December 21, 2011, Jeremy Laurance, The Independent

The tobacco industry is accused today of misleading smokers over the safety of additives in cigarettes.

READ MORE via Tobacco firms misled public about additives – Health News – Health & Families – The Independent.

July 15, 2011, Boston Globe, Alex Beam

“Hey, fatty! Pull that doughnut out of your pie hole! You look like a pig, and you are costing me, and every other taxpayer, billions of dollars in unnecessary health care each year!’’

How do you like my new public service ad campaign, designed to stigmatize the overweight and the obese in the same way smokers have been made to feel the knout of social opprobrium for the past quarter-century?

I got the idea when I heard professor Daniel Callahan, the retired cofounder of the Hastings Center, a bioethics research institution, speak on a radio program about two weeks ago. Why aren’t overeaters subject to the same stigmatization as smokers?, he mused. Why not indeed? I phoned him, and he sent me a draft paper he had written on the subject: “Harnessing Stigma or Stigmatizing Stigma? The Case of Obesity.’’

Callahan makes a persuasive case: 67 percent of Americans are overweight, he writes. “Obesity is a leading cause of diabetes, heart disease, and kidney failure. There are some prima facie reasons for thinking about stigmatization as one more arrow in the quiver of possible solutions.

“It can hardly be said that obesity is beyond individual control,’’ he continues. “So, why not stigmatize [the obese], bringing social pressure to bear?’’

What could be more logical? No category of US citizens, with the possible exception of prisoners, has been subjected to more government-sponsored economic and social harassment than cigarette smokers. Last month every newspaper and TV station in the country gleefully reported the latest taxpayer-funded attack on smokers: graphic new cigarette warning labels, depicting coffin-nail addicts as losers with rotten teeth and, of course, dead.

Taxed up the wazoo, forced to pay hundreds of extra dollars for health insurance, tossed out in the rain and snow to sneak a few puffs of the dreaded cancer sticks – smokers are the deadbeat dads of the public health landscape. Here in Boston, there is a move afoot to ban smokers from public housing. In New York, Mayor Michael Bloomberg is ticketing cigarette smokers in public parks.

“The effort of smokers to invoke their civil rights gained no traction,’’ Callahan writes, “and the public health community made no moves to come to their aid.’’

I was looking forward to chatting with Callahan, because he sounded like a public health writer unfettered by modish jargon and the strictures of political correctness. He agreed to speak with me by phone from his vacation aerie on Little Cranberry Island, Maine. Practically the first words out of his mouth were: “I am switching sides. I don’t want to lead a crusade for stigmatizing men and women who have trouble controlling their weight. It would be enormously hurtful for a lot of people.’’  …

Read the rest of the story at:  What’s wrong with subjecting obese Americans to the same stigmatization that smokers are? – The Boston Globe.

July, 5, 2011, Fast Company, Morgan Clendaniel

If you’re willing to put aside the cancer and emphysema and be a smoker, your last excuse might have just gone up in smoke. Smokers often claim that their habit serves as an appetite suppressant. They may be risking disease later in life, but at least they’re preventing obesity today. But that contention has just been disproved.

For the most part, smokers are actually more overweight than non-smokers.

The study looked at 6,000 smokers and non-smokers, comparing their body-mass index (BMI, a ratio of height to weight) and their waist-hip ratio (WHR). Lo and behold, the smokers were not the waifish models one has come to expect. Rather, both male and female smokers had higher WHR and male smokers had higher BMIs.

Could this mean that overweight people are simply more likely to smoke? Possibly, though during the course of the study, female smokers’ WHR increased, while female non-smokers stayed the same. It’s enough to poke holes in smokers’ last hiding place. There is nothing good to come from smoking, and the medical costs associated with caring for smokers affect us all.

via Smoking Isnt Why Youre Thin | Fast Company.

June 22, 2011, Boston Globe, By Deborah Kotz and Neena Satija

Cigarette packages will soon be splashed with horror-movie-style warning labels showing corpses, diseased lungs, and rotted teeth, which were among nine new images unveiled yesterday by the Food and Drug Administration. By September 2012, cigarette manufacturers will be required to place these images across the top half of every pack, with large-type warnings such as “smoking can kill you’’ and “cigarettes are addictive.’’

The new images will replace the small white warning boxes that have adorned cigarette packages unchanged for more than two decades; they are required under a federal law passed in 2009 that gave the FDA regulatory authority over cigarettes. The same new warnings will appear on print ads and must take up at least 20 percent of the ad space.

“The new graphic warnings will make a powerful difference,’’ FDA Commissioner Dr. Margaret A. Hamburg said in an interview. “Research demonstrates that they encourage smokers to quit and nonsmokers to not start.’’

Packages will also contain the 1-800-QUIT-NOW toll-free telephone number, she added, to provide smokers with a resource to help them quit.

Greg Connolly, a professor at Harvard’s School of Public Health and former director of Massachusetts’ tobacco control program, called the new labels “a marvelous improvement over what we’ve had for over 25 years.’’ But he cautioned that they won’t work unless they’re accompanied by a mass media campaign, similar to ads that Massachusetts and some other states have aired featuring “real people telling real stories.’’

While graphic warning labels appear to galvanize people to quit in the short term, there is no evidence that those smokers quit for good, he added.

Some 43 countries, including Canada, Great Britain, and Brazil, already require large graphic warnings on cigarette packages, and a European Union directive gives its 27 member countries the option of adding pictures to warnings as a way to educate smokers about risks.

A 2006 study found that two-thirds of smokers in four countries that have graphic warning labels reported that the package was an important source of health information and strongly associated with an intention to quit smoking.

