depicted in a historically incorrect way. The problem is with gratuitous smoking - smoking that is not "necessary." But no smoking is "necessary."

If the concern were purely one of youth exposure to smoking, then historical accounts of smoking - whether true or not - would not be acceptable. The fact that they are acceptable implies that the policy is actually directed not at youth exposure to smoking, but at the integrity of artistic expression related to smoking. The criterion being suggested is whether or not smoking is appropriate in a film. And what is being deemed appropriate is the depiction of smoking by a person who actually did or does smoke.

As soon as the anti-smoking groups begin to delve into the regulation of artistic expression, that's where they lose me, and that's where their argument loses as well. Who are they to argue that as long as smoking actually occurred in real life, it is acceptable for an artist to depict that in film? And who are they to argue that if smoking did not actually occur in real life, it is not acceptable to depict smoking in film?

There is plenty of gruesome violence that actually occurred historically. Does that mean that it is acceptable for artists to depict that violence in films widely seen by children? Or to put it another way, should the motion picture rating board not increase the rating of a film that depicts gruesome violence, so long as that violence is depicted in a historically correct manner?

It is not the historical accuracy of violence that is the problem, it is the violence. Parents don't particularly care whether the violence is real or not; if it is gruesome, they do not want their kids to see it - or at least they want the opportunity of preventing their kids from seeing it.

The anti-smoking groups have destroyed their argument by straying so far away from their original expressed concern - the exposure of youths to smoking in movies. They have shifted over into the artistic expression arena - how is smoking depicted in movies and under what circumstances? This is a far cry from the issue of whether or not youths are exposed to smoking in movies.

This is therefore the second reason why I don't find the anti-smoking groups' argument compelling.

3. Exaggeration and Narrow-Mindedness

Now we can finally stop stipulating. Let's look at the scientific evidence. What we know is that kids who tend to watch movies with pervasive smoking are more likely to smoke than those who do not. What we know is that kids whose parents allow them to view these kinds of movies are more likely to smoke than kids whose parents are more restrictive in their parenting. The kind of media habits that youths have, independent of the depiction of smoking, is likely to be an important influence on smoking behavior. Restrictive parenting is also known to be associated with a reduced risk of youth smoking. Thus, it is entirely possible that these types of factors are confounding the observed relationship between exposure to smoking in movies and smoking initiation.

Yes - I understand that the studies made some attempt to control for restrictive parenting. But I don't think that it controlled for it adequately; nor did it control for some of the other major differences between kids who go out to these kind of movies and kids who do not. Moreover, there are lots of other sources of media depictions of smoking - DVDs, videos, television shows, music videos, the internet, etc. - and exposure to smoking in these media correlates highly with exposure to smoking in movies in movie theaters. So there is no way that one can isolate exposure to smoking in movies and conclude that it is responsible for 38% of youth smoking, even if there were no confounding factors that provide a reasonable alternative hypothesis to the conclusions of these studies.

Now before you start attacking me - let me state clearly that I do think that smoking in movies is a problem. I do think that the widespread media depiction of smoking is a major problem. I do think that it contributes to smoking initiation. I do think that the problem needs to be addressed and I think it is great that anti-smoking groups have taken on this issue (or at least they appear to have taken it on - read on to argument #4).

However, I do not think that it is as simple as stating that smoking in movies in theaters causes 200,000 kids to start smoking each year, or that smoking in movies causes exactly 38% of all smoking initiation. I don't think it is as simple as saying that any depiction of smoking in movies causes kids to smoke. I take a much broader perspective on the problem. I think that the overall widespread exposure in the media to smoking is an influence on smoking initiation. I would be very hesitant to single out one particular mode of exposure and claim that it is single-handedly responsible for all the observed increase in youth smoking among those who are exposed to smoking depictions in that medium.

Moreover, I don't believe that decreasing youth smoking is as simple as reducing exposure to smoking in R-rated movies. There are many other media by which youths are exposed to smoking, and there is no guarantee that that reducing smoking exposure in one medium only is going to ameliorate the problem.

Furthermore, if movies with any smoking are given an R-rating, it could potentially undermine the entire ratings system. If parents think that a movie might have an R-rating simply because there was a whiff of smoke, might parents not become less restrictive about allowing their kids to see R-rated movies? Might parents start to become more lax? Could that actually result in kids seeing not only more smoking, but more sex and violence as well? I'm not stating that this is necessarily the case - I'm just pointing out that there has been no research to document that requiring an R-rating of movies that depict any smoking would actually save lives. There can be unintended consequences of policies, and in this case, I think it's quite likely.

Most importantly, even if one accepts the conclusions of the research, there is absolutely no evidence that a single depiction of smoking in a movie causes kids to start smoking. In other words, there is little scientific support for a zero-tolerance policy, such that any depiction of smoking in movies must be eliminated from movies which youths are likely to see.

All in all, I think the anti-smoking groups are exaggerating the science, over-stating their claims, and going way beyond the documented evidence in their public communications on this issue. I also think that we have become somewhat narrow-minded. Sure, smoking is a problem. But to be honest, it's not my first concern when it comes to my kids starting to watch movies in theaters. Violence, sex, and alcohol use are also major concerns. To single out smoking as warranting a zero-tolerance policy, but not treat violence, sex, or alcohol in the same way seems quite narrow-minded and inconsistent to me.

All in all, I think that the MPAA response makes a lot of sense. Consider smoking as a factor in the ratings system, just as sex and violence are considered (it seems to me that alcohol use is another factor that the MPAA should start addressing if it is not already). Don't use a zero-tolerance policy, but look at a movie in its entirety. And look at the pervasiveness and glamorization of smoking - not just whether there is any smoking depiction.

4. More Hypocrisy

Of course, the ultimate hypocrisy, which bears repeating here, is that the American Legacy Foundation is talking out of both sides of its mouth.

On the one hand, smoking in movies is the most terrible problem we face; it is killing people; the corporations that are responsible are complicit in the eventual deaths of thousands of young people each year; we must adopt a zero-tolerance policy and eliminate any depiction of smoking in movies; the response of the motion picture companies is unacceptable; by their anemic response, they are killing countless numbers of people.

On the other hand, the American Legacy Foundation is a corporate partner with the chief culprit - Time Warner. If Time Warner is really killing people and its refusal to eliminate smoking in movies seen by youths is going to kill people, then how can Legacy possibly partner with this company?

I'm not arguing that it is inappropriate for Legacy to partner with Time Warner per se. I'm just stating that Legacy needs to make up its mind. If smoking in movies is killing people, then there is no excuse for Legacy to partner with the chief murderer. On the other hand, if Legacy is perhaps overstating the case, then maybe it makes sense to try to work with Time Warner from the inside to address the problem. But you can't have it both ways.

To close, I can't do any better than to repeat what Christopher Buckley, author of the satirical novel "Thank You for Smoking," told the Washington Post in today's article: "I can only hope this means that the MPAA will strip such films as 'Casablanca,' 'To Have and Have Not' and 'Sunset Boulevard' of their G-ratings and re-label them for what they were: insidious works of pro-smoking propaganda that led to millions of uncounted deaths. Bravo."

The inconsistency, exaggeration, and blatant hypocrisy of the anti-smoking groups is ripe grounds for satire. If only I had Buckley's wit, perhaps I could write my own film. Any ideas for what I could call it?

American Cancer Society Continues to Mislead Its Constituents and Fails to Reveal the Truth

In a communication sent yesterday to its constituents, the American Cancer Society attempted to entice people to write Congress to support the proposed FDA tobacco legislation in the name of stopping Big Tobacco and countering Big Tobacco's own letter-writing campaign, but failed to reveal that the biggest company within Big Tobacco - Philip Morris - is strongly supporting the bill and that any letter-writing campaign from Philip Morris is invariably in support of the legislation, not in opposition to it.

