Philippe Boucher's Rendez-vous with Alan Blum (part 1)
Rendez-vous with Alan Blum (part 1)
By Philippe BoucherThursday, December 30, 1999
Rendez-vous with Alan Blum
First part
Alan, you and i have known each another for 15 years, starting when you were editor of the New York State Journal of Medicine, where you published the first theme issues on tobacco of any medical journal in the united states (December 1983 and July 1985). You had also published a similar issue as editor of the Medical Journal of Australia (March 1983). but as i recall, your work in this regard was considered worrisome to some people not just in the tobacco industry but also in the health community.
It's ironic that my devotion to the idea of producing an annual comprehensive theme issue on smoking as a means of galvanizing greater attention on the part of the medical profession to tobacco problems led to my being fired as editor.
In my own case, it's also a fascinating story of interlocking connections among several industries and institutions. I was fired without warning just after Christmas 1985 by an interim director of the Medical Society of the State of New York. He came from the old school of medical politics, where deals were made in smoke-filled rooms, such as the longstanding alliance between the American Medical Association (AMA) and tobacco state Congressmen to protect doctors' economic interests in exchange for doing nothing against tobacco.
Health care industry lobbyists and tobacco industry lobbyists often have been one and the same. The headquarters of four major cigarette manufacturers have been located in New York, making it the international capital of the tobacco industry. New York is also the home of many of the tobacco industry's advertising and public relations agencies, as well as the major television networks, such as CBS, which was owned by Lorillard Tobacco.
The advertising and pr firms in turn also work for pharmaceutical companies.
I have no doubt whatsoever that my consistent editorial opposition to the promotion tobacco was a source of concern not just to tobacco companies but also to some within the health care field who depended on (and feared) the tobacco industry's political support, not to mention its research funding.
The New York State Journal of Medicine tobacco theme issues contained more than 100 articles from around the world and spared no one. I'm especially proud of having helped to expose the hypocrisy of the news media, particularly The New York Times, for its longstanding collaboration with the tobacco industry, which The Times has still not acknowledged. One article consisted of the unexpurgated decades-long correspondence between surgeon George Gitlitz and The Times in which the newspaper's editors refused either to publish his letters or to address the ethical conflict of accepting tobacco advertising while rejecting ads for a variety of other legal products.
In 1999, of course, The Times at long last announced that it would refuse to accept any more tobacco ads (a policy that still does not include most of its other newspaper and magazine holdings), sidestepping the question of just what makes cigarette ads in 1999 so much more of a danger than they were in 1959, 1969, 1979, or 1989. Could it be that the newspaper really wasn't really losing anything (and did in fact gain favorable publicity), since cigarette advertising had almost all disappeared from its pages in recent years-gone to the alternative weekly entertainment papers that young people read? (Don't be surprised if The Times and other big media corporations start buying up these weeklies, replete with cigarette advertising.)
I suffered a further rebuff in 1988 when after being selected over two dozen other candidates for the editorship of a leading journal of family medicine, the contract I was offered specifically precluded me from speaking on smoking in any public forum for a minimum period of one year. After discussing this with then-Surgeon General Koop, I turned down the job. Had I accepted the position, I would not have been permitted to participate in two extraordinary, substantive meetings convened by Dr. Koop and arranged by Ron Davis in the Office on Smoking and Health. These were the first-ever conferences on tobacco and minorities and tobacco and sports, under the auspices of the Inter-Agency Council on Smoking and Health. I take great consolation in Ron's having adapted the format and style of the New York State Journal of Medicine-combining scientific research, opinion, and images of tobacco promotion-for the journal Tobacco Control, and I'm honored to have served as one of its first deputy editors.
IN ADDITION TO HAVING BEEN AN EDITORIAL PIONEER IN TOBACCO CONTROL, YOU HAVE WORN SEVERAL OTHER HATS, INCLUDING ACTIVIST, TEACHER, AND FAMILY DOCTOR WORKING TO GET PATIENTS TO STOP SMOKING, AND MOST RECENTLY ARCHIVIST AND HISTORIAN. WHICH ONE HAS BEEN THE MOST GRATIFYING?
Grassroots activism, by far. At the World Conference on Tobacco and Health in Perth in 1990, I made a special plea to the members of the audience, most of whom were from rather well-funded governmental and private health agencies: "Take an activist to lunch today." Activists by my definition are the ones who either by choice or necessity have had to work to change the system from the outside. And they have never worried about the money, because they would do this work anyway. In the US, the driving force behind anti-smoking efforts for most of the past half-century has been the independent clean indoor air activist with scant institutional support. Dr. Alton Ochsner began being a rabble-rouser in the late 1930s. John Banzhaf created the first organization to focus on tobacco regulation in the 1960s.
