Big Drugs, Pregnancy And Social Marketing III
Muzzling The Muzzlers
By Norman E. Kjono, July 8, 2007
Copyright © 2007 Norman E. Kjono
From the Seattle Times, July 11, 2007, "Ex-Surgeon General Says He Was Muzzled by Bush Administration," by Ricardo Alonso-Zaldivar, Los Angeles Times:
"WASHINGTON - President Bush's first surgeon general testified Tuesday that his speeches were censored to match administration political positions and that he was prevented from giving the public accurate scientific information on issues such as stem-cell research and teen-pregnancy prevention. 'Anything that doesn't fit into the political appointees' ideological, theological or political agenda is ignored, marginalized or simply buried,' Dr. Richard Carmona, surgeon general from 2002 to 2006, told a congressional committee. 'The job of surgeon general is to be the doctor of the nation, not the doctor of a political party.' Early in the administration, when the issue of federal funding for stem-cell research arose, Carmona said, he thought he could play an educational role by discussing the latest scientific research. Instead, he was told to 'stand down' because the White House already had decided to limit stem-cell studies. He said administration appointees who reviewed his speech texts deleted references to stem cells. Carmona said he also ran afoul of politics on teen-pregnancy prevention. While the administration emphasizes abstinence from sex, Carmona said he believes a variety of approaches are needed, including contraception for teens who are sexually active. The administration 'did not want to hear the science ... but wanted to preach abstinence, which I felt was scientifically incorrect,' Carmona testified. Carmona's remarks were the latest in a series of complaints from government scientists about what they say are administration efforts to control - and sometimes distort - scientific evidence in order to support policy decisions."
There's pots and kettles, and then there are surgeon generals. Considering the strongly-challenged content in the 2006 report of the U.S. Surgeon General, "The Health Consequences of Involuntary Exposure to Tobacco Smoke," what's black in the stem cell research and teen sex kettle becomes white in the tobacco control smoking ban pot.
Similar to the Otsuka study about heart disease and short-term exposure to Environmental Tobacco Smoke (ETS), serious questions regarding the 2006 surgeon general's report and conclusions were presented in a subsequent issue of the Journal of the American Medical Association (JAMA). See JAMA, "Report Reviews Secondhand Smoke Risks," by Bridget M. Kuehn:
"At a June 27 press briefing launching his new report on the ill effects of secondhand smoke, Surgeon General Richard H. Carmona declared that 'the debate is over.' But some scientists continue to question the magnitude and immediacy of cardiovascular and lung cancer risks attributed to secondhand smoke exposure."
See also, "JAMA Article Brings Surgeon General's Misrepresentation of Secondhand Smoke Science to the Forefront" by Dr. Michael Siegel, a noted tobacco control advocate:
"An article in the current issue of JAMA (Journal of the American Medical Association), reporting on the recent Surgeon General's review of the health effects of secondhand smoke, brings to the forefront the controversy over whether the Surgeon General misrepresented the science in his public communications surrounding the report's release (see: Kuehn BM. Report reviews secondhand smoke risks: some scientists question risk level. JAMA 2006; 296:922-923). The controversy stems from the press release and other ancillary materials released by the Surgeon General to accompany the report itself. . . . In other words, it appears that CDC agrees that it is preposterous to assert that a brief exposure poses any problem for a person who does not have severe coronary artery stenosis to begin with, and CDC is unwilling to defend the Surgeon General's misleading claims. At the same time, CDC is also apparently unwilling to suggest outright that the Surgeon General went too far in his press release, remarks, fact sheet, and brochure."
Neither the Otsuka study, nor the 2006 surgeon general's report, nor the University of Washington's study concerning prenatal exposure to tobacco smoke measured or quantified actual Environmental Tobacco Smoke exposures. Yet non-quantified, and therefore unknown, exposure to any degree whatsoever absolutely equals dead certain health consequences. Suffice it to say that those who attempt to credibly apply the 2006 U.S. Surgeon General's report about involuntary exposure to tobacco smoke to support smoking bans face a daunting task.
Accordingly, Dr. Carmona's bleatings before Congress fall on deaf ears for normal folks. Dr. Carmona is not arguing for scientific integrity or freedom of intellectual inquiry. He merely decries the reality that political censoring and expedient omission of facts results in his own ox being gored on occasion, too. What else could occur in a political environment where the conclusions required from scientific research are already defined by the policy agenda before the study data are gathered, let alone responsibly analyzed?
