Tobacco Control

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2020: Seeing COVID-19 through a cloud of cigarette smoke

  • Note: Long article with interesting points. We will grab a few tidbits, but recommend viewers of this site go read the whole thing.
  • Why did the AMA choose not to campaign against smoking, but rather to conduct the same kind of research that the report had already found sufficient for its indictment of smoking? The AMA/tobacco industry collaboration distributed research funds to dozens of universities to keep scientists in their laboratories and not out testifying to the need to end smoking now.
  • This, in turn, leads to another villain that has gone unnoticed: the insurance industry, which never lifted a finger to fight smoking, even long after a small Massachusetts insurer, State Mutual Life Assurance Company, offered the first non-smoker discount after the SG report came out in 1964.
  • One year later, he would be offered the editorship of the journal of the American Academy of Family Physicians, American Family Physician—contingent on his not speaking publicly on the subject of smoking. The AAFP was a recipient of advertising revenue from food subsidiaries of RJ Reynolds and Philip Morris. AB turned down the job.
  • And what about academia, organized medicine, and the voluntary health organizations, such as the American Cancer Society? What did they do as the battles over restrictions on cigarette advertising heated up in the 1980s? Most were nowhere to be found.
  • This was also in spite of the publication of the Surgeon General’s Report in 1964, following which the AMA, as noted here, spent 14 years conducting research funded by the tobacco industry in lieu of taking action or even calling for action against smoking, apart from advising the public not to smoke in bed.
  • “When did the medical and public health communities learn about the harmfulness of cigarettes and what did they do about it?” The much-avoided answer is that the public health community knew no later than the 1930s through the epidemiologic work of Raymond Pearl at Johns Hopkins and the clinical reports of Alton Ochner at Tulane. But did the American Medical Association, the American Public Health Association, medical schools, schools of public health, the American Cancer Society, or federal public health agencies launch anti-smoking efforts? An emphatic no.
  • This failure to own up to the health community’s failure in the mid-20th century has been willfully ignored by the professional field known as “tobacco control” that emerged in the 1990s. Tobacco control devotes most of its efforts to research, the bulk of which is aimed at providing the basis for regulatory or legislative approaches to reduce tobacco use and exposure to tobacco smoke, something called “tobacco regulatory science” by inside-the-Beltway bureaucrats.
  • In fact, much of the progress in tobacco control, most notably in protecting the public from exposure to others’ smoke by the passage of clean indoor air laws, occurred in the 1970s, 1980s, and 1990s—long before the creation in 2014 of 14 mostly university-based “centers of excellence in tobacco regulatory science,” each given $20 million by the FDA.
  • Research by one of us (ES) in the early-1990s found numerous cross-connections among the members of the Surgeon General’s advisory committee for the 1964 report, the AMA’s Education and Research Fund to administer grants from the tobacco industry, and the Tobacco Industry Research Committee (renamed the Council for Tobacco Research in 1964). The result was to pad the nests of pet institutions and delay any meaningful action for another 14 years while such important-sounding research was going on.
  • As for other funding to reduce smoking, Bloomberg Philanthropies awarded Johns Hopkins over $300 million to do more research and to support anti-smoking legislation around the world, as well as more than $100 million to the D.C.-based Campaign for Tobacco Free Kids for its anti-smoking lobbying and public education efforts. As with the government, engaging mass media education takes a back seat to the safe sinecure of research. The MSA-funded Truth campaign (formerly the American Legacy Foundation, established with $2.5 billion in settlement funds) also spends most of its budget on research, with a modest amount going for paid mass media, but with restrictions on the mention of tobacco company names and cigarette brand names.
  • By our estimate, this would put the reduction of smoking as one of the worst failures in public health. “Tobacco control advocates often proclaim that the 50% recent reduction in smoking since the first Surgeon General’s Report on Smoking and Health in 1964—from over 40% of the population then to less than 20% today—was a success,” he notes. “Given that over 50 years later the excess deaths attributed to tobacco in the United States still exceeds 500,000 per year, it would be more appropriate to call this a continuing disaster
  • “If we only produce pamphlets and posters, then people will be suspicious. But if we become too visible in raising the alarm about smoking, we’d be shut down in a minute.”