In the communication, the American Cancer Society writes: "We need your help to build momentum to Stop Big Tobacco. ... Tell your U.S. Senator that Big Tobacco must be stopped and this legislation must be voted on now! ... Please send a letter to your Senator urging them to take action on S. 625, the Tobacco Product Regulation Bill. Sending a letter now will help give our campaign the needed momentum to get this legislation moving again. We know that Big Tobacco’s friends and lobbyists are sending their letters. We need to send ours too. ... Together, we can Stop Big Tobacco!"

The Rest of the Story

This continues a campaign of deception being waged by the American Cancer Society to promote passage of the FDA tobacco legislation. The ACS is deceiving its own constituents into thinking that this bill is opposed by Big Tobacco, that the bill is not in the interests of Big Tobacco, and that Big Tobacco is orchestrating letter-writing campaigns against the legislation. The truth, of course, is that the largest company within Big Tobacco is strongly supporting the legislation and if Philip Morris is orchestrating any letter-writing campaign, it is certainly a campaign in support of the legislation.

I wonder how many of the ACS constituents who received this mailing would be angered to find out that they had been misled into supporting a bill that is being actively promoted by the nation's largest cigarette company. I suspect that a substantial proportion of these folks would be quite miffed to find out that they were not given all the relevant information.

I could have missed it, but I was unable to find mention of Philip Morris' support for the FDA legislation anywhere on the Cancer Action Network's web site.

An examination of some of the campaign materials being used by the American Cancer Society revealed other deceptive elements of its campaign. For example, the talking points being used by the ACS to entice people into supporting the bill are titled "Stop Big Tobacco from Marketing to Women."

This implies that the proposed legislation would stop Big Tobacco from marketing its products to women. Nothing could be further from the truth. The legislation does nothing of the sort. The FDA cannot stop the marketing of tobacco products to women. Clearly, it would be unconstitutional, as it would violate the First Amendment of the Constitution for the FDA to prohibit the cigarette companies from marketing their products to women.

In my view, this is a rather sleazy tactic - to deceive people who may be concerned about the marketing of tobacco products to women into believing that somehow this legislation will put a stop to that practice in order to gain their support.

The power point presentation which the ACS provides to train its spokespeople and advocates (what you might call the brainwashing mechanism in my opinion) is also very deceptive. It trains spokespeople by informing them that the FDA legislation requires "an end to ... marketing to children." The full text is: "The bill requires an end to free samples and marketing to children."

While it is true that the bill requires an end to free samples, it is false to state that the bill requires an end to marketing to children. In fact, the bill explicitly states that any advertising regulations promulgated by FDA must be consistent with the First Amendment (as if it needed to say that). Based on the Supreme Court's decision in Lorillard v. Massachusetts, it is quite clear that the FDA could not end marketing to children. In fact, it is quite likely that even lesser actions, such as banning ads within 1000 feet of schools and playgrounds would not pass muster in the Supreme Court (that was in fact the nature of the Massachusetts regulations that were overturned by the Court).

It is also important to note that the training presentation fails to mention any of the loopholes in the FDA legislation. It fails to mention any of the numerous provisions in the bill that limit the FDA's authority to regulate tobacco products.

What I find so sad is that in the name of protecting cancer victims and their families and preventing future cancer victims, the American Cancer Society is actually supporting a bill that I think protects the profits of Big Tobacco at the expense of the protection of the public's health. There are in fact numerous provisions in the bill that were most likely placed there at the insistence of Philip Morris which serve only to protect Big Tobacco profits. There is absolutely no public health justification for these provisions. Yet the ACS is not even informing its constituents that those provisions are present. They appear to not even be revealing that Philip Morris is behind the bill in the first place.

This is so unethical that it truly boggles my mind. I absolutely do not understand how this could have occurred. Did the American Cancer Society actually read the bill? Did one person just tell everyone else that the bill is great and everyone needs to support it? Is anyone questioning why the ACS would stand shoulder to shoulder with the company that is causing so many cancer deaths? Is the ACS allowing anyone to raise that question? Does it care? Does it not strike ACS constituents as odd that the ACS would support provisions that sell out the public's health to Big Tobacco profits and refuse to even consider any changes to the legislation?

Even if my opinion about the bill is dead wrong, it is unethical for the ACS to be using these tactics of deception to promote the bill. It is unfair to its constituents. It is a violation of the principle of informed consent not to inform their constituents about the truth behind the legislation. It is really what amounts to dishonesty, in my opinion.

It is sad for me because I think that it represents a profound injustice to the interests of cancer victims and their families throughout the country. It therefore goes against everything that the American Cancer Society is supposed to represent.

I truly hope that the American Cancer Society will reconsider its decision to support this bill. But at very least, I hope that they cut out the use of these deceptive, unethical, and sleazy tactics to promote the bill. Cancer victims and their families deserve a hell of a lot better than that.

ABC News 20/20 Re-Airs Piece on the 30 Minute Myth

This past Friday night, ABC News 20/20 re-aired a segment on the myth, being spread widely by many anti-smoking groups, that just 30 minutes of secondhand smoke exposure can cause heart disease. I appear in the segment - questioning the assertion that a brief secondhand smoke exposure is sufficient to cause heart disease.

"Dr. Michael Siegel, a leading advocate of bans on smoking in the workplace because of the harm from daily exposure to secondhand smoke, says the 20 or 30 minute claims are ridiculous. 'If someone is just exposed for 30 minutes, it's completely reversible, and it's not gonna cause hardening of the arteries,' Siegel said. Siegel, who helped ban smoking in restaurants and bars, now says his movement is distorting science. 'It has turned into more of a crusade,' Siegel said. 'The cause has kind of taken over.'"

The Rest of the Story

Since this segment first aired almost exactly one year ago, here is what has transpired:

1. The fallacious claims of anti-smoking groups have continued - many groups are still claiming that brief exposure to secondhand smoke causes hardening of the arteries (atherosclerosis). Many groups are claiming that secondhand smoke exposure is as harmful as active smoking. Many continue to claim that brief secondhand smoke exposure reduces blood flow to the heart and causes heart damage, and continue to imply that a brief exposure puts even healthy individuals at risk of suffering a heart attack.

2. Most groups have refused to retract or clarify their false and misleading claims.

3. Not a single bit of evidence has been presented to support the contention that a brief exposure to secondhand smoke causes hardening of the arteries or that it can cause a heart attack in anyone other than a person with severe existing coronary artery disease.

4. The problem has spread all the way to the top - the Surgeon General's office itself claimed that brief exposure to secondhand smoke can cause heart disease and lung cancer.

As readers of this blog know, I actually support workplace smoking bans, including bans on smoking in bars and restaurants. I have published articles about the health effects of chronic exposure to secondhand smoke. However, I just do not think that the worthiness of the cause justifies the dissemination of false or misleading information in order to further the cause. I think that we have an ethical responsibility as public health practitioners to accurately communicate the science to the public.

It is sad, discouraging, and disillusioning to me that in the past year, we have made virtually no progress in reclaiming our scientific integrity in the tobacco control movement. The misrepresentation of the science continues as strongly as ever, there have been only one or two organizations that have actually corrected or clarified their misleading claims, and tobacco control groups and advocates continue to refuse to even discuss or address my arguments. Instead, I continue to be personally attacked and excluded from discourse in the movement.

I am glad that 20/20 chose to re-air this segment. Because while the tobacco control movement seems closed off to the idea of communicating the truth to the public, the public is not. If the public starts to put pressure on the tobacco control groups, then I think things may begin to change.

Another Anti-Smoking Advocate Questions the Need for Some Outdoor Smoking Bans

While many anti-smoking groups and advocates are sure to use the results of a new study on outdoor tobacco smoke to push their agenda which seeks nearly complete bans on outdoor smoking, at least one anti-smoking advocate has joined me in publicly suggesting that these results do not justify many outdoor smoking bans.

