Download DeHaan Lecture Welcome and Introduction of Dearell Neimeyer:

Transcript of
2003 Virginia S. DeHaan Lecture on Health
Promotion and Education:
DeHaan Lecture Welcome and Introduction of Dearell Neimeyer:
James Curran, PhD, Dean, Rollins School of Public Health
Hi everybody. Welcome to, to one two three four five six seven eight nine ten eleven twelve
thirteen, fourteenth annual. I’m quantitatively impaired. Fourteenth annual DeHaan lecture. I, this
is always a really special time of year and this is my ninth annual DeHaan lecture here at the Rollins
School of Public Health. Many of you are here from our school or you’re our friends and neighbors
and you’re in the Rita Anne Rollins Room and that’s Rita Anne Rollins who died at a very young
age in the Rollins family, in the Rollins School of Public Health. I was I’ve been given all sorts of
promptings on how to behave at these sessions. Everybody thinks they’ll give me messages and
then they’ll say he never follows those anyway. It’s even so bad now that Bob DeHaan is telling
me how to behave. And so I must be really bad because this is the ninth year in a row I’ve been
with Bob DeHaan. This is a special lecture for a number of reasons. It’s a special lecture because it
honors Ginny DeHaan, one of our alumni, Bob’s first wife, and we’re very happy to have Bob and
Mary Anne S. DeHaan here with us today. It’s special because she was also a faculty member in
our department of behavioral science and health education and was a health education graduate and
health education teacher. And so this has often had the theme of health education in public health.
If you look at the past speakers, I think though that you would say that past speakers have really the
most in common is their leadership ability and I tried to figure out what they had in common.
When you look at the past speakers you see three people who had theories named after them in
health education, you have one former surgeon general, you have a couple people who have written
textbooks in health education, two people who’ve had the misfortune and crime of becoming school
of public health deans, one person who won a Peabody, Pulitzer, and Polk award for her journalism,
one person who’s the current head of the American Cancer Society, but what they all have in
common is their uncommon leadership in public health and I can remember after I was Dean for
about three years asking a group of students who were the people who had, who won the leadership
award in 1998 in public health? Who were the most important people in public health that year? It
was meant to be a trick question and I reminded the students that public health is what we as a
society do to assure health. It’s not what we as doctors do, it’s not what we as nurses do, it’s not
what we as biostatisticians do, and it’s not what we as health educators do, but we as a society do.
And the most important hero of that year are the people who have the greatest impact and lo and
behold they were lawyers and attorneys generals and we are fortunate to have the biggest hero of all
with us today, Hubert Humphrey the third. They made the biggest difference because they directly
made the assault that was effectively done on the greatest cause of death in the Western World, the
greatest preventable cause of death, cigarette smoking. And they single handedly, with the help of a
few friends changed the rules and it’s never been the same ever since. In the United States we have
the lowest smoking rates in the developed world despite having a very decentralized form of
government and a federal government which is somewhat powerless relative to other countries in
terms of its domestic work and we did it because of the strength of the community and the statebased work of people who redefined the unacceptable, who said, we just cannot have this many
deaths due to smoking in our country, we’re going to change that, it’s not right, we know the
methods to do it, and they did it. So Hubert Humphrey the third runs to the top of our previous
lecturers as our public health hero this year. The third reason I’m so happy to be here is that it
brings together people from the Atlanta community; alumni, friends, faculty, students from our
school, people from CDC, American Cancer Society, Atlanta University, and others to join in
celebration of the speaker and a little bit of wine and cheese afterwards and the wish that I could sit
down sooner. It’s really nice to have Skip Humphrey here because of what the legacy of his family
has meant to our country and school even before he became a public health hero in 1998 and that
was with his father Hubert Humphrey who was a political hero of mine when I first started to vote
in those days and is recognized as a hero by the program started by Jimmy Carter of the Hubert
Humphrey’s Fellows Program and of course it worked out just about right for us to walk downstairs
and see the pictures on the wall of the now over one hundred Fellows from probably 75 countries
and they have one from Kenya sitting in Dr. Brachman’s office who said, “Oh yes, thank you.”
Thank you those to our school, to family. Now I want to mention something about Bob DeHaan
and telling precisely what he’s doing now. The last few years I’ve gotten his job wrong each time.
Bob DeHaan is now Director of the Committee in Undergraduate Science Education in the Center
for Education in the Division of Behavioral Social Sciences in the National Academy of Sciences,
Five Hundred Fifth Street Northwest. His email address is available on the website. I’m only
teasing Bob because Bob, Skip is also a hero in many of our minds. He’s a guy who has turned his
life to community service after a very strong life in science and teaching at Emory as chairman of
basic science departments here. In the last ten years he’s turned to elementary school and middle
school education and after starting some model programs here at Emory he’s been asked to help the
National Academy of Sciences do that to talk about the next generation and next generation and
next generation of students in science so thanks Bob for what you do and thanks for this lecture.