David Pham, a Boston financial analyst, remembers his reaction when a friend offered him a cigarette from a Canadian box featuring the warnings. “I didn’t even want to smoke anymore … I told him I’ll pass,’’ said the 28-year-old. But while he’s been trying to quit ever since, he still smokes up to a pack a day. “When you need a fix, you’re still going to buy it,’’ he said as he puffed on a cigarette outside his office near South Station.

via Cigarette warnings getting graphic – Boston.com.

June 21, 2011, Press release, Harvard School of Public Health

A new study from Harvard School of Public Health (HSPH) and University of California, San Francisco, researchers suggests that men with prostate cancer who smoke increase their risk of prostate cancer recurrence and of dying from the disease. A link also was found between smoking at the time of prostate cancer diagnosis and aggressive prostate cancer, overall mortality (death) and cardiovascular disease mortality.

“In our study, we found similar results for both prostate cancer recurrence and prostate cancer mortality,” said Stacey Kenfield, lead author of the study and a research associate in the HSPH Department of Epidemiology. “These data taken together provide further support that smoking may increase risk of prostate cancer progression.”

The study was published in the June 22-29, 2011, Journal of the American Medical Association (JAMA). It is the largest study to date to look at the relation between smoking at the time of prostate cancer diagnosis and prostate cancer-specific mortality and recurrence.

Kenfield and her colleagues conducted a prospective observational study of 5,366 men diagnosed with prostate cancer between 1986 and 2006 in the Health Professionals Follow-Up Study. The researchers documented 1,630 deaths, 524 (32%) due to prostate cancer, 416 (26%) due to cardiovascular disease, and 878 prostate cancer recurrences.

The researchers found that men with prostate cancer who were current smokers had a 61% increased risk of dying from prostate cancer, and a 61% higher risk of recurrence compared with men who never smoked. Smoking was associated with a more aggressive disease at diagnosis, defined as a higher clinical stage or Gleason grade (a measure of prostate cancer severity). However, among men with non-metastatic disease at diagnosis, current smokers had an 80% increased risk of dying from prostate cancer.

Compared with current smokers, men with prostate cancer who had quit smoking for 10 or more years, or who had quit for less than 10 years but smoked less than 20 pack-years before diagnosis, had prostate cancer mortality risk similar to men who had never smoked. Men who had quit smoking for less than 10 years and had smoked 20 or more pack-years had risks similar to current smokers.

Prostate cancer is the most frequently diagnosed form of cancer diagnosed in the United States and the second leading cause of cancer death among U.S. men, affecting one in six men during their lifetime. More than 2 million men in the U.S. and 16 million men worldwide are prostate cancer survivors.

Study co-authors include Meir Stampfer, professor of nutrition and epidemiology at HSPH, and June Chan, associate professor of epidemiology and biostatistics and urology at University of California, San Francisco.

The study was supported by grants from the National Institutes of Health.

“Smoking and Prostate Cancer Survival and Recurrence,” Stacey A. Kenfield, Meir J. Stampfer, June M. Chan, and Edward Giovannucci, Journal of the American Medical Association, June 22-29, 2011.

via Smoking May Increase Risk of Prostate Cancer Recurrence, Death – June 21, 2011 -2011 Releases – Press Releases – Harvard School of Public Health.

Food and Health News, November 22, 2010

Eating five portions of fruit and vegetables per day is one of the means that experts most frequently recommend for preventing cancer. Now, the European EPIC study carried out by researchers from 10 countries has shown that, in the case of lung cancer, the important thing is not just the quantity but also the variety of fruit consumed, which can reduce the risk by up to 23%.

“This research looks more deeply into the relationship between diet and lung cancer”, María José Sánchez Pérez, co-author of the study and director of the Granada Cancer Registry at the Andalusian School of Public Health, tells SINC.
She says: “Aside from the amount consumed, it’s also important to take into account the variety. A varied diet reduces the risk of developing this cancer, above all in smokers”.

The results of this study, which have been published in the journal Cancer Epidemiology, Biomarkers & Prevention, show that eating “more than eight sub-groups” of vegetables cuts this risk by 23% compared with eating “less than four sub-groups”. In addition, this risk falls by a further 4% for each unit added to the diet from another sub-group.

“A significant link was only found in smokers”, the researcher stresses. “For every two additional units of different kinds of fruits and vegetables in the diet, the risk of lung cancer falls significantly by 3%. So if smokers increase the variety of fruit they eat they could have a lower risk of developing this type of cancer”.

The European Prospective Investigation into Cancer and Nutrition (EPIC) involves 23 centres from 10 European countries (Germany, Denmark, Spain, France, Greece, Holland, Italy, Norway, the United Kingdom and Sweden, working with a sample of 500,000 European subjects (41,000 of whom live in the Spanish regions of Asturias, Granada, Guipúzcoa, Murcia and Navarre).

Lung cancer continues to be one of the most common cancers in developed countries. For this reason, despite the encouraging results of this study, Sánchez Pérez concludes that “the most effective way of preventing it continues to be reducing the prevalence of tobacco consumption among the populace”.

The effect by type of cancerous tissue

Greater variety in fruit and vegetable consumption is associated with a lower risk of developing epidermoid carcinoma of the lung, with an additional two units of fruit and vegetable consumption leading to a 9% reduction in risk. This effect is clearer among smokers (where the risk falls by 12%).

No significant association between fruit and vegetable consumption and the risk of developing lung cancer was seen for the other kinds of tissues affected (adenocarcinoma and small and large cell carcinoma).

Made possible by: Stephan van Duin

New York Times, Duff Wilson, November 13, 2010

As sales to developing nations become ever more important to giant tobacco companies, they are stepping up efforts around the world to fight tough restrictions on the marketing of cigarettes.

