Judge allows smoking ban suit -WY

By W. DALE NELSON Star-Tribune correspondent

LARAMIE -- Voters challenging a public vote in favor of a smoking control ordinance will be allowed to make their case in court that there were election irregularities that might have affected the outcome, 2nd District Judge Jeffrey Donnell ruled Wednesday.
Donnell, who has set a non-jury trial in the case for May 18-20, granted in part and denied in part a motion filed by the city to dismiss the legal challenge filed by eight voters. The ordinance is scheduled to go into effect April 6.
"Wonderful," said Sherri Derenzis, one of the eight challengers. "This means we still have a chance to make our case."
City Attorney Peggy Trent said she was "very, very pleased" with the judge's decision, in which he said the burden will be on the plaintiffs to prove that any errors affected the outcome.

Donnell said the plaintiffs' claim that ballot boxes were left unsealed and were opened during the election "may rise to the level of misconduct or material negligence of an election official which affected the result of the election, and must be allowed to proceed."
Janet Tyler, the attorney for the plaintiffs, could not be reached by telephone Wednesday evening.
Regarding the claim that voters were deprived of absentee ballots or that there was any effect on the result of the election, the judge said the plaintiffs had not demonstrated that this was the case and "will have to satisfy that demand eventually, but, at the present time, their claim must proceed."
Donnell also left standing the plaintiffs' claim that the ballot was invalid because it did not include language required by state law instructing voters how to mark their ballots "for or against" a ballot proposition, although he said the argument "may place form over substance."
As for the allegation that some absentee ballots obtained from the city clerk incorrectly said they should be returned to the county clerk, the judge said the plaintiffs are entitled to prove that this happened and affected the result, although they have not shown so far that any ballots failed to get counted.
Donnell also said that the "plaintiffs' assertion that polling places failed to post instruction for the special election as mandated by statute must stand as it presents a claim upon which relief can be granted." The same applies, he said, to claim that some ballots were not folded.
The judge dismissed the portion of the lawsuit saying that the language on the ballot did not accurately describe the ordinance passed by the City Council by a 6-3 vote and approved by 366 votes in the Nov. 2 election.
The ballot description said the ordinance would "prohibit smoking in enclosed areas to which the public has access and places of employment, including but not limited to, restaurants, bars and private clubs." The challengers said this failed to make clear that it would also apply to offices.
The judge ruled that "even when considered in a light most favorable to the plaintiffs, the ballot summary was not misleading, especially given the summary's inclusion of the phrase ‘including but not limited to.'"
Donnell also dismissed the argument that not enough ballots were provided, saying the legal basis advanced for it applied only to general elections, not special elections such as the one on the smoking ordinance.

http://www.casperstartribune.net/articles/2005/01/29/news/wyoming/a3cf20776172f04c87256f96000d270c.txt

By: Rep. Jamie Boomgarden

R-District 17 (Chancellor) Monday, January 31, 2005

Greetings from Pierre. The weather started out so nice and then rapidly cooled down at the end of the week. I found out that in Pierre you not only need an ice scraper to clear ice from the windshield, but you also need one to remove the goose droppings that somehow end up on the windshield.

The bill of the week had to be HB1075, this bill intended to ban smoking in all public places. I supported this bill despite many of my friends that own bars and restaurants. I do understand the financial concerns and the desire to have the state stay out of personal lives and businesses. This is my preference, as well, unless there is a good reason to look the other way.

Many people approached me and said that people know the risks of smoking. My answer to this is they do not! Sure, they know it decreases life spans, and causes some illnesses, but they have never seen a person dying from these diseases.

I work at a hospital and have seen a couple hundred terminally ill patients; not all of them smoked, but the ones that did always repeat the same phrase -- "I wish I had never started that habit!" -- as they gasp for their breath. I have seen people constantly vomiting from chemotherapy and medications, and I have personally watched three young children and their mother all crying and hugging their 45-year-old father (who was a heavy smoker) after he just received word that he only has three months to live.

To this day, I cannot get that image out of my head, and that is why I had to vote in favor of this bill. The bad part was, I actually voted to table the bill after an amendment failed, fearing the bill would completely fail without it. This mistake made it look like I was against the bill, but I did favor it.

The House passed HB1061, which is one of those bills we have no choice on. If it did not pass, the state would lose $7 million the first year for highway funds and multiply the loss each year after. The bill affects commercial drivers licenses in that, if they are convicted of a DUI or other similar violation in their "personal" vehicles, they can lose their drivers licenses and NOT be able to get a work permit.

HB1055 passed the House and is related to the SDDS settlement fund. This involves the case of the waste disposal site out in western South Dakota in 1993. The state granted a permit to construct this disposal site, and the company put financial resources into the project. The permit was contested and brought before the people for a vote. The citizens of South Dakota voted to deny the permit. The company sued and initially won a $15 million lawsuit, but a technicality caused to go back to court. The case has been in court for 12 years and, at this time, there is a $5.2 million settlement on the table that will put this whole mess behind us. If it does go back to the courts, there is a good possibility that a new trial and unknown judgment could cost us a lot more.

I have received a lot of mail regarding section 269 of Senate Bill 43. This attempts to fix the amendment that was tied onto a Federal Lautenberg Domestic Gun Ban in 1996. This is a bad bill in that, if you're involved in a misdemeanor domestic violence act, you lose your gun rights for the rest of your life. This is not intended to make domestic violence a lesser crime but it did have very harsh (lifetime) affects on people who passionately like to hunt. This bill is in effect for those states like South Dakota which do not have domestic violence gun laws. The attempt of section 269 of SB43, as the state's attorney informed us, is that it is very likely that once the state establishes its own laws on this issue, it would satisfy the Federal Lautenberg clause. This is where section 269 comes in because it places a one-year ban on offenders of domestic violence as long as it is a misdemeanor. Ask yourself what is better: a one-year ban or a lifetime ban? The NRA is aware of and strongly supports this legislation. Be careful of the requests for money you are receiving out there, and make sure they are working in your best interest and not just for personal gain.