Now what I get to do is invite Dearell Neimeyer, who is the Executive Director of Arts of Tobacco
Technical Assistance Corporation to the podium to introduce Mr. Humphrey.
Opening comments from Dearell Neimeyer, MPH and Introduction of Mr. Humphrey:
Dearell Neimeyer, MPH, Executive Director, Tobacco Technical Assistance Consortium, RSPH
Well good evening. This is my first of the fourteenth so it’s a real pleasure to be here and it’s a
pleasure to have tobacco on the agenda this evening. It’s one that I have been working in for many
years so I appreciate the opportunity to have been involved in getting Mr. Humphrey here. I’m
going to deviate a little bit from the introduction the normal way, read the bio kind of thing. You
have a wonderful description of all the contributions that Mr. Humphrey has made to public health
and tobacco, but they need to frame a little bit the issue that Mr. Humphrey will be presenting to
you tonight. As the Dean said, not only do I really appreciate Mr. Humphrey’s coming to Emory to
talk to us about his role in the tobacco use situation in Minnesota and trying to change that, but his
family’s long term commitment. I was going to try to get away with saying I was a young child in
the sixties and seventies, but okay, young man, but remember also his father’s contribution to not
only health, but social justice in general. And then I had the good fortune to work with a Humphrey
Fellow last year from the eastern block states, countries. So it‘s touched me in a couple ways this
year. I met Mr. Humphrey in the late 90’s. I was with the Office of Smoking and Health at the
CDC and one of the conditions that Mr. Humphrey had fought so hard for in the settlement with the
tobacco industry was to set up a foundation in Minnesota that would be a lasting legacy to the
prevention and reduction of tobacco use and I had the good fortune to be asked to come up and give
some technical assistance at that foundation and I don’t know whether he’ll touch on that
foundation much, but if you’ve seen anything in the news the foundation was eventually sued by
another attorney general for maybe out stepping their bounds from that lawsuit agreement so in
tobacco control you’re never sure what’s going to happen at any one time. Change is the big thing.
Why are we so concerned about this issue? Public health, we all use the data, we all know it,
400,000 annual deaths, leading preventable cause of death. Four hundred, get your number right,
that number challenged also. Forty six million smokers, if patterns continue to exist today, 6.4
million of our young people will become smokers and will die prematurely from tobacco. 75
million dollars in medical care costs and the industry will spend billions this year to market its
product and to influence tobacco control public policy in this country. So those are the numbers.
S.O. has been working in tobacco control for about fifteen years now. Sometimes it feels like
we’ve gotten numb to the numbers. They’re the facts of life, they’re a reality in which we have to
work with and live with. I think in tobacco control we’ve gotten frustrated at times that public
health or the healthcare side of business, or businesses themselves, education, politics won’t pay
more attention to this issue, won’t look at it and understand it, that maybe we can do more and that
we aren’t doing enough and won’t see it as an unsolvable problem, but really it’s a solvable
problem. We have the data and we have the experience, we know what to do. There’s a model in
public health, the old triangle: the host, vector, and agent. For years we’ve worked on tobacco
control from the host perspective, trying to get the user of tobacco control to change their behavior,
to do something differently, almost at times we tried to inoculate them with information so they
wouldn’t use the product. We did little to look at the vector and the agent which was the tobacco
industry and its products and just quote on how dangerous that’s been in the industry documents
from the early seventies a quote was discovered that says, “They cost a penny to make, it sells for a
dollar, and it’s addictive, that’s what I love about this business.” So the industry had been skating
by for many years on this issue, but in the late 1990’s, four attorney generals decided to change that.
The states of Minnesota, Florida, Texas, and Mississippi sued the industry for its practices and its
harmful products. Three of those states settled out of court, but one state went to the mat. It was
bound and determined to hold this industry accountable and that was Minnesota. Out of that
experience we have thousands and thousands of pages of documents from the industry documenting
their practices and their history that for years can be used to hold this industry accountable. Mr.
Humphrey used public health data, used the industry’s own words, to win this case. The industry
finally settled out of court. The law and public health have long been partners. They’ve worked
hand in hand for years. You only have to look at the health and safety codes of this country to see
the fruits of those partnerships, but taking on the likes of the industry like the tobacco manufacturers
was truly a benchmark in the history of public health and law. Please welcome Mr. Humphrey to
tell us about Minnesota’s role in that historic public health inventive. Mr. Humphrey.