Companies like Philip Morris International and British American Tobacco are contesting limits on ads in Britain, bigger health warnings in South America and higher cigarette taxes in the Philippines and Mexico. They are also spending billions on lobbying and marketing campaigns in Africa and Asia, and in one case provided undisclosed financing for TV commercials in Australia.

The industry has ramped up its efforts in advance of a gathering in Uruguay this week of public health officials from 171 nations, who plan to shape guidelines to enforce a global anti-smoking treaty.

This year, Philip Morris International sued the government of Uruguay, saying its tobacco regulations were excessive. World Health Organization officials say the suit represents an effort by the industry to intimidate the country, as well as other nations attending the conference, that are considering strict marketing requirements for tobacco.

Uruguay’s groundbreaking law mandates that health warnings cover 80 percent of cigarette packages. It also limits each brand, like Marlboro, to one package design, so that alternate designs don’t mislead smokers into believing the products inside are less harmful.

The lawsuit against Uruguay, filed at a World Bank affiliate in Washington, seeks unspecified damages for lost profits.

“They’re using litigation to threaten low- and middle-income countries,” says Dr. Douglas Bettcher, head of the W.H.O.’s Tobacco Free Initiative. Uruguay’s gross domestic product is half the size of the company’s $66 billion in annual sales.

Peter Nixon, a vice president and spokesman for Philip Morris International, said the company was complying with every nation’s marketing laws while selling a lawful product for adult consumers.

He said the company’s lawsuits were intended to combat what it felt were “excessive” regulations, and to protect its trademark and commercial property rights.

Cigarette companies are aggressively recruiting new customers in developing nations, Dr. Bettcher said, to replace those who are quitting or dying in the United States and Europe, where smoking rates have fallen precipitously. Worldwide cigarette sales are rising 2 percent a year.

But the number of countries adopting tougher rules, as well as the global treaty, underscore the breadth of the battleground between tobacco and public health interests in legal and political arenas from Latin America to Africa to Asia.

The cigarette companies work together to fight some strict policies and go their separate ways on others. For instance, Philip Morris USA, a division of Altria Group, helped negotiate and supported the anti-smoking legislation passed by Congress last year and did not join a lawsuit filed by R. J. Reynolds, Lorillard and other tobacco companies against the Food and Drug Administration. So far, it is not protesting the agency’s new rules, proposed last week, requiring graphic images with health warnings on cigarette packs.

But Philip Morris International, the separate company spun out of Altria in 2008 to expand the company’s presence in foreign markets, has been especially aggressive in fighting new restrictions overseas.

It has not only sued Uruguay, but also Brazil, arguing that images the government wants to put on cigarette packages do not accurately depict the health effects of smoking and “vilify” tobacco companies. The pictures depict more grotesque health effects than the smaller labels recommended in the United States, including one showing a fetus with the warning that smoking can cause spontaneous abortion.

In Ireland and Norway, Philip Morris subsidiaries are suing over prohibitions on store displays.

In Australia, where the government announced a plan that would require cigarettes to be in plain brown or white packaging to make them less attractive to buyers, a Philip Morris official directed an opposition media campaign during the federal elections last summer, according to documents obtained by an Australian television program, and later obtained by The New York Times.

The $5 million campaign, purporting to come from small store owners, was also partly financed by British American and Imperial Tobacco. The Philip Morris official approved strategies, budgets, ad buys and media interviews, according to the documents.

Mr. Nixon, the spokesman, said Philip Morris made no secret of its financing of that effort. “We have helped them, not controlled them,” he said.

Mr. Nixon said Philip Morris agreed that smoking was harmful and supported “reasonable” regulations where none exist.

“The packages definitely need health warnings, but they’ve got to be a reasonable size,” he said. “We thought 50 percent was reasonable. Once you take it up to 80 percent, there’s no space for trademarks to be shown. We thought that was going too far.”

These days in courts around the world, the tobacco giants find themselves on the defensive far more than playing offense. The W.H.O. and its treaty encourage governments and individuals to take legal action against cigarette corporations, which have encountered growing numbers of lawsuits from smokers and health care systems in Brazil, Canada, Israel, Italy, Nigeria, Poland and Turkey.

But in other parts of the world, notably Indonesia, the fifth-largest cigarette market, which has little regulation, tobacco companies market their products in ways that are prohibited elsewhere. In Indonesia, cigarette ads run on TV and before movies; billboards dot the highways; companies appeal to children through concerts and sports events; cartoon characters adorn packages; and stores sell to children.

Officials in Indonesia say they depend on tobacco jobs, as well as revenue from excise taxes on cigarettes. Indonesia gets some $2.5 billion a year from Philip Morris International alone.

“In the U.S., they took down billboards, agreed not to sponsor music events, no longer use the Marlboro cowboy,” said Matthew L. Myers, president of the Washington-based Campaign for Tobacco-Free Kids. “They now do all of those things overseas.”

The world’s second-biggest private cigarette maker, British American Tobacco, with $4.4 billion profits on $23 billion sales in the year ending June 30, is spending millions of dollars lobbying against anti-smoking health measures, like smoke-free air policies in the European Union.

A video on the company’s Web site says some of the proven methods of reducing smoking — like taxes and display bans — encourage a black market in cigarettes and that, in turn, would finance drug, sex and weapons traffickers and terrorists.

The six-minute video, in which actors play gangsters, one with an Eastern European accent, concludes, “Only the criminals benefit.”

