If you pretend to be doing honest research, don’t punish people for believing you

Elaine Keller forwarded me this posting (at e-cigarette-forum) recounting the experience of someone who made the “mistake” of bringing up harm reduction concepts at a “Tobacco Cessation Summit”.

At the first of the three sessions, participants were asked to come back with some new ideas on how to decrease smoking rates. Our writer took the assignment seriously, did a little research, and ran across some of the same ideas and information that we regularly discuss on this blog. At the second meeting, assuming that the request for thoughtful and creative input was genuine, he shared what he had learned. It is important to note that he did not actually promote an approach, did not say that he supported harm reduction but simply that it was out there and should be introduced as a potential partial solution.

Before the third meeting took place, the person running the summit sent a letter to our writer’s superior and asked that he not attend further. She accused him of promoting harm reduction and e-cigarettes and misleading the group. This writer, like most of us who once thought that anti-smoking activists are really motivated by improving public health, had to revise his ideas about both the goals and the transparency and morality of anti-smoking organizations. In his words:

This whole thing is sad on so many levels. If an organization just wants to say that they have a narrow agenda and only wants to do certain things, fine. Just say that and don’t say that you want people to get new ideas and present them.

What happened here just shows me firsthand what we have all been saying: health isn’t even on the agenda anymore.

As I say above, most of us have had to revise our ideas about these groups. Since like everyone else we consume the same information, we also start with the view that these groups are working hard to pursue all possible means of improving the health outcomes of smokers, that they genuinely care about not only people and health but about the free exchange of information. I have many personal experiences of being shut out of smoking and health discussions but will recount just one – about the time I also made it two days into a three day conference. And like our writer above, I too was ejected on the third day. (Sounds almost biblical that….and on the third day…)

I was relatively new to the field and not as cynical as I have become since. I really thought that if we all got into the same room and just talked that not only would they see what seemed so obvious to me but also that I might learn something from them. After all, these people were not just activists but physicians and academics, people who had spent considerable time in arenas that championed the acquisition of knowledge and being open to new ideas but still tempered with a sense of social justice.

In 2006, I was attending the World Congress on Internet in Medicine (in Toronto) which covered everything from educating through the net, to net based research to remote surgery. Still back in Edmonton, I found that if I flew out a few days earlier I might be able to attend a satellite conference, a workshop, on web assisted tobacco intervention. It was described as:

will provide an opportunity for those engaged in WATI to meet with eHealth specialists to exchange ideas and share knowledge, promoting collaboration opportunities globally between sectors and between practitioners, researchers, and funders.
The aim is to lay the foundations for developing a global community of practice within WATI and eHealth by drawing both tobacco control and eHealth researchers together working on areas of common interest. (Link)

The larger conference was open to anyone willing to pay the cost of admission and fill out a normal registration form but this workshop also asked that you sign a disclaimer that you or the institution you were part of, had not received any support now or before from a tobacco company. Being new to the area, I was uncertain about how (or whether) to fill this out. I knew I had been hired for my capabilities and not any ideological orientation but also that my position existed due to a large unrestricted research grant to the University of Alberta School of Public Health from a tobacco company that was administered through the university. My paychecks were normal U of A School of Public Health paychecks. I was also uncertain as to whether this was a request or a demand (surely not an actual barrier to participation? This was the open access world of science, was it not?)

I was also uncomfortable about the idea of having to sign what seemed like a loyalty oath just to be admitted to a scientific discussion. It reminded me of years earlier on a visit to the States being asked to sign a declaration that I was not now nor had ever been a member of the Communist party. Whether or not I had been, seemed to have absolutely nothing to do with my purpose nor was it any business of theirs. (I did fill it out and sign it at the time. I was a teenager and it seemed too ludicrous to jeopardize my visit to Portland and filling it out felt like participating in a bizarre and outdated ritual from a strange land).

