The occasion for the rambling reflections on neoliberalism in the previous post was three “perspective” articles on tobacco in a recent issue of The New England Journal of Medicine. Two of them concern the FDA’s attempt to place graphic warnings on cigarette packs. The other is on cigarette smoking among the homeless.
The First Amendment
Placing graphic warnings on cigarette packs was part of the 2009 Family Smoking Prevention and Tobacco Control Act. The tobacco industry sued the FDA (R.J. Reynolds Tobacco Co. v. FDA), claiming the warnings violated the industry’s First Amendment rights. In a case decided last year, the tobacco industry won.
David Orentlicher, in his article The FDA’s Graphic Tobacco Warnings and the First Amendment, writes that the decision is both surprising and not surprising. It’s not surprising “given the Supreme Court’s increased sympathy toward corporations and their First Amendment rights. Regulations of commercial speech often succumb to judicial scrutiny.” It’s surprising because, while the Supreme Court now restricts the government’s power to regulate corporate speech, it has not in the past interfered with the government’s authority when it comes to regulating matters of public health. Evidently, that’s not the case anymore.
The upshot: (emphasis added)
[C]ompanies today are better able to promote their products, and government is less able to promote health than was the case in the past. Ironically, early protection of commercial speech rested in large part on the need to serve consumers’ welfare. In 1976, for example, the Supreme Court struck down a Virginia law that prevented pharmacists from advertising their prices for prescription drugs. The law especially hurt persons of limited means, who were not able to shop around and therefore might not be able to afford their medicines. Today, by contrast, courts are using the First Amendment to the detriment of consumers’ welfare, by invalidating laws that would protect the public health.
This post became much too long, so I’ve divided it into two parts. The first part is mainly about neoliberalism; the second mainly about graphic warnings on cigarette packs (plus smoking among the homeless). When I read, in a recent NEJM article, “The Supreme Court’s increasing sympathy for corporate speech and decreasing deference to public health authorities makes it more difficult for government to protect the public’s health,” my first thought was: What a perfect example of neoliberalism in action.
No one would claim that neoliberalism strives for consistency when implementing its ideals. For example, neoliberalism blames individuals for the health consequences of cigarette smoking (“I cause disease”) and at the same time opposes legislation to reduce cigarette consumption (graphic warnings on cigarette packs). When there is a choice to be made, the deciding factor for neoliberalism will be the efficiency with which wealth can be upwardly redistributed.
Personal responsibility — including personal responsibility for health — is a fundamental principle of neoliberalism. David Harvey writes on this in the context of neoliberalism and labor: (emphasis added in this and subsequent quotations from Harvey)
[L]abour control and maintenance of a high rate of labour exploitation have been central to neoliberalization all along. The restoration or formation of [elite] class power occurs, as always, at the expense of labour.
It is precisely in such a context of diminished personal resources derived from the job market that the neoliberal determination to transfer all responsibility for well-being back to the individual has doubly deleterious effects. As the state withdraws from welfare provision and diminishes its role in arenas such as health care, public education, and social services, which were once so fundamental to embedded liberalism, it leaves larger and larger segments of the population exposed to impoverishment. The social safety net is reduced to a bare minimum in favour of a system that emphasizes personal responsibility. Personal failure is generally attributed to personal failings, and the victim is all too often blamed.
Personal responsibility for health — fundamental to healthism (a frequent topic on this blog) — serves the interests of neoliberalism in a number of ways. It can be used to justify reduced spending on health care and social services by the state. This is desirable in itself, according to neoliberals, but it also increases consumer spending on health care, which in turn benefits the health care, pharmaceutical, and insurance industries. Read more
There are predictions for vaccines: No more AIDS, no more malaria, no more measles and rotavirus in developing countries. Neuroscience: “We’ll be able to plug information streams directly into the cortex”. Health: We’ll feel less healthy. (emphasis added)
Life expectancy is rising about three months each year, but we’ll feel less healthy, partly because we’ll be more aware of the many things that are, or could be, going wrong, and partly because more of us will be living with a long-term condition.
Being more aware of what could be wrong with us, and believing (and thus feeling) we’re less healthy as a result, has been going on since the advent of advertising. This proces has been greatly accelerated, however, by electronic mass media and now the Internet.
But the prediction I found most interesting was about advertising, offered by Russell Davies of Ogilvy and Mather. (emphasis added) Read more
In 2009 the FDA finally acquired the authority to regulate the production and marketing of tobacco. On the marketing front, the tobacco industry fought back with a legal challenge. It claimed the new Congressional law violated the industry’s right to free speech. If cigarette packaging had to feature strong graphic images – one of the provisions of the bill — the industry would required to “stigmatize their own products through their own packaging.”
