Tobacco Control Cabal Attack Physician Autonomy

Earlier this week, The Rest of The Story reported that anti-smoking cabal heavyweights are using threats of lawsuits to attack and undermine physician's professional autonomy.

"The national anti-smoking group Action on Smoking and Health (ASH) has written to the state health commissioners, asking them to threaten physicians in their states with malpractice suits if they fail to follow national smoking cessation guidelines, which require the use of pharmaceutical therapy for all patients."

"A February 11 press release from ASH states: "Public interest law professor John Banzhaf...the "law professor who masterminded litigation against the tobacco industry," has written to the health commissioners of the fifty states suggesting that they warn their state's doctors about such law suits based upon a recent article in a leading medical journal and an even more recent study about saving smoker lives. The letter notes a recent study which shows that physicians are killing more than 40,000 American smokers each year by failing to follow federal guidelines which mandate that the doctor warn the patient about the many dangers of smoking and provide effective medical treatment for the majority who wish to quit. 'The families of any one of those 40,000 victims - or the hundreds of thousands more who suffer heart attacks, strokes, amputations, blindness, or other problems because of their smoking - could sue physicians for malpractice for failing to follow the standard of medical care mandated by these guidelines,' says Banzhaf."

["these guidelines" - way back in 2006, John R Polito totally demolished the credibility of "these guidelines", specifically the June 2000 Clinical Practice Guideline (CPG): Minnesota 2002, California 2003, London 2003, Quebec 2004, Maryland 2005, UK NHS 2006, and Australia 2006.

Polito, a nicotine cessation educator who runs Why Quit.com, exposes in this letter on the BMJ site

that the CPG was created by a panel composed primarily of paid pharmaceutical company stooges, including some with serious financial relationships to the Robert Wood Johnson Foundation (RWJF), owners of Johnson & johnson products including a nicotine patch, nicotine inhaler and nicotine spray. "these guidelines" are clearly a marketing ploy for smoking-cessation products rather than serious, objective, medically necessary guidelines for anyone's "care".]

This threat against physician's professional autonomy should be of grave concern to everyone working in any medical profession, to academics and scientists in many fields, as well as to members of the general public around the globe. It reveals and exemplifies patterns of behaviour by powerful 'special interests', that threaten to destroy the credibility and integrity of all medical consultation and of all "public interest" research & science.

John Banzhaf threatens physician's professional autonomy -

The professional autonomy enjoyed by physicians in our society seems to be of extreme importance to most of them. It has been cited as one of a few satisfactory compensations for 50-70 hour weeks, onerous on-call duties, little time for personal relationships or family, and other job-related stresses that result in high rates of burnout and suicidal ideation among doctors. Professional autonomy has also been recognized as essential to high quality medical care for patients. The central element of professional autonomy is the assurance that individual physicians have the freedom to exercise their professional judgement in the care and treatment of their patients.

John Banzhaf is an American trial-lawyer who could be described as the ultimate 'ambulance-chaser on steroids'. "He stumbled into the anti-tobacco campaign and a career as a public- interest lawyer 35 years ago. Back then, he was a recent law graduate, working as sports director on the cruise ship MS Kungsholm. On a break between cruises, he wrote on a whim to the Federal Communications Commission to complain that the numerous adverts for cigarettes on US television networks, with no anti-tobacco messages to counter them, contravened a legal
principle called the "fairness doctrine". The FCC agreed, and mandated airtime for anti-
smoking ads. Seized by the idea of using the law for more constructive purposes, Banzhaf dumped a planned career as a patent lawyer, and founded Action on Smoking and Health (US)."