The conference beginning on Monday in Punta del Este, Uruguay, will try to add specific terms to a public health treaty known as the Framework Convention on Tobacco Control, which since 2003 has been ratified by 171 nations. It would eventually oblige its parties to impose tighter controls on tobacco ingredients, packaging and marketing, expand cessation programs and smoke-free spaces and raise taxes — proven tactics against smoking.

President George W. Bush signed the treaty in 2004 but did not send it to the Senate, where a two-thirds vote is needed for ratification. President Obama hopes to submit it to the Senate next year, a White House spokesman said on Thursday.

One recommendation drawing fire from tobacco farmers would either restrict or prohibit the use of popular additives, like licorice and chocolate, to blended tobacco products that account for more than half of worldwide sales.

The International Tobacco Growers’ Association says that could threaten the makers of burley tobacco, an air-cured leaf that has long been sweetened with additives, costing millions of farmers their jobs and devastating economies worldwide.

“We all know the real objective here is to eliminate tobacco consumption,” says Roger Quarles, a Kentucky grower and president of the association.

Aubrey Belford contributed reporting.

This article has been revised to reflect the following correction:

Correction: November 14, 2010

An earlier version of this article made an incorrect reference to Uruguay’s gross domestic profit rather than its gross domestic product.
Cigarette Giants in Global Fight on Tighter Rules – NYTimes.com.

The New York Times, Michael Barbaro and Anemona Hartocollis, November 16, 2010

By her own account, Cathleen P. Black, Mayor Michael R. Bloomberg’s choice to be the next New York City schools chancellor, has had almost no experience with the public education system.

But for nearly 20 years, she played an influential role in a company that did: Coca-Cola.

As America awoke to a national obesity epidemic and schools tried to rid their hallways of sugary drinks, Coca-Cola emerged as the biggest and most aggressive opponent of the scientists, lawmakers and educators who tried to sound the alarm.

The company unleashed a flurry of lobbyists, donations and advertising to fight the efforts, prompting local officials to describe it as “bullying” and “unconscionable.” Even as other large food manufacturers embraced the public-health measures, Coca-Cola dug in its heels, rewarding schools that kept selling its products and threatening those that would not, officials said.

Through most of these battles, Ms. Black, the magazine executive nominated last week to lead the nation’s largest school system, was one of 14 people on the company’s board of directors, and she sat on a company committee that focused on policy issues including obesity and selling soda to children. On a board that meets six times a year, she was privy to internal debates about the company’s combative strategy, and there is no public evidence that she ever questioned it.

“I don’t think we’ve gone to a single meeting in the last two years where we haven’t discussed that issue,” said Donald McHenry, a longtime Coke board member and a professor at Georgetown University who sat on the committee with Ms. Black.

Mr. McHenry would not characterize Ms. Black’s views on the topic, and she has declined interview requests since she was tapped. A spokesman for Coca-Cola and a spokesman for the city both declined to discuss Ms. Black’s role in the debate over how to handle the issue of sodas in schools.

Ms. Black resigned from the Coke board this week, citing potential conflicts of interest, but her time at the company is especially striking because the man who chose her for the schools job has declared soda an urgent public health menace and has plastered the city’s subway cars with advertisements that liken drinking it to ingesting goopy liquid fat.

“Normally, I would think that somebody who served for 18 years on the board of this junk-food producer is tainted,” said Michael Jacobson, executive director of the Center for Science in the Public Interest.

“If you’re judged by the people with whom you hang out, it’s not a good sign,” said Dr. Jacobson, whom Mr. Bloomberg recently nominated for a national health “hero award” and who received it last month. “But I wouldn’t say it’s disqualifying. I don’t know what role she played on the board. It could be she was pushing them to cut the sugar or sell fruits and vegetables. It’s hard to know.”

He added, “I don’t want to be naïve, because I don’t know what she pushed for, if anything — or was it easy money?”

Asked about the apparent conflict between Mr. Bloomberg’s views and the work of his nominee, a spokeswoman for the mayor reiterated his opposition to the sale of sugary drinks in schools and his support of Ms. Black, saying the policy would continue under her chancellorship.

In nominating Ms. Black, Mr. Bloomberg said she would bring corporate innovation and management savvy to the sprawling system. But her record at Coca-Cola shows she will bring corporate baggage as well.

Ms. Black had been on the board since 1990, except for a brief leave, earning well over $2.1 million in cash and stock over the years, according to Equilar, which studies corporate pay. (Her current stock holdings in Coca-Cola are worth $3.3 million.)

During Ms. Black’s tenure, pressure intensified on soda companies to limit sales in schools after Dr. David Satcher, the surgeon general, in 2001 declared obesity a national crisis with “tragic results.” He urged local communities to lead the fight. And much to the beverage industry’s chagrin, they did.

In 2003, California and New York City banned the sale of soft drinks in elementary and middle schools. At the same time, a coalition of lawyers who had successfully sued tobacco companies began developing strategies for taking on food companies, threatening a barrage of lawsuits.

By 2006, when Connecticut tried for the second year in a row to join the wave of local governments barring sugary drinks at schools, Coke and other companies pumped hundreds of thousands of dollars into a bare-knuckle battle to stop the legislation.

According to Connecticut state officials, Coke lobbyists warned school districts that if the legislation passed, Coke would stop providing money for after-school programs, which it had done in exchange for the right to put vending machines on campus.
State Senator Donald E. Williams Jr., who sponsored the legislation, recalled that company representatives “targeted urban legislators and reminded them that the soda companies often contributed significant amounts of money to schools to buy scoreboards and to supplement their needs.” (At the time, Coke denied making any threats.)

