Tobacco Control

Basic Information No. 1

By Norman E. Kjono, March 29, 2007

This report is the first of a two-part series concerning tobacco control its policies, and the conflicts that such policy raises. This outline is intended to be a public education work concerning basic information that persons reviewing tobacco policy should have. Absent understanding of the basic information included in this series one cannot have a full context in which to analyze or discuss tobacco control advocacy. See "Tobacco Control: Basic Information No. 2" for a discussion of important legal considerations that may be raised as well.  


1.0 Please see three source important documents published by the Robert Wood Johnson Foundation (RWJF) and five documents that I have prepared.


1.1 Robert Wood Johnson Foundation Accomplishments 00.PDF: Provides a summary of what the foundation considers its "major accomplishments" to be in each state for 1994 to 2000. 


1.2 Robert Wood Johnson Foundation Accomplishments 04.PDF: Provides a summary of what the foundation considers its "major accomplishments" to be in each state for 2001 to 2004. 


NOTE: When printed, the major accomplishments documents are hard to read because of extremely small type font. You can, however, easily read them by on computer screen by using the "Zoom" feature in Adobe Acrobat Reader. Relevant entries for a particular state can be transcribed into a one page document that is legible. 


1.3 RWJF Major Accomplishments WA CO OH.PDF (I prepared this document): Provides text from the foundation's .PFG file for Washington, Colorado and Ohio. Looking at these three states combined reveals extended and deep involvement by the foundation to influence public policy on a broad scale. The information for these three states also provides an indication of the vast infrastructure established for tobacco control throughout each state. That infrastructure often includes "partnerships" between state health departments and private special-interest tobacco control organizations such as the American Cancer Society.  


1.4 Taking on Tobacco: the Robert Wood Johnson Foundation's Assault on Smoking: A summary of the foundation's history in tobacco control advocacy. Pages 5 and 6 of the document list $446 million in tobacco control grants of more than $1 million by program and for some recipients. The document also provides a narrative summary of the foundation's historical involvement in tobacco control advocacy since 1992. 


1.5 JNJ-RWJF Summary.PDF (This is a document that I prepared):  


a.) This document provides authentication of Johnson & Johnson's connection to Nicotine Replacement Therapy (NRT) products during the 1990s with Nicotrol and from 2001 forward through NicoDerm CQ.  


b.) In addition, please note that Johnson & Johnson acquired Pfizer Consumer Healthcare for a reported $16.6 billion in 2006, including Nicorette brands (see "Johnson & Johnson to Acquire Pfizer Consumer Healthcare"). Johnson & Johnson and the Robert Wood Johnson Foundation are therefore directly connected to dominant market share positions in major NRT products from at least 1994 through present.  


c.) Pfizer subsidiary Pharmacia manufacturers Nicorette gum for GlaxoSmithKline, that now-Pfizer subsidiary Pharmacia manufactured the Nicotrol inhaler, and Pfizer currently offers the Champix nicotine-blocker smoking cessation product.  


d.) According to Yahoo Finance  as of December 3`, 2006 the Robert Wood Johnson Foundation owned 56 million shares of Johnson & Johnson valued at $3.7 billion. This places the Robert Wood Johnson Foundation in the center as both a causal nexus for and economic beneficiary of smoking ban advocacy: on the one hand the foundation has placed one-half billion dollars in total grants behind advocates of smoking bans and with the other hand reaps the economic rewards of increased product sales by a corporation that has a major market share stake in Nicotine Replacement Therapy products. 


e.) The Robert Wood Johnson Foundation, GlaxoSmithKline and Pfizer have sponsored World Conference on Tobacco OR Health  events attended by tobacco control advocates. Such events incorporate the vested economic and nicotine market share interests of Johnson & Johnson, Pfizer and GalxoSmithKline into recommended public policy. 


1.6 TFW22.PDF: Page 22 from "Planning for a Tobacco Free Washington" (I prepared this document)


a.) The right panel in this document establishes that smoking bans are an essential element of tobacco control policy and strategy as implemented by the American Cancer Society and that "reducing public tolerance" of tobacco use is a strategy employed to do so. 


b.) The left panel establishes that Actions Plans prepared under the supervision of the American Cancer Society have employed specific action items to enact smoking bans, dating as far back as September 1993.  


