Journal of American Physicians and Surgeons Mission Statement The Journal of American Physicians and Surgeons, the official peer-reviewed journal of Correspondence the Association of American Physicians and Surgeons (AAPS), is committed to publishing scholarly articles related to the practice of medicine and to promoting open debate and scientific integrity. Smoking Bans about these matters, have stopped smoking Subscriptions and Advertising around their children or in their cars. [email protected] Regarding Michael Marlow’s article on Second-hand smoke is not benign. But, smoking bans,1 he and everyone I read on God help us if the federal or state Subscription Rates: AAPS Members (included in annual dues) this subject ignore one of the biggest governments succeed in legislating what Non-members $75 per year problems of “second-hand” smoke—the we can do in our own homes. Government Institutions $125 per year effect on people with asthma or reactive is more dangerous to our health than Students/Residents $15 per year airways disease. second-hand smoke! Foreign $200 per year (US currency only) I hate smoking, and hate to be around second-hand smoke, but more than that, I Lee Hieb, M.D. hate giving the government power to Logan, Ia. legislate my safety. Because everything can fall under the rubric of public safety, giving Author Reply: I acknowledge that some government power to pass laws for safety is people find exposure to concentrated Omnia pro aegroto to turn our constitutionally limited govern- environmental tobacco smoke (ETS) ment into an unlimited one. So, as much as I causes health problems to varying degrees, Copy Editor appreciate the cleaner air, I am not writing to and many others find it aesthetically Stuart Faxon advocate tougher smoking bans. uncomfortable. These people certainly From a medical perspective, however, have an interest in seeking public places Cover Design public smoking does not just impact cancer that do not allow smoking, and indeed Noah Snavely and heart disease. In a very direct way it research has shown that business owners Typesetting and Printing limits access to people who wheeze when are much more likely to voluntarily ban A Plus Printing confronted with smoke. I do not consider smoking when they cater to many Tucson, AZ myself asthmatic as I take no regular nonsmokers. So, there are often public medications for my “reactive airways.” But places that voluntarily ban smoking, and it Website I was raised in a smoking household, and as is debatable whether all places should be www.jpands.org an adult, any significant smoke exposure subjected to government-imposed smok- Webmaster causes me to have difficulty. The practical ing bans. Defending bans in public places Jeremy Snavely aspect of this was apparent the day I had to based on aesthetics and health risks for a take a driver’s license test in North Carolina few people is much more ethical than The articles published in the Journal of and the officer monitoring the classroom relying on grossly exaggerated claims American Physicians and Surgeons represent was chain smoking. I started coughing and concerning the health effects of sporadic the opinions of the authors and do not necessarily reflect the official policy of the wheezing to the point I could barely finish ETS exposure to everyone in the popu- Association of American Physicians and the exam—and a driver’s license was lation, or asserting that smoking bans lead Surgeons, Inc., or the Journal. critical to my ability to make a living. Prior to dramatic and almost immediate reduc- to smoking bans I was limited in the tions of up to 47% in the incidence of acute Publication of an advertisement is not to be restaurants I could frequent, and never sat in myocardial infarction (AMI). considered an endorsement or approval of the a cocktail lounge. I had trouble traveling on product or service involved by either the ETS is also not the only health issue that Association of American Physicians and trains and planes and buses, and would have people may face in public places since Surgeons, Inc., or the Journal. to pre-treat myself before these events. peanuts, solvents from cleaning and So, while I applaud Marlow for taking painting, various cosmetics, etc. may also POSTMASTER: on false (possibly politically motivated) pose health problems to some people, and it Send address changes to: claims for the health hazards of second- remains an open ethical debate where to 1601 N. Tucson Blvd, Suite 9 hand smoke, I can say without question that draw the line on banning substances that Tucson, AZ 85716 second-hand smoke has consequences. pose health problems for affected Perhaps the major consequence is that to population groups. My paper1 did not Journal of American Physicians children raised in smoking households, or directly enter into this debate because it and Surgeons (ISSN 1543-4826) forced to endure closed car spaces with focused on how various public health is published quarterly. smoking parents. (The increased risk of Copyright ©2010 groups and the news media have distorted by the Association of American Physicians SIDS in smoking households is well the evidence on the relationship between and Surgeons, Inc. documented.) Many smoking parents AMI incidence and smoking bans by understand this and, thanks to education unethically misrepresenting the evidence

Journal of American Physicians and Surgeons Volume 15 Number 2 Summer 2010 33 in order to push a social agenda rather than RWJF and J&J profit from the sales of 4 RWJF. The Campaign for Tobacco-Free Kids. sound science. Nicoderm and Nicorette.8 J&J more or less Publications and Research, Mar 26, 2009. cornered the market on over-the-counter Available at: http://www.rwjf.org/pr/product. Michael L. Marlow, Ph.D. nicotine replacement products. Despite the jsp?id=40868. Accessed May 11, 2010. San Luis Obispo, Calif. 5 fact that a recent study of the patches show a Consumer demand: innovations in building consumer demand for tobacco cessation Acknowledgement: I am grateful to Dr. Carl V. 9 98.4% failure rate for quitting long term (1 products and services. Roundtable Meeting 3. Phillips for his helpful comments. year or longer), that users of the gum Available at: http://www.consumer-demand. 1 Marlow ML. Do smoking bans reduce heart experience many medical problems as well org/r3_pubs/latest_purposegoals.pdf. Accessed 10 attacks?J Am Phys Surg 2010;15:13-14. as severe addiction to the gum, and that the May 10, 2010. gum and lozenges pose a higher-than- 6 McGoldrick DE, Boonn AV. Public policy to Private Foundations expected risk of oral cancer,11 RWJF-funded maximize tobacco cessation. Am J Prev Med 2010;38(S3):S327-S332. Available at: www.rwjf.org/ I read with great interest the statement organizations continue to push J&J products, in many cases with publications pr/product.jsp?id=56008. Accessed May 11, 2010. from your archives on the Robert Wood 7 12 RWJF. Updated clinical practice guideline for 1 funded by RWJF. Tobacco control is highly Johnson Foundation (RWJF). I’ve been treating tobacco use. Publications and Research, profitable, as other nonprofits benefit such following their deeds for quite some time. July 2008. Available at: http://www.rwjf.org/ as the American Cancer Society for the use What I’ve found even more interesting reports/grr/055358.htm. Accessed May 11, 2010. 13 about this “nonprofit” foundation is its of their logo on NRT packaging. This is in 8 Zhang J, Mullins B. Nomination tests antilobbyist ability to profit from the public policies direct conflict with a recent study published policy.Wall St J , May 4, 2009. Available at: they influence, whether from pressure with inPLoS Medicine that said more people http://online.wsj.com/article/SB1241399608197 their many “partnerships” or the very successfully quit smoking “cold turkey” 82109.html. Accessed May 11, 2010. generous “grants” they award. Keep in than with nicotine replacement products.14 9 Rapid response to: Moore D, Aveyard P, mind that as of their last on-line annual RWJF has given half a billion dollars in Connock M, et al. Effectiveness and safety of report, RWJF owns 42,343,391 shares of grants to fight obesity.Alog of visitors to the nicotine replacement therapy assisted reduction 2 Johnson & Johnson (J&J) stock, valued at White House in early 200915 showed RWJF to stop smoking: systematic review and meta- analysis.BMJ 2009;238:b1024. Available at: more than $2.2 billion. Also consider that a CEO Risa Lavizzo-Mourey visiting more