As the Worm Turns...

Life was so simple when the only thing tobacco free advocates had to deal with were the petty interpersonal politics of unqualified bureaucrats and ill educated political sycophants accidentally undermining challenges to the tobacco industry. This was infuriating when we imagined we were all on the same side.  Over a decade of advocacy makes me a novice compared to many.  But what sincere tobacco free advocates are dealing with today in Arkansas is completely new.  We were alarmed that tea bagger conservatives had taken over the ledge in the last session.  But, and I count myself among the naive, we had no idea what having a pro tobacco executive could do to evidence based tobacco prevention. 

We see what little regard this legislative and executive body has for human rights re education, race, women's rights, and LGBT issues.  Why did we imagine that tobacco control might actually fly under the radar?  Hell, I was just hoping.

Thus far the damage has been minimal but what I hear from the periphery of tobacco free advocacy near the Arkansas Department of Health is that actual tobacco free policy change is strictly verboten within the bureaucratic and financial arms of this administration’s Arkansas Department of Health. If you smell something rotten in Denmark, he said being sophomoric and cute, it is tobacco smoke.

I had great hopes that Mr. Hutchinson’s pro tobacco tenure would be tempered by his defeat in the Senate race years ago.  As if the accusations of being big tobacco’s pawn would humble or at least slow down pro tobacco advocacy as Governor today.  Apparently that was just wrong as shit.  I say this watching the obviously tobacco industry bill (SB978) dealing with Electronic Nicotine Delivery Systems sailing through the bowels of the legislature.  Egregious as the language is in the bill, the most offensive note is an amendment by Central Arkansas’ Douglas House that preempts any local control for stronger pubic health efforts.  Challenging preemption is Tobacco Free 101.

And if that wasn’t bad enough, the Arkansas Department of Health’s Tobacco Prevention Cessation Program is cricket silent about a bill that can detract from decades of tobacco free efforts and hinder decades more. The few people  that will actually talk to me tell me that ADH not only does not oppose the bill they ask that TPCP grantees essentially shut the fuck up. Just pretend we are all back in Kansas. Of course, that’s a bad analogy too.

I do not know many more people in tobacco prevention that I respect more than TPCP’s medical authority, Dr. Gary Wheeler. And I know this gentleman must be grappling with his conscience now. The potential bargains pressed upon sincere public health advocates to surrender tobacco free challenges scare the hell out of me for things to come. 

The visigoths are upon the gates. Save your sword for one last self inflicted wound.

SB978 was written by the nicotine industry. If I’m not around,  please someone document these crimes. Thanks.

ADH Insults Tobacco Prevention Advocacy

I’ve had issues w the Arkansas Department of Health for about as long as I’ve known anyone associated. I’ve met some of the most insincere and self serving bureaucrats known to humanity working, ostensibly, toward tobacco prevention. That said, I’ve also known some of the most dedicated and committed individuals you could imagine.  The Tobacco Prevention and Cessation Program, with a few notable exceptions, has enjoyed talent and sincere advocacy.  Somehow they seem to move right along to other issues with too much frequency. 

Tobacco use is the leading cause of preventable death in the U.S. and in Arkansas.  The tobacco industry is responsible for the leading risk factors for heart disease, stroke, and lung disease. 90% of lung cancer is due to cigarette smoking killing more than the next top three cancer killers combined.  Tobacco kills.  Got that?

This week, I had the unfortunate opportunity to visit the Tobacco Prevention and Cessation Program’s offices. I had proposed to the Arkansas Cancer Coalition and was funded for a small grant to do air quality monitoring for a couple of the significant exemptions to Arkansas’ Clean Indoor Air Act of 2006. This was dependent on collaboration w the use of TPCP’s SidePak pm2.5 air monitors and damned if the device, that was actually purchased new for this venture, failed to work properly. Much to my disappointment I had to touch base w Debbie Rushing and lay the repair or replacement of this device on her table.  I have to say that she and Dr. Gary Wheeler have been more than supportive for my proposed activity.  Advocates need this kind of data to rectify our lame assed clean indoor air law.  And Gary and Debbie are both savvy and honest enough to admit it.

Enough about my complaining.  I had to return the SidePak.  This was my heuristic experience.  The last time I’d been to the TPCP offices was to meet Michael Johnson with the Rand Institute upstairs to discuss grantee evaluation about 2004.  The office was bustling with folks upstairs a in corner office space filled with windows.  Brochures and educational materials, were stacked in the hallways. 

On Monday I limped to the top of the exterior stairs to the main ADH security desk to return the SidePak.  The guard had to look up on his computer to discover where the TPCP offices were. “They are in the basement,” he said.  I took the elevator down into a short corridor with janitorial offices.  I could see stacks of paper towels in door windows.  I went back upstairs and a new police guy said I had to go through the double doors marked “No Admittance.”  I went back down and fortunately caught some gentleman to ask how to find the Tobacco Prevention offices and let me through.  He told me to follow him through the double door onto a loading dock and out through another.  He said the Tobacco Prevention office was down the hall and to the left.  I thanked him.  Stumbling down the hallway I found the TPCP sign on a door.  Inside, was a relatively empty roomful of cubicles, no reception.  Making my way to Ms. Rushing’s office I heard what makes her my hero for today speaking to the TSI SidePak people on the phone.  “And so, as a good customer service representative, what are you going to do for me?”  This after the failure of an unused, expensive, device.