Hubert Humphrey’s Presentation:
Hubert H. Humphrey, III, Senior Vice President, GCI Tunheim
Darryl to you and particularly to those that work in your clinic and the work that you’re
doing across this country I know with others, some of whom are mutual good friends in Minnesota I
thank you. To Dean Curran thank you so much for the opportunity to be here at your School of
Public Health. I will go back to the School of Public Health in Minnesota and tell them that yes, we
really should have a building where we can all be together. We're not yet, but we’re getting there.
We’ve got to solve a small little budget crisis in Minnesota. Of course nobody has any of those
anymore. Right, and most of all though to, to Mr. and Mrs. DeHaan, Dr. DeHaan thank you so
much for sponsoring this lecture and being a part of the larger part of what public health is all about.
I know we’ve only had a brief opportunity to visit, but I’m going to give you that call. I'd like to
learn more about it. I thank you very much for allowing me to be here, it was very special to go
downstairs and to see all of the Humphrey Fellows that have been here. I got to tell you, if you’re
up there dad and I know you are this is exactly what you wanted. This is exactly what he wanted to
see and I thank you for being a part of that. It’s a very, very special thing that we’re able to do.
And sometimes you get a little discouraged when you see things are happening around this world
and you wonder whether or not things are going in the right direction just think about the wonderful
people that have been able to come here to this great university, to this school and to learn and then
to be able to go back home and to help people have a better life. It’s a very, very special thing that
President Carter has done and I think he's a great hero for that and so many other things as well.
Well we got to be careful because you’ve got a Humphrey in front of you and I remember the old
adage that someone used to say at a couple of political events, “Here comes Humphrey when do
they serve breakfast.” So we have to be a little bit careful, but I want to thank you first of all also,
just a little bit humorously, I look out here and I see this magnificent green forestry that you have all
over here. It's nice to be away from the frozen tundra and it's not exactly frozen anymore, it
actually got up into the fifties today, so we're making progress, but we’re kind of far behind you and
it’s really nice to be able to be here. I am indeed honored to be here also literally and what I know
Dean you have said many times is you’re right at the center of the nation and the world's public
health. I know across the street literally is CDC and all wonderful things that are happening there
and here and elsewhere. It is something very special and unique that you have here in this great city
of Atlanta and I congratulate you on that. Now from what I gather and what I heard just a few
moments ago about this lecture series I may be the first attorney and former politician to have been
invited. You're very brave to do that folks, very brave. Lawyers and politicians, of course as you
know, never have held been held in very high esteem. However of late I guess we have moved up
the rung a ladder or two given some of the shenanigans that corporate CEOs and corporate
accountants in accounting firms have been dealing with. What I’d really like to do tonight is to
explore with you as I do with my students in my seminar class at the school of public health the
importance of using our nation's political and judicial process to successfully move forward and
reestablish the priority of the public's health. Now I know you’re deep in to it every single day so
it's important to you. You’re immersed in it, but unfortunately over the last several years if not
decade or two, we have slipped away, we have taken kind of, we just assume that we have good
public health. It's taken a few things like tobacco, like SARS, like bioterrorism and the rest to kind
of wake us up to the fact that you can’t just let this stuff sit. You have to keep working at it all the
time. So I'd like to visit with you a little bit about that special role that I think you do play and I
urge you to continue to play. Now as faculty, students, and friends of this school of course you
recognize, even though not everyone else does, that health science is truly leading a scientific, a
revolution of scientific discovery and investigation and practice. All one has to do is understand
just a little bit about genetics, the human genome, pharmaco-genomics or stem cell research and
I’ve just recently learned those words and you begin to understand the sweeping changes that are
occurring all around us and I think in a not dissimilar way there is a kind of a close revolution
happening, that has happened in a sense I saw throughout my life in my political career. I served in
our state senate for ten years and then I served as attorney general for some sixteen and of course
then I was raised up in a slightly political family. I think we woke up to politics and went to bed
with politics going. What was so exciting for me in the politics that I was surrounded with was to
be at the center of change and that’s in a sense where you are today. I know you've always kind of
been in it, but I’ll tell you, the public is beginning to realize the revolutionary change that is going
on and it is our task, and our opportunity to tap into that realization that the public is beginning to
have. With your informed understanding of the scientific revolution that is taking place in the
health sciences and with your capacity to translate that into public policy you are the key players in
an effort to provide for the improved health of the public. Now the challenges are great indeed, we
know that, but the opportunity for success is even greater. Now one such challenge is the
continuing struggle and I’m so glad Darryl that you mentioned it. Sometimes we get immersed in
the statistics and they’re around us so much that we forget about it and we don’t see it all the time
on the television, it isn’t there twenty-four hours a day so we don't, we don't understand how
devastating this problem of tobacco is.