The appropriate response to Dr. Carmona's testimony is to yawn and send a thought of profound gratitude that he no longer occupies the office of U.S. Surgeon General. He confounds the relevant issue of legitimate scientific research rather than presenting meaningful insight for members of Congress. Crying that his views were excluded on some subjects while he aggressively advances the worst of study-on-demand Junk Science and suppresses any dissenting views about tobacco speaks far more to an apparent paucity of intellectual integrity than it provides meaningful information for members of Congress.
An additional problem presented by Dr. Carmona's apparent position on scientific research is that what was published under his auspices has spawned a new generation of fatally-flawed studies to support ever-escalating claims about the alleged dangers of Environmental Tobacco Smoke. I wrote about that in context of pregnant mothers' exposure to ETS and later child behaviour problems in Big Drugs, Pregnancy and Social Marketing on July 6, 2007 and Big Drugs, Pregnancy and Social Marketing II published July 9, 2007.
The University of Washington study that the above commentaries address did not measure ETS exposures, inserted a numeric value created by the authors into the calculations that represented occasional smoking by pregnant mothers to mimic exposure to secondhand smoke, and contained no controls for study participants using antidepressants or Nicotine Replacement Therapy such as pharmaceutical patches and gums. Despite such deficiencies, as well as one author's written statement that a causal relationship cannot be established between ETS exposure and later child behaviour problems, the study concludes that nicotine ingested through exposure to ETS at work or in the home presents a risk to a developing foetus that can cause later behaviour problems in children.
I wrote both authors of the University of Washington study and presented an interview outline, which co-author Dr. Gatzke-Kopp kindly responded to. Dr. Gatzke-Kopp referenced Dr. Carmona's 2006 report of the U.S. Surgeon General on several occasions in her response. For example:
"However, I call your attention to a recent report by the Surgeon General on second hand smoke exposure. Several studies have found that individuals who are merely exposed second hand, can show blood levels that would classify them as smokers. So chronic, indoor, exposure can certainly accumulate in the bloodstream of an individual who is not actively smoking."
"The Surgeon General released a report last year documenting the extensive dangers of second hand smoke exposure-- including those to the fetus of an exposed mother. Our study aimed to extend the documentation of risks into psychological well being as well as physical health. Our study in unable to draw conclusions about causality, . . ."
For the full, unedited text of Dr. Gatzke-Kopp's interview outline responses please see Lisa Kopp UW July 6, 2007 Response.PDF.
NicoDerm CQ patch manufacturer, Johnson & Johnson, as well as the product's distributor GlaxoSmithKline, have good reason to appreciate the University of Washington's alleged science in support of their mercantile interest. The more smoking bans expand the higher their Nicotine Replacement sales rise. Much the same applies to Nicorette, also distributed by GlaxoSmithKline, since Johnson & Johnson's acquisition of Pfizer Consumer Healthcare in 2006 for a reported $16.6 billion.
The Robert Wood Johnson Foundation also has good reason laugh all the way to the bank at gullible politicians and researchers, as well as the public: every new box of NicoDerm CQ or Nicorette flowing from GlaxoSmithKline warehouse to consumers supports capital appreciation of the foundation's reported $3.9 billion stock position in Johnson & Johnson and assures continued dividends derived therefrom. Finally, the University of Washington shares in the research funding largess through numerous grants from the Robert Wood Johnson Foundation, including those for childhood obesity, E-Health Technologies, King County Asthma Forum, Healthy Eating Research, local health department costs, and intensive care.
Unfortunately, many bar and tavern owner's in Washington and other states are paying millions per year in reduced revenues due to smoking bans supported in large part by the 2006 surgeon general's report and research such as that concerning prenatal exposure to ETS. Publication of uncertain and often contradicting causal factor risks predictably equals dead certain costs to small business owners, their employees and their vendors.
It appears that other University of Washington research data may strongly undermine current Social Marketing sound bites concerning child obesity, despite its grants from the Robert Wood Johnson Foundation on that subject. From the Seattle Times, July 11, 2007, "Maybe Corn Syrup Isn't to Blame UW Study Says," by Kyung M. Song:
"Beverages containing high-fructose corn syrup - that supersweetener blamed by some for the nation's obesity crisis - actually affect people's appetites no differently than drinks made with regular table sugar, researchers at the University of Washington have found. It's a small study - 37 subjects - but its authors say it appears to undermine a recently popular theory that high-fructose corn syrup contributes to weight gain by making people feel less full than other sweeteners do. The study showed that 'people don't seem to react differently to the different kinds of sugar,' said Pablo Monsivais, nutritional-sciences research fellow at the UW and the lead author of the report, which appears in this month's American Journal of Clinical Nutrition."