In a USA Today article on the new study, Dr. Simon Chapman, a professor of public health at the University of Sydney and editor of the journal Tobacco Control, is quoted as suggesting that there is not necessarily a need to ban outdoor smoking simply because there might be transient exposure to plumes of smoke:

"Some question the need to regulate outdoor smoke. 'If you burn anything, the smoke contains hundreds of noxious particles,' Simon Chapman, editor of the journal Tobacco Control and a professor at the University of Sydney's School of Public Health, says in an e-mail. He notes that 'people get brief exposures to intense plumes of noxious smoke from barbecues, campfires and home cooking, yet we don't ban those.'"

The Rest of the Story

Congratulations to Dr. Chapman for having the courage and integrity to stick to the science and to retain a solid evidence base in his jusitification for tobacco control policies. It is so easy to jump onto the bandwagon of the anti-smoking crusaders who are calling for nearly complete bans on smoking outdoors. And to challenge that agenda from within entails a substantial risk of being termed a traitor or a tobacco stooge.

Now I don't feel quite so alone. Although it would be nice to have someone in the United States to commiserate with, rather than all the way over in Australia.

New Study Reveals Lack of Health Justification for Many Outdoor Smoking Bans

A new study published this month in the Journal of the Air Waste Management Association examines levels of particulate matter due to cigarette smoke in a variety of outdoor locations under various circumstances (see: Klepeis NE, Ott WR, Switzer P. Real-time measurement of outdoor tobacco smoke particles. Journal of the Air Waste Management Association 2007; 57: 522-534).

According to the study abstract: "The overall average OTS [outdoor tobacco smoke] respirable particle concentration for the surveys of public places during smoking was approximately 30 ug/m3. OTS exhibited sharp spikes in particle mass concentration during smoking that sometimes exceeded 1000 ug/m3 at distances within 0.5 m of the source. Some average concentrations over the duration of a cigarette and within 0.5 m exceeded 200 ug/m3, with some average downwind levels exceeding 500 ug/m3. OTS levels in a constant upwind direction from an active cigarette source were nearly zero. OTS levels also approached zero at distances greater than approximately 2 m from a single cigarette. During periods of active smoking, peak and average OTS levels near smokers rivaled indoor tobacco smoke concentrations. However, OTS levels dropped almost instantly after smoking activity ceased. Based on our results, it is possible for OTS to present a nuisance or hazard under certain conditions of wind and smoker proximity."

The basic finding of the study is that if you are within a few feet of a smoker in an outdoors location, your exposure to secondhand smoke can be quite high, approximating that of indoor exposure under relatively smoky conditions. On the other hand, once you get beyond about 6 feet from the smoker, the exposure is minimal.

The authors conclude: "OTS [outdoor tobacco smoke] levels are highly dependent on source proximity. Levels at 0.25–0.5 m can drop by half or more as the distance increases to 1–2 m. At distances >2 m, levels near single cigarettes were generally close to background."

The Rest of the Story

While the results of this study are likely to be used by some anti-smoking groups to try to justify on health grounds widespread bans on outdoor smoking, even in places where nonsmokers can freely move about - like sidewalks, streets, parking lots, and parks - the rest of the story is that the study actually demonstrates that there is little health justification for banning smoking outdoors except in locations where nonsmokers are not easily able to move away from smokers.

For example, the findings justify smoking bans in locations where nonsmokers are in fixed seating - such as an outdoor stadium. In such situations, a nonsmoker could be within 6 feet of a smoker and unable to move away, due to the fixed seating. Secondhand smoke exposure could be considerably high, justifying a smoking ban on health grounds.

However, the findings demonstrate the lack of a health justification for more widespread bans on outdoor smoking, such as the ban recently enacted in Calabasas, where smoking is prohibited in just about any outdoor location, such as streets, sidewalks, parking lots, and parks. In such situations, the study documents that nonsmokers can easily avoid substantial exposure to secondhand smoke simply by walking away from the smoker(s). At a distance of 6 feet or greater, exposure becomes minimal.

This study appears to confirm the validity of the criterion I have previously suggested be used to judge the health justification of smoking bans: are nonsmokers easily able to avoid the smoke by moving away from smokers? If the answer is no, then an outdoor smoking ban in that venue is justified. Of the answer is yes, then it is unlikely that an outdoor smoking ban in that situation is justified on health grounds.

Will the results of this study cause anti-smoking groups to reassess their support for widespread outdoor smoking bans in places where nonsmokers can avoid proximity to smokers? I highly doubt it. Why? Because as I have learned, this is no longer about the science. It is about the agenda. We no longer need the science to justify our agenda. As this movement has largely become a crusade, rather than a reasonable, evidence-based practice of public health, we no longer need scientific or health justification for our actions and policies.

Now that the tobacco industry has largely decided to discontinue its opposition to smoking bans, there is nothing left that requires us to justify our policies on health and science grounds - perhaps with the exception of some guy's tobacco policy blog.

The bottom line is that secondhand smoke outdoors poses no substantial health threat to nonsmokers unless they are not easily able to avoid proximity of less than about 6 feet from any smoker. The distance required to avoid substantial exposure may be somewhat higher for a group of smokers. If nonsmokers want to avoid exposure to secondhand smoke outdoors in such situations, they can just walk away. It is only in situations where walking away is not an option (such as waiting tables in an outdoor cafe or sitting in a stadium with fixed seating) that regulation of outdoor smoking is justified on health grounds.

And Now for Something Completely Different: More Deception by the Campaign for Tobacco-Free Kids

In an April 4 message to its constituents, the Campaign for Tobacco-Free Kids wrote: "Every major public health organization, including the American Cancer Society, American Lung Association and American Heart Association, strongly supports S. 625/H.R. 1108, legislation introduced in the U.S. Congress that gives the FDA authority to regulate tobacco products."

The assertion in question is that "Every major public health organization...strongly supports S. 625/H.R. 1108."

The Rest of the Story

The rest of the story is that in refutation of the Campaign for Tobacco-Free Kids' claim, the American Association of Public Health Physicians strongly opposes the proposed FDA legislation.

It seems deceptive to tell its constituents that every major public health organization in the country strongly supports the proposed FDA legislation when in fact, the major public health organization that represents the nation's public health physicians opposes the legislation.

I suppose that the Campaign could argue that the American Association of Public Health Physicians is not a major public health organization, but doing so would be spitting in the faces of the nation's public health physicians. I'm not sure which would be worse.

Incidentally, the Campaign's message to constituents also deceives them about what the legislation would and would not do. It states that the bill would require that tobacco companies remove harmful ingredients from their products. The bill does not do that. It merely gives the FDA the authority to require removal of some harmful ingredients. And it gives the tobacco industry tremendous power to block any significant FDA regulations. Moreover, the statement implies that all the hazardous ingredients would have to be removed. This, of course, is not true. I have discussed this issue in great detail previously.

Even if I supported the FDA legislation, I do not think it is appropriate to use unethical tactics to promote the bill. Deceiving your constituents about what the bill does is unethical. So is making a claim that is false, or at least very deceptive.

I just need to go on record as stating that I condemn the Campaign for Tobacco-Free Kids' unethical tactics in the strongest possible terms.

American Heart Association Deceives Public About Secondhand Smoke, Sets Policy for Meetings in Smoke-Free Cities, then Immediately Violates Policy?

The American Heart Association (AHA) yesterday announced a new policy of holding its conferences only in cities that provide a smoke-free workplace, either through local ordinance or state law. Beginning on May 1, 2007, all AHA scientific meetings must be held only in cities that have enacted smoke-free workplace laws or are located in states that have such laws in place.

According to its press release: "'The American Heart Association has long advocated for smoke-free workplace ordinances at the state and local levels,' said American Heart Association Board Chairman Andrew B. Buroker. 'We are equally committed to protecting the health of our staff and volunteers by providing smoke-free environments for Association-sponsored meetings and conferences.' ... 'We can no longer excuse holding meetings in smoky localities that could put staff, volunteers and visitors at risk for cardiovascular diseases,' said Buroker. 'In order to save many lives, the American Heart Association strongly believes that the nation's indoor public places should be 100 percent smoke-free.' The policy goes into effect on May 1, 2007 for American Heart Association conferences. It requires all meetings and conferences organized or sponsored by the association to be held in communities that have enacted smoke-free workplace laws by a state law or local ordinance."