1.7 King County Health NRT Advocacy.PDF (I prepared this document): Summarizes representative RWJ Foundation grants to county and state health departments in Washington, provides written proofs of county health department advocacy for NRT products, and establishes state health department advocacy for NRT products. 


a.) Page 1, Right Panel: Summarizes representative grants 


b.) Page 1, Left Panel: Presents a letter from King County health stating that NRT could be recommended for children, even though the products are not approved by FDA for such use. 


c.) Page 2: Establishes Washington health department's promotion of NRT products.  


2.0 These documents are extremely important for several reasons in terms of constructive opposition to smoking bans


2.1 The connection of special-interest organizations that support and promote smoking bans, such as the American Cancer Society, to Nicotine Replacement Therapy (NRT) distributors is clear.  


a.) A major institutional shareholder of NicoDerm CQ manufacturer and Nicorette brand rights holder Johnson & Johnson, the Robert Wood Johnson Foundation, awards tobacco control grants to the American Cancer Society and others who promote the bans.  


b.) In addition, Nicorette distributor GlaxoSmithKline has paid an annual fee to the American Cancer Society for use of the society's seal to promote Nicorette and NicoDerm CQ.  


c.) The American Cancer Society participates in World Tobacco OR Health conferences and advances policy consistent with the interests of pharmaceutical nicotine manufacturers and distributors. See, for example, 2006 13th World Conference Declaration Committee   Co-Chair Thomas Glynn is with the American Cancer Society and has co-authored reports such as "Improving the Treatment of Tobacco Dependence"  (BMJ 2000;321:311-312 August 2000) 


d.) The American Cancer Society was the nationwide manager of the George H. W. Bush Administration's $135 million 1991 to 1998 American Stop Smoking Intervention Study (Project ASSIST). In such capacity the society established much of the infrastructure currently employed by tobacco control to advocate for and to cause the enactment of smoking bans. 


e.) Based on the foregoing, one reasonably concludes that both the Robert Wood Johnson Foundation and the American Cancer Society have deeply-entrenched professional and economic vested interests in successful smoking ban advocacy. Those vested interests, and the conflicts-of-interest that they raise are not disclosed by either the foundation or the society when advocating smoking bans. The conflicts-of-interest raise serious and sustaining questions concerning both the veracity of tobacco control statements about the actual risks of exposure to Environmental Tobacco Smoke (ETS) and the quality of data or studies used to support advocates' unwarranted claims.  


2.2 The connection of tobacco interests to smoking ban advocacy is now also well-established:  


a.) Philip Morris supports smoking bans (see Smoking Restrictions in the legislation and regulation section of its Web site. 


b.) See Philip Morris' position on other subjects in "Smoking & Health Issues" section of the company's Web site. 


c.) One mercantile basis for Philip Morris' support of smoking bans is October 2005 announcement of its "Smoke Free" Aria nicotine inhaler. Philip Morris also benefits from smoking ban advocacy through its partnership with US Tobacco for sale of smokeless tobacco products such as the Taboka brand.  


d.) Philip Morris shares at least eleven common points of interest and policy with tobacco control advocates (see Philip Morris & Tobacco Control). 


e.) The above information places Philip Morris as an economic beneficiary of smoking ban advocacy, not an arch-rival opponent of smoking bans. The company's vested interests in its relationship with those who oppose smoking bans mandate undermining earnest opposition.  


f.) Philip Morris vested interests in supporting smoking ban policy are not disclosed to the public as part of its smoking ban advocacy. Tobacco control advocates often falsely characterize Philip Morris as an arch foe when on fact the company shares at least eleven points of common agreement and vested interests with tobacco control advocates.  