As I said, one such challenge is the continuing struggle to break tobacco’s addictive hold on so
many of our fellow citizens and tonight I'd like to discuss the fight to change the public's attitude
about using and tolerating the use of tobacco that we, where we've been, where we are, and where I
think we have to continue to go. Understanding big tobacco and what we have had to confront may
well mirror what we have to deal with, with other pressing public health issues and I’d like to touch
on that. Well it’s an old adage, but a true one, that you have to know where you’ve been to better
understand where you’re going and with this in mind I'd like to just tell you a little bit about the
tobacco wars. I know you've heard it all before, but first of all it’s a good story and secondly I think
it does remind us of the very heavy challenge that we continue to face and that the globe, the world
continues to face. Now all of you here, of course, understand the ubiquity of tobacco use
throughout the world and of course we understand the dire consequence of that omnipresence; the
injury and death of millions of our world citizens. It goes without saying that this industry is
powerful. It jealously guards its interests by substantial and sophisticated lobbying efforts, heavy
campaign contributions, massive investments in marketing and advertising and I know what some
of that is now that I’ve gotten into the marketing and advertising side of business; I work in public
affairs and I’ve got to tell you these guys really know how to use it. So they’ve used that and heavy
campaign contributions and the relentless, aggressive legal defense tactics whenever this industry is
brought in court. Now let me just say that back in the nineteen ninety-four when we filed our
complaint suing big tobacco was not exactly the politically correct thing to be doing. So then you
have to ask yourself, well, why would a popularly elected state law enforcer, state law enforcers
attorneys general take on this politically powerful industry? I think there's a simple answer and I
commend my colleagues for feeling the same way as I did. We knew, or we came to know they had
broken the law and it was our responsibility to deal with that situation. More specifically in
Minnesota's case they had violated our state statutes, the strong laws protecting the consumer and
ensuring free fair competition in the marketplace and as a result of that millions of citizens suffered
and died while millions of others, taxpayers, paid for the medical costs associated with the smoking
caused disease. Now, notwithstanding the industry's claim that our lawsuit was merely about
cutting off a citizen’s right to smoke or that the problems caused by smoking were merely caused,
were merely the result of the conduct of the smoker and it was the smoker’s fault, the so called
choice that this consumer makes. This case that we brought instead was one of law enforcement; it
was all about illegal conduct of the industry and its executives. Now our case was a bit unique, we
were the first one to sue not because the product was hazardous, but because of the illegal conduct
of the executive industries, the industry executives. We allege that they broke our laws, committed
fraud, false advertising, used deceptive trade practices, illegally conspired together to suppress the
research making sure that no one in the industry would compete with one another by offering the
public a safer cigarette among many other things. So, we began to put our case together. The first
thing we had to do of course was to assemble a team with the capacity and the experience to take on
this tough industry. Now remember in nineteen ninety-four this industry had been sued over four
hundred times and it never lost a single case. Now while the Minnesota attorney general office at
that time had a record of actively pursuing antitrust and consumer protection cases when it came to
this one we knew we needed outside help. We not only could not spare the human resources that
would have to be reassigned to the case for several years, but we also needed help with lawyers
experienced in complex massive civil litigation. Now fortunately we found help right in our
backyard; a locally based national law firm that had extensive litigation experience in health and the
environment. If you remember the environmental health law case about, in India, the Bhopal
problem there and the huge environmental problems there this law firm, the Robins Kaplan law firm
had represented the nation of India in those cases. Our legal action was directed towards achieving
three fundamental goals: stop the marketing of tobacco to kids, tell the truth about what the industry
knew about the health hazard of their products, and pay damages that were commensurate with the
harm caused by the industry's illegal conduct. Now on the day that we announced the lawsuit I said
publicly that if the industry would meet these three simple requirements the case would be over they
day that it began, but of course it wasn’t going to be that simple. I wouldn't be telling you the
whole story if I didn’t talk just a little bit about what it's like to go to war with the tobacco industry.
For example at one point when the industry first started trying to cut a national deal that would have
protected them against future lawsuits this industry met with one of the other state’s attorneys
general and assured him that the tobacco industry and they said and I quote, “money is no problem,
money is no problem at all.” I guess that when of course you have forty five to fifty million people
addicted to your product and you can raise your prices whenever you want money isn't a problem.
This industry has proved that it, they proved that in their settlement office, offers to the states alone
two hundred and sixty billion dollars plus. In a way they also have unilaterally raised their price of
their product, they raised their price before anybody had to raise any taxes they raised their price
over and above the amount that would cover all of that two hundred sixty billion dollars over the
period of time that it was to be paid and they prove it, of course, in the way they handle litigation.