Since that time I have discovered that tobacco harm reduction is so disfavoured that, if you wish to work in the area, the tobacco industry is the only source of funding. If you are exploring safer alternatives you need to examine tobacco products and to not engage with industry is to cut off the only entities that actually conduct research into these products as products that people use rather than as abstract political points.

To return to the narrative thread here, what I ended up doing was faxing (yes, we were still faxing in those days) in my form but without including the disclaimer. I did not receive notice that I had been accepted but just thought I would show up and see what happened. I did and just as Woody Allen observed “80% of success is showing up”.

The first night was a showing of Thank You for Smoking where I raised the point that I thought that in this case the progress made in getting smoking out of films resulted in eviscerating the anti-smoking message. (For those who have not seen it, though the book contains many smoked cigarettes, the film has next to none: read the book by Christopher Buckley, it is better). Nobody really responded to my comment but no one argued against it either.

The next day, and by this point I felt the administrating secretary eyeing me, we alternated hearing reports on cessation operations and forming small groups to come up with new ideas. Though I did not parade tobacco harm reduction in front of the crowd, if directly asked about my area, I did volunteer THR as my interest. In the meanwhile, I held my tongue when faced with dogma rather than information but in general took the approach that I was there, as I thought the others were, to learn from each other. A couple of them even brought up the idea that maybe they should be considering smokeless tobacco as an option and while the idea did not go far, neither was it shouted down. Unfortunately, I also got the impression that these same people would never have admitted such broadmindedness outside of a closed small group meeting.

Later that day, I was approached by the secretary saying that they still needed the disclaimer signed. I said that I was not sure I could do that, that I really was not sure what I should put. The head of the conference was called in and when he heard I was from the U of A School of Public Health said I would have to leave since tobacco money had been accepted by that institution. I tried to argue the point, asking whether we weren’t all really after the same end, less smoking and better health, but that, as well as the entreaties of some others in the group who appeared to think it would be better if remained, did not seem to matter much.

What I discovered later was that though the conference was Canadian, and I was Canadian, my right to free association in my own country was taken away because the major funders of the conference included the U.S. government and closely associated American quasi-NGOs, and they had insisted on the disclaimer as one of the conditions to their support. This is not uncommon. I, and my colleagues, have never been able to attend the major, albeit grammatically challenged, conferences on Smoking Or Health, including the one that was held in Edmonton (our city, clearly chosen to harass us) even though we were the largest tobacco and health (the correct grammar) research group and only internationally-known researchers on the topic in that city.

On the bright side, while waiting for an elevator during the conference following that workshop, I was approached by someone from The American Cancer Society saying they were strongly in favour of THR, and so were many of their colleagues but they still had to toe the party line. This to me was the high point of sessions; there were cracks in the facade, new voices were rising in the organizations, things could change.

But that was five years ago and that organization has since become even more adamantly anti-harm reduction.

Though support for THR has exploded during that period, anti-tobacco groups have solidified in their extremism. Apparently their loyalty oaths, intimidation of any dissidents, and wielding of their enormous wealth have succeeded in shutting down or driving away any independent thinkers among their younger personnel. This includes those that are ostensibly focused on preventing diseases rather than being anti-tobacco per se. As the forum poster noted, if an organization wants to call itself simply anti-tobacco (or anti-nicotine if they also oppose e-cigarettes), so be it, but it approaches being fraud for an organization to call itself the American Cancer Association, but to oppose substitution of low-risk nicotine products that cause no measurable cancer risk, let alone to claim to be the American Lung Association but to fiercely oppose low-risk substitutes for smoking that have absolutely no effect on the lungs.

I am reminded of any of several quotations along these lines:

“As soon as men decide that all means are permitted to fight an evil, then their good becomes indistinguishable from the evil that they set out to destroy.”
– Christopher Dawson

Of course, it is not so clear that anything these groups are fighting is actually evil, but there can be little doubt that their censorship and politics of personal destruction are.

-Paul L. Bergen (with contribution from Carl V. Phillips)