http://online.wsj.com/article/SB1241399608197 strategy in warfare is to appear larger so as frequently than Secretary of State Hillary to convince the opposition (or Congress 82109.html. Accessed May 11, 2010. Clinton. Why? Because RWJF is entrenched 10 Askapatient Database. Ratings for Nicorette. and legislatures) they should be 16 in the “healthcare reform” establishment. intimidated by your vast numbers. Available at: www.askapatient.com/view Who has pushed for taxing soft drinks RWJF has been at the forefront in rating.asp?drug=18612&name=NICORETTE containing sugar? Note that J&J owns &page=1. Accessed May 11, 2010. tobacco control, funding advocacy organ- Splenda. Lavizzo-Mourey has met with the 11 Henderson M. Cancer risk of nicotine gum higher izations. They have awarded $446,398,054 3, pp 5-6 First Lady, who is now spokeswoman for than thought.Timesonline, Apr 22, 2009. in tobacco control grants. They created childhood obesity. A recent article17 writes Available at: www.timesonline.co.uk/ tol/life_and_ and funded the Campaign for Tobacco-Free style/health/article6143744.ece#cid=OTC- Kids with $84,000,000 in start-up money.4 of a study that showed the cost benefit of having insurance pay for weight-reduction RSS&attr=797084. Accessed May 11, 2010. RWJF has funded the American Cancer 12 American Lung Association. Helping smokers surgery to decrease later costs of obesity- Society, the American Lung Association, quit: state cessation coverage. Tobacco Policy and the American Heart Association, and related illnesses. The study was funded by Trend Report. Available at: www.rwjf.org/files/ awarded $10,000,000 in grants to the Ethicon Endo, a J&J company that research/helpingsmokersquit11132008.pdf. University of California San Francisco manufactures the medical devices for Accessed May 11, 2010. Medical School for the Smoking Cessation weight-reduction surgeries. 13 Veracity D. Is the American Cancer Society Leadership Center, directed by former When RWJF funds programs with more interested in cancer profit than cancer RWJF chief executive officer (CEO) Steven grants, both RWJF and J&J profit. Is that a prevention?Natural News, Jul 31, 2005. Schroeder, who is mentioned in your article. coincidence? Available at: http://www.naturalnews.com/ Nearly every initiative ties back to 010244_American_Cancer_Society_the_ACS. marketing nicotine replacement products: Pam Parker html. Accessed May 13, 2010. 14 ways to increase consumer demand5 and the Columbus, Ohio Hyde A. Nicotine replacement therapy over- promoted since most ex-smokers quit push to have public and private insurers pay 1 Orient JM. Statement on the influence of private 6 unassisted.Eureka Alert, Feb 8, 2010. Available for their products. Those key in promoting foundations on public policy. J Am Phys Surg at: www.eurekalert.org/pub_releases/2010- tobacco control received “awards” from 2010;15:24-26. 02/plos-nrt020410.php. Accessed May 10, 2010. 2 RWJF, for example, Michael Fiore who was RWJF. Financials. 2007 Annual Report. 15 Visitors log. Available at: http://msnbcmedia. Available at: http://www.rwjf.org/files/ key in writing the Treating Tobacco Use and msn.com/i/msnbc/Sections/NEWS/PDFs/white_ publications/annual/2007/notes-investments. Dependence guidelines which recommends house_visitors_release_2009_10_30.pdf. html. Accessed May 11,2010. physicians “provide evidence-based Accessed May 10, 2010. 3 Bornemeier J. Chapter 1. Taking on tobacco: the cessation counseling and medications. For 16 RWJF.Health reform. Available at: http://www.rwjf. Robert Wood Johnson Foundation’s assault on patients unwilling to quit at this time, org/healthreform/. Accessed May 10, 2010. 7 tobacco. In:To Improve Health and Health Care , 17 provide motivation counseling.” Stanton vol VIII. The Robert Wood Johnson Foundation Rundle RL. Obesity surgery is called cost- Glantz, James Repace, and many other Anthology; 2005. Available at: www.rwjf.org/ effective.Wall St J , Sep 8, 2008. Available at: tobacco control researchers and advocates files/publications/books/2005/chapter_01.pdf. http://online.wsj.com/article/SB12208279402 also received “awards” from RWJF. Accessed May 11, 2010. 6608293.html. Accessed May 11, 2010.

34 Journal of American Physicians and Surgeons Volume 15 Number 2 Summer 2010