"At the George Washington University Law School, Prof. John Banzhaf teaches a unique world-famous course — "Legal Activism", which has been dubbed "suing for credit" or "Sue the Bastards" — where his law students learn to become public interest lawyers by bringing their own legal actions. He and his students are widely known for bringing hundreds of public interest legal actions. Recently, Prof. Banzhaf started a movement to use legal action as a weapon against obesity modeled on his earlier successes in using legal action as a weapon against smoking." [condensed from Banzhaf.net]

Legal action as a weapon, that's what John Banzhaf is all about - that is what "using the law for 'constructive' purposes" means to him. To a large extent, Banzhaf popularized the idea of "promoting health" through coercive & punitive laws rather than through education and persuasion. Banzhaf believes he has the ability and the right to judge how each of us should live every aspect of our lives, and he is determined to force us all to obey his judgements. Anyone who dares defy Banzhaf's apparently 'Divine' Will is very likely to end up on the wrong side of a record-settingly enormous lawsuit, one that will be brought against the victim again and again and again under subtle variations until they "see the wisdom" of doing (or not doing) whatever Banzhaf wants them to do (or not do).

John Banzhaf wants physicians to do something, now, and if they don't all do it he will arrange for them to be "sued out of existence". What Banzhaf wants physicians to do, is to treat every patient they see who show signs of being a smoker (or confesses to being a smoker), as a species of drug-addict. Banzhaf wants physicians to explain the dangers of smoking to every smoker they see (issue warnings), and then he wants physicians to prescribe a smoking-cessation "treatment plan" for all of them. Banzhaf wants physicians to act as marketing agents for pharmaceutical companies that make smoking-cessation products, and to prescribe a smoking-cessation treatment for every smoker they see - regardless of what the patient's stated wishes might be, and regardless of whether or not the physician judges such treatment to be appropriate for that patient at that time.

That is what it would mean, for physicians to "follow the guidelines" with every patient:

"The US Public Health Service's Clinical Practice Guideline for Treating Tobacco Use and Dependence provide that 'every patient who uses tobacco should be offered at least one of [two] treatments.' Many major guidelines by other respected medical bodies - e.g., the Agency for Health Care Policy and Research, U.S. Preventive Services Task Force, etc. - also require that smoking patients receive not just warnings but also treatment, including counseling."

In Banzhaf's letter to the health commissions, he threatens that if any physicians dare to excercise their professional autonomy i.e., "the freedom to exercise their professional judgement in the care and treatment of their patients" by not "following the guidelines" with all their patients who smoke, or by refusing to act as a marketing shills for pharmaceutical smoking-cessation products, he or his associates will sue those physicians into kingdom-come:

Banzhaf's letter warned that: "Since many in the antismoking community (including hundreds of organizations, many with their own attorneys), as well as lawyers associated with antismoking groups and others in private practice, are now considering how to proceed with the article's litigation suggestion, the need to remind doctors of their responsibilities and of their potential legal liability is paramount..." and "...it should not be surprising if antismoking lawyers, as well as those in private practice working on contingency fees, find physicians who deliberately flout federal guidelines to be a major target of litigation."

Blaming doctors for patient's diseases and other methods of bullying physicians -

Banzhaf & ASH's press release contains one of the most absurd twists of logic I've ever encountered - only Health Promotion zealots could concoct & promote such obvious bullshit with a straight face: "...physicians are killing more than 40,000 American smokers each year by failing to follow federal guidelines which mandate that the doctor warn the patient about the many dangers of smoking and provide effective medical treatment for the majority who wish to quit."

Physicians are killing smokers? What a load of crappy-crap-crap!

Smokers may be killing themselves, through their own smoking, but the physicians they encounter during their lifetimes cannot be held responsible for that. Banzhaf is notorious for this approach to consumer lawsuits, however. "I didn't know that eating nothing but fast-food would make me fat! It's someone else's fault that I have weight-related illnesses, (or smoking-related illness or drinking-related illness, etc) - THEY failed to prevent me from doing what I wanted to do!" and similar BS sniveling around which Banzhaf has attempted to form lawsuits against every corporate entity, institution or individual except the person who made themselves sick through their own choices & behaviours.