2.3 The fact that smoking bans impose severe economic costs and disruptions on many hospitality establishments is now certain


a.) Anecdotal information in news stories from across the nation allege severe economic losses by some hospitality trade establishments. 


b.) Many bars, restaurants, taverns and casinos engaged in opposition to smoking bans are now maintaining month-to-month revenue records for the year preceding and following enactment of the smoking ban. The records speak for themselves. The difference between pre and post ban revenues may be regarded as economic damages associated with the smoking ban. In addition revenue data for periods when certain establishments did and did not comply with the smoking ban provide additional damage information.  


c.) The fact that revenues may modestly rise over time compared to those immediately after the ban was imposed and/or complied with does not change the fact and/or amount of ban-related damages. The preceding months have come and gone with documented losses, revenue lost in the past cannot be recovered. 


d.) The fact that some hospitality establishments, such as large chain franchise chain venues, may have experienced increases in revenues after the ban does not change the fact or amount of ban-related losses sustained by other establishments. First, many such establishments were voluntarily "Smoke Free" before the smoking ban was enacted and the ban would enure to their market share advantage; second, trade associations, such as state restaurant associations for which the majority of members are large chain francises, have historically supported smoking bans; third, trade association support for public policy that benefits its members at the expense of nonmembers or smaller members more strongly supports the mercantile nature of smoking ban advocacy and diminishes public health arguments to support such advocacy; fourth, fairness and freedom of competition dictate that one business owner's voluntary mercantile choice should not and does not equal another business owner's legal mandate; fifth, tobacco control advocates' reporting of total industry statistics to garner support for smoking bans is deceptive in that it masks and/or hides revenue loss disparity between segments of the hospitality industry.  


2.4 The connection between special-interest public policy that is directly related to a mercantile smoking ban intervention in the nicotine market is now clear


a.) Absent clear documentation of genuine, bona fide material health risk of exposure to ETS as represented by tobacco control advocates the consequences imposed by such bans strongly support the contention that smoking bans advocacy and enactment are a mercantile intervention and are not a legitimate public health intervention


b.) It is clear that mercantile special-interests such as the Robert Wood Johnson Foundation and the American Cancer Society, Johnson & Johnson, GlaxoSmithKline, and Pfizer-as well as the biggest of Big Tobacco, Philip Morris-that support and/or promote smoking bans are directly tied to prospective economic rewards garnered by doing so. 


c.) We observe the biggest of Big Tobacco, Big Drugs and Big Foundations working hand-in-glove together to advance smoking ban public policy that supports their mutual economic and other vested interests. Rather than arch-foes, as falsely held out to the public, tobacco control has become the best friend that Marlboro Man ever had.  


d.) See page  2 of Philip Morris & Tobacco Control for a graphic illustration of the Tobacco Control Enterprise created by the entwined relationships of tobacco control advocates, state agencies, pharmaceutical nicotine distributors and Big Tobacco.  


3.0 The foregoing information raises important public policy questions concerning tobacco control advocacy in general and smoking bans in particular


a.) "Blind Eye:" Elected officials cannot continue to ignore the above self-serving entwined relationships and conflicts of interest. Against such deeply-entrenched special-interests, private citizen taxpayers, consumers, and small business owner face a daunting task to be heard on tobacco-related issues or have their legitimate interests be earnestly considered by public officials. The "exclusive club" nature of state and special-interest "partnerships" effectively disenfranchises private citizens, depriving them of  meaningful representation, proper due process, and equal protection of the laws.  


b.) Consumers: Tobacco consumers are regarded by Tobacco Control Enterprise member participants to be a "Target Group" ever-escalating cigarette taxes and expanding smoking bans-now even on their private property or in their homes and vehicles. Both Big Tobacco and Big Drugs support and benefit from such policies. Against a political juggernaut of public policy supported by Big Drugs, Big Tobacco, and Big Foundations consumers have little or nor voice in public policy that adversely affects them. Moreover, tobacco control policy to "reduce public tolerance" for tobacco use negatively labels and unfavorably stereotypes them, thereby rendering them as those to be ignored. Equal protection of the laws and elected representation are virtually non-existent for tobacco consumers, in distinct contrast with nonsmokers who enjoy the special-privilege of immunity from discriminatory taxation on non-tobacco products and adverse stereotyping.  


c.) Small Business Owners: Hospitality trade establishments that accommodate patrons who smoke increasingly experience the same lack of meaningful representation and absence of equal protection of the law as the tobacco consumers they serve. In many states, enforcement of smoking bans in bars, taverns and restaurants now violates due process requirements. As many of their patrons are treated, so are hospitality small business owners.  


Perhaps we have indeed reached the "tipping point" for tobacco control. The second paper in this series will examine related legal issues.


Norman E. Kjono

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