They give a new meaning to the term scorched earth litigation. Now another example, in a sense I
looked at this as kind of David and Goliath kind of fight. One of the industry's famous internal
documents was the one from one of their attorneys to the executives about litigation. Paraphrasing
General George Patton he said the tobacco industry strategy was not to spend all of its money on the
cases but rather quote, “I say to make the other son of a bitch spend all of his,” and up until the
states action they've been very successful at doing that. What in a sense they had done was they
would put untold resources into those lawsuits, they would drag them out until the private plaintiffs
either went away because they had no money or they died and that's how they won, but the one
interesting thing about states is they don’t go away, they’re still here and we’re still at it. Now let
me also paint a picture how this case proceeded. Minnesota's case was the only state that went to
trial, five grueling months in the courtroom. We had one law firm, twelve attorneys and legal
assistants, and a small team from our office. Arrayed against us were thirty two law firms and we
never knew how many people, but I do recall at one point in an argument before the Minnesota
court Philip Morris complained to the judge that they had over a thousand people working on
Minnesota's case alone and that it was costing them over a million dollars a week. Oh I wished I’d
had those resources and of course they also use the tactic of appeal and delay. We were in court all
the time. There were probably tens of thousands of pages of briefs that were filed. There were over
three hundred court orders issued, twenty appeals taken going to our state supreme, several going to
our state supreme court, two going all the way to the United States supreme court. The tobacco
companies made trench warfare look easy. Because they had unlimited resources the name of the
game was to bog you down, to stall you, and regardless of the issue they mounted a full-blown legal
fights over every conceivable issue and some that weren’t conceivable like the motion to dismiss
arguing that the state of Minnesota didn't suffer any loss but instead actually benefited from
smokers dying early because the state did not have to pay things like continued pension costs and
the resulting lowering cost of health care costs as being a benefit. Now where have you heard that
argument before? Since then in Czechoslovakia; same argument. Well fortunately our judge said
number one, that's irrelevant, number two, it’s morally reprehensible, don't even push it. So they
didn’t. Now the whole part of this would have fallen apart though without a good discovery
process. The key to our success and now the foundation of current, ongoing litigation was our quest
for the industry's documents. By a disciplined process of discovery lasting more than three years
we eventually succeeded in getting over thirty million pages of industry documents this is indeed a
treasure trove of truth. It’s the largest production of documents in history and with these documents
and the accompanying indexes we were able to uncover the industry's misdeeds and make the
revelations that you have all to read about. Let me just tell you how this happened. We started
making a little bit of a breakthrough finally the judge was starting to penalize them for not releasing
any of the documents and so they decided well we’ll just bury them and they did. They dumped,
literally dumped all of these documents. If you go to Minnesota there’s twenty six million of them
in a warehouse up there and they’re just stacked all the way up. You can see the original
documents, they’re all there, but they dumped them and they were all mixed up. So the question
was how in the heck were we going to make anything out of this? In a sense it was trying to find
the needle in the haystack. Well fortunately we had some pretty innovative lawyers and we had a
judge that was interested and what that, what those lawyers did is they went and they said well we
know that they had four hundred cases and we know out of those four hundred previous cases they
know which documents are the most dangerous to them. Therefore they must have an index of
those documents. Let us go after the index and they went to court and they asked the judge to have
the, they wanted to discover the index. Oh no you can’t do that; attorney client privilege, that's
what they argued. The judge said, “No, I’m sorry these are not the documents, this is just an index
to the documents. Yes, you may have, Minnesota you may have the index.” And that's how we
unraveled it was like a road map right through all of this junk that they had given us. Although I
have to tell you every single one of those pages of documents was read and so it was a very
interesting. Fortunately the documents had been preserved as a condition of our settlement in two
depositories, the larger one in Minneapolis as I’ve mentioned and the other in England, seven
million pages in Guilford just outside of London. You might ask well why in outside of London?
Why in London? Well this industry was smart. It knew that some of the most dangerous
documents shouldn’t be around at all so they moved them over into Germany and all around Europe
and the judge did agree and said okay we understand it’ll be a little hard of a burden to bring seven
million documents back to Minnesota. You have to put a depository in London and bring them all
there on the continent so that's where seven million of them sit today. Fortunately those documents
have been preserved as I’ve said and of course now almost all are now online thanks to the
wonderful work of professor Stan Glantz at UCSF and the thousands that have become trial exhibits
and they are the premise for additional documents now that have been found on all of that. It was a
trial through, it was a trial through the witnesses' testimony that the truths contained in the
documents came alive and I’ll tell you what a trial it was. I sat in for a good part of it. Fifteen
weeks long, motions by the defense to try and throw out the entire jury, to get our law firm thrown
off the case, to get the judge thrown off the case, to even throw the judge’s law clerk of the case.