The AHA justified its policy, in part, by claiming that just 30 minutes of exposure to secondhand smoke reduces coronary blood flow, greatly increasing a person's risk of suffering a heart attack: "Thirty minutes of exposure to secondhand smoke stiffens coronary arteries, slowing the flow of blood to the heart muscle, making a person much more susceptible to a heart attack."

The AHA's 2007 annual scientific conference will be held in Orlando this fall.

The Rest of the Story

In justifying its new policy, the American Heart Association is deceiving the public about the acute cardiovascular health effects of secondhand smoke and misrepresenting the science.

The very study which the AHA is relying upon to support its claim that 30 minutes of secondhand smoke exposure slows the flow of blood to the heart muscle actually showed that 30 minutes of secondhand smoke exposure has no effect on the baseline rate of flow of blood to the heart muscle (see: Otsuka R, Watanabe H, Hirata K, et al. Acute effects of passive smoking on the coronary circulation in healthy young adults. JAMA 2001; 286:436-441).

As I have explained in detail elsewhere (post 1; post 2; post 3; post 4; post 5; post 6; post 7; post 8; post 9), the Otsuka et al. study which is being relied upon to support this statement actually found that 30 minutes of secondhand smoke did not impair basal coronary blood flow in healthy adults. What was impaired was the coronary flow velocity reserve, a measure of the coronary arteries' ability to dilate in response to artificially imposed stressors. This finding does not mean that someone exposed to secondhand smoke suffers decreased coronary blood flow.

Coronary flow velocity reserve is a measure of the ability of the coronary arteries to dilate in order to increase blood flow under experimental conditions. What a decline in coronary flow velocity reserve indicates is something called endothelial dysfunction - an impairment of the ability of the coronary arteries to dilate in response to a variety of stimuli. This ability to dilate is mediated by the endothelial cells -- the cells which line the blood vessel.

The endothelial cells respond to certain stimuli by producing nitric oxide and other chemicals which diffuse into the smooth muscle in the artery wall, sending a chemical message that causes the muscle to relax and therefore causing the artery to dilate. There are a number of exposures that impair the ability of the endothelium to accomplish this function; among them are active smoking, secondhand smoke, high cholesterol, consumption of trans-fats, and consumption of a high-fat meal.

When endothelial dysfunction is triggered repeatedly over a long period of time, it has been shown to result, ultimately, in atherosclerosis (narrowing of the coronary arteries). When this occurs, coronary blood flow is reduced. It is important to note that a reduction in coronary blood flow is not observed acutely when the endothelial dysfunction is being measured from a single experimental exposure (such as in the Otsuka et al. study). The Otsuka et al. study demonstrated that if you simply measure coronary blood flow in a person exposed to secondhand smoke for 30 minutes, it is not significantly reduced.

Thus, the AHA's statement is false and unsupported by the evidence, or at least, very misleading.

There is absolutely no truth to, and no plausibility to the assertion that 30 minutes of secondhand smoke makes healthy people much more susceptible to a heart attack. If you don't already have severe coronary artery disease, 30 minutes of secondhand smoke exposure will not greatly increase your susceptibility to a heart attack. Such an effect is completely implausible, and there is no scientific evidence to support such an assertion.

Interestingly (and importantly), the American Heart Association's statement is completely unqualified. It does not assert that 30 minutes of secondhand smoke exposure makes a person with severe existing coronary artery stenosis much more susceptible to a heart attack (even that assertion would be highly speculative, but at least there is some evidence to support it). The statement implies that anyone exposed to secondhand smoke for 30 minutes faces an increased heart attack risk.

This is so far off from the truth. Essentially, if you don't have pre-existing severe heart disease, your risk of suffering a heart attack from 30 minutes of exposure to secondhand smoke is zero.

The ultimate irony in the American Heart Association's press release is that despite what on the surface looks like a strong and principled stand designed to pressure cities to protect workers from secondhand smoke, the stand appears to be little more than fluff.

The very first city in which the AHA is hosting its first conference in accordance with the new policy is Orlando - a city in which bar workers are exposed to extremely high levels of secondhand smoke. You see - in Florida, smoking is still allowed in bars. If attendees of the AHA conference this fall go out for drinks in the evening in an Orlando bar, they will more likely than not be exposed to high levels of secondhand smoke. Can you imagine all the heart attacks that are going to occur during the conference. It's a good thing that there will be so many cardiologists around.

Does the American Heart Association not realize that a bar is a workplace? Does the American Heart Association not believe that bar workers are deserving of the same protection from the apparently life-threatening acute hazards of secondhand smoke as everyone else in the population? Does the American Heart Association believe that it is justified to exempt this major segment of our working population from health protection?

If anything, by holding its conference in Orlando amid all the fluff of this major announcement, the American Heart Association is rewarding cities that fail to protect their bar workers. Any city that might previously have been afraid of potentially losing the AHA's business now knows that it can "safely" exempt bars from their smoke-free protection laws and still have a chance to serve as a host for the AHA convention.

The hypocrisy of the AHA's press release is startling. Secondhand smoke is so dangerous that only 30 minutes of exposure decreases your coronary blood flow and can trigger a heart attack; however, it's not so bad that we need to protect bar workers from secondhand smoke. Let them keel over from heart attacks - as long as the AHA conference attendees have a place to enjoy their evening cocktails to unwind after a long day of scientific presentations (many of which, incidentally, are going to be about how harmful secondhand smoke is).

Add today's story to the story from Monday about another so-called principled stand taken by the AHA which turns out to be little more than fluff in my opinion, and it looks like the American Legacy Foundation and Action on Smoking and Health are in real trouble. The American Heart Association is now in the driver's seat for my next hypocrisy in tobacco control awards.

American Cancer Society Deceives the Public About FDA Tobacco Legislation; Joins the Campaign of Deception

In a press release issued last Thursday, the American Cancer Society informs the public that the proposed FDA tobacco legislation would require the tobacco companies to remove the harmful ingredients from their cigarettes, something which the legislation does not do.

According to the press release: "The legislation would make great strides by restricting tobacco advertising and promotions, stopping illegal sales of tobacco products to children, requiring changes in tobacco products, such as the removal of harmful ingredients and requiring tobacco companies to disclose the contents of tobacco products, among other things."

The assertion in question is that: "The legislation would...[require]...the removal of harmful ingredients."

The Rest of the Story

The American Cancer Society's statement about the FDA legislation is deceptive for two reasons. First, it asserts that the legislation would require the tobacco companies to remove harmful ingredients from their cigarettes. The legislation does nothing of the sort. It merely gives the FDA the authority to require the removal of certain ingredients. It does not force the FDA to eliminate any particular harmful ingredients from cigarettes. The bill actually gives the tobacco companies tremendous power to block any significant FDA regulation, simply by using their influence in Congress to overturn any proposed regulation.

Second, the statement implies that the tobacco companies would be required to remove the harmful ingredients from cigarettes. This is not the case. Even if FDA acted and the tobacco companies were not successful in their attempt to get Congress to veto the regulation, the most FDA could do would be to require the removal of certain harmful ingredients. By no means could the FDA require the removal of the harmful ingredients from cigarettes (i.e., all the harmful ingredients). In fact, the legislation precludes the FDA from requiring the removal of all the harmful ingredients of cigarettes because it prohibits the FDA from banning the sale of any particular class of tobacco product.

Perhaps it has not occurred to the American Cancer Society, but a cigarette without the harmful ingredients would not be a cigarette.

This story is an important development, because the American Cancer Society has now joined the Campaign for Tobacco-Free Kids in its campaign of deception regarding the proposed FDA tobacco legislation. It has become clear that the supporters of this legislation are so desperate that they cannot afford to merely tell the truth to the public about what the legislation would and would not require.

Quite ironic, don't you think, as in the same press release the American Cancer Society complains that "the industry continues to deceive the public." A more accurate description would have been to state that "the industry, like us, continues to deceive the public."

