Tuesday, December 21, 1999
Thank you Tom for accepting our "rendez-vous". May I ask you to introduce yourself ?
As to an introduction, I am a family physician, and was initiated into tobacco control at a presentation by Alan Blum, MD, at the national Conference of Family Practice Residents and Students in 1979. Alan's dynamic, aggressive speech brought tobacco use to my attention as never before, and I immediately went back home to Mississippi and started "Mississippi DOC."
Among other things, we placed paid billboard advertising countering tobacco messages in 1980, one of the first to use non-public service space for that purpose. I went on to do a weekly television show on health, including tobacco control, a program that lasted 18 months. After a year in practice, I was recruited to academia at the Ohio State University Department of Family Medicine. I continued to be active in DOC (Doctors ought to Care, founded by Alan Blum) and in 1982 became DOC National Coordinator, running the day-to-day activities for DOC for the next 8 years.
My academic career took me from Ohio to Georgia to Kansas. During this time I was active on the American Academy of Family Physician national Committee on Patient Education, and helped craft the Academy's "Stop Smoking Kit" for family physicians. The DOC national leadership (Alan Blum, John W ("Rick") Richards, and I were honored with the Surgeon General's Medallion in 1988, and with a national award from the American Medical Association in 1990. In mid-1990, I joined the AMA to help bolster its efforts in tobacco control and general preventive medicine.
Over the years, I have made numerous presentations on tobacco control activism, cessation, and professional advocacy, and written many editorials and articles on these issues. I have been on the board of Stop Teenage Addiction to Tobacco, was a national trainer for the National Cancer Institute's series of cessation seminars, and have been on the editorial advisory board for Tobacco Control since its inception.
In 1993, I became the director of the Robert Wood Johnson
Foundation (RWJF) funded "Smokeless States National Tobacco Prevention
and Control Program,"
funding coalitions in tobacco control across 29 states and two cities.
Smokeless States has become one of the major forces in state and local tobacco control policy and advocacy activities in the US.
I have attended and made presentations at several of the World Conferences on Tobacco or Health, and led the team that brought the 11th World Conference on Tobacco or Health to the US. The Conference will be August 6-11, 2000 in Chicago, Illinois, and is co-hosted by the American Cancer Society, the AMA, and the RWJF. More information on the Conference can be found at its website, 11wctoh.org.
1. At a recent talk you mentioned that you had been for the last 20 years in tobacco control and you worried that "We are still where we are". Where are we ?
I worry that the tobacco control movement is still fragmented, less
coordinated than appropriate, and still often competing in what Mike
Pertschuk called "column-inches envy." I worry that though we have
gained in many areas such as clean indoor air regulations, we continue
to fail to do what we know to be effective, and spend scarce resources
on "solutions" that have not been found useful. Most politicians and
decision-makers continue to do business as usual with the industry, and
despite the revelations in the industry documents, the political
strength of the industry is still very evident. I also worry that we
will now spend too much time and energy chasing the settlement dollars.
And while securing adequate funding for tobacco control is important,
we must continue to do the policy and program work that helps reduce
tobacco consumption among all the population.
Finally, I worry that we have focused too much on one subset of tobacco
users-school-based youth-to the detriment of policy and programs that
affect adults, minority groups, and the high-risk youth community.
2. While tobacco smoking kills the equivalent of 4 aircrafts crashes
everyday, the equivalent outrage and media coverage are nowhere to be
seen. Aren't the physicians carrying part of the blame because they are
not vocal enough about this tragedy ?
How many physicians do step out to speak up on behalf of all the
tobacco patients/victims they see ? Is their silence linked to their
obligation of confidentiality ? But they are not obliged to give names,
they can only tell their stories. Any clue on this restraint ?
Physicians certainly must step up to the plate in expressing the outrage about the carnage caused by tobacco use. It is, after all, the leading cause of death in America. And while many physicians and groups in organized medicine do speak out about tobacco use as a public health priority, many do not, because they see the problem as someone else's to fix. Along with other areas in preventive medicine, tobacco use prevention and control must be added to medical school curricula; training in these issues should be a part of all the primary care residency programs; continuing medical education seminars should include these issues routinely; and medical specialty and state medical societies should include tobacco control as a priority for public health advocacy.