Thank you for the opportunity to serve you. This has been an invaluable learning experience for me and I hope to improve more each week. Feel free to contact me with questions or concerns at rep.boomgarden@state.sd.us.

Remember the troops and their families in your thoughts and prayers as they go through these tough times.

http://www.yankton.net/stories/013105/community_20050131015.shtml

Smoking Ban Goes Into Effect January 31, 2005

COLUMBUS, Ohio -- The city's smoking ban went into effect at midnight Monday, NBC 4 reported.

The ordinance, which was upheld by voters in November, outlaws smoking in all enclosed places of employment and public places within the city's corporation limits.

The banned areas include all places of employment, including restaurants and bars; all enclosed areas, including buildings and vehicles that are owned, leased or operated by the city of Columbus; and all areas near entrances and exits of a smoke-free building, so that smoke does not enter through doorways, windows or ventilation systems.

Smoking is still allowed in private residences, but is prohibited in those that are licensed childcare facilities, adult daycare facilities or healthcare facilities. Smoking is also allowed in hotel and motel rooms designated as "smoking;" family-owned and operated businesses and offices of self-employed people; retail tobacco stores; outdoor patios that are physically separated from the enclosed area of the establishment and do not allow smoke to enter open windows and doors; and private clubs with a valid D-4 liquor permit.

If smoking occurs illegally, the Columbus Board of Health will issue a warning letter to the proprietor. The second occurrence is considered a minor misdemeanor offense and carries a maximum fine of $150.

At least one local restaurant is welcoming the change.

"We actually had some new customers come in because they knew we were smoke-free and they didn't like the smoke," said Tom Kraft, of Tee Jaye's Country Place. "We'll do all right."

A local group is collecting signatures to put a referendum on the May ballot that would exempt bars from the ban.

Several other Central Ohio communities are considering their own smoking bans.

The city of Heath in Licking County is working on a smoking ban proposal that would forbid smoking in all public places. A vote could be made by city leaders by the end of February.

Newark and Granville also are considering smoking bans.

http://www.nbc4i.com/news/4145486/detail.html

MONDAY, JANUARY 31, 2005 12:00:01 AM

Movie stars are actors, not role models
This is the age of stifling political correctness. These 'democratically' acceptable attitudes to everything colour our vision in all things socio-cultural. In the past few weeks, from Prince Harry to Harvard's Lawrence Summers, the media appears to have declared open season on anything remotely controversial. Another example of this is the WHO report which states that Bollywood stars smoke far too frequently on screen. It says this unfortunate depiction could lead more young people to take up this deadly habit. This is to confuse a problem with a symptom. No one denies that smoking is injurious to health, or that it is a serious public health issue. But to expect our movie stars to foster clean habits in people is irrational. Cinema, like all art, only mirrors prevailing social contexts and situations. If directors are making stars smoke, it is, as they point out, because the role calls for it. Nothing more.

A good case in point is the criticism that Pierce Brosnan was subjected to, for a similar 'indiscretion' in his last portrayal as James Bond. He was shown lighting up a cigar in a scene set in Cuba. It led to a spate of condemnation in the media. From anti-tobacco campaigners to civil rights organisations, everyone criticised the depiction of Brosnan smoking. All of this was ostensibly to prevent unwary young men who know no better from being misled by the habits of the man who played Bond. The fact that the actor was playing a deceitful, ruthless, oversexed spy, who usually has no qualms about despatching diabolical villains and their henchmen to their dooms, seems lost on the cigar haters. Clearly, this is a case of political correctness run amok. Better education and awareness of public health is the need of the hour, not castigating our actors for their celluloid portrayals of social mores. They are just doing their jobs, let's not expect them to be real life role models.

http://timesofindia.indiatimes.com/articleshow/1005407.cms

Monday, January 31, 2005

EAST BAY - Broad new prohibitions on smoking, along with enhanced enforcement mechanisms, will have a big effect on area restaurants and workplaces in the state when a new law goes into effect on March 1. The new law targets second-hand smoke and is designed to protect workers and the public from its hazards.

Yet at least one entrepreneur, Portsmouth resident Jay Massa, owner of Stafford Design/Build in Fall River, sees opportunity caused by the smoke-free laws. A non-smoker himself, he nonetheless believes smokers have rights to gather and enjoy smoking as part of the experience of eating out.

"There needs to be some accommodation for the smoker," Mr. Massa said, "while protecting the non-smoker from toxic gases. At the board of health level they would like to see every smoker stop smoking, but the reality is that's not going to happen."

He has designed what he calls a "hot spot smoking shelter" constructed of aluminum rods and supports, numerous removable panels, and roofed with durable flame retardant fabric. The shelter has a 12-foot by 15-foot footprint, is 9-feet high, rests on a wooden platform, and is designed to be free-standing outside and next to a restaurant.

The only one that exists so far, at Magoni's Restaurant in Somerset, contains a Keno TV and a standard TV set, an exhaust fan, a heating system, lights, carpeting, chairs, tables and ashtrays. It is enormously popular, he says. "It provides a space where smokers can go and not bother other people." Mr. Massa notes that "in New York, nightclub owners have rented limousines so people can go outside and smoke."

"What's the difference between a limo, or a Winnebago, or a mobile home, or a hot spot smoking shelter," he asks.

However, health authorities in Massachusetts aren't so sure the "hot spot smoking shelter" complies with that state's laws. Eileen M. Sullivan, who directs tobacco control policy in the Massachusetts department of public health, said that reports that "made it sound as though we had approved the smoking shelter at Magoni's were not correct. We had not." According to Ms. Sullivan, "It appears the smoking shelter is being used as an enclosed smoking room, and our law does not allow for enclosed smoking rooms."

The health official with direct jurisdiction over the shelter at Magoni's restaurant is Christina A. Wordell, an agent with the Somerset board of health. While expressing sympathy for the idea of providing an alternative for patrons who like to smoke, Ms. Wordell states that the shelter "does not meet the no-smoke-in-the-workplace law," and that she "will defer to the state department of public health which is about to issue regulations enforcing the law." Magoni's owner declined to comment.