Further, the American Cancer Society might have gone on to state that: "While the tobacco industry's deception is unacceptable because they are selling harmful products, our deception is fine, because we're working towards a good cause."

Deception is deception, and if it's wrong for the tobacco companies, then it's wrong for us. In fact, it's even more important that we refrain from the tactic of deception because if we want to retain any credibility in arguing that action is needed to prevent the companies from deceiving the public, we need to be beyond reproach in our own use of that very tactic.

It continues to escape me why telling the truth is no longer enough in tobacco control. We apparently now have to deceive the public in order to promote our agenda. The shame and irony of this story is that the American Cancer Society is actually using deception in order to promote Philip Morris' agenda.

Philip Morris must truly be enjoying seeing these developments unfold. Who would have thought that the company could simply sit back and allow the health groups to promote its legislative agenda? And that the company could just lay back and that the health groups would misrepresent the details of the bill so severely that the public would be deceived into thinking that the legislation would actually require the companies to remove the harmful ingredients from their products?

Philip Morris doesn't even need to run a campaign to try to misrepresent the provisions of the legislation to convince policy makers and the public that this legislation would require cigarettes to be safer products. It can sit back and relax and watch the health groups do all the dirty work for them.

While the brilliance of Philip Morris never ceases to amaze me, the lack of ethical behavior on the part of the major health groups amazes me even more.

I guess telling the simple truth is simply not in vogue any more in tobacco control. As usual, I guess I need to catch up with the times.

Today's Highlights: Hypocrisy, Inconsistency, and Junk Science

Today I feature 3 posts that highlight hypocrisy, inconsistency, and junk science within the tobacco control movement:

1. Hypocrisy: The American Heart Association bans Miss New Hampshire from walking in the AHA Heart Walk, while at the same time teaming up with Philip Morris to support its chief legislative priority.

2. Inconsistency: The American Medical Association criticizes the tobacco industry not for advertising its deadly products, but for advertising too much.

3. Junk Science: The Campaign for Tobacco-Free Kids commissions a survey on the public's attitudes toward the FDA tobacco legislation.

Campaign for Tobacco-Free Kids' Public Opinion Poll Shows Widespread Support for FDA Tobacco Legislation, Or Does It? Junk Science Rears its Ugly Head

According to the Campaign for Tobacco-Free Kids (TFK), a new public opinion poll commissioned by TFK shows widespread public support for the proposed FDA tobacco legislation, which would grant the FDA severely limited authority to regulate tobacco products. That authority is specifically limited by the bill's provisions which were insisted upon by the nation's leading cigarette company - Philip Morris.

According to the poll: "83 percent support requiring tobacco companies to take measures, when scientifically possible, to make cigarettes less harmful; 76 percent support requiring the reduction or removal of harmful ingredients, including nicotine, from tobacco products."

The Campaign for Tobacco-Free Kids concludes that "A new national poll of registered voters finds that 77 percent of American voters support Congress passing a bill to give the U.S. Food and Drug Administration (FDA) the authority to regulate tobacco products."

The Rest of the Story

Junk science has reared its ugly head again in tobacco control. Frankly, this is junk science at about the worst as I have ever seen it in the movement. In my opinion, this poll - commissioned by the Campaign for Tobacco-Free Kids - is more shoddy than any public opinion poll that the tobacco industry has ever commissioned to "demonstrate" that smoke-free bar and restaurant laws result in devastating economic impacts to businesses.

In my opinion, this poll was rigged in order to generate the impression of widespread support for the legislation, when in fact, we have no idea based on the survey whether or not the public would actually support this legislation or not.

Why? Because the survey was rigged, in my opinion. It did not ask people the appropriate questions that would need to be asked in order to determine whether the public supports the legislation. The way that the questions were worded, and the topics they cover, ensured that the public would overwhelmingly express support for the legislation. But the public was specifically not asked about those aspects of the legislation that might have resulted in overwhelming disapproval of the legislation.

Incidentally, this is precisely the kind of thing we criticize the tobacco companies for in commissioning surveys that purported show that restaurant smoking bans are devastating for business. But apparently the same technique is acceptable as long as it works in our favor.

I'll make my point by suggesting the kinds of questions that I think would need to be asked to get an accurate reflection of the public's actual opinion about the proposed legislation. But first, let's just take a look at three of the questions that were asked.

The main question asked was: "Would you favor or oppose the U.S. Congress passing a bill that would give the Food and Drug Administration (the FDA) the authority to regulate tobacco products, including restrictions on sales and marketing to children?"

This question is virtually meaningless, because it doesn't indicate support for the actual legislation being proposed. It simply indicates support for the general idea of granting the FDA authority to regulate cigarettes. Much of the public probably would support the general idea of giving the FDA regulatory authority over cigarettes but would not support the specific regulatory scheme that Philip Morris helped craft that is reflected in this particular legislation.

I, for example, fall into that category. If I had been a subject in the survey, I would have responded that I indeed favor the U.S. Congress passing a bill that would give the FDA the authority to regulate tobacco products. But as all my readers know, I am one of the most vocal opponents of the proposed legislation out here. That's how meaningless this particular question is.

Another question asked whether respondents would favor a provision in legislation that would: "Require tobacco companies to take measures, when scientifically possible, to make cigarettes less harmful."

Who wouldn't support such a provision? The problem is that the bill contains no such provision. There is nothing in the bill that requires the tobacco companies to make cigarettes less harmful in any way that is scientifically possible. In fact, the bill precludes the FDA from taking precisely that action which would correspond with the question that was asked - to require companies to simply remove all the harmful constituents from their products. It is certainly scientifically possible to do that. But the bill precludes that action, because it does not allow FDA to ban any particular class of tobacco product. Once again, I would have answered that I indeed favor a provision in the bill that would require tobacco companies to take all measures that are possible to make cigarettes less harmful. Unfortunately, there is no such provision in the bill. If anything, the bill gives tobacco companies the ability to easily block any attempt by FDA to make even more minor changes in cigarette design.

Another question asked whether respondents would favor a provision in legislation that would: "Require the reduction or removal of harmful ingredients, including nicotine, from tobacco products."

Again, it's hard to imagine why anyone would not favor such a provision. However, once again there is no such provision in the bill. The legislation merely gives the FDA the ability to require the reduction or removal of particular harmful ingredients. The FDA could not require the reduction or removal of all harmful ingredients (which is implied by the question), nor does the bill require that the FDA take any particular action at all. In fact, the bill gives the tobacco companies the ability to block any required removal of an ingredient merely by getting a majority of Congressmembers to veto the regulation. Moreover, the bill specifically precludes the FDA from requiring the complete removal of nicotine from cigarettes. So this question - while it provides a result quite favorable to TFK - also has no relevance to the actual legislation in question.

If one were interested in getting a truthful impression of the level of support of the American people for the actual FDA legislation, rather than in simply using junk science to obtain rigged, politically useful, pre-ordained answers to irrelevant questions, here are examples of the questions that I think would also have to be asked of people:

1. Would you favor or oppose the U.S. Congress passing a bill to regulate tobacco products that is strongly favored by Philip Morris, the nation's leading cigarette manufacturer?

2. Would you favor or oppose the U.S. Congress passing a bill to regulate tobacco products that was negotiated with, and possibly written in part by Philip Morris?

3. Would you favor or oppose a bill that contains provisions, inserted to appease the interests of Philip Morris, that interfere with the protection of the public's health from the harms of cigarettes?

4. Would you favor or oppose a bill that ties the FDA's hands in terms of its ability to regulate tobacco products in an unfettered manner?

5. Would you favor or oppose a bill that provides Congress with veto power over any major regulation promulgated by FDA to protect the public's health from tobacco products?

6. Would you favor or oppose a bill that precludes the FDA from completely removing nicotine from cigarettes?

7. Would you favor or oppose a bill that preempts the ability of state governments to regulate tobacco products?

8. Would you favor or oppose a bill that makes it virtually impossible for cigarette companies to market what may be truly safer products?