Perhaps the authors for the above university of Washington study should compare notes with authors reported by NewsTarget.Com. From "Anti-Depressant Drugs Found to Cause Birth Complications," August 19,2004, by Mike Adams:"
"Frankly, what pregnant women need in terms of battling depression is the same thing that every adult needs, and that is natural sunshine touching their skin on a regular basis. That's because most adults suffer from chronic vitamin D deficiency, and they either need sunlight or regular cod liver oil supplements in order to get adequate amounts of vitamin D. Pregnant women also need to avoid all environmental toxins in their food, drinks, and lifestyle habits. That means, of course, no alcohol whatsoever, no cigarette smoking, and absolutely no consumption of over-the-counter drugs, which are extremely toxic and by last count, responsible for at least 40,000 deaths each year just from painkillers alone.
Remember, these over-the-counter drugs are not necessarily safe or even mild, even though they can be purchased without a prescription. They are powerful, biochemically active chemical substances that kill human beings, that compromise the function and health of the human liver, and that pass through the bloodstream into the body of an unborn child. So, when a mother is taking over-the-counter painkillers, she's effectively dosing her child with those same toxic drugs.
At the same time, mothers need to avoid all toxic food additives and metabolic disruptors such as MSG, sodium nitrite, and food additives like artificial colors. She also needs to avoid hydrogenated oils and refined carbohydrates such as high-fructose corn syrup, white flour, white sugar, sucrose, and other similar substances.
In other words, a pregnant woman should have the highest level of responsibility to control her intake of dietary and lifestyle substances, and yet, in the United States today, I regularly see pregnant women smoking, drinking, and doing things that should potentially be considered criminal, such as drinking alcohol and taking ibuprofen at the same time -- which of course creates a highly toxic chemical cocktail that damages the liver of both the mother and the unborn child. It's one thing for a woman to compromise her own individual health in any way she chooses, and I'm all for freedom of choice and allowing people to eat what they want, but it's entirely different when a mother is destroying the health of her child. In the case of pregnancy, I think women need to be held to a higher standard, and in this country we need a program of education and support to help pregnant women get better nutrition and a better understanding of what is required to raise a healthy child.
The confounding factor of anti-depressant use by pregnant women was addressed in Big Drugs, Pregnancy and Social Marketing. Judging by the above report one wonders what foods among those available from a local grocery story a pregnant mother could eat. God forbid that the prospective mom should wash down a headache remedy with a swig of white wine. More important is the notion that high fructose corn syrup is also associated with threats to the health of unborn children. Whatever the cause-of-the-day may be - from drinking Coca Cola to self-medicating a headache, or someone lighting up a cigarette - we can be absolutely certain the unborn will be factored in to a study-on-demand somewhere.
I recommend that a full round of psychology studies be immediately undertaken to determine the affect of rampant Social Marketing on child behavior development. The magnitude of highly-charged emotional sound bites focused on those still in the womb simply has to have an adverse effect on developing neural pathways. The unfortunate kids' thought processes could be twisted by the steady drumbeat about what will make them grow up to be misfits long before they drop out the shoot. A better idea is to shut down Social Marketing and leave the kids out of self-serving political dogma promoted by Agenda Afflicted adults.
The above study report from the University of Washington comes as much too little far too late for Seattle area parents and taxpayers. In June 2003 the Seattle school board and its members individually were threatened with lawsuits if they renewed a vending contract with Coca Cola. See my July 14, 2003 commentary "Seattle Schools: Shoot First and don't Bother With Questions Later," and July 21, 2003, "Which Members Do We Sue Now?" published by Forces.org. The July 14, 2003 commentary includes quotes from my interview with then-Seattle School Board candidate Brita Butler-Wall, copies of E-Mail correspondence between state health department employees and public policy advocates, as well as direct quotations concerning the specific nature of the threat to file lawsuits. For example, that work includes quotes from a June 25, 2003 E-Mail by Action on Smoking and Health (ASH) Executive Director John F. Banzhaf III, Esq:
"In the instant situation it is very hard to argue that eating [drinking?] sugary soft drinks, especially during school hours, is healthful to in the students best interests. Therefore, than (sic) alone could create potential liability under the tort theory of breach of fiduciary or quasi-fiduciary relationship, or ordinary negligence. Moreover, two additional factors add to the strength of the legal argument. The first is that the school often receives money from the contract in the form of a commission, bonus or incentive. Thus, it could be argued, the school and even individual school board members have a conflict of interest between the desire to earn/receive money and the interest in being sure the activities are safe and healthful for the student. Indeed, under the circumstances, a jury might even see these payments as a bribe or payoff." (Bracket inserted, underline added.)