The fate of such shelters in Rhode Island is distinctly uncertain. Mr. Massa said he's received "nothing but negative comments" from state officials and that the "health department people have not been very supportive."

According to Elizabeth Harvey, who directs the tobacco control program in the department of health, an official legal opinion, responding to a specific description of the "hot spot smoking shelter," and how it would function in relation to a restaurant or other business, would need to be issued before the department of health could approve it.

It does not look encouraging, she said. "[Mr. Massa's] shelter would appear to be enclosed, not open, is likely to be part of a workplace, if only for maintenance, is open to the public, and is under the control of an employer. My read is that the new law would probably prohibit smoking in such a structure."

What restaurant owners think

Rhode Island restaurant owners have mixed reactions to the upcoming new law. John Silva, co-owner of Barcellos Family Restaurant in Tiverton, anticipates that business will "definitely" drop, and that take-out orders will increase. He believes smoking policy "should be left up to the owner and customers should be warned and free to choose."

"I've never had a customer leave due to smoking," said Mr. Silva, who also said he'd never received a complaint about smoking in his restaurant. "As for employees, a lot of them smoke, and a lot of them that don't smoke don't mind if others do," he said.

On the other hand, John Louglin, owner of the Crossroads Restaurant in Warren, said "we initiated non-smoking in all our dining rooms five years ago. At first a lot of customers were upset, but in the long run we've seen more people and more families coming in than before." Acknowledging that currently allowed smoking in the bar area of his restaurant will soon be banned, Mr. Louglin said, "A lot of smokers know the law's coming, and they'll just have to adjust to it."

Ms. Harvey is optimistic about the impact of the new law. "Other states that have gone this route," she said, "have been very successful and have not had serious enforcement problems."

"At the beginning," Ms. Harvey said, "there will be complaints from people who don't know how others elsewhere have fared. But leveling the playing field helps. Most restaurant owners do better. People will still eat out, and some people will eat out more often, and some who didn't eat out before because of smoke in restaurants will start eating out."

"It's not a huge economic problem," she continued. "A lot of scare tactics came from the tobacco industry trying to thwart this new law."

"Don't forget," said Ms. Harvey, "that 70 percent of Rhode Island smokers want to quit. People forget how powerful the addiction is. With nicotine, you get 80 doses per cigarette. It's the most addictive drug we've encountered."

At a glance: The new smoking ban

"Rhode Island is leading the way in strong tobacco control policies in this country," said Deborah Ruggiero, president of the American Lung Association of Rhode Island. Once implemented, the law "will be one of the strongest smoke-free laws in the country," she said. The new law requires that:

* All restaurants must be completely smoke-free after March 1. This includes bar areas in restaurants. Separate smoking and non-smoking sections will no longer be permitted.

* Outdoor areas of a restaurant where smoking will still be allowed must be physically separated from the enclosed establishment so as to prevent the migration of smoke into the restaurant.

* Until Oct. 1, 2006, smoking will still be allowed in Class C (stand-alone bars) and Class D (private clubs) license holders with fewer than 10 employees.

* All businesses and workplaces inside will need to become completely smoke-free, without any "smoking rooms."

* If an employer wants to allow smoking by employees, the area must be outside and must be physically separated so that smoke cannot "migrate" back inside. The department of health recommends that any outdoor smoking area be at least 50 feet from the building.

* Smoking is prohibited in vehicles owned by a business and used by more than one employee.

* Smoking is prohibited in private offices, even the office of the owner or head of the business.

* Child care, adult care and health care facilities must be smoke-free, even when located in a private residence.

* The smoking prohibitions covering restaurants and workplaces apply to everyone entering the location: customers, patrons, visitors, employees and others alike.

* There are limited exemptions for retail tobacco stores, "smoking bars," hotels, private rooms in assisted living facilities and designated, separately ventilated areas in Newport Grand and Lincoln Park.

* Signs with approved language must be posted at all entrances to restaurants and workplaces with mandated language stating that smoking is prohibited and providing a telephone number and contact information for the filing of a complaint. Present and future employees are required to be told the establishment is smoke-free.

* Any individual — employee, customer, patron or member of the public — who wishes to register a complaint can do so by calling or writing the state department of health. Health and fire officials conducting routine inspections for other purposes can also file a complaint. It's anticipated that local substance abuse task forces will provide community support for complaint mechanism.

* Enforcement will be complaint-driven by the health department office of environmental health risks assessment (Robert R. Vanderslice, Ph.D., director).

* A first complaint will result in direct notification by the health department to the employer, whether a restaurant or other business, demanding immediate corrective action. Any second and subsequent complaints will be forwarded to the solicitor for the town where the license holder is located. The solicitor must then "without delay" initiate an injunctive action against the employer.

* Civil penalties for a first violation are $250, for a second $500, and $1,000 for a third and each subsequent violation. Each day a violation occurs is a separate violation. Failure to post signs is a violation. Allowing smoking, not just smoking itself, is a violation.

______________________________________________________________________________

Rhode Island's smoking grades

Tobacco prevention and control spending: F

* FY 2005 tobacco prevention and control appropriations:* $3,609,989 (actual)

* CDC best practices minimum state spending requirement: $9,890,000 (recommended)

* Includes FY 2004 funding from the Centers for Disease Control and Prevention

Smoke-free air: Incomplete*

Overview of smoke-free air law(s):

* Government workplaces: Bans

* Private workplaces: Bans

* Schools: Bans

* Childcare facilities: Bans

* Restaurants: Bans

* Bars: Restricts

* Retail stores: Bans

* Recreation/cultural facilities: Bans

* Penalties: Yes

* Enforcement: Yes

* Preemption: Yes

* Citation: GEN. LAWS OF RI § 23-20.6-1 et seq. & 11-19-32 & 23-28.15 & 23-17.5-26

*Incomplete: Rhode Island's smoke-free air legislation is effective March 1, 2005. Exemptions include 50 percent of hotel/motel rooms, retail tobacco stores, smoking bars and facilities with Class C & D liquor licenses with no more than 10 employees until Oct. 1, 2006. The American Lung Association of Rhode Island expects the grade to be changed from an incomplete to an A with the enactment of the smoke-free air legislation on March 1.