Expert witness testimony included that of Doctor Richard Hurt of the Mayo clinic and lead
epidemiologist for the University of Minnesota’s School of Public Health and the cross examination
of defense witnesses by our lead attorneys was as compelling and captivating as any of today's TV
law series. Now all of that was going on, on the frozen tundra in Minnesota but there was a second
front to this war. All along during the several years of the case there was another front on which we
had to wage the battle with this powerful industry. It was in Washington DC in the halls of
Congress and the corridors of the White House. While the case was being successfully prosecuted
in Minnesota the industry was working tirelessly to try and cut us off at the pass having Congress
enact legislation that would preempt future and current pending litigation meaning our case. It was
a full press by some of the most seasoned lobbyists in Washington additionally the industry had
lured the other litigating states with promises of hundreds of billions of dollars conditioned on their
active support for passage of federal legislation containing the sweeping preemption language. The
proposed federal legislation also contained many caveats that would have allowed the industry to
continue operating without a change perhaps forever. Along with Doctors Coop and Kessler and
the blue ribbon panel that issued a report that was highly critical of that proposal Minnesota's best
counter-punch was the daily revelations of lies and distortions by the industry as document after
document was presented and the witness after witness testified in court. The news media,
congressional staff members, as well as key policy advisers to the President were kept informed up
to the minute of the progress in the courtroom. We literally had a situation where when a, when a
document was introduced and accepted by the court within fifteen minutes that would be in the
hands of reporters of the Wall Street Journal, The New York Times, The Washington Post, it would
be on the desk of certain senators and house of, members of the House of Representatives and their
council and staff and also to key policy decision makers in the White House. We basically had to
fight to battles going back and forth all time. The proposed as I said as we came down to the end of
the trial commentators and observers started suggesting the possibility of a huge verdict against the
industry. Knowing there are no guarantees in litigation we began to ask ourselves where are we
when it comes to meeting those three basic goals that we had started out with. When the industry
approached us about a possible settlement it became clear that they were finally ready to meet our
goals. In the last hour on the last day of trial just before the last argument was made and the jury
handed the case for their deliberation, this is five months into it and literally the judge had said if I
don’t hear from you within forty five minutes this is going to, its going to the jury and no we're not,
I'm not accept any settlement. That’s literally what happened. They agreed to settle. The industry
surrendered and they surrendered on our terms. The settlement has now become a national
standard. This was the third largest legal case in history. It resulted in what was by far the largest
per capita recovery of all of the state's efforts and perhaps far more important than any of the money
and the size of that, the injunctive orders of the court set the stage for significant change in the way
the industry conducts its business in Minnesota and around the nation. And given the huge budget
shortfall that we're facing today it’s rather interesting that the, that we find that even though our
governor has sacked the tobacco endowments appropriated to the Department of Health in order to
balance the budget the one thing that remains even after the current attorney general has attacked it
is the, is the foundation that was established under that settlement. So there's at least something left
after all of that, but now I want a step away from tobacco for a minute. That’s a fun story to tell but
we have to ask ourselves what does that allow us to see about this industry and what we need to do
in the future and what kind of things can we, what kind of lessons can we perhaps learn about other
situations that you see. So how might we have, what might we have learned about the dealings with
tobacco industry that instruct us as we confront other public health issues. Let me give you just one
example. The other evening I was watching our public television channel and listing to Bill
Moyer’s investigative program NOW, N-O-W. The topic of the show was the alleged collusion of
members of the handgun manufacturing industry and their willful failure to obtain easily available
government produced information about handgun dealers with high rates of purchased weapons
used in crimes. Much like the tobacco industry and its insider whistleblower Jeffrey Wigand,
Moyers’ NOW investigator interviewed one of the gun industry’s insiders and the NRA's most
trusted congressional lobbyist. Former industry lobbyist Bob Ricker is now telling all about
corporate collusive meetings and the industry's efforts to quote, and I say quote “not know about
their bad dealers.” If you’re interested in looking at this any further just go to the PBS web site and
also look at under NOW and it's a, it's a fascinating story that's just unfolding as we speak. Just as
the tobacco industry tried to hide the knowledge they had so it seems that another industry that
produces a dangerous product is trying to avoid responsibility by denying that it has the information
needed to root out the bad dealers even though the government report detailing the gun sales is
generally available to the public for a mere fifty dollars from the ATF. And much like tobacco
these willful acts by another industry results in injury and all too often death. For public health
advocates trying to stem the tide of harm caused by handgun crime it has to be deeply troubling to
know that not only must they fight an ideological battle with the NRA and legal battles but now it is
confirmed that they have a whole industry arrayed against them actively avoiding getting rid of bad
dealers and distributors and so far successfully petitioning congress to give the industry immunity
from lawsuits. Last week the House of Representatives passed a wholesale industry immunity law
and it is going on it’s going to be deliberated on in the Senate next so stay tuned folks. Hear again
is an industry saying one thing and doing another. Does it remind you of Enron, Worldcom,
Healthsouth, other companies who dupe shareholders, the market, cause untold pain and harm to
honest employees and retirees and are now out of jobs, out of retirement funds, out of health care
insurance coverage, just plain out of luck? Something's wrong with all of this and it affects not only
our pocketbook, but our health.