The fight in Connecticut put a harsh spotlight on Coke’s longstanding practice of rewarding school districts for exclusive contracts to sell its beverages. Lawmakers revealed that Coke paid a higher commission to schools for the sale of carbonated drinks than for juice or water. And they showed that the company dispensed “marketing bonuses ” to districts that signed on, including free supplies of sports drinks and Coke-branded coolers to be placed on the sidelines at athletic fields.

Connecticut’s attorney general, Richard Blumenthal, called the strategies “unconscionable.” The state law was enacted by a slim margin.

About the same time, under pressure from the growing tide of state legislation and the intensifying threat of lawsuits, Coke eventually agreed to not sell sugary soda in American schools (the agreement allowed diet sodas and sports drinks to still be available in high schools).

But it was not long before Coke once again pushed the envelope. This March, the leading soda makers seemed to reached a milestone agreement to stop selling sugar-laden drinks to schools around the world, bowing to critics who argued that the companies were still exploiting children in emerging markets like India and China.

But while Pepsi said it would keep the drinks out of all schools, Coke carved a loophole, conspicuously reserving the right to sell them depending on local demand. “Shame on Coca-Cola,” proclaimed the Center for Science in the Public Interest.

“High school students everywhere deserve the same help as American high schoolers,” the group said.

In New York, where Ms. Black is the chancellor in waiting, her likely new boss, Mr. Bloomberg went well beyond school grounds, trying to curtail soda consumption with a new statewide tax on sugary drinks.

Coca-Cola and Pepsi bottlers, joined by the American Beverage Association, a trade group, spent heavily on an elaborate television campaign featuring hard-up mothers and children stocking the family refrigerator with beverages. The proposal was defeated.

Mr. McHenry, the Coke board member, said he opposed the efforts, like those in New York City, to single out individual products and companies as an unfair overreaction. “The ads in New York City and the approach in New York City is not fact-based,” he said. “It’s good publicity, but I just think it’s poor science.”

Asked how Ms. Black might handle the issue as chancellor, he said, “I am sure Cathie’s effort is the same as mine would be: to make sure that people make policy on the basis of science and facts, and let those things guide you.”

Cathleen P. Black on Coke Board During Soda Wars – NYTimes.com.

The Huffington Post, November 18, 2010

Research is medicine’s field of dreams from which we harvest new findings about the causes, treatment and prevention of disease. During the 20th century, the triumph of public health and medical interventions as a result of investments in research significantly improved the health and well being of people living in our country. In 1900, the average life expectancy for Americans was just 48 years and the major causes of death then were infectious diseases and, for women, also complications of childbirth. Since then, food and water safety, improved hygiene and sanitation, vaccines, antibiotics, and other medications, better nutrition and improved access to health care extended Americans’ average lifespan by more than 30 years. That’s a 40 percent increase in lifespan in one century–what a remarkable achievement! This represents a greater increase than occurred in the prior 200,000 years that the human species has existed!

As a result, nations are facing a chronic disease epidemic with rising rates of heart disease, cancer, stroke, diabetes, and neurodegenerative illnesses like Alzheimer’s. These chronic illnesses now account for 87 percent of deaths in the United States and nearly 50 percent of mortality and disability in low- and middle-income countries (LMICs). The combined toll taken by chronic diseases with that of infectious illnesses such as HIV/AIDS, malaria, TB and influenza (accounting for one out of four deaths worldwide), represent international enemies that rob citizens of good health , damage economies as a consequence of lost productivity and escalating health care costs, and threaten national security.

This is why science matters. By generating new knowledge and fueling innovation, science provides solutions to national and global health challenges. And that is why I am honored to be included in this year’s Rock Stars of Science campaign, a philanthropic initiative supported by the Geoffrey Beene Foundation and GQ magazine. This educational initiative shines a spotlight on science and scientists, underscoring the urgent need for increased investments in research to find cures for the diseases that devastate people’s lives, strategies to promote better health, as well as to attract young people to careers in medical and public health research and practice. The campaign does this by pairing doctors with rock stars, highlighting the synergies of both professions, in the December, 2010 issue of GQ magazine and online. You see, rock stars and scientists share passion, creativity, and the thrill of discovery. Where musicians use their minds, instruments and voices to create new rhythms, researchers use science and technology to make the music of medicine: new discoveries that improve health and eradicate disease.

The campaign draws attention to the fact that in order for the United States to continue making significant improvements in the quality of our lives and in longevity as well as to remain competitive in an increasingly technology-driven global economy, our country must strengthen its investments in science and support a new generation of researchers. Research is the foundation for all medical and public health interventions. Over the past 50 years there has been an explosion of new knowledge and revolutionary changes in the practice of medicine driven by science and technology.

In fact, more has been learned about health and disease in the past 50 years than in the entire history of medicine. This transformation over the past half century in knowledge about our health has been driven by two major discoveries: the semi-conductor in 1947 that led to the development of computers, and of DNA in 1953 that led to the emergence of a new field, genetic medicine, which is illuminating the very building blocks of life. In 2003, scientists completed mapping the human genome — a monumental accomplishment that resulted from an international scientific collaboration begun in 1990.

Learning more about genes is leading us to a better understanding of disease, earlier detection of illness, and to the development of designer drugs targeting specific genetic misspellings so that certain illnesses might not have to develop in the first place. It has also produced a new field of personalized medicine where interventions are targeted to the molecular mechanisms and biological signature of a person’s illness. For example, much like antibiotics revolutionized the treatment of infectious diseases, in the war against cancer (a disease that will affect 1 out of 3 people in their lifetimes), a whole new generation of therapies is being designed based on new knowledge about what gives cancer life in the first place. New treatments are being developed to trick cancer cells into self-destructing. Other strategies include targeting the genes that tell cancer cells to divide and turning them off. Still other approaches include medications that choke off the blood supply that cancer cells need to grow (a process called angiogenesis) as well as monoclonal antibodies and vaccines to boost the immune system to fight cancer more effectively as well as to prevent the disease from ever occurring in the first place.