Cigarette tax: A

* Tax rate per pack of 20: $2.460*

* On July 1, 2004, the cigarette tax was raised from $1.71 to $2.46 per pack

Youth access: A

Overview of youth access law(s):

* Minimum age requirement: Yes

* Packaging: Prohibits all cigarette sales other than in a sealed package conforming to federal labeling requirements: Yes

* Clerk intervention: Prohibits access to or purchase of tobacco products without the intervention of a sales clerk: No

* Photographic identification: Require merchants to request photographic identification for customers who appear to be under 21 years of age: No

* Vending machines: Restricts

* Free distribution: Bans

* Graduated penalties or fines on retailers: Yes

* Establishes random, unannounced inspections: Yes

* Establishes statewide enforcement agency: Yes

* Preemption: No

* Citation: GEN. LAWS OF RI § 11-9-13 et seq.

Source: American Lung Association

______________________________________________________________________________

Facts & figures , A few interesting Rhode Island statistics pertaining to smoking:

* Every year, 1,800 Rhode Islanders die from smoking

* 200 people annually die in the state from exposure to second-hand smoke.

* 19% of high school students and 9% of middle school students smoke.

* 5% of high school males use smokeless tobacco.

* Every year 2,700 children in Rhode Island become established daily smokers.

* 22% percent of Rhode Island adults smoke.

* 53,000 children are exposed to second-hand smoke at home, and are more likely to get colds, allergies, asthma and ear infections as a result.

* Babies of smoking parents are twice as likely to die from Sudden Infant Death Syndrome (SIDS).

* 0.9 million packs of cigarettes each year are illegally sold in Rhode Island to children and youth.

* Health care expenditures directly related to tobacco use exceed $396 million every year.

* Tobacco costs Rhode Islanders $170 million in taxes for health care and $90 million in Medicaid payments.

* Additional annual expenditures in Rhode Island for babies' health problems caused by smoking or being exposed to second-hand smoke during pregnancy is $4 to $13 million.

* Second-hand smoke contains more than 4,000 chemicals, including 43 known to cause cancer.

* Waitresses have higher rates of lung cancer and heart disease than any other traditionally female occupation.

* One 8-hour shift in a smoke-filled bar is the same as smoking 16 cigarettes.

* Smoking is worse for women than it is for men. Women are more likely to get lung cancer than men, and more women die of lung cancer than breast cancer.

— Source: Rhode Island Department of Health, American Lung Association of Rhode Island

______________________________________________________________________________

Resources

* To file a complaint about smoking in any restaurant or business, call 222-3293; online, log on to http://www.health.ri.gov/disease/tobacco/workplacelaw.php and click on link marked "No Smoking Non-compliance Complaint Form"

* If you smoke and want to stop, or want to support employees or patrons who want to quit (free patches, free gum, free counseling), call 800/879-8678 or log on to http://www.health.ri.gov/disease/tobacco/tobaccobenefits.php

* To learn about Rhode Island's Tobacco Control Program, signs, enforcement, guidance, education, definitions of terms, visit http://www.health.ri.gov/disease/tobacco/index.php

* To read the new state law, known as Chapter 20.10, General Laws of Rhode Island, the "Public Health and Workplace Safety Act," visit http://www.hrcomply.com/law/RI.8392.html

* To read Department of Health "Rules and Regulations Pertaining to Smoke-free Public Places and Workplaces" implementing the new state law, visit http://www.rules.state.ri.us/rules/released/pdf/DOH/DOH_3258.pdf

* For National Cancer Institute findings about second-hand smoke, visit http://cis.nci.nih.gov/fact/10_18.htm

* For Environmental Protection Agency findings about second-hand smoke, visit http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=2835

By Tom Killin Dalglish

http://www.eastbayri.com/story/295247238659417.php

Arthur L. Caplan

The Truth about the Drug Companies: How They Deceive Us and What To Do about It. Marcia Angell. xx + 305 pp. Random House, 2004. $24.95.

On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health. Jerome P. Kassirer. xx + 251 pp. Oxford University Press, 2005. $28.

Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs. Jerry Avorn. viii + 448 pp. Alfred A. Knopf, 2004. $27.50.

Is the pharmaceutical industry a dangerous and crooked business that federal and state authorities need to bring to heel? Should those who develop, market or prescribe drugs hang their heads in shame when faced with the stark reality of what they do to earn a living? Is Big Pharma in fact the moral equivalent of the tobacco industry? One could well come away from Marcia Angell's The Truth about the Drug Companies or Jerome Kassirer's On the Take thinking so. In both books, the sort of moral opprobrium once directed against Big Tobacco is aimed squarely at the pharmaceutical industry, along with its legions of lobbyists, the politicians awash in its campaign contributions and the doctors it has bought, free meal by free meal, junket by junket, free sample by free sample and trinket by trinket.

Kassirer and Angell, who are physicians at Tufts and Harvard, respectively, and who are both former editors of the New England Journal of Medicine, are not the only authors currently taking a critical look at industry excesses. Harvard physician and pharmacoepidemiologist Jerry Avorn also has a new book examining some of the problems with the way prescription drugs are brought to market, the thoughtful and incisive Powerful Medicines.

It's not hard to see why demonization of the pharmaceutical industry has become such a popular sport. As Avorn points out, drug companies are now so obsessed with profits that they are no longer willing to pay for the innovative research that they claim justifies the high cost of their products. He and Angell each demonstrate that the numbers do not support the contention that without high prices there would be no money for the next generation of miracle drugs. Avorn notes that data from financial reports submitted to the Securities and Exchange Commission by nine of the largest U.S.-based pharmaceutical companies show the hollowness of this rationale for exorbitant prices. He cites a 2002 report by Families, USA, which indicated that these companies spent the greatest proportion of their revenues (27 percent) on marketing, advertising and administration. Next came profits at 18 percent—a rate of return that almost no other industry expects or can match. Money spent on research and development ran a distant third, at 11 percent of revenues. No matter how hard drug companies spin these numbers, they reveal priorities that serve neither patients nor the general public.