From the 1970s to the present, groups like GASP and Americans for Nonsmokers Rights and individuals like Ed Sweda in Massachusetts, Don Morris and Dr. Lee Fairbanks in Arizona, Jeannie Wigam in Minnesota, Gina Carlson in New Jersey, and Dr. Charles Tate in Florida, to name but a few, have been the heart and soul of efforts to reduce tobacco use. In the 1980s, BUGA-UP in Australia was the model for tackling tobacco advertising and increasing public disgust over smoking, and Gar Mahood's Non-Smokers' Rights Association in Canada was the model for creating first a local, then provincial, then national clean indoor air policy.
Meanwhile, the well-funded voluntary health agencies have lagged way behind, especially when one considers their enormous annual tax-deductable income.
Typical is the one-day-a-year smokeout in the US, which has long since lost its impact except as a pharmaceutical promotion. I've always felt we should give the tobacco industry one day a year to push smoking, and we'll take the other 364. US Government efforts for the most part have been disappointing and uninspired, with the rare exception of Surgeon General Koop and less successful attempts by surgeons-general Antonia Novello and Joycelyn Elders and Secretaries of Health Joseph Califano and Louis Sullivan.
SO HOW DID YOU BECOME INVOLVED IN THE TOBACCO ISSUE?
The inspiration came from my late father, also a family doctor. He was a great skeptic, and when I would watch Dodgers baseball games with him as a young boy in the 1950s, he was always upset at the fact that one of the sponsors was Lucky Strike cigarettes. One day soon, he predicted, no one would possibly believe that anyone ever associated tobacco and sports! He urged me to tape record the cigarette commercials and save the sports magazines for posterity, as well as to write about tobacco as editor of my high school newspaper in 1964 when the first Surgeon General's report came out. I know only a handful of individuals who have been continuously involved in the tobacco issue from that time, including Don Shopland, who has worked with several government health agencies and served as director of the Office on Smoking and Health, and Mike Pertschuk, who was a behind-the-scenes force in the prescient efforts of Senator Maurine Neuberger to scrutinize the tobacco industry.
By the time I entered Emory University School of Medicine in the early 1970s, I assumed that I would be in a health care environment in which everyone would be taking up the charge of the Surgeon General's report and actively fighting tobacco use and promotion in the clinic, classroom, and community.
Nothing could be further from the truth. Medical schools and schools of public health have done an appalling job of teaching about tobacco. I heard only one lecture in four years that dealt primarily with tobacco-a presentation by Dr. Brigitte Nahmias on pulmonary disability. But by including a slide of a colorful cigarette ad in her talk followed by a slide of a patient with emphysema, she gave me an idea to create an archive of tobacco advertising, out of which I could develop slide presentations juxtaposing tobacco advertising and tobacco-related diseases. By the end of medical school, I was giving presentations to my colleagues and in local schools, and in 1977 I started DOC (Doctors Ought to Care) in an effort to unite medical students and physicians in tackling the tobacco pandemic and other lethal lifestyles in the clinic, classroom, and community. (Earlier this year I gave my 1700th invited presentation since 1973.)
WHAT HAS MADE DOC SO DIFFERENT FROM OTHER HEALTH GROUPS?
We took an issue-smoking-that everyone had heard over and over again was "dangerous to your health" and got people to think about it in a different way. We moved beyond the pamphlets, preaching, and posters of other groups and kept challenging them to do more. From day one, our aim has always been to tap the highest possible commitment of every health professional, to inspire the highest possible creativity of every adolescent, to purchase counter-advertising space in the mass media, to use satire and pungent humor as our main weapon, and to undermine Marlboro and other major brand-names and their associated imagery.
I am proud of the fact that in 1977 DOC became the first organization anywhere to put its money where its mouth was to purchase counter-advertising space-in newspapers, on radio, on bus benches, and on billboards. The funding came from $10, $25, $50, and $100 membership donations, and we have been one of the few such self-sustaining organizations in the movement.
Virtually every physician in the US who has been actively involved in the tobacco issue can trace his or her involvement to DOC. We also convened the US' first youth conference on tobacco (SuperHealth 2000) in Miami in 1978 and led the first street protests (which we named "housecalls") to ridicule tobacco promotions such as the Virginia Slims Cigarettes Tennis Tournament (which we renamed the "Emphysema Slims"). To give you an idea of the kind of uphill battle we faced, when I founded DOC in 1977 in Miami, Florida, the local division of the American Cancer Society was still the beneficiary of the proceeds from the Virginia Slims Cigarettes Tennis Tournament. Over the years, we have established more than 150 chapters in the US and in 27 other countries.
The early achievement of DOC was to shift the focus away from nicotine, the smoker, and lung cancer, and instead onto the source of the problem: the tobacco industry. I was fortunate to work for over a decade with Dr. Rick Richards and Dr. Tom Houston, as we fought to jump-start the involvement of organized medicine in truly attacking the tobacco industry. And for several years of the pre-Globalink era, Drs. Greg Connolly and John Slade and I would spend countless stimulating hours brainstorming by telephone or letter on new strategies for taking on tobacco.
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The second part of the Rendez-vous with Alan Blum is on the next email!
Prepared by Philippe Boucher mailto:IslandErsk@aol.com
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