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Project ASSIST: Image and Reality

Federal funds cannot legally be used for political purposes.1 Yet the American Cancer Society and the National Cancer Institute (NCI), part of the federal government's National Institutes of Health which is charged with conducting cancer research, are using as much as $100 million in federal tax revenues for lobbying and political advocacy. The NCI's Project ASSIST, the American Stop Smoking Intervention Study for Cancer Prevention, is the major funding vehicle for a coordinated campaign whose aim is to support groups that favor raising tobacco taxes at the state level so that revenues can be earmarked for their own use.

Launched in 1991, ASSIST is the federal government's largest anti-smoking program. Over a seven-year period, some $115 million in tax dollars will go to state health departments, which in turn will fund local "tobacco control coalitions." The ACS will contribute another $25 to $30 million as well as educational materials and thousands of volunteers. According to public materials, these coalitions will operate programs to increase "public information" about tobacco and health issues and promote policies that "reinforce 'nonsmoking throughout the community."2 The reality is that "coalitions" are usually formed to lobby, and "tobacco control" has become a euphemism for raising tobacco taxes.

This article challenges the National Cancer Institute and the American Cancer Society to inform taxpayers and donors of the exact role they are playing in establishing local anti-smoking groups and in channeling federal tax revenues to them through Project ASSIST.

Origins of Project ASSIST

The NCI and ACS spent years planning for Project ASSIST. The ACS' 1989 annual report says that "In November 1988, the Board of Directors approved a collaboration with the [NCI] on [ASSIST]. National Society staff...has worked with NCI to develop a request for proposals...ASSIST is designed to accelerate a reduction in tobacco use through the formation of tobacco control coalitions in up to 20 states and/or major metropolitan areas."3

In August 1990, the NCI awarded Prospect Associates, Ltd., a Rockville, Maryland-based company, a $15,672,514 grant to establish a coordinating center for ASSIST. It stipulated that nearly $4.3 million of this amount be allocated to subcontractors to provide "training, design, media advocacy, and information services..."4 Much of this $4.3 million was targeted to the Advocacy Institute, a leading anti-smoking group which, through its Smoking Control Advocacy Resource Center (SCARC), trains grassroots organizations in how to use the government to restrict smoking. The ACS is one of its main clients.5 The NCI also stipulated that Michael Pertschuk, head of the Advocacy Institute, be the subcontract manager. According to Pertschuk, the long-term strategy of groups receiving training is: "the elimination of advertising and promotion...the restriction of indoor smoking in public places...restricting minors' access to cigarettes...[and] taxation."6

In October 1991, Louis Sullivan, then Secretary of the Department of Health and Human Services (HHS), formally announced Project ASSIST and the awarding of contracts to 17 state departments of health.7 ASSIST would reach 18 million smokers and help about 4.5 million quit, while preventing another 2 million from starting. "What sets ASSIST apart from other government smoking programs," an HHS press release said, "is its emphasis on the development of community-based coalitions throughout the entire states...ASSIST will empower [communities and individuals] by providing the information and help that they need to change attitudes about smoking and counter the sinister strategies of the tobacco industry."8

The program was planned in two phases. From 1991 to 1993, state health departments would develop "community-based tobacco control coalitions" and help plan smoking-control programs. These would identify high-risk groups and determine the best way to reach them. During Phase 2 form 1993 to 1998, coalitions in each state would conduct "smoking control activities," using the media, workplaces, schools, health-care facilities, and community groups.9

Thus, for public-relations purposes, ASSIST was described as a massive stop-smoking campaign. However, the HHS press release also noted that "When federal funding for ASSIST ends in 1998, NCI and ACS expect that the local tobacco control coalitions will continue to function effectively."10 It is apparent that anti-smoking groups plan to lobby for new tobacco taxes and have the revenues earmarked for themselves.