Other data in these three books strengthen the moral case against the industry. In the United States, patented, brand-name drugs sell on average for 80 percent more than in Canada and 100 percent more than in France and Italy. Efforts to redress price inequities by allowing the importation of drugs to the United States from Canada have met with fierce resistance from Big Pharma, which has waged a bizarre and deceitful campaign to impugn the safety of Canadian drugs. The campaign would be laughable had it not been so effective in keeping Canadian drugs in Canada.

The sins do not end with high prices, huge budgets for marketing and advertising, and efforts to restrain free markets. Drug companies, Angell and Kassirer remind us, have connived to do everything they can think of to capture the attention, allegiance and gratitude of physicians. And they have been able to think of quite a lot.

Dip anywhere at random into The Truth about the Drug Companies or On the Take and you will find disturbing passages such as this one (from Angell's book):

Suppose you are a big pharmaceutical company. You make a drug that is approved for a very limited use. . . . How could you turn it into a blockbuster? . . .
. . . You could simply market the drug for unapproved ("off-label") uses—despite the fact that doing so is illegal. You do that by carrying out "research" that falls way below the standard required for FDA approval, then "educating" doctors about any favorable results. That way, you could circumvent the law. You could say you were not marketing for unapproved uses; you were merely disseminating the results of research to doctors—who can legally prescribe a drug for any use. But it would be bogus education about bogus research. It would really be marketing.

Angell goes on to show that this is exactly what many pharmaceutical companies have done. In the name of "research," they have subtly encouraged doctors to use drugs for unapproved purposes, or for groups of patients (children, for example) in whom the agent's effectiveness has never been studied. The industry has also encouraged "innovative" prescription practices on the part of doctors who are not equipped to safely monitor and to learn from what they are doing. Outrage about this sort of conduct infuses every page of her powerful book.

Kassirer, like Angell, is no slouch at condemning ethical shenanigans:

Big business and physicians alike are involved in a massive charade. Representatives of the drug companies claim repeatedly that marketing serves an essential function in the health-care delivery system by helping to educate doctors so they can prescribe drugs more appropriately. At the same time, they press their drug salesmen to push the newest (and usually the most expensive) products, and their surrogate intermediaries, the medical education companies, are advertising their services as "persuasive" education.

Kassirer does not write with the same overt anger as Angell, but his quiet fury is palpable as he watches his beloved medical profession being corrupted by businesses willing to do whatever it takes to get their drugs prescribed.

It turns out to be relatively easy to make the case against bloated profits, the herd mentality of companies looking for blockbusters, dishonesty in marketing and crass schemes to pay off doctors, politicians and the media. No one can read these books and not believe that something needs to be done to reform the way drugs are discovered, patented, sold and used in the United States and around the world. But these books are far less satisfying when it comes to providing solutions.

Despite all the corruption documented by Angell, Kassirer and Avorn, the pharmaceutical industry is not the tobacco industry. Its products may sometimes be sold at bloated prices and marketed using techniques more commonly associated with used car dealers and Internet mortgage brokers. And some of those products may even turn out to be dangerous or ineffective. But Big Pharma, unlike Big Tobacco, is not selling inherently evil products. Many Americans have benefited from pharmaceuticals, and more do so every year, which is as much a cause of higher total expenditures for the nation as are increases in the prices of individual drugs. So medicine has no real choice but to deal with Big Pharma; nobody wants it just to go away. But clearly the drug industry must be better regulated.

Angell and Kassirer take a fairly straightforward route in their prescriptions for reform: Get the pharmaceutical industry away from the medical profession. Prohibit the drug companies from underwriting continuing medical education, get their sales representatives ("detail" people) out of hospitals and doctors' offices, and shut off the junket pipeline. And stop the industry from flooding the airwaves with ridiculously deceptive direct-to-consumer advertising.

Easy enough to say, but these are deeply ingrained practices that will prove next to impossible to eradicate. If you take the detail men and women out of doctors' offices, they will quickly reappear in the homes, country clubs, civic organizations and vacation spots of physicians. Companies are willing to invest heavily in these activities, which means that control (rather than eradication) is probably the most realistic goal.

Nor is there a lot of sentiment in Washington to take on Big Pharma. In the recent election the American people made it clear that they do not want or trust the federal government to regulate much of anything.

What Angell and Kassirer, for all the power of their books, fail to convey is that the activities they rightly condemn are all symptoms of deeper, more serious problems in the pharmaceutical industry. As Avorn correctly notes, it is a lack of science as much as venality that is responsible for the conflicts of interest and inefficiencies that are rife in medicine's relationships with the drug business.

Americans think that the U. S. Food and Drug Administration provides tight oversight ensuring the safety and efficacy of drugs. But the FDA lacks the authority and resources to do this job well. The FDA and its European counterparts can demand that pharmaceutical companies provide them with data to show that drugs are efficacious. But they have no mandate to show that drugs are effective—that they will work not only in closely monitored clinical trials but also in the real world under a variety of conditions. Nor is there any systematic, independent source of evidence about the comparative value of drugs and medical technologies. Head-to-head trials comparing a drug with a rival company's similar product or generic version are almost nonexistent. There are no databases that report the results of all trials in a standardized way, describing adverse events and efficacy in various subpopulations. "The initial FDA approval of a drug should be seen as the beginning of an intensive period of assessment, not the end," Avorn says. But that's not the case. And into this data vacuum rush the detail men and women bearing gifts.

Doctors, patients, policy makers and regulators are all blind as bats when it comes to having the data needed to rein in the huge excesses of the pharmaceutical industry. If no one can really say which drugs are the most effective for whom and which will get the job done most cheaply, then marketing based on trinkets, junkets and hype will continue to flourish. If no one challenges the industry to live up to its stated ethical goal of using science to benefit patients, then simply telling the industry's detail men and women to keep out of the lecture halls at medical schools will do little to weaken their influence.

Not only is there insufficient science guiding the pharmaceutical business, the financial incentives it has are pointing in the wrong direction. Big Pharma still looks to make its breakthroughs and find its blockbusters by creating pills that lots of us can take every day for most of our lives. This means that the supply of birth control pills, remedies for toenail fungus, cholesterol blockers and antidepressants is ample, whereas vaccines are scarce. Big Pharma and its university partners pay little attention to public health and the ailments of the poor because there is little money to be made from them.