The true purpose for this, latest, semantic delusion game (physicians are killing smokers) is very transparent. The intent is to force physicians into adopting the role of Behaviour Police in their patients lives. Suing the tobacco companies didn't stop all smoking, raising the taxes on tobacco didn't, banning smoking in public everywhere on the planet didn't, banning tobacco advertising didn't, slandering smokers with hate-propaganda didn't...so now physicians are to be forced, by threat of lawsuit, into relentlessly hounding their patients who smoke everytime they see them. And what this is most likely to accomplish, if physicians are forced to play Behaviour Police in their patient's lives, is: patients avoiding physicians until and unless they are at death's door.

This Banzhaf-ASH threat of lawsuits is only the latest in a long list of techniques that have been employed, to bully physicians into conformity with one or another agenda developed by "health promotion" & "disease prevention" theorist-fanatics.

It's an interesting, if unfortunate, reality that "peer pressure" is a more prevalent and important influence in the lives of physicians than it is in the lives of the youths for whom it was coined. Peer pressure is omnipresent and omnipotent in the lives of doctors. Peer approval, and the conformity necessary to acheive and sustain it are of supreme importance for most physicians.

In part, this is a consequence of the sense of social isolation many physicians experience: they work long hours, they may lose touch with events in the lives of their loved ones, they have experiences and problems that many people outside of medical fields can't relate to. If they lose face or standing with their professional colleagues -if they are accused of misconduct or malpractice or medical error and live under a cloud of suspicion and distrust from their colleagues while their litigations are resolved, feelings of isolation can intensify dramatically to the point of being intolerable. Desire to be accepted, well-liked and respected by their professional colleagues generates intense pressure to "fit-in", to conform, to go along with whatever they perceive the majority opinion or view on a subject happens to be among their peers at any given point in time.

This atmosphere of peer pressure and need to be liked & respected by their peers has been ruthlessly exploited and manipulated by Health Promotion cabalists within medical circles, for decades and around the globe. Physicians in Western nations were actually the first targets of their social bullying tactics.

Health Promotion cabalists use a top-down model when recruiting people and organizations into whatever 'cause' they are obsessed with. They target leaders of organizations, highly respected individuals in their fields, and other disproportionately influential members of a group - they don't attempt to recruit the masses of lesser entities. They depend on recruiting a handful of persons who have the power to commit their organization, business, institution or government to 'the cause' regardless of the opinions or wishes of the mass of lesser members:

"Most groups have formal and informal leadership and decision making structures. They also usually have informal leaders who have been active and influential in society activities.
An interested and motivated leader, or a small group of leaders, can sometimes persuade to our cause a whole organization that would otherwise be uninterested in tobacco control. In India, for example, the leader of the Jaipur tobacco control coalition personally knew and recruited the president of the automobile dealers association. The entire association then became an active member of the coalition. Similarly, a motivated president of a students association, or the elected head of a residents association, can bring that group into active tobacco control advocacy." [American Cancer Society Strategy Guides - globalink]

Medical professionals were targeted in exactly this manner:

"Leaders of doctors professional organizations or of medical institutions, such as hospitals and medical schools, speak with institutional authority. This is one reason their involvement in your movement is crucial.
For example, a handful of members of the Royal College of Physicians in London were responsible for the groundbreaking report in 1962, which concluded that smoking caused cancer. The same group of doctors later persuaded the Royal College to establish and provide early financial support to the smoking control advocacy group known as ASH (Action on Smoking and Health)". [ACS Strategy Guide]

"A handful of members" of the Royal College were responsible for "...the report in 1962, which concluded that smoking caused cancer". NOT, a concensus of the majority of the membership - not even "a significant portion" of the membership. Just "a handful". The same group of doctors "persuaded" the Royal College to establish and support ASH (UK). This is an example of organizations being committed to serve 'a cause' by an influential elite within them.