The lawsuit is still pending, but the results of new marketing requirements have begun to appear. The question remains: Will they be effective?
Scary labels may be counter-production
Martin Lindstrom, a former ad agency executive and expert on the science of marketing, has used neuroimaging to study what makes people buy. In his bestseller Buyology: Truth and Lies About Why We Buy, he describes a study he conducted on cigarette advertising. He found that especially vivid anti-smoking warnings actually increase a smoker’s craving for cigarettes.
There’s a possible explanation for this in a concept called Terror Management Theory, which includes the idea that a threat to one’s life increases the need for self-esteem. Read more
It’s easy to understand – if not condone – the behavior of politicians who are financed by tobacco and oil companies. They oppose the regulation of smoking or pollution because they benefit from the financial contributions of those industries.
But what motivates certain scientists to relentlessly cast doubt on peer-reviewed scientific evidence that’s inconveniently contrary to financial interests? A new book, Merchants of Doubt by Naomi Oreskes and Erik M. Conway, attempts to answer this question.
To some extent, the motivation for certain scientists is the same as that of politicians. Those who opposed the issues covered by this book – nuclear winter (could we survive a nuclear war), Star Wars, acid rain, the ozone hole, global warming, DDT, cigarette smoking and second-hand smoke – are frequently members of “institutes” or think tanks heavily funded by tobacco and “dirty” energy donations.
The answer is much more complex than money, however. And much more interesting. Read more
The Australian government is about to introduce a number of public health measures dealing with smoking, alcohol, and obesity. The measures are designed to reduce chronic diseases and make Australia the world’s healthiest nation by 2020.
Australia’s National Preventative Health Taskforce has published a report that includes 174 recommendations for preventing disease. Among the measures that could be implemented:
A 50% increase in the price of cigarettes
Cigarette packaging that allows only a bland box with the brand name and a health warning
A minimum unit price for alcohol and increased taxes
The elimination of alcohol advertising during TV sports events
The elimination of alcohol advertising before 9 PM, when more children and adolescents are viewing
Tougher restrictions on where and when alcohol can be sold
The elimination of TV advertising for “energy-dense”, nutrient poor (i.e., high empty-calorie) foods before 9 PM
Reduced taxes on health foods to make them more affordable
Tax breaks for gym memberships and for parents who enroll their children in sports activities
Health care reform
(Obama’s AMA speech; Underlying issues; David Brooks on Obama; Robert Samuelson’s take; WSJ fiction)
(Benefits of alcohol?; Ritalin and unexplained deaths)
(Litigating over free speech; Is the FDA demoralized)
Health care reform
The American Medical Association (AMA) came out last week against any government sponsored insurance plan, but a few days later they back pedaled a bit, saying they’d been misinterpreted and that they were simply opposed to “any public plan that forces physicians to participate, expands the fiscally challenged Medicare program or pays Medicare rates.”
So there was a great deal of anticipation surrounding President Obama’s address to the AMA’s annual meeting in Chicago yesterday. Here is a video of the address, compliments of C-SPAN and Kaiser Health News (the clip is about 8 minutes), or if you prefer, you can read the speech as text at the Wall Street Journal.
[T]he president’s speech on Monday was the latest example of an oft-used ploy to press his case: appearing before skeptical audiences, confident of his powers of persuasion but willing as well to say what his listeners do not want to hear. …
“The public option is not your enemy,” Mr. Obama said. “It is your friend, I believe.” Saying it would “keep the insurance companies honest,” the president dismissed as “illegitimate” the claims of critics that a public insurance option amounts to “a Trojan horse for a single-payer system” run by the government. …
Mr. Obama assured skeptics in the audience: “You did not enter this profession to be bean counters and paper pushers. You entered this profession to be healers. And that’s what our health care system should let you be.”
I noted in a previous post (The Altria Earnings Protection Act) that Philip Morris, the major player in the U.S. tobacco industry, was fully supportive of the upcoming Congressional bill that will give the FDA control over tobacco. At the time it seemed to make sense that “Altria,” the newly sanitized name for the same company we used to call Philip Morris, would support the bill, since it gave them an economic advantage against their competitors, who oppose it.