The role of sex and gender differences in these interventions and in the causes, presentation and prevention of disease are being elucidated and is one of the most important frontiers of research in the 21st century. It is a field that I am proud to have helped advance through research initiatives, advocacy, the use of technology, including the establishment of initiatives such as the National Centers of Excellence on Women’s Health at academic centers across the United States, the National Women’s Health Information Center, and the ” From Missiles to Mammograms” initiative that transferred DOD, CIA, and NASA imaging technology used for intelligence and space exploration to improve breast cancer detection.

A Prevention Revolution
Over 2000 years ago, Hippocrates wrote, “prevention is preferable to cure.” For centuries, we have spoken about the importance of prevention, yet only 3-5 percent of America’s $2.6 trillion health care budget was spent on it in recent years. That is why today, more than ever, a prevention revolution is needed given that 50 percent of the cause of the ten leading killers of Americans, including heart disease, stroke, cancer and diabetes, are linked to lifestyle and behavioral factors. Furthermore, 75 percent of health care costs in the U.S. are associated with preventable factors including smoking, obesity, lack of physical activity, and alcohol abuse.

More research is required on the environmental factors that affect health including what has changed in our homes, workplaces and the atmosphere such as pollution, environmental toxins,and climate change that may be contributing to rising rates of some diseases in our lifetimes. Public health research addresses the key role that behavioral, social and environmental factors play in illness and improves our understanding of the causes, treatment and prevention of disease. Through the identification of risk-enhancing and protective factors, this research develops and evaluates interventions to prevent chronic and infectious diseases as well as injuries, including strategies to improve health over the long-term. Public health research is also a critical component of the science of health care delivery, identifying methods to change health behaviors — not just of patients, but of doctors, nurses, and the system in which health care services are delivered.

In this regard, a new field of comparative effectiveness research is emerging to inform medical decision — making by evaluating a broad range of interventions to help produce better outcomes, safety and quality services at a lower cost. This field of study is an important component of determining the most cost-effective medical and public health interventions, serving as an important ingredient for helping to guide practice standards, accelerating health systems redesign and encouraging innovation in health delivery. The development and dissemination of such information will have enormous benefits for increasing the effectiveness and efficiency of clinical practice and our health care system where currently patients receive the right treatment only 55 percent of the time.

Furthermore, we must decrease the 15 year science to service gap that currently exists from the time of a new discovery in the laboratory to its wide dissemination and adoption into community practice. In the Information Age, why shouldn’t the science to service gap be reduced to a nanosecond? Science cannot save people unless we apply what we know. That is where information technology has a critical role to play. By building a 21st century health information infrastructure with electronic medical records, clinical decision support tools, remote monitoring of chronic disease, telemedicine, and the use of mobile phones for health research, consumer participation and to aid clinical practice, patients and providers can be connected almost instantaneously to state-of-the-art information and real time expertise to improve their health.

What the World Needs Now Is Research
In an interconnected world where 2 million people cross national borders every day, the transmission of an infectious disease like AIDS or pandemic flu, the spread of obesity and tobacco use, as well as food and water safety, do not respect country boundaries. And that is why increased investments in global health research are essential for humanitarian, economic and national security reasons. In some nations, because of deaths from AIDS and other infectious diseases, people’s life-spans are shrinking to what they were in medieval times. One-fifth of children around the world have a shorter life expectancy than their siblings born 15 years ago as a result of HIV/AIDS. Premature death from AIDS, TB, and malaria leads to lost productivity and political instability.

However, over the past 50 years, thanks to investments in global health, we have witnessed more gains in human development than at any time in history. Health care is now reaching the far corners of the world. Smallpox, a disease that had killed millions of people, was eradicated. In the last twenty years, polio infections have decreased 99 percent as a result of global efforts to eradicate this disease. Thanks to advances from global health research, antiretroviral medications to treat HIV/AIDS have been developed that have saved the lives of millions. Soon the results of scientific studies conducted in multiple countries will reveal whether these medications can be taken as a “prevention pill” to stop transmission of the virus before infection. Recent research has also found that a microbicide gel reduced HIV transmission by 40%, providing hope for a prevention technology for women worldwide. And studies are underway to develop new prevention strategies, including vaccines to prevent infection with HIV/AIDS and malaria. The work of PEPFAR, the Global Fund to Fight AIDS, TB and Malaria, and other initiatives are making a lifesaving difference but require increased funding to strengthen their impact. These illness continue to devastate countries as 33 million people are currently infected with HIV, 2 million people die annually from AIDS, 1.7 million from TB, and 1 million from malaria.

Furthermore, the President’s Global Health Initiative (GHI) is expanding scientific collaboration with other countries and investing in science and technology to spark a leap forward in development. A critical component of the GHI is investing in the health, education and the rights of women. Currently, a woman dies from childbirth complications every minute globally — that’s 500,000 deaths annually. These lives could be saved with public health interventions that have been developed through investments in research. The initiative underscores that when the health of a woman is improved and she is provided with educational and occupational opportunities, not only will she flourish, but the health and prosperity of families, countries and the world will be enhanced.

But we must do more. Increased investments are needed to foster innovative, collaborative global health research initiatives for health systems strengthening in nations to promote their independence, to increase access to lifesaving treatment , to scale up prevention, and to deliver better and more coordinated care as well. Public/private sector partnerships are needed that can respond effectively to global health threats and to promote better health worldwide. Strengthening research, surveillance, monitoring and evaluation are essential to developing effective interventions to advance global health. A critical component of such efforts is training the next generation of scientists to address global health needs. This will require including an emphasis on global health in medical and scientific university curricula as well as providing funding in order to support the development of interdisciplinary research training. Universities can play an important role by harnessing the talent and interest of young scientists and enabling them to conduct research in international settings.

