Monday, January 3, 2011

Things Can Change, Perhaps

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Tobacco drying. Image courtesy of CDC.

Recently, our family took a step into the modern age by opening a subscription to an online movie outlet so that we can stream movies over the Internet to our television. All this means is that we have spent way too much time over winter break watching movies that we missed when they were released or that we've seen before and of which we are especially fond. Such is the case of the The Insider, Michael Mann's recounting of the beginning of the sea change in opinion against the big tobacco companies.

For those of you who haven't seen it, The Insider takes place in the mid-to-late 1990s. The story revolves around a high-level Brown and Williamson research scientist, Jeffrey Wigand, who told the truth about his employer and the tobacco industry first in a deposition in Mississippi (where the Attorney General was suing tobacco companies to get them to pony up for Medicaid expenses for illnesses related to tobacco use) and then during a Mike Wallace interview on 60 Minutes. The plot becomes more complicated when 60 Minutes aired a heavily edited version of the original interview because its parent organization, CBS/Westinghouse, was concerned about potential lawsuits from the tobacco company. The original interview, which strongly indicted big tobacco as being fully aware of (and working to enhance) the addictive properties of its products and gave evidence that the CEOs of the big seven tobacco companies perjured themselves in a congressional hearing, was aired a few months later. However, it was only aired after other news outlets discredited the smear campaign against Dr. Wigand that was orchestrated by his former employer and outed 60 Minutes as caving to corporate interests.

It was a public health story, corporate whistle-blower story, and a journalism ethics story all rolled into one big messy ball of a movie. And, for the most part, it was true.

What is iconic of that time is the image of the seven tobacco CEOs (referred to as the Seven Dwarfs) standing in the Hon. Henry Waxman's hearing and perjuring themselves by declaring, under oath, that nicotine is not addictive. Below is a Youtube video of this historic moment that exposed these corporations for what they are - makers of nicotine delivery devices.

I was working at the American Cancer Society when these events began unfolding, but honestly, I didn't appreciate the magnitude of them at the time. Sure, everyone knew that tobacco use was the number one cause of cancer and that nicotine was addictive and that tobacco companies wanted to addict people - especially young people - in order to replace customers that would inevitably die. But the power and influence of the tobacco companies were formidable and those of us in public health held slim hope that a right-leaning Congress would support public health over big tobacco.  Fortunately, there were some visionaries who could see the far-reaching effects of the rulings, visionaries who never gave up the fight despite personal and professional hardships.

Because what emerged from all this was a deal of historic proportions: in 1998, the attorney generals of 46 states and the big tobacco companies signed the Tobacco Master Settlement Agreement, (MSA) in which the tobacco companies agreed to pay $246 billion over 25 years to the states, desist from marketing to youth, end all outdoor advertising (remember cigarette billboards?) and other sanctions. Four other states had individual agreements that predated the 1998 MSA. The money has been used to  bolster Medicaid, fund campaigns against smoking and smoking cessation programs, and other health-related items.

So that's the good news.

There is some bad news, too. In fact, there is a lot of bad news. In recent years, criticism has grown against financially strapped states because they are diverting the MSA money away from its intended uses. In fact, they are diverting MOST of it from its intended use. This from the Campaign for Tobacco-Free Kids, which publishes an annual report on how the money from the MSA has been used:

"Our latest report, issued November 17, 2010, finds that the states have cut funding for tobacco prevention and cessation programs to the lowest level since 1999, when they first received tobacco settlement funds.
"The states this year (Fiscal Year 2011) will collect $25.3 billion in revenue from the tobacco settlement and tobacco taxes, but are spending only two percent of it — $517.9 million — on programs to prevent kids from smoking and help smokers quit."

Of course, the tobacco companies love this. Fewer education and smoking cessation programs mean more cigarette consumers. And that is exactly what has happened. Any progress made in reducing smoking has slowed or even stalled. From Campaign for Tobacco-Free Kids' most recent report:

"The CDC recently reported that the adult smoking rate in 2009 was 20.6 percent – essentially unchanged since 2004 when 20.9 percent smoked.   This is a troubling development after decades of progress in reducing adult smoking rates.  While smoking among high school students has declined by 46 percent from a high of 36.4 percent in 1997, 19.5 percent of high school students still smoke and declines have slowed in recent years, according to the CDC. "

So looking at the movie again, during a different phase of my life, is an interesting experience. On one hand, it is an affirming experience because the daily minutiae of working in public health for governments or non-profits can be slow and frustrating. There can be a lot of waste, bureaucracies to wade through, and we all lose sight of our goals from time to time. Therefore, The Insider reminded me that things can change, albeit with great difficulty and usually not very quickly, but every now and then we can hit it out of the park and score big for public health.

On the other hand, watching the movie was incredibly frustrating because by all accounts, politics as usual have minimized the effects of this landmark settlement.

Ultimately, though, if you're looking for an influx of optimism that sometimes good does prevail, or just an interesting way to spend a few hours with a real-life dramatic story, I recommend revisiting The Insider. It is dated a bit - the cell phones look like shoeboxes, the fax machines spit out curly paper, and everyone's eye glasses are so outdated that they're coming back in style again. But the outcome of this David and Goliath story has changed how the world views Big Tobacco and saved many, many lives in the process. Not as many as could have been saved, but it's been at least a baby step in the right direction.


Tangent: During the research process for this post, I was reminded what a staunch advocate for health we have in California Representative Henry Waxman. He has been in the trenches for years, holding hearings and crafting legislation in order to protect our health and welfare.  He has been a good public servant and we could use more like him.

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