The ACS: A "Full Partner"

In November 1991, the NCI issued "Questions and Answers About ASSIST," which said that the ACS would contribute on full-time employee devoted solely to ASSIST in each of the 17 states receiving grants. In addition, a "Request for Proposal for ASSIST," issued by the NCI in January 1990, said that "At the beginning of the concept development for ASSIST, the NCI joined together with the [ACS] to discuss their respective roles...It was agreed that the national ACS would participate as a full partner in the overall planning and management of ASSIST, and that ACS would serve as a lead agency in demonstration sites along with state or local health departments."11

Moreover, "In ASSIST sites, ACS Divisions...will join with the health departments as co-leaders...An executive committee shall be formed to coordinate and manage the project [and] will have equal representation from the [ACS] project [and will have equal representation from the coalition...A suggested model would consist of three employees of the health department..., three ACS...representatives and a representative of the coalition."12

Thus, while the NCI distributes funds to state health departments that are authorized to make grants, the ACS' state divisions have authority equal to the state in determining which anti-smoking groups receive funds and how much they receive.

Project ASSIST Guidelines

The NCI's 268-page "Request for Proposal for Project ASSIST," used by grant-seeking state health departments, denies that ASSIST engages in politics. One footnote says, "There are a variety of statuatory restrictions on the use of funds to lobby legislative bodies or to influence election or referendum results. This chapter does not suggest that these restrictions be violated in any way."13

But when grantseekers turn to a list of recommended resources, they find these entries:

  • Legislative Approaches to a Smoke-Free Society, Americans for Nonsmokers Rights;
  • Smoke Fighting: A Smoking Control Movement Building Guide, Michael Perschuk, Allan Erickson and the Advocacy Institute Staff, 1987.
  • Smoke Signals: The Smoking Control Media Handbook, Michael Perschuk, Allan Erickson and the Advocacy Institute Staff, 1987
  • The Cigarette Excise Tax, Institute for the Study of Smoking Behavior.14

    These resources are primers on influencing the media, public opinion, and lobbying. In addition, attached to each ASSIST contract award is a government form: the "Disclosure of Lobbying Activities Form SF-LLL."

    Increasing Tobacco Taxes

    The NCI and ACS have also issued ASSIST Program Guidelines.15 One chapter, "Tobacco Price Policy," suggests ways of increasing tobacco taxes: "Government officials who possess the authority to increase taxes on tobacco products must be educated to [sic] the value of enacting such measures. The same is true of other government representatives, including health officials, whose support might be influential. In practical terms, this often means that staff members who work for these individuals must be educated and informed [i.e., lobbied] about the need for substantial increases in tobacco taxes."16 Moreover, "advocates can argue that if state or local revenues are not raised through increased taxes on tobacco products, other tax increases may be imposed that are less desirable."17

    In addition to influencing legislators, the Guidelines are very explicit about ways to use the media. These include:

    • "Calling a radio talk show host to suggest that a visiting expert would be available to discuss issues relating to tobacco taxes...,"
    • "Arranging for a coalition member and community leader to write an 'op-ed' column in the local newspaper calling for substantially increased taxes on tobacco products;"
    • "Taking out an ad in a local newspaper highlighting new evidence regarding the health impact of increased taxes on tobacco products (being prepared also to make a story out of the refusal of the paper to accept the ad);"
    • "Holding a press conference to call for state and local government action to substantially increase taxes on tobacco products;"
    • "Issuing a press release in support of adoption by the state or local government of substantially increased taxes on tobacco products..."18

    Under the heading "Direct Advocacy Tactics," ASSIST grantees also learn that through resolutions and campaigns, "state or local professional associations [can] promote advocacy for increased taxes on tobacco products and implementation of such increases by the state and local governments."19