Well these are just some of the horror stories of today that are affecting the health of our
society, but we also have to acknowledge the good news. Let me go back to tobacco for just a
minute. Yes, we still have a long uphill fight to achieve the goals of cessation of prevention but
we’re climbing that mountain. Look at the states like California and Florida with their
comprehensive, sustained, and well-funded efforts of smoking prevention and cessation they are
accomplishing fantastic efforts of reduction. Look at the increasingly successful individual and
private class action lawsuits against the industry. Sure shaking them up. You know if you’re in
Illinois and Lord Sakes now we even managed to say oh my gosh we might go bankrupt. When I
was asked about that I said gee whiz, wouldn’t that be nice. People forget when you go into
bankruptcy it isn’t the end of life, it maybe the beginning of a new and better life. You get rid of
the problem and you start over doing the right thing. So maybe, maybe a little bankruptcy here and
there with this industry might not be such a bad idea. And hurrah for the leaders like Mayor
Michael Bloomberg of New York City and the thousands of other brave elected officials all across
this country who are demanding clean non-smoker free bars and restaurants not to mention the
thousands of businesses that have on their own been working to remove all vestiges of secondhand
smoke on their property. Pharmaceutical companies have produced and actively market new
products to help smokers break their addiction. Public and private health clinics are more
aggressively helping people quit and helping young people not to start. I saw today in the Wall
Street Journal I think it was a story about you can online now and get direct assistance and help to
break your addiction online through a clinic. Internationally through, though the industry continues
to expand its markets and indeed it is very aggressively, still real progress is being made. In Ireland
and soon in Norway and other countries no smoking will be the standard for restaurants and bars.
In June the World Health Organization will announce the convention treaty to place significant
worldwide restrictions on tobacco advertising. Litigation continues to reclaim millions of public tax
dollars lost because of the industry collusion in the smuggling and black marketing of their products
and private litigation of course as I've said is pressing the industry to pay for the private harm that
they have caused. The industry is feeling the financial pinch in its operating costs and this is being
reflected in the stock analyst warnings and industry cries of threatened bankruptcy. Now all of the
successes are a result of the growing army of concerned individuals organizations and learned
public, learned public health academicians and practitioners like you. The industry knows it is in
the struggle for its life because of the grassroots efforts of citizens and professionals like you. We
have much more to do. Let me just raise a couple of questions that we’ve got to address. Where is
our federal government in all of this? Why hasn't Congress acted to give the FDA authority to
control the sale and use of this addictive product? What can Congress do to deter or punish these
companies that willfully cause harm to our citizenry by their failure to carefully manage the sales of
their dangers products? How do we help state legislators and governors to increase taxes on
tobacco products, one of the most effective deterrents to smoking, and I know you’re in that battle
here in Georgia, we are too in Minnesota. And when state governments are faced with hard choices
in order to balance budgets how can we show them the worth of continued, even increased
investment in public health cessation and prevention initiatives as a good cost reducing program?
The public must continuously be reminded that while war, whether it’s in Iraq or anywhere else,
SARS, the threat of biological terror and public, other public emergencies must be attended to so
also must we keep up our efforts to break tobacco's grip. That failure to do so means the untimely
painful injury and death of people; millions, hundreds of millions of people all over this world and
this is where I think you in particular, you who have the talent and the ability to work the studies,
the interventions, applying your knowledge of public health science, this is where you have the
greatest opportunity to make the difference. Your capacity to take the science based evidence of
public health and move it into the arena's of the political debate and public discussion is crucial to
our continued success. This industry is unrelenting. It is there at the capital today here in this state
and in my state fighting against us. We need to be there too informing those decision makers,
informing the public about the scientific truths that we know and how much of a difference it can
make in their lives and in our society. Now we must press our case for reestablishing public health
as a principal concern and responsibility for citizens and our government. I know you are so
engaged and I hope you’ll continue to keep doing it. On the day we announced the Minnesota's
tobacco lawsuit settlement I said that even as we were flushed from the courtroom victory we were
still in the shadow of a greater challenge. Like the mountaineers who climb Mount Everest we
stood at the base-camp not on the top. Having accomplished much, but knowing that the even
harder thing to do was still ahead of us; conquering the addiction to nicotine, changing the public
attitudes that support its use. Well we're still climbing, we’ve reach higher plateaus, but the
pinnacle we can see is still above us. The time, the climb is tough and dangerous, but we know we
can achieve our goal through the patient, persistent, sustained pursual of our better public health.
