Personal Ambition, Tobacco Prevention in Arkansas

A little knowledge is a dangerous thing.  I started trying to find out WTF was going on within Arkansas Department of Health TPCP issues.  Long time advocates were being edged out.  Given the revolving door for ADH employees and community grantees the institutional memory of tobacco prevention was being put at serious risk.

Snot the first time.  

Years ago functionaries within the Arkansas Cancer Society and the Arkansas Heart Association did their royal best to wrest ADH funding from the Coalition for a Tobacco Free Arkansas.  I recall former CTFA Chair, Dr.Caesar Compadre, laughingly talk about his first issue w CTFA was a motion to dissolve the coalition. Fortunately this bizarre coup was thwarted.

Unfortunately, the pettiness of some individuals involved, at w least tobacco, still seems the take away. Recently the bureaucracy within ADH has gone out of their way to alienate and de-fund the two statewide coalitions, the Coalition for a Tobacco Free Arkansas and the Youth Extinguishing Smoking Teams.  Both CTFA and the fiduciary for YES teams have declined to re-apply for restrictive and micro managed grant opportunities. Couple this w an ADH request for proposals for a statewide coalition that both CTFA and the YES people have been encouraged to ignore and one can see a very focused attack on the two most effective coalitions, and individuals, in the state.

A sincere tobacco free advocate has to ask, “Why?”

In 2003 the very first real lesson tobacco free advocates in Arkansas learned was that there must be a distinct separation between the tobacco free lobbyist and the tobacco free advocate.  At one level this is a matter of simple semantics. At another it is bureaucratic and ineffectual neurosis.

There is bullshit going on within the Arkansas Department of Health and those ostensibly working as public health advocates that truly stinks of pettiness, ambition, and personal gratification. Unfortunately, this comes at an inopportune time for  tobacco free advocates. We should not be fighting among ourselves now. We should be educating policy makers up and down a legislature dominated by right wing de-regulation anti public health zealots.

Funny how long time tobacco (free) lobbyists do so little of that.

I am always open for queries and conversation.

Tobacco Leaves on a Dollar

Dr.s Simon Chapman and Ross MacKenzie’s 2010 paper, The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences, and more recently Chapman’s op ed on the marketing and promotion of NRT and pharmacopeia for tobacco cessation may well be the key to the next paradigm for effective tobacco control.

Recently there has been much attention given the ostensible “inveterate smoker”, the smoker who does not quit. It has been felt that after we raise the cost of tobacco, create tobacco free space, and eliminate tobacco marketing there still are going to be people who will not or cannot quit. This alleged population has been much of the motivation for those referring to themselves as harm reduction advocates, encouraging the promotion of forms of nicotine delivery allegedly less harmful than smoking. Chapman and Mackenzie’s work here calls into question whether that population exists at all and the validity of research funded by those marketing NRT or pharmacopeia.

He make 3 structural points: Most research is done by those interested in interventions and because of that primarily are testing their own means. In a capitalist society there is the tendency for medical means to become commodities. And lastly that these interventions are based on the erroneous assumption that there are some individuals who have an impenetrable addiction that warrants the interventions.

Yet 3/4 of all ex-smokers quit with no assistance at all. Cold turkey quitters outnumber all cessation methods combined. Studies have shown that most successful nicotine addiction was overcome with no preparation at all, that certain environmental cues prompted cessation and abstinence.

Recent genetic discoveries have suggested that there are predispositions to nicotine addiction and has been a facet of the thesis of the inveterate addict. This should not be underestimated in evaluating the risks of ever starting to use nicotine. But Chapman and Mackenzie’s research sheds light on the need to shift our perspectives toward modifying the environment beyond increased pricing, tobacco free spaces, and marketing reform. What we have been calling cessation support perhaps should not take as strong an active, or pharmaceutically interventionist, role as it does a further reformation of the environment.

The theory that some people cannot quit without intervention becomes a self fulfilling prophecy when seen with the enormous amounts spent by pharmaceutical companies, and others, advertising cessation assistance and funding research to test their products. We know that youth are more likely to start smoking if they believe quitting will be easy. Are we not re-enforcing the myth that quitting is difficult with our capitalist emphasis on marketing cessation support?

The under publicized figures surrounding cold turkey cessation point to rogue capitalism as a major factor in challenging tobacco perhaps no less than that of the tobacco industry. Somewhere in the evolution of dealing with nicotine addiction the emphasis on changing people’s perspectives on tobacco use from a social issue to a medically treatable problem a step was missed. There is little doubt that if there weren’t a dollar to be made it would not have happened.