To have drugs, we must have a pharmaceutical industry. The key to reforming it in the short run is, as these books show, going after its worst excesses and tamping them down. In the long run, more serious measures are needed. With its self-proclaimed ethical mission in mind, the industry must be restructured. It needs to be firmly grounded in science and properly motivated to provide us with the drugs that will do us all the most good. Accomplishing that is a matter of dialogue and redirection, not demonization.

Reviewer Information

Arthur L. Caplan is Emmanuel and Robert Hart Professor and chair of the Department of Medical Ethics at the University of Pennsylvania School of Medicine in Philadelphia. He is the author or editor of many books; recent volumes he has coedited include The Human Cloning Debate (Berkeley Hills Books, 2004), Health, Disease and Illness: Concepts in Medicine (Georgetown University Press, 2004) and Who Owns Life? (Prometheus Books, 2002).

By Dr. Jeffrey A. Ratner Posted on Mon, Jan. 31, 2005

It is becoming clearer that at any given level of overall economic development for a country or region within a country, the populations of countries and regions with smaller gaps between rich and poor, in general, are healthier than the populations of countries and regions where the gap is larger.

These observations imply that the economic structure of a nation may be the most important determinate of the health of its people. To illustrate this, look at the health of people in the United States, measured by life expectancy. Fifty-five years ago, the United States was one of the healthiest countries in the world by this measure. Today, there are about 25 countries that are healthier than ours.

The United States has the highest infant-mortality rate, the highest child-poverty rate, the highest teen-pregnancy rate, the highest child-abuse death rate, and so on, among all rich countries. There are no indicators in which we excel, except in spending money on health care, for we spend half of the world's total healthcare bill.

Think of it -- for every dollar in the world spent on health care, 50 cents is spent here; yet, our residents are less healthy.

Japan has the highest life expectancy of any country in the world, yet there are twice as many smokers per capita in Japan than in the United States. To understand this phenomenon, we need to look at post-World War II Japan and the changes that occurred from 1945 to 1950, during the U.S. occupation: The first was demilitarization; the second was democratization, as U.S. policy-makers wrote the country's constitution, providing for representative democracy, free universal education and the right of labor unions to organize and engage in collective bargaining; and the third "D" was decentralization, when the 11-family zaibatsu that ran the huge corporations controlling the country was broken up. The most successful land-reform program in history was carried out. What this did was bring down the economic hierarchy and leveled the playing field. The resulting rise in health in Japan is the most profound ever observed on this planet.

So why do people with lower incomes get sick more? Is it because they smoke more (which they do)? Is it because they drink more (which they may do)? Is it because they use more heroin (which is true)? Is it because they eat more (which is true)? Is it because they don't exercise as much (because they don't)?

Studies have shown that even though these behaviors are considered bad for health, the excess smoking, drinking, heroin use and food consumption in conjunction with a lack of exercise, only explains about 10 percent of the reason that poorer people have poorer health. Learning this has been a revelation for me. I used to blame sick people for their behaviors that made them sick.

It is tempting to say that the reason low-income people get sick more is because they can't afford health care. But that isn't the case. Consider the Hispanic population: They don't access health care much, they tend to not have medical insurance and they tend not to go to the doctor. Yet, they tend to be much healthier than their non-Hispanic white counterparts.

The truth is that in the past 55 years, we have drastically changed the rules of who gets what share of the pie in regard to health care. Relative poverty, living in a large gap society is the worst part of poverty.

In next week's Health Break column, we will examine this tragic phenomenon between poverty and poor health.

Dr. Jeffrey A. Ratner specializes in pulmonary and internal medicine and is in private practice in State College. He is Chief of Staff at Mount Nittany Medical Center.

http://www.centredaily.com/mld/centredaily/living/10775661.htm

Monday, January 31, 2005

For the second time in four years, this column is bearing the title, “Making advertising a scapegoat.” The first time was on April 9, 2001, when the Society for Family Health launched a radio campaign in its bid to fight sexually transmitted diseases especially HIV/AIDS. The ads advised the use of condom “when you no fit hold body” so as to prevent you from getting “any yama yama disease.” Many criticized the ads for encouraging promiscuity, forgetting that the scourge of HIV/AIDS was mightier than that of promiscuity. I could not but rise in the defence of the ads.

Once again, we have what I like to call strident criticism of an ad - the “MTN Na Boy” television commercial – for allegedly promoting discrimination against the female gender.  I have watched the commercial several times and I don’t see any explicit (or even implicit) discrimination against or hatred for the female child. The fact is that a male child was born to a couple in a city and the husband used his cell phone to immediately announce the news to the mother in the village. On hearing the news, the mother and her neighbours were excited and danced jubilantly to the vigorous and pulsating “udje” music of the Urhobos, ending it with the usual chorus of the ethnic group while dancing or jubulating – eeeh eeyeh!

Perhaps one is too simple-minded or naïve. Otherwise, there is nothing in the commercial to suggest preference for the male child. Some mothers would have danced the same way on hearing the news of the birth of a female child, especially if they had been craving for one.
I see critics imputing motives or reading too much into the “na boy” TV commercial – all because there has always been discrimination against the female child worldwide.

The criticism strikes me as misplaced, unwarranted, unnecessary and even hypocritical.  That’s why I am engaging in today’s update of my 9/4/2001 article. My main motive is, however, to draw the attention of practitioners to the fact that some of society’s ills are often blamed on advertising and that practitioners should not always succumb to such criticism. I am also seizing this opportunity to advise the regulatory body: the Advertising Practitioners Council of Nigeria (APCON), to avoid taking any hasty decision on the “na boy” commercial, if that body is not to be accused of strangulating rather than regulating advertising.

And now to some points I want noted once again about the criticism of advertising.
I would like it noted that it not unusual for advertising to be blamed for some of society’s ills. If anything, advertising is used to being made a scapegoat.

