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Concussions, Cigarettes, and Liability: The Cover-Up is Worse than the “Crime”

July 27th, 2011 2 comments

In my latest piece for Slate, I look closely at the complaint recently filed by a group (75!!) of former NFL players against the league and the manufacturers of the helmets the players wore.

The comparison to tobacco is this: the cover-up (danger of long-term consequences of even mild concussions for the NFL, the health risks and addictive nature of tobacco for the cigarette companies) is usually worse than the crime. Everyone knows this, and at least pays lip service to it, but it continues as a catch phrase because it still happens…again and again.

They’ve moved the piece up near the top (in the band of stories just below the headline group), which is a first for me. It would help if you’d wander over there and “like” (or even better, comment) on the piece.

Public Health Gone Mad! (Manipulations on Abortion and Marriage Equality)

March 15th, 2010 1 comment

Public health has a lot to answer for. Aside from its many justly celebrated triumphs from the mundane (clean water and improved sanitation) to the dramatic (the polio vaccine, the development of antibiotics), it has also been guilty of using people, especially African Americans, as a means to an end. The best-known example of public health gone wrong is of course the Tuskegee Study of Untreated Syphilis in the Negro Male conducted by the Public Health Service (predecessor to the CDC) in conjunction with the Tuskegee Institute. The CDC has a good timeline and explanation of the study here, but the essential point is that the researchers allowed the study subjects’ syphilis to go untreated even after the development of penicillin. The study began in 1932 and wasn’t discontinued until forty years later. Since then, compensation and a national apology have followed, but the damage has been done. Many African Americans harbor a deep, and to an extent justified, distrust of public health authorities.

At its more extreme form, this kind of sour taste spins off theories of vast conspiracies to wipe out the population. During the early stages of the HIV/AIDS epidemic, a rumor that the virus was a plot to cause genocide against blacks had some currency. Even more recently, about half of African-Americans surveyed either believed that HIV was a man-made virus created for black genocide or were “unsure” whether that was the case.1

It should be obvious that such distrust, and such theories, can impede prevention efforts. Nowhere is this more depressingly apparent than in a recent effort by the Georgia legislature to pass what must be the stupidest — just stupidest — bill ever considered in the effort to prevent abortions. Under the proposed law, aborting a fetus because of its race or gender would be a serious crime by a health care provider (not the woman who has the abortion). This piece of cosmic idiocy is being supported by an unlikely coalition of conspiracy-theorists and “traditional” anti-abortionists. A horrifying stew of toxic conspiracy theories can be found at this site, which seems to be a clearing house for several groups claiming, variously, that abortions are being performed on black women because doing so is profitable for abortionists, that abortion is some kind of plot to eliminate African-Americans, and that abortion is a way of controlling the birth rates of blacks (and the poor).

As with many conspiracy theories, this one has some basis in historical fact: This page does offer some useful information and links on the eugenics movement, which not surprisingly targeted African-Americans to a greater degree than the majority population. But the idea that those who are willing to perform abortions — in the face of protests, threats, and often for little financial reward — are part of some whispered effort to control or limit the African-American population is…well, nuts. But it’s this theory that accounts for the idea of punishing doctors for performing abortions: “They’re aborting to get rid of African-Americans! These genocidal maniacs must go to prison!”

How many cases do you expect would be brought, or would be successful? Very few, obviously. But the radical edge of the pro-life wing is willing to abandon principle or reason in service of any law that might possibly cause a drop in abortion rates. The hope is that by adding another threat to abortion providers, the increased in terrorem effect will be enough to drive more of them away from helping women to realize the full range of their options.

Now it’s true that black women abort their fetuses at a much higher rate than do white women. The Radiance Foundation brought forth the numbers on Georgia here, but their effort to dismiss this report by the Guttmacher Institute doesn’t work. The plain fact is that a higher incidence of unintended pregnancies, which is itself caused by deep and systemic inequalities plaguing the African-American population, is a sufficient and much more plausible explanation for the disparity. The author of the analysis had this to say:

Antiabortion activists in minority communities who are trying to protect African American women and Latinas from themselves by restricting access to safe and legal abortion have it backward. They should instead focus their efforts on reducing the disparities in access to quality health care and in health outcomes more broadly. And if they are most concerned about the disproportionately high abortion rates, they should begin by advocating for improved access to high-quality contraceptive services to reduce the disproportionately high rates of unintended pregnancy in these communities.

But the Operation Rescue crowd will take whatever allies, and whatever arguments, they can get.

Distrust of public health shouldn’t lead to an abandonment of the scientific and population-based tools that public health uses; principally, epidemiology. But the inability or unwillingness to use public health where convenient is common. Let me finish this long post with a quick note on another disturbing case, this one from Iowa. Here is a statement from the President of The Iowa Family Policy Center:

“The Iowa Legislature outlawed smoking in an effort to improve health and reduce the medical costs that are often passed on to the state,” said Chuck Hurley, president of the group. “The secondhand impacts of certain homosexual acts are arguably more destructive, and potentially more costly to society than smoking.”

He continued: “Homosexual activity is certainly more dangerous for the individuals who engage in it than is smoking.”

Hurley was relying on a recent CDC report on the disturbing incidence of HIV and syphilis on MSM (men who have sex with men). And these statistics are disturbing. But will his solution — rolling back marriage equality in Iowa — do anything to fix the problem? And is he right on the smoking comparison? No and no. And this shows that talking-head ideologues should try public health only at home, to twist a well-worn phrase.