Dr. Chapman points out that for the developing world, the growth market for tobacco companies, NRT and pharmacopeia is not a viable economic or realistic option. His paper suggests that we are far from optimizing the environmental and behavioral cues that enhance cessation and should not be dissuaded by the drive to profit in our capitalist society.

This also helps clarify where the harm reductive E cigarette clamor is coming from. Right now E cigarettes can’t decide whether they are cessation devices or that fairy tale of a safe tobacco habit. Emphasizing the fact that most people overcome nicotine without NRT shows how unwarranted another nicotine delivery device is.

400 years ago European colonial efforts to export tobacco co-opted an entheogenic plant from aboriginal Americans. In short order the plantation economy spawned the genocide of native peoples and the importation of an enslaved African population. As the leading cause of death and disease today is the capitalism surrounding tobacco today significantly different? The profit certainly isn’t.

Industry collaboration

“We cannot continue allowing hatred and disdain towards tobacco companies to interfere with and trump efforts to achieve our fundamental goal of rapidly reducing the leading cause of disease, disability and death (i.e. cigarettes). Its daily cigarette smoking that is killing millions of people, not nicotine, tobacco, or tobacco companies.”

Bill Godshall, Pennsylvania

Mr. Godshall’s exemplary missive conveniently ignores the fact that daily cigarette smoking would not occur were it not for addictive nicotine. Nicotine is inherent to tobacco. Tobacco use would not be prevalent were it not for tobacco companies, and tobacco companies would not market nicotine were it not for the profit.

Our esteemed colleague, Dr. K. H. Ginzel has noted that harm reduction is analogous to Allied forces negotiating w Hitler on the beaches of Normandy for how many lives we can accommodate for the Nazis to remain in power. Collaboration, whether complicit or duplicate, is still culpable.

It most certainly is the tobacco companies that are killing people. Tobacco has not been a benign weed on the side of the road for 400 years. Without the predatory capitalist promotion of an addictive deadly product there would be no pandemic. To assume that tobacco companies are going to rectify this with new nicotine products is ludicrous.

We already have ‘harm reduction’ policies proven to reduce the harm of prevalent use: taxes, tobacco free space, and marketing reform. And criminal proceedings for corporate executives seems promising. The best we can hope for with Reynolds, or any tobacco company, in producing NRT products is a perpetuation of the misdirection that warranted a federal conviction in a U.S. court for fraud and racketeering. A corporations’ only obligation is to profit and the tobacco industry’s profit is incompatible with the public health.

One of the best gauges of the effectiveness of tobacco free advocacy is how the industry behaves. This dubious flirtation with NRT and the incredibly overhyped E cigarette should do little more than question the efficacy of either to actually reduce use. The tobacco industry has had decades to reduce the harm they cause and have responded with fraud, smuggling, endless litigation, manipulation of policies and politicians, and an ever increasing mortality rate in the developing world.

An alliance with the tobacco industry is just that. Don’t expect any applause.

harm reduction or criminal distraction

The recent acquisition of cessation products manufacturer Niconovum by Reynolds American International reveals much in the way prevention advocates should treat a harm reduction perspective and provide greater emphasis on challenging the rogue capitalists that market nicotine. Mr. Ezekwesiri Eluchie has quite astutely pointed out that the industry is once again setting the agenda within which tobacco control advocates find themselves.

The acquisition of Niconovum displays just how much harm reduction is of necessity product centered and by definition unconcerned w the corporations that profit from the spread of nicotine addiction. Harm reduction advocates do little more than collaborate with sophisticated marketing strategies that subtly shift the onus of addiction back to the user. Until advocates can unite in recognition that it is not merely tobacco, but the rogue capitalism practiced by nicotine profiteers we must challenge, they will continue to set the agenda.

As well this casts umbrage on those that profit from NRT and pharmacological solutions to nicotine addiction and unfortunately raises questions about funding from these companies for tobacco control. Given how woefully and comparably underfunded advocates are I have no immediate solution. But Mr. Eluchie’s suggestion that we fully acknowledge the magnitude of death and disease from tobacco as simply criminal seems a very good place to start.

e cigs, advocacy, and prevention

While I appreciate the serious discussion of e-cigarettes, on a global scale it is probably fairly academic. Those most likely to become addicted to nicotine, the poor and undereducated, are unlikely to find nicotine vapor or low emission devices a real option. (if you don't like butts imagine the environmental impact of these latest delivery devices!) Individuals should decide whether they are public health advocates or tobacco prevention advocates working in the realm of public health. The relative harm from spit, low emission, or e-cigarette effluent is rather immaterial if either is not proven to reduce the prevalence of nicotine addiction.

Tobacco free spaces are not ends in themselves but tools for challenging those culpable and profiting from the leading cause of death and disease on the planet.