9. Now I'm going to read a list of ways in which the Food and Drug Administration could regulate tobacco products. After each one, please tell me if you favor or oppose the FDA implementing that particular proposal or policy.

a. Increasing the age of sale of tobacco products to 19.

b. Banning the sale of tobacco products at pharmacies.

c. Keeping cigarettes out of the hands of minors by requiring prescription-only access.

d. Including two tobacco industry representatives on an advisory panel to recommend regulatory actions to the FDA.

It is hopefully clear from these questions that the Tobacco-Free Kids survey is a sham; it does not truly measure support for the bill in question. Instead, it is an example of using junk science to promote an anti-smoking group's agenda. The distinctions between the tactics of the tobacco companies and our leading anti-smoking organizations are becoming narrower by the day.

American Medical Association Suggests that Tobacco Companies Should Be Allowed to Market their Deadly Products; But Not Too Much

In response to the release of a Federal Trade Commission report revealing that tobacco companies spent approximately $13 billion on advertising and promotion of cigarettes in 2005 and $14 billion in 2004, the American Medical Association (AMA) issued a statement criticizing the companies for spending so much on marketing: "In 2004 and 2005 alone, the tobacco industry spent an exorbitant $27.7 billion to market their deadly products to the American people. That same money could pay for virtually every smoker in America to receive a full course of nicotine treatment to help them quit."

The AMA's statement is being widely interpreted as a complaint against the volume of cigarette advertising. For example, HealthDay summarized the story as follows: "Despite a two-year decline in the amount of money tobacco makers spend on marketing and advertising, the American Medical Association says too much is still spent on promoting cigarettes and other forms of smoking."

The Rest of the Story

It certainly sounds like what the AMA is bemoaning and criticizing is the amount of money that the cigarette companies spend on marketing their products. The AMA is using the new FTC report to argue that Congress should heed Philip Morris' desire for legislators to pass the company-supported FDA tobacco legislation. In other words, the amount of money tobacco companies spend on marketing is too high. That money could and should be put to better use - paying for pharmaceutical smoking cessation treatment for every smoker. That's why we must do something about it.

There are a number of things that I find wrong with the way the AMA is framing this issue.

First, it is not the amount of money that is being spent on cigarette marketing that makes it problematic or inappropriate. Cigarettes are a legal product and therefore there is no particular limit on the amount of money that the tobacco companies should be allowed to spend marketing the product. The tobacco companies are and should be free to determine their marketing budgets. Setting a limit on the advertising amount would almost certainly be unconstitutional.

If the AMA is going to criticize the tobacco companies for spending so much money on marketing, then how can the AMA fail to call on the companies to cease their marketing altogether? It seems quite an inconsistent position to me to state that the companies spend too much on cigarette marketing. If the cigarette companies had cut their advertising and promotional expenditures from $15 billion in 2003 to $7 billion in 2005, would that have led the AMA to praise the companies? How could the AMA possibly praise a company for spending $7 billion a year to market a deadly product? There appears to be a huge inconsistency in the AMA's position.

Second, is the AMA seriously suggesting that it is the tobacco companies' responsibility to cease their marketing of their products and spend the same amount of money instead on trying to encourage people not to use their products? If you're going to criticize the companies for trying to sell their legal products and not trying to get every customer to stop using the product, then it seems to me that you ought to simply be calling for the prohibition of these products in the first place. Yet the AMA is doing the exact opposite: supporting a bill that precludes FDA from ever banning the sale of any class of tobacco product. Once again, the AMA's position is entirely inconsistent.

Third, it seems to me that the AMA's criticism is misplaced. It is not the amount of advertising and promotion that is irresponsible. After all, this is a legal product and how can you criticize a company merely for advertising a legal product? What is irresponsible is two things: (1) the use of misleading or deceptive advertising; and (2) the marketing of tobacco products to youths. By focusing on the amount of the advertising and criticizing the tobacco companies for spending too much money, the AMA is distracting attention away from the aspects of the marketing that really determine the level of responsibility of the companies: whether the advertising is truthful or deceptive and whether it is directed at youths versus adults.

Sometimes I get the feeling that anti-smoking groups, especially those supporting the proposed FDA legislation, are looking for any excuse to criticize the tobacco companies, whether or not the companies ought to be criticized for that reason or not. I get the idea that those groups supporting the FDA legislation are looking for any opportunity to show that this particular event or finding demonstrates that we need FDA legislation, regardless of whether that event or finding actually demonstrates the need for the FDA legislation or not.

I think what is happening is that our arguments are getting weaker and weaker, less and less consistent, as our zeal to criticize the companies and promote the FDA legislation spirals out of control. As a result, we are losing sight of the appropriate science and policy base that should underlie tobacco control. We are losing the footing of our movement, as we transfer our foundations from cement to ever-shifting and sinking quicksand.

American Heart Association Bans Miss New Hampshire from Walking in AHA Heart Walk; Has No Problem Teaming Up With Philip Morris to Support FDA Bill

According to an article on the WMUR (New Hampshire) web site, the American Heart Association (AHA) will not allow the Miss New Hampshire organization to participate in the AHA's Heart Walk as a team because the group has received funding from R.J. Reynolds.

According to the article: "The Miss New Hampshire organization has been banned from walking as a team in the annual American Heart Association Heart Walk because of the organization's ties to a tobacco company. Miss New Hampshire Emily Hughes travels to schools to talk to children about the dangers of smoking. But Dover Middle School recently withdrew its invitation to her once it was discovered that the anti-smoking program was funded by tobacco giant R.J. Reynolds. The American Heart Association has now decided to not allow walkers to march under the Miss New Hampshire banner during the Heart Walk. AHA officials said that they hope anyone who takes part in its signature event shares its message of no smoking. 'The American Heart Association has a national policy that prohibits us from working with organizations that accept funds from the tobacco industry,' said Deborah Hornor, AHA regional vice president."

The Rest of the Story

The rest of the story is that although the American Heart Association has a national policy that prohibits it from working with organizations that accept funds from the tobacco industry, the AHA apparently does not have a policy that prohibits it from teaming up with Philip Morris to support federal legislation that would provide unprecedented special protections for the tobacco industry.

Despite its refusal to allow an organization that has received funds from Big Tobacco to associate itself with an AHA event, the AHA apparently has no problem teaming up with Philip Morris to lobby for the FDA tobacco legislation - which contains special provisions that sacrifice the protection of the public's health in order to protect the profits of the nation's largest cigarette manufacturer.

I have no problem with the American Heart Association taking a principled stand and refusing to associate in any way with any organization that has anything to do with any tobacco company. But the hypocrisy of the American Heart Association's own actions - in contrast to its statement to others - is striking.

Obviously, I'm not suggesting that the Heart Association is working directly with Philip Morris. However, the reality is that the American Heart Association is standing shoulder-to-shoulder with Philip Morris in promoting the company's chief legislative priority, and that the AHA is supporting a bill that was essentially negotiated (although not directly) between the Campaign for Tobacco-Free Kids and Philip Morris. The AHA is supporting a bill that is a direct result of negotiations with Philip Morris! That's fine. It's the Heart Association's right to do so. But once they've made the decision to team up with Philip Morris in terms of setting national public health policy, I think the organization loses its ground in then telling other groups that they cannot so much as participate in a fund-raising event if they have accepted money from a tobacco company.

American Legacy Foundation and Action on Smoking and Health - move over. You may have some competition for the next hypocrisy in tobacco control awards.

Campaign for Tobacco-Free Kids Misleads the Public about FDA Legislation; Campaign of Deception Continues in Full Force

In a press release issued on Tuesday, the Campaign for Tobacco-Free Kids misleads the American public by telling us that the proposed FDA tobacco legislation requires tobacco companies to remove harmful ingredients from their cigarettes and by implying that all harmful ingredients would have to be removed.

