January 9, 2003
By Linda Gorman
After sitting through the recent Cessation Subcommittee meeting of the Interagency Committee Meeting on Smoking and Health in Denver, one can only be delighted that the Bush administration plans to let the private sector take over commercial activities[i], like mowing federal lawns. Maybe this will free up federal resources and we can stop contracting large chunks of public health policy to wealthy private foundations with radical political agendas.
Three of the Subcommittee members at the Denver meeting were supported by the Robert Wood Johnson Foundations tobacco control programs.[ii] Another, a current board member of the American Medical Association, was a Foundation grant recipient and founding editor of Tobacco Control, a journal that it supports.[iii]
The federal agencies represented, the Tobacco Control Research Branch of the National Cancer Institute, the Agency for Healthcare Research and Quality, and CDCs Office on Smoking and Health, are members of NOTURF. Created in 1997 by the Robert Wood Johnson Foundation, NOTURF is the National Organization of Tobacco Use Research Funders. Its goal is to enable collaboration among research funders and investigators.[iv] NOTURFs web page says it is funded by financial and in-kind support from member organizations. If true, U.S. taxpayers pay a private organization to control the direction of research on tobacco use in the United States.
With more than $9 billion in assets, the Robert Wood Johnson Foundation is the nations 4th largest private foundation. [v] It bankrolled the Clinton attempt to nationalize health care and has bribed state health care bureaucracies with grants in exchange for policy since the early 1990s. Since 1993, the Foundations SmokeLess States program has given millions of dollars to local chapters of the American Lung Association, the American Cancer Society, and the American Heart Association for supporting campaigns to increase tobacco taxes.[vi] The Foundation has almost $20,000,000 in active grants with the American Medical Association (AMA), the administrator of the SmokeLess States project.[vii] It may be the AMAs most important member, as the AMAs 2001 membership dues totaled $54.4 million.[viii]
Federal health agencies rely heavily on the Foundation for personnel and ideas. The authors of a 2002 CDC publication covering state highlights in tobacco control saw fit to give special thanks to the Office of Smoking and Healths partners at the SmokeLess States Initiative and The American Legacy Foundation.[ix] The American Legacy Foundation, another member of NOTURF, is a vehicle set up to spend an expected $1.45 billion endowment obtained from the spoils of the state attorney generals tobacco lawsuits.[x] Its president, also on the Smoking Subcommittee, gives speeches on such topics as Tobacco as a Social Justice Issue.[xi]
Given the incestuous nature of the anti-smoking policy groups, it is no surprise that U.S. public health policy on smoking has become increasingly strident and authoritarian. Though addictions are not diseases and people quit smoking on their own every day, current U.S. policy guidelines reclassify smoking as a treatable chronic disease.[xii] They urge clinicians to identify every tobacco user and to offer intensive counseling and drug treatment to those who want to quit. Those who dont are to be lectured on the risks and quizzed about their resistance every time that they come in. Unsurprisingly, researchers find that some pregnant women now lie about their smoking habits.
Neither the costs nor the benefits of such clinical guidelines have been adequately explored. The costs of smoking are routinely overstated, beginning with uncritical acceptance of federal estimates of smoking related deaths.[xiii] Though supporters of clinical guidelines cite thousands of studies supporting their views, statistics are not science and work in the area tends to have problems with high dropout rates, excessive reliance on self-reports and unrepresentative study groups.
As is always the case when the Robert Wood Johnson Foundation is involved, skepticism is in order because the ultimate goal is health care paid for with other peoples money. Strategies to force Medicare, Medicaid, private insurance, and employers to pay for the tracking systems, nicotine gum, counseling, and anti-depressants specified by the clinical guidelines were prominent at the Denver meeting. A possible glimpse of the long-term agenda was offered by a speaker who said, I cant think of a better way to start drug coverage than with tobacco.[xiv]
People who care about individual smokers should also be concerned that official anti-smoking zeal slights harm reduction. Guidelines stress that total abstinence is essential, not a single puff after the quit date. But other researchers suggest that encouraging smokers to reduce their smoking or to substitute smokeless tobacco for cigarettes may improve health even when smokers dont quit entirely.[xv] Safer cigarettes might also be possible, but meeting participants derided the very idea portraying tobacco companies as purveyors of evil dedicated to killing their customers.
A patent unwillingness to recognize tradeoffs was also clear. Smoking was repeatedly equated with alcohol abuse, as if smokers typically damage others by behaving violently and driving erratically. Meeting participants mocked Colorado Governor Bill Owens for cutting tobacco education programs as he struggles to balance the state budget. In fact, the state may not need more anti-smoking education right now. In 2001, Colorados Tobacco Education and Prevention Partnership said that the states middle and high school population had high levels of awareness that tobacco is addictive and harmful.[xvi]
Tradeoffs implicit in tobacco tax increases were also unacknowledged. People at the meeting appeared to believe that higher tobacco taxes always reduce smoking and increase state revenues. The Robert Wood Johnson Foundations Tobacco-Free Kids web site expands on this bizarre claim, explaining that raising state cigarette taxes always increases revenues and that increasing federal cigarette taxes will not create a black market in the United States because crossing into Mexico or Canada to buy cigarettes simply would not be worth the time or trouble. [xvii]
People who believe such fairy tales are free to believe that Prohibition succeeded, that illegal drugs are inconvenient to obtain, and that smuggled cigarettes with fake tax stamps are figments of the imagination.[xviii] Should they also be free to make the rest of us pay for their flawed policy initiatives
[i] Ron Fournier, November 14, 2002. Bush administration puts 850,000 federal jobs up for private sector bids, Associated Press.