Recall that harm reduction involving tobacco companies originated with the mirage of the filter tip and the low tar cigarette. Arbitrarily deciding that a certain level of risk is acceptable only serves to collaborate with an industry that could care less.

Handsel Art

7 October 2009

FOR IMMEDIATE RELEASE

contact J.R. Few

handselart@marioncounty.com

or 870-427-1365

Local Advocate Speaks in Wales

Tobacco prevention in Marion County, Arkansas acquired international note last week with local activist, J.R. Few’s presentation at the second annual ASH Wales’ Communicate, Collaborate, Celebrate Conference in Cardiff, Wales October 5 & 6. Speaking during the “Engaging Smokers” workshop, Few shared insight and successes from work as volunteer media coordinator for Tobacco Free Marion County between 2002 until 2009.

“It was an honor and a privilege to be invited to this event. The challenges to the tobacco industry are truly global. We get caught up in our own local mediocrity and often forget that the world at large is where the tobacco industry profits most.”

Few is creative director for his family’s business, Handsel Art and Advertising. Handsel Art has offered to the public quality art, advertising, public relations, and photography since 1971 and currently works to challenge a predatory rogue industry with tobacco prevention activists in Arkansas and around the globe.

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The primary sponsors for the event were Pfizer and McNeil and because of this the conference is subject to the same critique the World Conference on Smoking or Health in Mumbai received. The fashion in which we engage the tobacco pandemic should be evidence based. But the slippery aspect of saying something like that is that the paradigm from which one begins shapes the questions and evidence one seeks. It is a very good question to ask if having these corporate sponsors determines the flavor of a conference. And these particular sponsors are involved quite directly with profit from using their products to treat nicotine addiction, not control and prevent the prevalence and spread of nicotine.

That said, the gathering was certainly a cessation based perspective but with a serious effort at broadening the scope. I got the impression that tobacco prevention advocates were beginning to feel the frustrations that they may have maxed out the utility of a certain direction of effort.

The challenge to tobacco in the UK has been a decade of the National Health Service focusing on cessation. This of course couldn't make the industry any happier because they are more aware than anyone how difficult, even impossible, overcoming nicotine addiction can be. However, this seems to be on the cusp of change. It made my presentation about adhering to best practices and strict media tie in very appropriate. They are only now getting the knack of their foe being the industry itself. John Tilley, speaking for NHS, noted that a new national tobacco policy was imminent. The last session we attended outlined the 2008 report of the Tobacco Control National Support Team suggesting an evidence based approach much like the CDC Best Practices for engaging the industry. Wales itself is seeking a unified national tobacco policy. This conference, only the second for ASH Wales I believe, is part of that effort. In many ways Arkansas is far ahead of the game, especially for Wales. And even the UK too.

My gig actually went over pretty well. I'm large and loud and had lots of colorful slides. Additionally my "Kill 'em all, let god sort it out" approach to the tobacco industry was fairly novel for much of the audience. And the numbers I was able to bring from our efforts in Marion County were a pretty straight forward approach to successful tobacco control. But we know from experience in Arkansas that doesn't mean anybody is listening. Additionally, the English have the same difficulties w ignorant politicians pandering to the lowest common denominator and eating out of the hands of the industry whether they know it or not.

It truly was an enlightening honor and privilege to attend the ASH Wales Conference and speak to so many dedicated advocates. I believe we made some friends with whom collaboration and communication will have a positive challenge to the tobacco industry. Might be a little early to celebrate.

CTFA state conference

Not a bad way to spend a day listening to the likes of former Justice Department attorney Sharon Eubanks talk about how the Bush administration thwarted efforts at a RICO conviction for big tobacco.

Another note; if you ever get a chance to hear Ms. LaTanisha Wright speak, run, do not walk, to see her presentation. She is a former Brown and Williamson employee and now a member of the National African American Tobacco Prevention Network. She is a sharp, effective speaker.

Handsel Art

19 September 2009

FOR IMMEDIATE RELEASE

contact J.R. Few

handselart@marioncounty.com

or 870-427-1365

Advocates Hold State Conference

Advocates from across Arkansas gathered to challenge the tobacco industry at the 7th annual Coalition for a Tobacco Free Arkansas’ Striking Out Tobacco in Arkansas Conference at the Wyndham-Riverfront Hotel in North Little Rock September 17th.