    The Guidelines also stress that "Staff members assigned media responsibilities must have basic public relations training, including techniques for initiating news coverage and reacting to breaking news stories; skills in developing press releases, press kits, op-ed columns, letters to the editor, arranging editorial board visits, handling media interviews and holding press conferences, and possess a basic understanding of the roles and relative cost-effectiveness of public service announcements and paid advertising."20 Moreover, "The use of mass media is a priority intervention in ASSIST. It can serve to stimulate and reinforce broad and intense support among the public and policymakers for tobacco use control policies..."21

    Stifling Free Speech

    How can the ACS and NCI have respect for basic freedoms guaranteed by the Constitution when one major "program policy objective" of ASSIST is the "elimination of all tobacco product advertising and promotion"?22 Advertising is commercial speech and is protected by the First Amendment. That civil liberties are abridged by advertising bans is even acknowledged in the Guidelines: "there are substantial constitutional and congressional limits on state and community action to curb cigarette advertising and promotion. The courts have yet to delineate those limits, but it is clear...that no state can ban cigarette advertising in magazines that are sold in interstate commerce. In addition, Congress, in the Cigarette Labeling an Advertising Act, has expressly prohibited the states from requiring any warnings in advertising 'related to the health hazards of smoking' other than those mandated by Federal action."23

    Although the Guidelines seem to recognize the constitutional issues involved, ASSIST grantees are nonetheless urged to forge ahead: "there is ample room for state and community action to bar certain forms of advertising and promotion..."24 Among the strategies suggested:

    • "Petition and persuade public authorities with regulators [sic] powers to restrict or ban advertising and promotion within the scope of their authority;"
    • "Promote public attitudes and actions supportive of advertising control policies;"
    • "Spur public policymakers into taking action by exposing tobacco industry lobbying and their policymakers' failures to act to curb advertising and promotion abuses."25

    The Guidelines claim that "Restrictions on the advertising and promotion of tobacco products are one of the most effective ways to reduce demand."26 Yet speakers at the Third World Conference on Smoking and Health, sponsored by the ACS and NCI, noted that there is little evidence that advertising bans effect tobacco consumption. Researcher James L. Hamilition's study found that "For seven countries that have enacted bans, the evidence reveals that bans have not, in general, slowed consumption growth...A ban of cigarette advertising has not been an effective policy for reducing cigarette smoking."27 Similarly, researcher Karl Warburg concluded that "There is no evidence to support the view that a ban on advertising would have a positive effect on smoking habits...Nor has anything been found to suggest that advertising entices nonsmokers, young people in particular, to become smokers..."28

    Furthermore, advertising bans, like many government interventions, can lead to a further loss of freedom. Economist Ludwig von Mises has argued that "[Once] the principle is admitted that it is the duty of government to protect the individual from his own foolishness, no serious objections can be raised against further encroachments."29 In 1775, Thomas Jefferson expressed the same view: "False is the idea...that would take fire from men because it burns, and water because one may drown in it; that has no remedy fro evils, except destruction [of liberty]."

    Needed: A Return to Charity

    The true intent of Project ASSIST has become so apparent that two years ago the New York Times Concluded a story about the program by observing, "Major lobbying efforts will be devoted to raising tobacco taxes, with a portion of the revenue set aside for smoking control programs."30 Lobbying for increased tobacco taxes and revenue "set asides" for anti-smoking groups is the major thrust of Project ASSIST, not public health.

    Like oil and water, politics and charity do not mix. The NCI is using its congressional appropriations to fund grassroots political activity coordinated by the ACS. Such use of federal funds diverts money form cancer research, which should be the main mission of the NCI, and also raises serious questions of legality.31 The ACS should return to its traditional mission of providing direct services to cancer victims--a mission it has increasingly abandoned in favor of lobbying for restrictions on personal behavior.32