From American Cancer Society strategy guide -

"Companion Guide 2 - Engaging Doctors in Tobacco Control"
What is our goal?
Our goal is to motivate more doctors to become active in the full range of tobacco control activities.
In most countries, doctors and other health care professionals are highly respected and influential community leaders. According to Doctors and Tobacco: Medicine's Big Challenge, by David Simpson, medical professionals probably have "the greatest potential of any group in society to promote a reduction in tobacco use, and thus, in due course, a reduction in tobacco-induced mortality and morbidity
Unfortunately, too many doctors in too many countries do not consider tobacco control to be part of their professional responsibilities. Instead they simply treat the illnesses tobacco use causes. This mindset is especially harmful in countries that lack strong tobacco control advocates-often the very same countries in which medical professionals are most respected and influential." [ACS Strategy Guide]

Physicians are a critically important constituency for Health Promotion 'cause' advocates to gain control over. However, as noted above, doctors who are involved in diagnosis and/or treatment of illness tend to be focused on diagnosis or treatment - not on "prevention, by whatever means are necessary". Regulatory force, coercion, bullying...these are the tools Health Promotion employs to "change hearts & minds". Therefore, medical professions were the first targets and victims of these tactics.

"Who do we need to persuade in order to motivate doctors to become more engaged in tobacco control?
We need to persuade doctors themselves and those who most influence them.

"Our target audience also includes those who have the most professional influence with doctors, including deans of medical schools, professors of medicine, and other respected, award-winning doctors and medical scientists. It also includes those with institutional and economic influence, including health ministers and senior public health officials, hospital administrators, boards of directors, hospital medical department heads, nursing directors, and inspectors of hospital hygiene and safety."

"Who can best deliver these messages to doctors?
Doctors need to hear messages from other doctors who are already active in tobacco control. As Krzysztof Przewozniak of the Polish Health Foundation says, "Doctors believe doctors." Doctors who have already become tobacco control advocates are perhaps the most powerful messengers. This is especially true of those doctor/advocates who have institutional and economic influence on doctors and/or hospital administrators."

Here we see the importance of medical professional vulnerability to pressure for conformity emerging. Doctors believe doctors. Doctors want to be accepted and respected by other doctors. Doctors tend to stampede in the direction that popular and professionally influentional doctors are moving. Voicing dissenting opinions or opposition to the direction that popular & influential doctors are going, is likely to get you branded an oddball or an obstructionist, "not a team player", etc. If physicians persist in "opposing the flow", they may even experience ostracism, shunning, loss of professional advancement, inability to get published in peer journals. Forget about "may" - they will experience these things. They have experienced these things. Non-conformers were "made examples of", when disease "prevention" and coercive manipulation of the public's behaviour became trendy & fashionable with the most influential elites in the medical professions.

"How do we get doctors to heed our message?
Doctors will be receptive to messages that come from other medical professionals, medical societies, and other leaders of the medical community.

Medical societies are in a unique position to influence the behavior of their members. They can:

- Conduct surveys of their members, which would include questions about their smoking patterns, the extent to which they provide tobacco use counseling and cessation treatment, and their willingness to become engaged in tobacco control advocacy
- Organize plenary speakers and panel discussions at society conferences and workshops
- Adopt resolutions and issue ethical opinions on members' tobacco control responsibilities
- Publish stories in their journals and newsletters about directives, ethical opinions, and model tobacco control initiatives taken by member societies
- Issue press releases, hold press conferences, make members readily available for news and talk show appearances, and organize direct lobbying by medical society leaders" [ACS Strategy Guide]

Note that there is no mention of disseminating conclusive scientific research to the membership, at this stage. The efforts described above have nothing to do with winning over the membership in general by persuading them of the overwhelming medical necessity for reorienting their priorities to whatever Health Promotion 'cause' is being pushed. The efforts described above have everything to do with creating a social pressure that will compel the membership to conform to and ultimately endorse the direction their leadership has already committed them to.

These are some of the ways that medical professionals have been bullied, cowed or intimidated into participating in trendy Health Promotion "initiatives" that they might not have believed were truly in the best interests of their patients or of their profession.

None of these, however, are even on the same scale as John Banzhaf's threat to ruin them with malpractice suits.

OBEY! or else....