According to the press release: "Among other things, the legislation would crack down on tobacco marketing and sales to kids; require that tobacco companies disclose the contents of tobacco products and remove harmful ingredients; stop tobacco companies from misleading the public about health risks of their products; and require larger, more effective health warnings on cigarette packs."

The statement under contention is the claim that "the legislation would...require that tobacco companies...remove harmful ingredients."

The Rest of the Story

The rest of the story is that the legislation would not require tobacco companies to remove harmful ingredients. There is nothing in the bill that requires tobacco companies to remove the harmful ingredients from their products.

What the bill does is authorize the Food and Drug Administration (FDA) to require the reduction or elimination of certain constituents. However, there is no requirement that the FDA actually demand the elimination of the harmful ingredients in cigarettes.

In fact, there are a number of provisions in the bill that give the tobacco industry tremendous power to block the FDA from actually requiring the elimination of harmful ingredients from cigarettes. For one thing, the bill grants Congress veto power - with a simple majority vote - over any significant FDA regulation, such as removing a cigarette ingredient. This puts the decisions about the safety of tobacco products into the hands of a political rather than a scientific body (although one could easily argue that FDA itself has become more of a political than a scientific body). It also allows the tobacco industry to use its power and influence in Congress to block any requirement for removal of ingredients that it does not like.

There is an immense difference between a bill that would require the companies to remove harmful ingredients and one that merely authorizes the FDA to require the removal of these ingredients. By failing to tell the public about this distinction, the Campaign for Tobacco-Free Kids is pulling the wool over the public's eye, continuing its long-standing campaign of deception in support of this legislation.

The second part of the rest of the story is that the Campaign for Tobacco-Free Kids' statement is also misleading because it suggests that the FDA legislation would require tobacco companies to remove all of the harmful ingredients from cigarettes. The bill would do nothing of the sort and it in fact precludes the FDA from taking such an action by prohibiting the FDA from banning the sale of any particular class of tobacco product.

Stating that the bill would require that tobacco companies remove harmful ingredients from their cigarettes implies - at least to a large segment of the public - that the bill would eliminate the harmful ingredients from cigarettes. Nothing could be further from the truth. Not only is there no requirement for any constituent of tobacco to be removed, but the best FDA could do is to require the removal of some of, or more likely a few of, the constituents. Contrary to what the Campaign is suggesting, the bill is not going to result in the elimination of harmful ingredients from cigarettes.

And by the way, the most harmful ingredient in cigarettes, by far, is the tobacco. And the bill precludes the FDA from requiring the removal of that ingredient.

Not only does the legislation fail to require tobacco companies to remove the harmful ingredients from their products, but there is, in fact, one provision in the bill that precludes the FDA from requiring cigarette companies to completely remove perhaps the most harmful component - the addictive nicotine - from their products.

The continued deception of the public about the facts relating to the proposed FDA tobacco legislation is, in my opinion, unethical behavior on the part of the Campaign for Tobacco-Free Kids. And I find it ironic that in an effort to promote legislation that it claims is intended to prevent deception by the tobacco companies, Tobacco-Free Kids is using deception of its own:

In order to prevent deception by the tobacco companies, we're going to deceive and mislead the American people. Why is it that deception by the tobacco companies is heinous, but deception by an anti-smoking group is acceptable.

The answer, of course, is that while the tobacco companies are working towards an evil end, the FDA legislation is promoting a noble end - the protection of the financial interests of Philip Morris. Wait a minute, even that reasoning doesn't quite work.

My point is that in using deception to pursue its legislative goals, the Campaign for Tobacco-Free Kids is acting as unethically as the tobacco companies. We are no better than the tobacco industry if we continue to use deception to promote our goals. In this case, the Campaign is not even using deception to promote a shared goal of the public health community. It is using deception to promote the chief legislative priority of the nation's leading cigarette company -- a legislative goal that is opposed by many of us in the public health community.

Don't get me wrong - even if the Campaign were using deception to support what I perceived as a worthwhile measure, it would still be unethical and irresponsible. It just adds insult to injury when the leading anti-smoking group is using deception and promoting the financial interests of Philip Morris at the same time.

I'm all for demanding an end to tobacco industry deception of the public. But I think if we're going to make that demand, we need to first put an end to our own deception of the public. Otherwise, isn't this just the pot calling the kettle black?

New Jersey Town Bans Smoking in Cars with Kids; Feel-Good Law Would Do Little to Protect Public's Health But Would Interfere with Parental Autonomy

The town of Keyport (New Jersey) on Tuesday enacted an ordinance banning smoking while in a vehicle with a child. The offense will be a secondary one, meaning that police cannot pull someone over for smoking in a car. However, if a person is stopped for another motor vehicle infraction (such as speeding), he or she could be given an additional citation for smoking in the presence of a child. The fine for this violation is $75.

The town's mayor stated that the law is not intended to protect children from secondhand smoke, but is simply intended to make a statement: "'We're not trying to use the power of the motor-vehicle system to punish people into behaving the way we want them to,' Mayor Robert Bergen said. 'This ordinance is really intended to be a positive public policy statement about the need to take care of our kids.'"

The mayor added: "'The Surgeon General's report clearly documents the dangers of secondhand smoke, particularly on young people,' he said. 'It's really not good for children.'"

Not everyone is happy with the new law. According to an Associated Press article: "Audrey Silk, the founder of a New York smokers' rights group, says Keyport is overstepping its authority. 'A car is an extension of your personal property,' said Silk, whose group, NYC Clash, stands for Citizens Lobbying Against Smoker Harassment and is active in New Jersey. 'For the government to regulate what you can do in your own private property, everybody should be afraid of that.'"

The Rest of the Story

The rest of the story is that the mayor has essentially admitted that the law is not intended to protect children from secondhand smoke, but simply to harass smokers about this particular health risk to which they are exposing their children. He stated that Keyport is not trying to get people with kids not to smoke in cars. What it is trying to do, apparently, is to send a statement to smokers who do smoke in cars with children so that they feel bad that they are not taking care of their kids.

The lack of any sincere intention on the part of the Keyport policy makers to actually reduce children's exposure to secondhand smoke is evidenced by the fact that they chose to make this a secondary - and therefore unenforceable - offense. Without the ability to stop people for violating the law, it lacks any teeth, and therefore will - like almost all other secondary traffic offenses - be ignored.

If the true intention of the Borough Council is to protect children from secondhand smoke, then it should have simply banned smoking around children, period. Most secondhand smoke exposure of children occurs in the home, not in cars. So if your true intent is to protect kids and their health, it makes little sense to ban smoking in cars but not homes with children present.

The fact that the Council failed to protect kids in the home and at the same time, essentially made the protections for kids in cars meaningless, suggests to me that the true intention is not really to protect kids after all. Instead, it appears to be a feel-good law that allows the policy makers to feel good about themselves for making a statement (albeit a meaningless one), but without actually having to confront the real issue by tackling the problem of smoking in the home.

Typical politicians! All talk and no action. Talk the talk, but not willing to walk the walk.

Frankly, the apparent intent of this law is to harass smokers and make them feel guilty about smoking around their kids in the car, but without actually changing their behavior. What the Keyport Borough Council is saying is: "You can smoke around kids if you want to, but we're going to make sure that you feel bad about it."

That's fine, but why not make parents also feel bad about feeding their kids fast food from McDonalds four days a week? Why not also make parents feel bad about not breastfeeding their infants? Why not make parents feel guilty for allowing their kids to drive a car before they are 18 years old. Why not make parents feel like they are not taking care of their kids if they allow them to play hockey?

The mayor is right. Smoking in a car is not good for children. But neither is feeding them junk food day after day, letting them risk life-threatening injury by getting pummeled into hard boards on ice, or letting them ride with their friends at probably too high a speed in a car.

The Borough Council could have made a statement about any of these choices that parents make that increase health risks for children. But they didn't. Instead, they singled out smoking. And not even all smoking. Just smoking in a car. Why?

The reason, I believe, is that it turns their stomach to think about parents smoking in a car with children. But it doesn't turn their stomach to think about parents not breastfeeding their kids. It doesn't turn their stomach to think about parents allowing their kids to drive a car. It doesn't turn their stomach to think about parents taking their kids to McDonalds four days a week?