The bill has now emerged from the Senate Committee on Health, Education, Labor and Pensions (HELP). In the final rancorous days of disagreement among committee members, the ranking Republican Senator, Mike Enzi, revealed that Philip Morris was not only involved in negotiating the bill, but was actually a co-author. “We need to fight the war on tobacco head on, not sign a peace treaty with Philip Morris, one of the authors and strongest supporters of this bill.” This was not a casual comment where the Senator might have been speaking figuratively. This was in an official post on the HELP Committee website.
Enzi proposed placing tobacco regulation under the Centers for Disease Control and Prevention (CDC), where decisions would be made using “science, not politics.” He believed the FDA, concerned with restoring health and keeping the nation’s food supply safe, was not the appropriate organization. Said Enzi: “[The] FDA approves cures, not poisons.” Read more
As I mentioned a few posts back, Altria, the sanitized name for Philip Morris, is the major player in the U.S. tobacco industry. The company spent $12.9 million on lobbying in 2006. And yet they fully support the upcoming bill that gives the FDA control over tobacco, the Family Smoking Prevention and Tobacco Control Act. All the other big tobacco companies – Reynolds American, Lorillard — oppose the legislation. Why is Altria so supportive?
[B]ecause the firm has read the small print. “This legislation might as well be dubbed the Altria Earnings Protection Act,” says Fortune magazine. For starters, the bill prevents the US Food and Drug Administration (FDA) from ever banning cigarettes. But just as importantly, the wording makes it extremely unlikely that the FDA will ever approve a new cigarette product because the entrant would have to be deemed “appropriate for the protection of the public health”. So the bill basically featherbeds the dominant tobacco groups’ [Altria’s] share of the market.
It’s fairly common knowledge that the tobacco industry has engaged in nefarious practices, such as secretly verifying the addictive quality of nicotine and strategizing how best to get kids to smoke. If you take a moment to read some of the actual memos and reports that chronicle these goings on, I think you’ll find it’s much worse than you imagined.
The once-secret documents of the tobacco industry are available at Tobacco Documents Online.
As part of the Master Settlement Agreement between the States and the tobacco companies, the industry was required to make the documents used during the trials available. They posted the documents on their websites, but searching required going to several different sites, each with a different interface.
That same agreement required the industry to turn over a snapshot of their sites as of July, 1999. Tobacco Documents Online (TDO) spent over a year standardizing the document descriptions to allow uniform searching, and through the American Legacy Foundation, obtained tapes of the document images. TDO offers powerful searching across all the companies, access to high-quality images, OCR, and the ability to collect and annotate documents. The tools here have been built for document researchers, and are available to anyone with a web browser.
We’ve come a long way in the history of cigarette advertising. Here’s a 1949 commercial for Camels.
The “More doctors smoke Camels” campaign was a response to concerns, starting in the 1940s, that smoking caused lung cancer and heart disease. There had been a series of articles on this in the widely read Reader’s Digest. What better reassurance that smoking was not harmful than an endorsement from doctors? Read more
Smoking causes lung cancer. We’ve known that for 60+ years. But the regulation of tobacco has happened in slow motion, thanks largely to political lobbying by the tobacco industry. In 2000, the Supreme Court ruled that the FDA could not take it upon itself to regulate cigarettes. It would first need legislative approval from Congress.
With President Bush gone, Congress should finally be voting on FDA regulation of tobacco in 2009. The proposed bill, called the Family Smoking Prevention and Tobacco Control Act, was introduced in February 2007 by that health and energy hero, Rep. Henry Waxman. The bill has been out of committee since April 2008. As I mentioned, these things happen slowly.
The proposed bill strengthens restrictions on advertising and youth marketing, and it requires new, stronger warning labels. The Canadians have graphic illustrations of smoking-related diseases directly on a pack of cigarettes. Here’s a whole page of Canadian warning labels. The Canadian graphics are mild compared to the Brazilian warning poster that shows a gruesome case of smoking-related gangrene. The U.S. tobacco bill would presumably usher in Canadian-like labels. It also requires full disclosure of all ingredients in tobacco products and restricts harmful additives. Read more
Roll Call, the daily paper aimed at Washington politicos, gets endorsements such as the following from members of Congress:
Former House Minority Leader Richard Gephardt (D-Mo.): “Roll Call is a critical and indispensable tool for deciphering the day-to-day maneuverings of Capitol Hill. Roll Call has its finger on the pulse of Congress.”
Former Sen. John Warner (R-Va.): “I get a lot of information from Roll Call that I can’t find in other publications. I have to read it to keep my head above water in this town.”
When you want to send a message to Congress, you can take out a full page ad in Roll Call.