Compare the above threats with those to doctors who fail to recommend Nicotine Replacement Therapy for their patients who smoke, as reported in That's Ridiculous! published November 2006 and the first commentary in this series, Big Drugs, Pregnancy and Social Marketing, as reported by the journal Tobacco Control (2006;15:447-45), "The US Public Health Service 'treating tobacco use and dependence clinical practice guidelines, as a legal standard of care:'"
"There are four items that need to be considered in negligence torts: legal duty, a breach of that duty, causal relationship between breach and injury, and damages. . . . Although each case of medical malpractice depends on a multitude of factors unique to individual cases, a court could have sufficient basis to find that the failure to adequately treat the main cause of preventable disease and death in the US qualifies as a violation of the legal duty that doctors and hospitals owe to patients habituated to tobacco use and dependence." (Underline added.)
While making such comparisons it should be kept firmly in mind that the threats are made by an individual and organization that reviewed and promoted a book containing what the author describes as a tested and proven plan to cyanide product tamper with cigarette packages for the express purposes of killing persons who smoke (see "New Book Tells How Protagonist Kills Smokers). As reported in that review, the author stated that he had in his possession "enough cyanide to murder 2,500 people." Now there's a credible and wholesome source of information about how to protect the unborn. Where's Homeland Security when we need it? What if a pregnant mom happened to purchase a cyanide-tampered pack of smokes? The fetus' death would probably be blamed on secondhand smoke because, after all, it was known to contain cyanide. Oh boy, we're in for it . . . !
The Seattle School Board voted to renew the Coca Cola contract in July 2003, and later ended the relationship. The cost to taxpayers in lost vending revenue is reported to be about $400,000 per year. Again uncertain causal factors, which in this case are contradicted by the University of Washington study about high fructose corn syrup, predictably equal dead certain costs, this time to taxpayers.
Social Marketing is, by definition, applying corporate marketing and advertising disciplines to public policy. Problem is that when special-interests apply mercantile procedures to agenda advocacy the result is not competent or legitimate public policy. Application of mercantile procedures equals mercantile results every time. But why should taxpayers, consumers and small business owners continue to involuntarily subsidize Social Marketing agenda tomfoolery? It seems to me that the intelligent option is to sue the socks off the threat purveyors so small business owners, consumers and taxpayers can recover the economic damage mandate muggers' penchant for legal puffery has imposed. In the process, researchers who publish Social Marketing statistics as legitimate conclusions to support special-interest agendas might be considered as defendants.
The central problem with Dr. Carmona's politicized science - beyond his self-serving complaints before Congress when the same process occasionally gores his ox, too - is that it allows use of a government office as the spawning ground for new generations of even more extreme, mutant Junk Science.
Indeed, "The job of surgeon general is to be the doctor of the nation, not the doctor of a political party," as Dr. Carmona opined in the above article reprinted from the Los Angeles Times. It is also well worth pointing out that the job of the surgeon general is to be the doctor of the nation, not the medical fact spinner of corporate and private foundation special-interest agendas.
Therein, we find the true crux of the issue: so long as political appointees and university researchers believe that Junk Science is fine so long as it is in pursuit of an agenda they approve of or find to be career enhancing the people will continue to be presented with male bovine dropping research as if it were genuine scientific inquiry. Then again, fertilizer has its constructive uses - it promotes growth of wholesome, nourishing alternative thinking, too.
I do not profess to have a complete solution to the Social Marketing problem. It is apparent to me, however, that those with professional interests in legitimate research and earnest scientific inquiry, as well as those responsible for defining constructive public policy, must have higher standards than applying epidemiological crap-shoots-of-the-day. It is becoming painfully obvious that not only are current Social Marketing research dysfunctional but once the study results are published than we soon learn they were wrong or do not produce the results touted. Taxpayers, consumers and small business owners are not an unlimited deep pocket to sustain Social Marketeers' ongoing game of dice with public policy. If those currently in such positions cannot see to it that constructive change occurs then they need to be removed through due process to make room for those who can and will.
Again, the best course of action is to yawn while expressing profound gratitude that not only is the former surgeon general's own ox being gored by the process that he obviously endorses but that he is no longer in a position to further discredit scientific integrity.
A supplemental response is to vote out of office every politician who sits on the committee that Dr. Carmona recently testified before. Where was their voice on behalf of the American people in asking cogent and direct questions about his 2006 secondhand smoke report that even the staunchest tobacco control supporters, the Journal of the American Medical Association and the Centers for Disease Control and Prevention, found it necessary to question?
Norman E. Kjono