So the really interesting question, then, is why it turns their stomachs to think about parents subjecting their kids to one health risk, but not to any other (equally, or more dangerous) health risks?

The only answer that is apparent to me is that there is some hatred of smokers. They are an easy target to pick on in terms of making a statement about "healthy" parenting. So politicians appear to be using smokers to bolster their own sense of good (they can claim that they are protecting the public's health) without actually having to confront the real issue (smoking in the home).

I agree completely with Audrey Silk. We should be afraid of this invasion of parental autonomy. Especially because it is coming without any substantial evidence that it will greatly protect the public's health. If the express intent of simply making a statement is all that it takes for policy makers to interfere with parental autonomy to this degree, then I think we should be scared.

While it may feel good for the policy makers, it does little (if anything) to protect kids, it distracts attention from the real issue at hand, and it represents an unjustified intrusion into parental autonomy.

New Study on Obesity Costs Shows Folly of Smoker-Free Employment Policies

According to an Associated Press article published Monday in the Boston Globe, a new study has shown that "fat workers cost employers more." AP writer Carla K. Johnson writes that: "Overweight workers cost their bosses more in injury claims than their lean colleagues, suggests a study that found the heaviest employees had twice the rate of workers' compensation claims as their fit co-workers."

"Duke University researchers also found that the fattest workers had 13 times more lost workdays due to work-related injuries, and their medical claims for those injuries were seven times higher than their fit co-workers. Overweight workers were more likely to have claims involving injuries to the back, wrist, arm, neck, shoulder, hip, knee and foot than other employees. The findings were based on eight years of data from 11,728 people employed by Duke and its health system. Researchers found that workers with higher body mass indexes, or BMIs, had higher rates of workers' compensation claims. The most obese workers -- those with BMIs of 40 or higher -- had the highest rates of claims and lost workdays."

The study was published in the current issue of Archives of Internal Medicine.

Based on these findings, the authors of the study recommended that employers institute fitness programs to help their overweight employees lose weight.

In response to the study: "New York employment attorney Richard Corenthal cautioned employers not to overreact with discriminatory policies. 'Employers need to be careful not to view this study as a green light to treat obese or overweight workers differently,' Corenthal said."

The Rest of the Story

The rest of the story here is not the study itself, but the response to the findings. And the story is not what researchers recommended, but what they did not recommend. You don't hear anyone suggesting that to save health care and workers compensation money, employers fire fat people or stop hiring them in the first place. It simply isn't part of the discourse. The suggestion simply does not arise. No public health groups are suggesting - or would suggest - anything of the sort. The response (and an appropriate one) is to recommend fitness or other programs to help employees control their weight.

Not so with an almost identical problem - off-the-job employee smoking. That problem is also costing employers money in terms of health care costs. However, in contrast to the obesity and overweight problem, many anti-smoking groups are supporting the idea of firing smokers or refusing to hire smokers in order for employers to save money. The World Health Organization has gone so far as to institute its own smoker-free employment policy, refusing to consider applications from smokers for any WHO job.

It is time that anti-smoking groups understand that the precise reasoning they are using to support discrimination against smokers in employment also supports discrimination against obese and overweight people. If we are going to support the idea of excluding smokers from employment to save health care costs for employers, then we must also support the idea of excluding fat people from employment.

Another aspect to the rest of the story is the immediate and vigorous way in which the mere possibility of employers discriminating against overweight people is confronted. The article concludes with a caution to employers not to take these findings as a green light to discriminate against overweight job applicants.

Not so with smoker-free employment policies. You generally are not hearing a vigorous response warning employers not to discriminate against smokers. You certainly will not hear such a warning from any U.S. anti-smoking group.

In fact, I might go so far as to say that my greatest disappointment right now as a tobacco control advocate is the failure of any U.S. anti-smoking group to step up and condemn discrimination against smokers in employment. I don't think that discrimination is something we should be supporting or even condoning in the tobacco control movement. The fact that we are supporting it is a grave disappointment to me, and it makes me quite ashamed to be a tobacco control practitioner and a part of that movement.

Another Anti-Smoking Group Calls Smoking Around Children a Clear Form of Child Abuse

In a letter published recently in The Telegram (St. Johns), the Alliance for the Control of Tobacco (Newfoundland and Labrador) calls smoking around children a clear form of child abuse:

"High-profile instances of child abuse get attention — and certainly they should get attention — but it is, indeed, time to see smoking in vehicles and homes in the presence of children for what it really is: a clear form of child abuse. A recent report from the U.S. Surgeon General clearly states that there is no safe amount of secondhand smoke. The report indicates that breathing even a little secondhand smoke can be dangerous. Further to this, it states that children are more likely to have lung problems, ear infections and severe asthma from being around smoke, and secondhand smoke causes heart disease and lung cancer. ... The days of ignoring this form of child abuse should be no more."

The Rest of the Story

The major fallacy in the argument that smoking around children is a form of child abuse is that secondhand smoke does not necessarily cause harm to children - it increases the risk of ear infections, respiratory infections, and asthma. This failure by a number of anti-smoking groups to recognize the distinction between risk and harm is a dangerous one, and would lead to us categorizing as child abuse a wide range of parental behaviors - not just smoking.

A second fallacy in the argument is that the intention of the behavior is not viewed to be relevant. Child abuse is not being defined as knowingly inflicting harm upon a child, but as any behavior that increases health risk, whether the intention is to cause harm or not. This failure to distinguish between intentional infliction of harm and any exposure to increased risk is also dangerous.

What the Alliance for the Control of Tobacco is essentially arguing is that any time a parent exposes their child to an increased risk of health problems, that is child abuse. No harm need be done. Even a small increase in risk equates to child abuse.

By that definition, allowing a child to eat peanut butter prior to age 3, which is known to significantly increase the risk of potentially deadly peanut allergy, would be a clear form of child abuse. So would not breastfeeding an infant, which has been well-documented to decrease the risk of a host of medical problems. Allowing a child to play contact sports would also be child abuse. So would placing a child's car seat on the side of the back seat, rather than in the middle (the side locations significantly increase risk compared to the middle position).

Can you imagine a maternal and child health organization coming out and publicly suggesting that failing to breastfeed your child is a form of child abuse? Such a group would be instantly attacked and condemned. So should the Alliance for the Control of Tobacco for this particular statement.

The Alliance also fails to consider the fact that child abuse entails an intentional infliction of harm. If the harm occurs by accident or without knowledge of potential harm, it is not child abuse. For example, if you accidentally leave a bottle of vitamins on the kitchen table and a child swallows them, you will not be charged with child abuse. If you intentionally put a bottle of vitamins on the floor - hoping that the child will swallow them - that is child abuse. Consideration of the state of mind of the parent is critical to the definition of child abuse.

However, the Alliance is defining child abuse in a way that ignores the state of mind of the parent. If you smoke around your child, that is child abuse, regardless of whether you even know that secondhand smoke is potentially harmful to your child.

This, too, is a dangerous argument to make. Can you imagine a health organization calling on all parents who serve their kids nuts prior to age 2 to be treated as child abusers, even if those parents were not aware that this behavior increases the likelihood of serious allergies to nuts? They would be instantly attacked and condemned. So should the Alliance for the Control of Tobacco for this particular statement.

Interestingly, the Alliance seems to exempt from child abuse the intentional exposure of one's children to secondhand smoke produced by other smokers. If you smoke around your children, that is child abuse; however, if you bring your kids to a smoky restaurant, the Alliance is not suggesting that is child abuse. This exposes the weakness of their argument.

The rest of the story is that the anti-smoking movement is treading into dangerous territory. In our zeal to extract revenge on smokers, to punish them, and to condemn them, we are actually setting a dangerous precedent that could completely destroy parental autonomy. If policy makers actually listen to what these anti-smoking groups are saying, it will cause great harm to our children. But it will prevent ear infections!