I would be remiss if I did not mention some of the groups that are, in fact, very active in this area: the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Preventive Medicine, the American College of Chest Physicians, the American Society of Internal Medicine/American College of Physicians, the American Thoracic Society, and several of the state medical societies such as those in Maryland, New Jersey, Washington, Hawaii, Illinois, Nebraska, Alaska, New York, Massachusetts, Oregon, Utah, and North Carolina.
3. Elected officials still seem very often reluctant to get involved in
tobacco control (as the fate of the settlement dollars shows).
You quoted Stan Glantz : "They cannot see the light until they feel
the heat"
What kind of heat do you think is going to be required to push for adequate funding for tobacco control ?
Are the advocates back to the initiative process (when available) ?
What political alternative do they have ?
Politicians need to hear, in great numbers, from voters about tobacco control issues. Whether about local indoor air laws concerning ETS or a state tax increase or the FDA control over tobacco, the network of grassroots Americans who are part of the American Cancer Society or one of the other voluntary health agencies, the membership of medical societies, and the advocates and activists must become politically active in speaking out about tobacco control. Media advocacy should be a primary tool we use to highlight political hypocrisy, and to expose those who are friends of the industry (as well as to thank those who are friends of public health). Unfortunately, I see no quick solution to the issue of tobacco industry contributions to politicians and political parties until true campaign finance reform comes about. On the other hand, we have on our side many things that the industry can't buy-truth, fairness, and ethics.
4. You are coordinating the smokeless states program (29 states). Can you tell us about it and how do you think interstate cooperation could be improved ?
SmokeLess States is the grant program that has put private-sector tobacco control coalitions in place across 28 states and two cities (Tucson AZ and Washington, DC), funded by the Robert Wood Johnson Foundation and administered by the AMA. Emphasizing policy change, education, media advocacy, and cessation, our coalition strives to bring private-sector groups together as partners in tobacco control. We have tried to make the statewide coalitions as inclusive as possible, bringing many non-traditional players to the table. Our coalitions work closely with public sector groups such as the former ASSIST coalitions, and now with the CDC-funded health department projects across the country. We provide input, political "cover," and try to hold the public sector accountable for their activities (or lack thereof) in tobacco control. While our coalitions do not lobby with RWJF funds, the partners we bring together often use their individual political clout for mutual gains.
As we move into the next decade, state and local activity in tobacco control will take on new importance, given the potential for some new program and policy accomplishments funded through CDC, the American legacy Foundation, and tax/settlement funds. Private sector groups must be major players in continuing the tobacco wars. As the industry tries to change its image, we must try to respond not only reactively, but also to be innovative in keeping the issue before the public, the media, and in the political scene.
5. Where are you with the preparation of the World Conference in Chicago ? What's going to be different ? Is it going to be a totally digitalized conference so that even people not present physically can participate ?
The 11th World Conference on Tobacco or Health will be held August 6-11, 2000, in Chicago. The conference planning process has involved over 250 people from many nations. Primary conference hotels are the Chicago Hilton and Towers and the Palmer House; most of the conference sessions will be held here as well. Dr. Harlem Gro Brundtland, Director General of the WHO, and C.
Everett Koop, MD, are honorary chairs of the Conference, and will participate in opening and closing ceremonies, respectively. We are planning many new kinds of program activities, including debates, interactive discussions with tobacco control experts from around the world, and seminars that will fit the needs of both novices and those experienced in tobacco control--not just more "talking heads." We are looking into how much of the Conference can be web-cast, and anticipate an enhanced Globalink presence at the meeting for electronic transmittal of information and events. The conference website, 11wctoh.org, is up, and will be set for accepting on-line registration shortly after the first of the year. We look forward to seeing many of the Rendez-vous readers in Chicago next year.
Thank you Tom for taking the time to be with us today.
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