Tobacco Control editor won't share panel with tobacco industry

Ruth Malone, editor of Tobacco Control, writes an open letter to the FDA declining an invitation to discuss tobacco industry research on a panel including delegates from the tobacco industry.

The FDA is a body I know very little about. The little I know suggests that it falls under the undue influence of the very powerful. However I take issue with some of Malone's reasoning.

First, involving the tobacco companies as “stakeholders” on a panel with the public health community in this way suggests that all parties share a common or at least congruent goal.

Is it? Is that the basis on which talks took place in Northern Ireland? I would have thought the opposite was the case. There is a common agenda, one that recognises tobacco industry research as something worth talking about, but it wouldn't be worth talking about if everyone had the same view of it.

Second, any such discussion among “stakeholders” would require a minimal level of mutual understanding about the nature and purpose of science.

This is also an absolute requirement. Tobacco is legal according to specific guidelines, and it is vital that the parties reach a common understanding on this issue.

While the companies may have an interest in reducing the numbers who die prematurely from using their products (so that they will live to purchase more of them), they have never indicated any willingness to pull from the market the products that kill half their longtime users and continue to be sold. Absent such willingness, the practical goals of public health and the tobacco industry are in direct conflict. No “dialogue” will change that.

Unless the tobacco companies commit harikari, consigning to the black market a product used by billions worldwide, on which countless people depend for their livelihoods, there can be no common ground. Is this outlook – the fantasy that a recreational product will simply cease to exist – really consistent with sound public health goals?

As the Kessler decision found, the tobacco industry engaged in a conspiracy to cover up and distort the evidence of their products’ harmfulness, and they have a long track record of egregious manipulation of science.

No industry associated with health ever behaves like that!

From Malone's third point:

As we demonstrated in our papers examining Philip Morris’s support for FDA regulation of tobacco products [1]and its development of Project Sunrise, which sought to create and exploit divisions within tobacco control, [2]engagement with public health organizations allows tobacco companies to position themselves as reasonable and responsible, and position those who refuse to engage as extremists.

My issue with Tobacco Control is their obsession with tobacco as a public health issue in spite of ample evidence of other potential environmental hazards created by other powerful industries. Public health should identify environmental health hazards and seek to minimise them, but its current approach is judgemental and self-righteous. It is scarcely believeable that no one working for tobacco companies has any concern about the health consequences of their product, any more than it is believeable that everyone who works for GlaxoSmithKlein is a crook. Public health needs to do away with its self-righteous attitude and simply attempt to influence matters in such a way as to limit harm. Refusing to engage with industry because it causes harm is a bizarre approach. (Does any other industry than tobacco get singled out in this way?)

Ruth's Malone's summary shows up how far I disagree with her argument:

Fourth, tobacco industry denormalization is a key part of successful tobacco control efforts. Convening a meeting of this sort undermines those critically important efforts by creating a forum for re-legitimation through association with respected public health agencies and leaders. Lending the FDA imprimatur to a public meeting featuring tobacco company speakers suggests that something has indeed changed and the industry is no longer harming people through its promotion of deadly products.

On the contrary, engaging with the tobacco companies is only necessary because the product is recognized as a hazard to health. Where did this cosy attitude come from, that government is a matter of engaging only with those whose goals are alike?

The FDA may be required to interact with the industry for the purposes of discussing proposed regulation of tobacco products and what tobacco companies must do to comply. The FDA is not, however, required to “facilitate” dialogue as though it were acting as a neutral mediator between two parties with equally valid but divergent interests. In positioning itself as some sort of neutral party, FDA is unwittingly acting as an agent for the tobacco industry’s public relations initiatives and undermining a strong tobacco control strategy.

This would naturally work against her goal of denormalization. As far as she is concerned, the tobacco companies are required to turn up at the FDA offices just to be told what orders to follow. Anything else is giving the tobacco companies ideas above their station.

Tobacco is a huge market and the best that public health can hope for is that the companies' corporate reponsibility is strong and checks are in place to ensure that standards are reached and maintained. Public health also needs to recognise that although its contribution is important it does not trump everyone else's, and does not entitle it to tell the FDA how to engage with stakeholders (although it is entitled to an opinion, of course).

Those who refer to engage are extremists? As if!!