But scientific breakthroughs and improvements in U.S. and global health don’t just happen. They are the result of sustained investments in research at the NIH, CDC, NSF, and other Federal agencies in the United States and in countries around the world as well as in the private sector. Erractic funding for biomedical research has severely crippled the field with below inflation funding at the NIH and other science agencies over the last several years until the $10 billion bolus from the Stimulus Bill. This boost in financial support provided by the American Recovery and Reinvestment Act should be the catalyst for innovative research to come if it marks the beginning of sustained increases in research funding.

That is why we all must be advocates for increased funding to accelerate the pace of progress from scientific discovery, to improve clinical care, and to foster the career development of young scientists.

Science Amnesia
The bottom line: science matters. Our long-term investments in research, in science education, in the career development of researchers and in laboratory infrastructure have produced once-unimaginable discoveries that serve today as significant drivers of America’s economic competitiveness, national security and are an engine of societal progress. America’s health and economic future lies in science and technology growth and research.

Yet the American public has grown distant from science. Most Americans cannot explain the scientific process — what it means to form a hypothesis and test it — and few can name a living scientist. Scientific and medical topics are conspicuously absent in the media: In 2009, science and technology issues represented only 1.6 percent of all news stories in print, online, and on television. For every five hours of cable news, one minute is devoted to science.

Furthermore, we are losing this generation of young Americans to careers other than science, undermining our future innovation and global competitiveness as a nation. America has witnessed a slow, steady erosion in its homegrown scientific talent base. As of 2003, only 12 percent of all college graduates held jobs in the fields of science and engineering. For medicine and public health, training of new professionals must begin at the earliest stage of primary education, and continue through adult life. In the big picture of global competition and societal needs, it is critical for the United States to produce more scientists and engineers in order to sustain its leadership in research. Primary and secondary education systems are currently suffering from a wide variety of challenges: a morass of educational standards; high student-to-teacher ratios; “burnout” of quality teachers; and teacher preparation and compensation disparities. Beyond the secondary level, inadequate preparation in mathematics and science prevents many students from achieving their potential, as do increased costs of science-intensive college and postgraduate education. The nation’s research universities are also undergoing financial stress because of recent federal research funding cuts, which typically provide 65% of these institutions’ total biomedical research funding.

The independence of young investigators also needs to be emphasized. In 1981, that average age of scientists receiving their first NIH grant was 36; today, the average age is 42. As the age at which individuals get their first grant has increased, an age distribution and demographic shift in funding has occurred that favors more established scientists. This phenomenon may discourage young investigators from entering the field as well as impede their career development.

None of these problems is easy to solve, yet all will need to be addressed if the United States is to maintain its global scientific and medical leadership.

Science Matters
Despite the short shrift that science and health issues receive in funding and in the news, most Americans recognize the importance of research to their lives. In fact, according to a recent Research!America survey, 68 percent of Americans are willing to pay more in taxes to support scientific efforts, and 93 percent believe that it is either “very important” or “somewhat important” for the United States to be a global leader in research to improve health . 3 out of 4 Americans also recognize that science, technology, engineering and math (STEM) education is essential to ensuring that the United States remains economically competitive . To the same end, over three-quarters of Americans agree on the importance of creating incentives to encourage people to become nurses, physicians, public health professionals, dentists, and pharmacists.

And this is where the Rock Stars of Science Campaign established by the Geoffrey Beene Foundation in collaboration with GQ magazine plays an important role. By pairing Rock Stars with Rock Docs, this initiative aims to make science rock as a career choice for American youth– and for adults to better understand how science–and the policies linked to it–affect their lives and our future . The musicians you’ll probably know. As for the other people, they’re the doctors and scientists whose work has brought us closer to cures and prevention strategies for global health threats including cancer, HIV/AIDS, mental illness, and Alzheimer’s disease as well as increased our understanding about sex and racial/ethnic differences in illness. The campaign acknowledges that the doctors might not set your soul on fire like the rock stars featured in the initiative, but the researchers and physicians are lighting up the future with something just as powerful–hope. When it comes to improving our health, science is the music that is played and researchers and doctors are the musicians who are orchestrating a healthier future for us all. Now it’s up to the American people and policymakers to provide a resounding chorus of support to accelerate research progress so that America can become the healthiest nation in a healthier world.

Susan Blumenthal, M.D.: How Science Is Crucial To Improving Health Worldwide.

The New York Times, Duff Wilson, November 13, 2010

Companies like Philip Morris International and British American Tobacco are contesting limits on ads in Britain, bigger health warnings in South America and higher cigarette taxes in the Philippines and Mexico. They are also spending billions on lobbying and marketing campaigns in Africa and Asia, and in one case provided undisclosed financing for TV commercials in Australia.

The industry has ramped up its efforts in advance of a gathering in Uruguay this week of public health officials from 171 nations, who plan to shape guidelines to enforce a global anti-smoking treaty.

This year, Philip Morris International sued the government of Uruguay, saying its tobacco regulations were excessive.World Health Organization officials say the suit represents an effort by the industry to intimidate the country, as well as other nations attending the conference, that are considering strict marketing requirements for tobacco.

Uruguay’s groundbreaking law mandates that health warnings cover 80 percent of cigarette packages. It also limits each brand, like Marlboro, to one package design, so that alternate designs don’t mislead smokers into believing the products inside are less harmful.