    Notes

    1. For a detailed discussion of this issue, see James T. Bennett and Thomas DiLorenzo, Destroying Democracy: How Government Funds Partisan Politics (Washington, DC: Cato Institute, 1985).
    2. HHS press release on Project ASSIST, HHS News, U.S. Department of Health and Human Services, October 4, 1991, p.2.
    3. ACS, 1989 Annual Report (Atlanta: ACS 1989), p. 11. This action by the ACS board of directors was approved the same month that Propostition 99: Pork Barrel for Anti-Smoking Groups,"Alternatives in Philanthropy, (Washington, DC: Capital Research Center, July 1994).
    4. NCI, Research Contracts Branch, PCCS, "Award Contract No. N01-CN-05259 effective 09/25/90" (Bethesda, MD: NCI, 1990), p. 1 and Attachment 8, p. 1.
    5. Thomas J. DiLorenzo, Hidden Politics: "Progressive" Nonprofits Target the States (Washington, DC: Capital Research Center, 1993), pp. 43-44.
    6. "Tobacco Buster: An Interview with Michael Pertschuk," Multinational Monitor, January/February 1992, p. 28).
    7. The states are: Colorado, Indiana, Maine, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New Mexico, New York, North Carolina, Rhode Island, South Carolina, Virginia, Washington, West Virginia, and Wisconsin.
    8. HHS press release, pp. 1-2.
    9. Ibid., p. 3.
    10. Ibid., p. 5.
    11. NCI, "Request for Proposal (RFP) No. NCI-CN-95165-38, American Stop Smoking Intervention Study (ASSIST) for Cancer Prevention" (Bethesda, MD: NCI, January 15, 1993), pp. 29-30.
    12. Ibid., p. 38.
    13. Ibid.
    14. Ibid., p. 134.
    15. NCI, ASSIST Program Guidelines for Tobacco-Free Communities (Bethesda, MD: NCI, October 1991). Proper citations to materials in this document are difficult to make because each major topic or "chapter" begins as with the page number.
    16. Ibid., "Tobacco Price Policy," p. 2.
    17. Ibid., p. 1.
    18. Ibid., p. 4.
    19. Ibid., p. 5.
    20. Ibid., p. 7.
    21. Ibid., "Mass Media," p. 1.
    22. Ibid., Tobacco Advertising and Promotion Control Policy." p. 1
    23. Ibid
    24. Ibid
    25. Ibid., pp. 2-3
    26. Ibid
    27. James Steinfeld, William Griffiths, Keith Ball, and Robert M. Taylor, eds, "Proceedings of the Third World Conference on Smoking and Health, " vol. 11,, Health Consequences, Education, Cessation Activities, and governmental Action, NIH 77-1413 (Bethesda, MD: National Institutes of Health, 1975), p. 829.
    28. Ibid., pg 854.
    29. Ludwig von Mises, Human Action: a treatise on Economics, rec. ed. (Chicago: Henry Regnery Company, 1966), pp. 733-734.
    30. Jane E. Brody, :17 States in Vanguard of War on Smoking,"New York Times, November 10, 1993
    31. The international Revenue Code, Section 4911(d)(1), defines "influencing legislation" and "(a) any attempt to influences any legislation through an attempt to affect the opinions of the general public or any segment thereof (grass roots lobbying) and (b) an attempt to influences any member or employee of a legislative body, or with any government official or employee who may participate in the formulation of legislation (direct lobbying)."
    32. See, for example, there issues of Alternatives in Philanthropy) Washington, DC: Capital Reseach Center): December 1991, ACS-Texas: Health or Wealth? James T. Bennett; April 1992, ACS-Florida: Cancer or Cash? James T Bennett; November, 1993, The Health Crisis: Where are the Health Charities, James T. Bennett; and August 1994, Health Charities Rhetoric verses Reality: James Bennettt and Thomas DiLorenzo's Unhealthy Charities, Danel T. Oliver.

    Capital Research Center is a non partisan education and research organization classified by the IRS as a 501 (c)(3) public charity.

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    D.T. Oliver, Editor

    Reprinted with permission from the author - Dr. James T. Bennett

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