Gay men in stable relationships are less likely to have multiple partners than those who aren’t in such relationships. The more partners, the higher the likelihood of STDs. Marriage improves stability, as its proponents tirelessly remind everyone. (And by the way, he makes no case against lesbians.)

As for the smoking comparison? He has no evidence — none — for the assertion that homosexual activity is certainly more dangerous to the individual than smoking. But who needs evidence when demonization will do?

  1. As the survey shows, they’re not the only ones with this belief, but the percentages are highest among African-Americans, and, according to some studies, Latinos.

Exporting Death: Big Tobacco, Meet Rabidly Anti-Gay Evangelists

January 4th, 2010 1 comment

This connect-the-dots article in today’s New York Times details a gruesome connection between talks that three American evangelists gave in Uganda last March and the subsequent, well-publicized, and internationally condemned proposed legislation that was introduced just a month later. A current draft of that bill lifts the death-by-hanging penalty for homosexuality in favor of life imprisonment. But the battle continues.

Naturally, the participants are beating a head-long retreat from the bill that their speeches condemning homosexuality and the “homosexual agenda” clearly spawned. At least one of the three does seem deeply sorry: Don Schmierer called the bill “horrible” and claims to have been “duped.” Scott Lively, on the other hand, is awash in blood, and apparently proud of it. He has admitted meeting with the lawmakers to discuss the bill, and blogged, provocatively, that the evangelical campaign in Uganda had been likened to “a nuclear bomb against the gay agenday” there. Bombs are lethal, and so has been the effect in Uganda, where anti-gay violence, including the “corrective rapes” of lesbians I wrote of earlier, has been on the rise since the “education” provided by this Unholy Trio. (Caleb Lee Brundidge was the third speaker.)

This wasn’t the first visit to Uganda by evangelics. Rick Warren — who, remember, delivered the invocation at Obama’s inauguration — traveled there in 2008 to deliver his anti-gay screeds. With the downturn in the domestic market for vicious anti-gay law and rhetoric, look for more of these dismal exports to follow, to Uganda and other receptive nations.

This all reminds me, in a way, of the U.S. tobacco industry’s response to the shrinking domestic market for their products, and to the troublesome increase in regulation here: Go overseas, and find and develop markets for cigarettes in nations with friendlier laws.  This report by the World Health Organization begins ominously:

Tobacco use is the leading cause of preventable death and is estimated to kill 5 million people each year, worldwide. Most of these deaths are in low and middle-income countries.

Yet the industry, as the WHO also reports, continues to resist calls for tobacco regulation, including smoke-free environments; in a reprise of its earlier dissembling about the health effects of tobacco on smokers,  Big Tobacco now refers to the harms of second-hand smoke as  “junk science.” When they do have to ‘fess up, expect the same kind of hand-wringing that we’re now seeing from the Unholy Trio.  But they won’t mean it, either.

Categories: Gay Rights, rape, religion, tobacco policy, Uganda Tags:

A Smoke-Free World?

September 25th, 2009 1 comment

I’ve just learned that, beginning in mid-2010, my school will join many others in establishing a completely smoke-free campus. No tobacco anywhere, even in your own car.

http://www.tobaccofreeutah.org/images/large_sign2icon.gifHow far we’ve come. I’d be hard-pressed to think of another common human activity whose social meaning has changed as radically over the past couple of generations. When I was working at a big ol’ NY law firm in the mid-80’s, the smokers among the junior associates were accommodated by getting their own office — three of them packed into a box barely large enough for two, with smoke billowing from the room at every hour of the day and night. But this accommodation was already a major improvement from the pervasiveness of smoking just a short time earlier: Watch any episode of Mad Men from the mid-1960’s, and you’ll see my point.

At Widener, as at many other schools and workplaces, smoking has been driven out by degrees, starting about 20  years ago: First, from common indoor areas; then out of private offices; then from general permissibility outside to restricted areas; and finally to a complete ban. Of course, state legislatures and local city authorities have been proceeding along the same course, with fewer and fewer places available for the smoker to get that fix. Indeed,  when I was in NY a couple of weekends ago for a conference, I was astounded and put off when I was given a smoking room — without notice or choice, at that. “Smoking room? What year is this?” I’d  assumed that such rooms no longer existed. They likely won’t for  much longer.

But why is this happening? The evidence on the harms caused by second-hand (or “environmental”) smoke is fairly strong, but that doesn’t explain the more extreme forms of the ban. It’s very unlikely that folks walking past a few people smoking outside are going to suffer any adverse health consequences. And there’s no reason, along those lines, for prohibiting people from smoking in their own cars.

So what, if anything, justifies the campus-wide ban on smoking and similar measures by state and private actors? Opponents argue, with some justification, that these blanket approaches are nanny state (or analogous private) intrusions on their personal autonomy and right to decide what to do with their own bodies. What’s next, stopping us from eating Snickers on campus?

I have some sympathy with this view (more so when the state is involved), but there’s another aspect to the public health, population perspective that isn’t as often considered: The harder it is to find places to smoke, the likelier it is that people will quit. Given the enormous financial and social cost of smoking, there’s justification for initiatives that discourage people from lighting up.

But it’s crucial, in such cases, to respect those that you’re about to coerce, as by offering them smoking-cessation programs and support. No habit, including heroin addiction, is harder to break. So by changing the social environment, we provide another tool for the construction of what we hope will one day become a smoke-free world. This would be one of the best health care reforms achievable, and the cost savings alone would make the rest of the debate much easier.