Frank Galbraith, an eminent economist, spent the greater part of the century just ended, lampooning advertising for making people buy what they don’t need. It never occurred to him to check whether the people he was referring to had any willpower or were mere zombies.

Some other eminent economist blame advertising for increasing the cost of goods, forgetting that advertising facilitates mass production which, in turn, helps in bringing down the unit costs of commodities.

Today, smoking of tobacco is blamed on advertising, drinking of alcohol is blamed on advertising, sexual promiscuity, which has bedevilled society since Sodom Gomorrah, is blamed on advertising, obesity is blamed on advertising and now the discrimination against women is being blamed on advertising.

Let’s first consider sexual promiscuity which some four years back had to be blamed on the condom ads by the Society for Family Health.

People so heavily criticized the ads that APCON had to suspend or ban them. Strictly speaking the SFH commercials were unparalleled in fighting HIV/AIDS and other sexually transmitted diseases. How?

First, they were true-to-life.  The situations painted were real and reflective of everyday happenings in the society.

“Correct Babes” was the title of the first one.  It began with a certain Celina crying and begging her friend, Sylvia, to escort her to a doctor to terminate her pregnancy. Sylvia said she would not escort her because she had terminated one some five months back and that correct babes “no dey carry anyhow belle.”

An authoritative male voice then took over to warn babes not to “scatter” their chances of making babies in the future or catching yama yama diseases like AIDS.

Additionally, he admonished brothers and sisters to use condom to “protect our today and tomorrow.”

Critics including APCON were perhaps holier than the pope by seeing obscenity or the encouragement of promiscuity in that commercial.

Abortion is an everyday occurrence. And AIDS is the greatest scourge in the African society today – especially in East, South and West Africa in that order. To checkmate AIDS and abortion, that commercial encouraged men and women to use condom.

Granted that the commercial did not preach abstinence from sex. But why bother to preach what the over-filled churches on Sundays and the electronic or Pentecostal Christian pastors have so ably preached without success.

The remaining two commercials - “Angelistic Angie” and “Evelyn Baby” - advised us to use condom if we “no fit hold body.” Is that obscene? Where is the obscenity in asking people to use condom so as to protect themselves against sexually transmitted diseases?
To me, the commercials were more beneficial than harmful to the society. Yet they were banned by APCON following some public criticism.

As I said then and I like to say now, sexual promiscuicity is not a creation of advertising.  It was there in the days of Sodom and Gomorrah.

Similarly, the discrimination against women is a worldwide phenomenon.  It is there in churches and mosques and in government. Even civilized Europe and America do not yet have the culture of paying top female executives the same salaries they pay their males counterparts. And advertising has nothing to do with it.

Coming back to the MTN TV commercial, “Na Boy,” I would like to advise APCON to critically analyze the content and find out where it is really offensive. The actual content is definitely not offensive. What may be offensive is in the imagination of the critics and that should never be the reason for imposing a ban by a professional body.

Artistically, the commercial is first-class.  It is true-to-life.  It is striking.  It is simple.  It is memorable and entertaining.  We need more commercials like it.

http://www.vanguardngr.com/articles/2002/columns/advertising/ad31012005.html

By Graham Johnston  January 31, 2005

Local business owners can throw their support behind a proposed no-smoking ordinance for Columbia. They just can’t expect to know who those supporters are.

The Boone County Coalition for Tobacco Concerns is quietly circulating a letter of support, asking area business leaders to endorse the measure. That support, though, is strictly behind the scenes.

“NOT FOR PUBLIC RELEASE,” reads the undated letter, which is in the form of a contract. “This information is for the Board of Health and City Council ONLY!”

The coalition has been passing out the letters on an individual basis rather than as part of a mass mailing. Lara Sansing, who is in charge of education and planning for the coalition, said that the individual delivery allowed the group to speak with each business owner.

Sansing said the decision to keep the identities of ordinance supporters under wraps was designed to win over hesitant supporters. Some businesses are afraid of losing customers if they openly support the ordinance, she said.

“There are a lot more people that are supportive of this than are actually comfortable saying they are,” Sansing said. “Our purpose in those letters (is) to get members of the business community who support this effort to have a chance to let their voice be heard.”

The coalition hopes this effort will show elected officials that the measure has the support of those with significant economic interests at stake, said Kim Waters, a coalition leader.

“(It is) obviously a concern to the City Council,” Waters said. “It’s a public health issue, but everyone else is concerned about the businesses and the ramifications there.”

The letter contains eight statements explaining the hazards of secondhand smoke and the status of no-smoking ordinances in other parts of the country.

But business owners may want to examine at least one of the statements a little more closely before deciding to sign.

The letter’s second statement cites a federal Centers for Disease Control and Prevention statistic that says 53,000 nonsmoking Americans die each year as a result of secondhand smoke. But the latest information from CDC estimates the number of such deaths at 38,000, of which 3,000 are due to lung cancer and the remaining 35,000 from heart disease.

That number is not definitive, said Joel London, a spokesman with CDC’s Office on Smoking and Health.

“We report at the very low end of the range,” he said. “Our numbers are actually underestimated.”

The coalition based its calculation of secondhand smoking deaths by taking the midpoint between the highest and lowest estimate from various sources, according to Waters.

After learning of the discrepancy, Waters wrote in an e-mail that, “It is not our intention to misrepresent any information. When you have many people working on an issue like this, it is possible to miss corrections that should have been made. Ineither case, the health effects are profound. We will make every effort to be sure our information is represented accurately in the future.”

Some businesses aren’t even aware of the letter’s existence.

Bill Woods, owner of two Steak ‘n Shake restaurants, one in Columbia and one in Jefferson City, wasn’t aware of it. Even though both his restaurants currently allow smoking, he accepts that he may soon have to change that policy.

“It’s a coming trend,” Woods said.

The smoker is used to getting kicked around, he said. Woods believes that in the future more emphasis will be placed on creating effective non-smoking sections.

“If you’re going to have a smoking section you’re going to have to spend the money to segregate the environment,” he said.

Woods is not the only owner left out by the coalition.

“I haven’t heard anything about it,” said Joel Thiel, owner of Otto’s Corner Bar and Grill downtown.

