ITALICS MINE


April 15, 1994, was a memorable day:  The executives of tobacco companies stood before a congressional hearing, under oath (Italics mine), and said these words, among others:

“Cigarettes may cause lung cancer, heart disease and other health problems, but the evidence is not conclusive.”

At one point during the hearing, Rep. (now Sen.) Wyden presented data from medical groups and a 1989 Surgeon General’s report on the health consequences of smoking, asking each executive if he believed that cigarettes were addictive. Each answered no.  I saw that on TV. (Italics mine.)

“What the anti-tobacco industry wants is prohibition,” said one. “We hear about the addiction and the threat. If cigarettes are too dangerous to be sold, then ban them. Some smokers will obey the law, but many will not. People will be selling cigarettes out of the trunks of cars, cigarettes made by who knows who, made of who knows what.”

I know what: carcinogenic and addictive substances, same as now.

Despite earlier denials, a Philip Morris study that suggested that animals could become addicted to nicotine was suppressed in 1983 and 1985.

Wow, if cigarettes are banned, only outlaws will have cigarettes, and as bad as firearm lack of regulation in our society is, the magnitude of deaths is at least 20-fold more in the case of cigarettes. (Italics mine.)

The executives stated that tobacco companies could control the amount of nicotine in cigarettes, using these blends for flavor.

Or to addict people.  Turns out smoking is not a character flaw, but is an addiction, like high fructose corn syrup, but the latter is for another time.

Pressed by the subcommittee’s chairman, Mr. Waxman, and Representatives Wyden and Synar, (all Democrats), the companies agreed to supply many private company papers, including all the research done by the Philip Morris researcher whose scientific paper on addiction was blocked from publication by company executives.  (Italics mine.)

When one executive said that all products, from cola to Twinkies, had risks associated with them, Mr. Waxman replied, Yes, but the difference between cigarettes and Twinkies is death.”

“How many smokers die each year from cancer?” Mr. Waxman then asked.

“I do not know how many,” was the reply, adding that estimates of death are “generated by computers and are only statistical.”

If computers are banned, then we won’t die, I guess.  (Italics mine.)

Mr. Waxman asked, “Does smoking cause heart disease?”

“It may,” Mr. Johnston said.

“Does it cause lung cancer?”

“It may.”

“Emphysema?

“It may.”

Could the world be flat?

It may.  (Italics mine).

The term “only statistical” underpins science. We stopped the study on the effectiveness of polio vaccination because of statistics proving the vaccine was effective.  I am polio-free today because of that.  I received the Salk vaccine when it was first available; I was in the first cohort who received the Sabin vaccine.  We have confidence intervals stating with high (not complete) confidence that global climate change is occurring.  I have never seen one CI saying that it isn’t.  (Italics mine.)

We didn’t regulate tobacco enough, allowing “market forces” and “getting government out of business” to handle such issues.  The result has been as many deaths from tobacco-related illnesses every year (Italics mine) as the number of Americans who died in World War II.  Stalin said that “One death is a tragedy, one million a statistic.”  Yes, it is a tragedy when it involves a death at 40, or 53, my father-in-law, or my brother.  This should be a national outrage.  Wow, I can make a case for anti-government being in line of Stalinist thinking.  (Italics mine, but reasoning probably faulty.)

The incredibly rich tobacco company executives lied in front of Congress, suppressing evidence that went back decades.

That, Mr. Boehner, and Mr. Cantor, and Mr. Joe Tea Party, is why we need federal regulation.  Without it, people DIE.  (Italics mine.)

We regulate, because left to their own devices, people make a mess of the world.  We learn that early in school when “today, on your break, you will stay quietly in your seats, because a few people abused the privilege by jumping on their desks and screaming.”  You can use whatever you want for what you couldn’t do, but the first seven words in the subordinate clause stay the same throughout our lives. (Italics mine.)

I unsuccessfully tried to regulate medicine.  With no regulations, doctors did piecework and expected to be paid for it.  I remember a few of these doctors.  Those were the “golden days” of medicine, when “Doctor” was “God,” surgeons threw instruments, people cowered, nurses and medical students abused.  I was verbally abused to the point of tears by many doctors and had a retractor slammed on my thumb once.  “The Giants” made mistakes, because they were human.  Their mistakes were covered up, not investigated so we could learn from them. because to rat on a colleague would result in ostracism and no referrals.

My colleagues operated on carotid arteries, with frighteningly bad results, worse than the natural history of the untreated disease.  I counted these and presented the statistics.  I was screamed at and told I had no business to interfere. I was unpopular; however, I did notice that 12 physicians who became my patients never referred their patients to me.  (Italics mine.)  I thought that interesting. We allowed rods and fusion for low back pain, without adequate evidence that they did any good, which with few clear exceptions, they didn’t.

We failed to do what was proven effective to decrease post-operative infections:  inject a specific antibiotic for clean case infections 30-120 minutes before incision.  Easy, right?  In my hospital, we did it 25% of the time, and physicians refused to change.  We couldn’t even mandate the right antibiotic, promoting resistance to stronger antibiotics that some surgeons insisted upon using.  (Italics mine.)

After many years, we finally mandated that only pulmonary physicians, not general internists, could manage ventilators, because the former had better results.  That was strongly resisted, but it was one powerful group against another, not a dweeby neurologist (Italics and individual mine.) trying to change the profession through data and outcomes.

Politically powerful physicians who brought money into the hospital had special treatment.  Facts, outcomes, right or wrong were too often subsidiary.  It had to do with money. (Italics mine.)

My point is simple:.  Every law, every regulation, came because of a reason.  Maybe the law could have been better written, but the fact that there is a law speaks to a reason.  Some person said, “There ought to be a law against…..”

Don’t like regulations?  Neither do I.  Then self-regulated your group, your peers, your city, your country.  Want government out of your life?  Then figure out how 310 million people can each do what he or she wants without upsetting somebody else.  (Italics mine.) Hear that, Mr. Boehner and Mr. Cantor?

I don’t miss second hand smoke.  Nor does my body.  

(Italics mine.)

 

 

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