After a welcome from CTFA Executive Director Katherine Donald And CTFA Board Chair Carla Sparks, the audience enjoyed a panel discussion: The Past Present and Future of Tobacco Control in Arkansas. Panelists ranged from attorney Tim Gauger, who worked with then Attorney General Winston Bryant to secure Arkansas’ Master Settlement funds in the late 90s, to the current Tobacco Prevention and Cessation Branch Chief for the Arkansas’ Department of Health, Dr Carolyn Dresler. Speaking for the American Heart Association, Barbara Kumpe reminded that Arkansas’s distinctive use of MSA dollars for health related issues was the result of a 64% voter mandate in 2000.

Former Department of Justice attorney Sharon Eubanks gave the Luncheon Plenary as an overview of her successful prosecution of the tobacco industry as lead attorney for racketeering and fraud charges in 2006. A career government lawyer, Eubanks recounted how Bush Administration appointees, when it became apparent the case would succeed, directed her to drop a $130 billion remedy that included a national tobacco cessation program and even attempted to get witnesses to change their testimony just days before the final hearing. She resigned from the Justice Department as the result of this politically motivated interference. An appellate court upheld the racketeering decision earlier this year.

Briefing the audience on the recent law giving the FDA limited authority over tobacco, she noted that this bill was written 10 years ago. “And we have learned much more about the industry and tobacco since then.” She went on to suggest that certain commercial speech restrictions may not stand the scrutiny of litigation.

Mr. Joe Arnold was recognized with the Trail Blazer Award for his persistent and successful efforts to enact a tobacco free policy for all Little Rock city parks, including Riverfront Park.

Conference participants were given a wide choice of workshop topics including tobacco in the gay and lesbian community, tobacco in the Coordinated School Health programs, recent laws in Arkansas involving tobacco, and a media and counter-marketing workshop by local activist J.R. Few.

Perhaps the highpoint of the day was the closing presentation by La Tanisha Wright with the National African American Tobacco Prevention Network. A former Brown and Williamson employee, Ms. Wright gave an eloquent, informative, and emotional insider’s overview of the history of tobacco and slavery and how marketing tactics continue to target and enslave African Americans today.

Local advocates Harry Meyer and his daughter Ida attended the CTFA event. “Ida talked about the last speaker all the way home and is still talking about it,” says Meyer. “That woman made a huge impression on her, me too for that matter. The conference was a tremendous learning opportunity for anyone.”

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Tobacco industry camouflaged marketing

This was a pretty good summary of what needs to be discussed, so copy and paste, right?

“Who could have seen it coming?!  That's sarcastic of course.  Dr. Ginzel forwarded this NY Times article with the admonition that supporters are getting their due.  

http://tinyurl.com/mvctnl

The synopsis is that first amendment challenges to advertising restrictions are expected.  And here's the rub.  Speech restrictions are allowed only when the government has a specific reasonable interest at stake. "In the case of the new tobacco law, Congress specifically defined the government interest as a reduction in youth smoking."  'Adults only' language is peppered throughout the bill yet that is exactly what the tobacco industry wants us to believe; that tobacco use is appropriate and acceptable at some level.  This is the same argument that fills our clean air laws with exemptions for venues that restrict youth.  Neither instance is correct.  Tobacco is never safe.  This was the opinion of the Supreme Court a decade ago that sent congress on a quest to limit the FDA's authority enough to oversee tobacco here.  But by specifying the interest of reducing youth smoking it slipped right in line with the industry's best marketing tool for youth, adults only.”

And the point now is that if the courts get around to simple black and white signage with the exception of adults only situations how then will the industry market?  

One of the most heinous marketing devices the industry uses now are the ostensible anti- smoking campaigns that not only are ineffective but have been shown to increase youth initiation.

 

    “Furthermore, youth- and parent-focused anti-tobacco advertising campaigns sponsored by the tobacco industry have been shown to actually increase youth tobacco use. Youth exposed to these ads are more likely to report greater intention to smoke in the future and more positive feelings toward the tobacco industry than those who were not exposed.”  p. 32 Health Communication Interventions        - 2007 CDC Best Practices

This is the sort of sophisticated marketing the industry already camouflages.

The tobacco industry would market the perspective that tobacco use is a behavior for adults only.  This emphasizes and includes the inference that only a mature choice would elect to use their product, and couches that in all manner of rhetoric about rights, etc. Never mind nicotine and addiction or that 90% are addicted before the age of consent.

Minors only signs are another fine example of camouflaged marketing. The courts have held that the FCLAA  allowed states to regulate advertising at tobacco retailers only to the extent with which it informed the population about laws regarding minor sales.  This led to the profusion of industry sponsored signage, We Card etc.  

There’s an awful lot to discuss here.  And for the sincere tobacco free advocate much to  anticipate given the new FDA legislation. 

Post One

By way of welcome, this is an experiment; another autodidactic adventure in posting art, angina, and activism.  I'm not sure I can tell them apart at all.