Thiel, though, is well aware of the proposal, and is adamantly opposed to the ordinance. He pointed out that Columbia residents seem to be more concerned about smoking cigarettes than they are about smoking marijuana, referring to the group of laws approved by voters in November that makes possession of small amounts of the drug comparable to a traffic offense.

After seeing a copy of the letter Thiel said he was concerned the coalition wasn’t seeking input from all area restaurants and bars.

“I think it should be left up to the proprietor of the establishment whether or not they want to be smoke-free,” Thiel said.

http://columbiamissourian.com/news/story.php?ID=11805

By John F. Banzhaf III Mon Jan 31, 7:13 AM ET

It took lawyers and litigation to start the civil rights, environmental protection, disability rights and anti-smoking movements. Legislators wouldn't act until the lawsuits caused change and produced publicity that led to laws and other reforms. For example, lawsuits aimed at smoking did what Congress refused to do: slashed smoking rates and returned hundreds of billions of dollars to taxpayers.

Five fat lawsuits have already been successful and, as USA TODAY reported, they were a major factor in pressuring fast-food and other food companies to provide more nutritional information and more healthful alternatives, and to take other steps to reduce obesity.

A court of impartial federal judges has now unanimously held that the same legal rules that apply to hundreds of products, from cigarettes to automobiles, should apply to fast food, and that those who sell it should be liable for their fair share of the costs if they misrepresent or fail to disclose risks that aren't common knowledge.

USA TODAY opposes the suits, arguing for public education and personal responsibility. But expensive taxpayer-funded government educational campaigns weren't very effective in reducing smoking, race discrimination, sexual harassment or other behaviors, while lawsuits were. Face it, personal responsibility by itself simply hasn't worked for obesity any better than it did for smoking and the others, and it isn't likely to.

Juries continue to rule that, while smokers must bear much of the responsibility for their own health, Big Tobacco must share some responsibility if its misconduct contributed to it. Surveys suggest that juries will apply the same principle in obesity cases, especially where young children are the innocent victims. After all, we don't hold sick children liable for the faults of their parents.

Moreover, if fast-food companies are not held liable, or otherwise forced to change, the $117 billion-a-year cost of obesity will continue to be paid largely - and unfairly - by the non-obese in the form of higher taxes and bloated health insurance premiums.

That's why, until lawmakers legislate against obesity, lawyers will continue to litigate against it - and probably continue to win.

John F. Banzhaf III is a professor of public interest law at George Washington University Law School and an adviser to the plaintiffs in the McDonald's lawsuit.

http://story.news.yahoo.com/news?tmpl=story&cid=679&ncid=742&e=18&u=/usatoday/20050131/cm_usatoday/lawsuitscanfightfat

The grim forecasts of widespread bankruptcies in the pub, bar and restaurant sector after Norway's introduction of a total ban on smoking in workplaces proved mistaken, at least so far.  The smoking ban was in place for seven months in 2004 and the number of bankruptcies in the risky industry declined.

In 2003, 386 businesses in the sector went bust. In 2004 this declined slightly to 372, with 338 restaurants and 34 bars closing their doors.

The indoor smoking ban was set to be the toughest in the world, but Dagfinn Høybråten, then Health Minister, decided not to start the measure by sending smokers out into the wintry cold, and delayed the ban until June 1, 2004, allowing Ireland to enforce a similar law two months earlier.

Oslo had fewer restaurants go bankrupt in 2004 while the casualty count for pubs and bars remained the same. Møre og Romsdal, Buskerud and Rogaland counties saw a rise in closures in the sector.

 (Aftenposten English Web Desk/NTB)

http://www.aftenposten.no/english/local/article959680.ece

'Fire-safe' cigarettes for California?

January 31, 2005

In hopes of preventing house fires -- and the needless deaths -- caused by careless smokers, two state lawmakers have proposed that all cigarettes sold in California be self-extinguishing.

Pointing to the thousands of house fires caused by cigarettes in California over the past 10 years, Paul Koretz, D-West Hollywood, and state Sen. Deborah Ortiz, D-Sacramento, have co-authored Assembly Bill 178 that would prohibit the sale, manufacture or distribution of cigarettes in the state that are not wrapped in special slow-burning paper, starting in 2006.

"During the past decade in California alone, cigarettes caused more than 25,000 fires, killing 700 people and injuring almost 100 firefighters, Sen. Ortiz said. "This bill is crucial to protect California families and the men and women who risk their lives for us ever day."

Locally, officials said Ventura County firefighters responded to four fires in 2004 that were caused by smoking, including one in Meiners Oaks that claimed the life of a 47-year-old man. In all, the fires did more than $1 million worth of damage.

In many cases, the deaths, injuries and damages result from smokers falling asleep, allowing their cigarette to touch something flammable, such as clothing or furniture. Nationwide, more than one-third of cigarette-related deaths are children and adults who do not smoke.

Reason enough to support the long-overdue bill.

AB178 is modeled after a New York law, which went into effect last June after the cigarette industry finally met the required standards for manufacturing a fire-safe cigarette. Regulations call for cigarettes to be wrapped in ultrathin bands that serve like speed bumps to stop the burning of a cigarette not being puffed on.

It is hoped anti-smoking advocates, firefighters and consumer groups will rally behind this bill. Now that the technology for "fire-safe" cigarettes exists, there's no reason for cigarette manufacturers to object, especially since a recent Harvard University study of the New York law concluded that requiring slow-burning cigarettes did not result in higher costs, nor did it affect sales significantly.

Besides California, lawmakers in Maryland, Massachusetts and Oregon are seeking to pass similar laws, all which should serve to give Congress a needed push toward establishing a national standard for self-extinguishing cigarettes.

Although these cigarettes do not lessen the health hazards linked to cigarettes or reduce their toxicity, these new self-snuffing butts will make the habit of lighting up much safer for children and nonsmokers.

http://www.venturacountystar.com/vcs/opinion/article/0,1375,VCS_125_3509470,00.html

* notice that they never mention the combustibility of cloth. Exactly how did those fires start?  They never mention what the evidence is