[ii] Susan Curry, PhD, University of Illinois at Chicago, and Michael Fiore, MD, MPH of the University of Wisconsin medical school are directors of the Robert Wood Johnson Foundations Addressing Tobacco in Managed Care national program. See http://www.ctri.wisc.edu/main_dept/research/res_main.html; and http://www.medsch.wisc.edu/pophealth/rwjscholars/mfiore.html; for more detail. Linda Bailey is the Director of the Center for Tobacco Cessation at the University of Maryland Law School a program jointly funded by the American Cancer Society and the Robert Wood Johnson Foundation according to the University of Maryland web site. http://www.law.umaryland.edu/Environment/fac/bailey.asp.
[iii] Ronald Davis, MD. Currently director, Center for Health Promotion and Disease Prevention, Henry Ford Health System, Detroit, Michigan. Listed as principal investigator on 1998-99 RWJF grant Policy-Makers Support for Community Tobacco Control Policies: The Impact of Local Public Opinion Profiles awarded to Michigan Department of Public Health as part of the Foundations Tobacco Policy Research Program. http://www.rwjf.org/publications/publicationsPdfs/library/oldhealth/exh2-1.htmgt; as of November 18, 2002. For more complete bio see http://www.ama-assn.org/ama/pub/category/6081.html.
[iv] Web site of National Organization of Tobacco Use Research Funders as of November 16, 2002. http://www.noturf.org/funding.html;.
[v] Foundation Center, November 5, 2002. Top 100 U.S. Foundations by Asset Size. New York, New York. Online edition, lt;http://fdncenter.org/research/trends_analysis/top100assets.htmlgt; as of November 18, 2002.
[vi] For a partial list of grants see the programs web site at http://www.rwjf.org/aboutGrantees/npoDetail.jspid=TPC#046836
[vii] Robert Wood Johnson Foundation web site as of November 18, 2002. Search on active grants with American Medical Association as recipient.
[viii] American Medical Assoc1ation Consolidated Financial Statement, December 31, 2001 and 2000. Online edition, http://www.ama-assn.org/ama/upload/mm/31/2001financials.pdf ; as of November 18, 2002.
[ix] Office on Smoking and Health. 2002. Tobacco Control State Highlights 2002: Impact and Opportunity. Centers for Disease Control and Prevention. Online version, November 16, 2002, http://www.cdc.gov/tobacco/statehi/html_2002/FrontMaterial.htm;.
[x] Martin Morse Wooster. July 2000. The American Legacy Foundations Truth Campaign: Using Tobacco Funds for Anti-Smoking Ads, Foundation Watch, Capital Research Center, Washington, D.C. Online edition as of November 16, 2002. http://www.capitalresearch.org/publications/foundation_watch/2000/0007.htm.
[xi] American Legacy Foundation. Remarks of Dr. Cheryl Healton, November 27, 2001. Online version as of 16 November, 2002, http://pressroom.americanlegacy.org/pubs/18-S6N4Iio6QiMooPsLhJ8X/Speech%20Brochure.pdf
[xii] Michael C. Fiore, et al. June 28, 2000. A Clinical Practice Guideline for Treating Tobacco Use and Dependence, A US Public Health Service Report. JAMA, vol. 283, no. 24. pp. 3244-3254. Online edition, http://www.thejcdp.com/issue004/bakdash/Tobacco%20Guidline.pdf, as of November 18, 2002.
[xiii] Robert Levy and Rosalind Marimount. Fall 1998. Les, Damn Lies, and 400,000 Smoking-Related Deaths. Regulation, 21, 4. pp. 24-29. See also the exchange of letters between the
[xiv] Authors notes from meeting.
[xv] For more information see Todd Seavey, July 1, 2002. Harm Reduction Topic of ACSH Symposium, American Council on Science and Health, online at http://www.acsh.org/press/releases/symposium070102.html; as of November 18, 2002; Jack E. Henningfield and Karl O. Fagerstrom, 2001. Swedish Match Company, Swedish Snus and Public Health: A Harm Reduction Experiment in Progress Tobacco Control,10, 253-257, online version at http://tc.bmjjournals.com/cgi/reprint/10/3/253.pdf. Some sample citations in the medical literature include DL Trudeau, C Isenhart , and D Silversmith. 1995. Efficacy of smoking Cessation Strategies in a Treatment Program, J. Addict Dis.; C Jimenez-Ruiz et al. 2002. Harm reductionA Treatment Approach for Resistant Smokers with Tobacco Related Symptoms, Respiration, 69,5; J.F. Etter et al. 2002. Nicotine Replacement to Reduce Cigarette Consumption in Smokers Who Are Unwilling to Quit: A Randomized Trial, J. Clin. Psychopharmacology, Oct;2,5;
[xvi] Press release, April 2, 2001. Colorado Department of Public Health and Environment. http://www.cdphe.state.co.us/release/2001/040201b.html ; as of November 18, 2002.
[xvii] Eric Lindblom. October 10, 2002. Raising State Cigarette Taxes Always Increases Revenues, National Center for Tobacco-Free Kids, http://tobaccofreekids.org/research/factsheets/pdf/0098.pdf ; and Increasing Federal Cigarette Taxes Will Not Create A Black Market in the United States, http://tobaccofreekids.org/research/factsheets/pdf/0024.pdf ; as of November 18, 2002
[xviii] For a representative column on cigarette smuggling see Bruce Bartlett. August 6, 2002. Cigarette Smuggling. http://www.townhall.com/columnists/brucebartlett/bb20020806.shtml ; as of November 18, 2002. For comments from the Commerce Committee of the U.S. House of Representatives see Tobacco Policy, January 22, 1998. Online edition at http://www.house.gov/commerce/issues/tobacco/issue3.pdf ;.
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