Debbie, I apologize for adding to your workload.

My issue is that the Arkansas Department of Health literally has buried the people burdened with challenging the leading cause of death and disease in the basement. 

But wait there’s more!  I left Debbie on the phone with whatever cretin at TSI who may or may not make things right.  They sure won’t make the three days right I sat in smoke filled space at a horse track to get data. The notable thing here is that the Arkansas Department of Health does not really give a shit about the leading cause of death in Arkansas.

I left the TPCP offices and went through the double doors at the loading dock.  A young lady actually held the door for me.  Unfortunately, the doors on the other side, and that side too, were locked.  The door buzzer for assistance on my return went unheeded leaving me locked outside. I was starting to hike around the building when I saw a pair of women pushing a mail cart. She asked me if I was trying to get into the building and told me I was not supposed to be there.  I thanked her and took the elevator to give the young police guy my visitor’s sticker. (He was probably the most sympathetic and helpful individual I met with the exception of Ms. Rushing.)

The whole point of this missive despite my whining was to note that the Arkansas Department of Health and in consort with the Department of Human Services has done their very level best to hide the individuals charged with challenging the leading cause of preventable death in offices behind the janitors, a loading dock, and the mail room, w two doors that lock behind you.  This sucks.

If the state of Arkansas had any sincere ambition to protect the public health the political figureheads would do more than pay lip service to tobacco prevention.  And the actual individuals charged with the actual work would get better treatment than they do now.  I knew that the powers that be had abused and driven away a celebrated thoracic surgeon and one of the leading tobacco prevention advocates on the planet in Dr. Carolyn Dresler.  I did not know how far they had gone to discourage anyone of merit to make any habit of challenging the tobacco industry.  

Just in case anyone in Arkansas had any optimism about the political courage our policy makers have for tobacco prevention you should make more of an effort to thank the TPCP people who continue to work in Little Rock. The folks that run the Department of Health would rather we don't find the tobacco prevention branch.

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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.

Arkansas Clean Indoor Air, needs work yesterday

Most recently a glaring example of how poor the Arkansas Clean Indoor Air law is occured. Sportsfans will remember that this was then Governor Huckabee’s effort at leaving Arkansas to campaign for president as the health care candidate w a minimum of tobacco prevention. It wouldn’t do for his record of collaboration with the tobacco industry without some lip service of a clean air act to survive. That is what the ACIA is, lip service badly in need of repair.

Adding insult to this are serious questions about enforcement from the Arkansas Department of Health today.

One saturday in late July my friend Harry stops in the Goldpan Cafe in Lakeview AR for breakfast on his way to help his brother lay a foundation. Harry is retired, got time on his hands, and the Goldpan is open. He also is the parent of a middle schooler avid on tobacco prevention. So he knows that the half a dozen kids he sees shouldn’t be sitting in the smoking section. Smoking Section? Arkansas law protects them from secondhand smoke in all businesses. They shouldn’t be inside the building!

So he files a complaint w the Arkansas Department of Health at the Breatheasy site. Done. Until a few days later he gets a call, and a hang-up. Then immediately after a call and verbal abuse for making his report of noncompliance. When he notices his answering machine has 3 more ‘messages’ later in the week from apparently Goldpan patrons, all abusive. He starts to reconsider his decision to ignore the first call. The ACIA contains a ‘non retaliation’ clause ostensibly intended for employee protection, and according to the ADH lawyer, never tested in this kind of case.

To synopsize, the ADH lawyer says that there is no official procedure under Arkansas’ Freedom of Information Act to get Harry’s name and apparently the ADH investigator provided this information at the time of the visit. One can file a non-compliance report anonymously.

I drove by the Goldpan today and took this photo. Came home and filed a a report of noncompliance stating:

"In attempting to enter the business, which has been granted an exemption and is a smoking establshment, I noticed that the business had no signs conforming to Section VI of the Rules for Arkansas Clean Indoor Air law http://www.arcleanair.com/pdf/clean_indoor_air_act_rule_2006.pdf . The only signage visible at the entrance was a crude paper sign saying, "No one under 21 allowed in, 7,28,09." I fled."

Investigators from ADH had time to give out my friend’s name and contact info yet not enough to rectify simple signage requirements? It would be easy to fault the local ADH tobacco prevention coalition grantee, and probably should. But not all counties have a coalition and how many businesses remain noncompliant simply because no one informed enough about the law has entered the business? A complaint driven public health and safety law is ridiculous enough without lacking sincere efforts at enforcement.

Policy makers need to know how badly flawed this legislation is. There is no safe exposure to secondhand smoke and no room for second tier enforcement of a public hazard that kills 5,000 Arkansans annually.