The lawsuit against Uruguay, filed at a World Bankaffiliate in Washington, seeks unspecified damages for lost profits.

“They’re using litigation to threaten low- and middle-income countries,” says Dr. Douglas Bettcher, head of the W.H.O.’s Tobacco Free Initiative. Uruguay’s gross domestic product is half the size of the company’s $66 billion in annual sales.

Peter Nixon, a vice president and spokesman for Philip Morris International, said the company was complying with every nation’s marketing laws while selling a lawful product for adult consumers.

He said the company’s lawsuits were intended to combat what it felt were “excessive” regulations, and to protect its trademark and commercial property rights.

Cigarette companies are aggressively recruiting new customers in developing nations, Dr. Bettcher said, to replace those who are quitting or dying in the United States and Europe, where smoking rates have fallen precipitously. Worldwide cigarette sales are rising 2 percent a year.

But the number of countries adopting tougher rules, as well as the global treaty, underscore the breadth of the battleground between tobacco and public health interests in legal and political arenas from Latin America to Africa to Asia.

The cigarette companies work together to fight some strict policies and go their separate ways on others. For instance, Philip Morris USA, a division of Altria Group, helped negotiate and supported the anti-smoking legislation passed by Congress last year and did not join a lawsuit filed by R. J. Reynolds, Lorillard and other tobacco companies against the Food and Drug Administration. So far, it is not protesting the agency’s new rules, proposed last week, requiring graphic images with health warnings on cigarette packs.

But Philip Morris International, the separate company spun out of Altria in 2008 to expand the company’s presence in foreign markets, has been especially aggressive in fighting new restrictions overseas.

It has not only sued Uruguay, but also Brazil, arguing that images the government wants to put on cigarette packages do not accurately depict the health effects of smoking and “vilify” tobacco companies. The pictures depict more grotesque health effects than the smaller labels recommended in the United States, including one showing a fetus with the warning that smoking can cause spontaneous abortion.

In Ireland and Norway, Philip Morris subsidiaries are suing over prohibitions on store displays.

In Australia, where the government announced a plan that would require cigarettes to be in plain brown or white packaging to make them less attractive to buyers, a Philip Morris official directed an opposition media campaign during the federal elections last summer, according to documents obtained by an Australian television program, and later obtained by The New York Times.

The $5 million campaign, purporting to come from small store owners, was also partly financed by British American and Imperial Tobacco. The Philip Morris official approved strategies, budgets, ad buys and media interviews, according to the documents.

Mr. Nixon, the spokesman, said Philip Morris made no secret of its financing of that effort. “We have helped them, not controlled them,” he said.

Mr. Nixon said Philip Morris agreed that smoking was harmful and supported “reasonable” regulations where none exist.

“The packages definitely need health warnings, but they’ve got to be a reasonable size,” he said. “We thought 50 percent was reasonable. Once you take it up to 80 percent, there’s no space for trademarks to be shown. We thought that was going too far.”

These days in courts around the world, the tobacco giants find themselves on the defensive far more than playing offense. The W.H.O. and its treaty encourage governments and individuals to take legal action against cigarette corporations, which have encountered growing numbers of lawsuits from smokers and health care systems in Brazil, Canada, Israel, Italy, Nigeria, Poland and Turkey.

But in other parts of the world, notably Indonesia, the fifth-largest cigarette market, which has little regulation, tobacco companies market their products in ways that are prohibited elsewhere. In Indonesia, cigarette ads run on TV and before movies; billboards dot the highways; companies appeal to children through concerts and sports events; cartoon characters adorn packages; and stores sell to children.

Officials in Indonesia say they depend on tobacco jobs, as well as revenue from excise taxes on cigarettes. Indonesia gets some $2.5 billion a year from Philip Morris International alone.

“In the U.S., they took down billboards, agreed not to sponsor music events, no longer use the Marlboro cowboy,” said Matthew L. Myers, president of the Washington-based Campaign for Tobacco-Free Kids. “They now do all of those things overseas.”

The world’s second-biggest private cigarette maker, British American Tobacco, with $4.4 billion profits on $23 billion sales in the year ending June 30, is spending millions of dollars lobbying against anti-smoking health measures, like smoke-free air policies in theEuropean Union.

A video on the company’s Web site says some of the proven methods of reducing smoking — like taxes and display bans — encourage a black market in cigarettes and that, in turn, would finance drug, sex and weapons traffickers and terrorists.

The six-minute video, in which actors play gangsters, one with an Eastern European accent, concludes, “Only the criminals benefit.”

The conference beginning on Monday in Punta del Este, Uruguay, will try to add specific terms to a public health treaty known as the Framework Convention on Tobacco Control, which since 2003 has been ratified by 171 nations. It would eventually oblige its parties to impose tighter controls on tobacco ingredients, packaging and marketing, expand cessation programs and smoke-free spaces and raise taxes — proven tactics against smoking.

President George W. Bush signed the treaty in 2004 but did not send it to the Senate, where a two-thirds vote is needed for ratification. President Obama hopes to submit it to the Senate next year, a White House spokesman said on Thursday.

One recommendation drawing fire from tobacco farmers would either restrict or prohibit the use of popular additives, like licorice and chocolate, to blended tobacco products that account for more than half of worldwide sales.

The International Tobacco Growers’ Association says that could threaten the makers of burley tobacco, an air-cured leaf that has long been sweetened with additives, costing millions of farmers their jobs and devastating economies worldwide.

“We all know the real objective here is to eliminate tobacco consumption,” says Roger Quarles, a Kentucky grower and president of the association.
Cigarette Giants in Global Fight on Tighter Rules – NYTimes.com.