Whether it's tobacco control or obesity of far too many and its attendant risk of diabetes and host of
other diseases or the many other concerns of our society's health those of us charged with the
investigation and care of the public's health must renew our efforts to reach out, connect with the
people, participate in the public debate, counter the adverse marketing, and change attitudes and
seek the better day. I know here at the Rollins School of Public Health you’re up to that task and I
thank you for letting me come and visit with you. Whatever questions you might have, or not have,
or whatever. Yes sir.
Audience Questions and Answers:
1. First we thank you for an elegant lecture, but I think some of us get, wonder whether any
sane person is ever going to show up in Washington?
Well, I read today and I did not see what the total announcement was, but I read today that
Richard Gephardt announced that his whole premise for running for President was going to be a
forum of providing health care for everyone in the United States so he's going to make it an issue so
I think there are opportunities, but we’ve got to, you know we got to put our action where our
mouth is in a sense. I grew up in a family where we had lots of debates, lots of debates. I usually
didn’t win them, but I remember my father always saying, “OK, that’s fine, we’ve had fun, what are
you going to do about it?” That was the answer that I always got. It wasn't good enough to just
complain. You had to be willing to get in and take the action and take the risk of that action and
that's what I ask you to do. It's not that you’re not doing that, but we've got to step up the pace, we
need to coordinate statewide, multistate effort. If Congress isn’t going to do it, then the states ought
to do it. If the states aren’t going to do it then the communities ought to do it and if the
communities aren’t going to do it, then citizens themselves have to do it, but there are tons of
people out there, good companies and others that are hungry be involved in this effort. They see it,
they know what it, how it affects their bottom-line. They know how it affects their families and
their employees and all the rest so I think we have a great opportunity and when that pressure builds
even the money that is paid out by this industry is not going to be able to overcome that
overwhelming effort in the political arena, but it’s going to take a lot of work, a lot of continued
work.
2. What role did the school of public health play in your work during the tobacco settlement
time and how are they affected now and how did they act on their own?
Well, first of all we had several witnesses from the school of public health that were expert
witnesses. A couple actually epidemiologists, so that was a very direct impact. We also used some
of their studies. They had done some earlier studies that helped, helped us understand what the
dynamics of the losses were and the effects in Minnesota, so that was a really important part.
They’re continuing to do that frankly with the funding that has come from the Department of
Health, the State Department of Health which of course comes through grants, that of course was
funded by the endowments. In Minnesota we had a governor Jesse Ventura, remember The Body;
he did a few good things. One of the things he did was he said were going to endow and so he put
over a billion dollars in endowment. Now that sounds like it's safe, but as the old adage goes
nothing is safe when the legislature is in session particularly if you’ve got deficits that you’ve got to
balance budgets. We’re not like the federal government where we can go and give tax breaks and
go into deficits at the same time and neither are you here in Georgia. You have to balance that
budget. Well, they’re taking money from every place they possibly can and unfortunately they’re
pulling those endowments out so about the only thing we got left is the two hundred million that
was set aside by the court and even that was under challenge by the current attorney general, but the
court basically turned that away and said no, we’re going to reform the structure of MPAAT
Minnesota Partnership for action against tobacco and the two hundred million is going to stay there
so we have some of that money, but the ongoing challenge now is to come back to the legislature
and let people like yourselves get in front of your legislators and inform them how important this is
to their district, to their constituency. That’s what’s really helpful. Yes.
3. Some of the Humphrey Fellows will tell you that part of what they deal with in regard to
health is the aftermath of tobacco related harm. A lot of it related to US exports and I wondered
are there particular trade laws or procedures or agencies that are points that one should apply
pressure to in order to change the exportation of US tobacco?
I think everyone of you should right this administration I, with great respect to the President the
reality is we withdrew from the World Health Organization's negotiations. The United States of
America’s not there. How can you be a part of the game if you're not there? I mean get in, if you
don’t like what’s happening, get in and fix it, change it, but to leave, we just walked away from it.
That’s terrible and you really ought to call him to task on that. If you don’t like what’s there get in
and start working at it. Don’t just walk away from it and that’s one of the real important things that
can happen. I think that there are any number of other ways of becoming engaged. What’s
happening on the local community level that's terribly important to be involved with. Don’t think
for a minute that your local suburban city council isn’t important when a little ordinance comes up,
really important. Guess how hard it is for that industry to have to come to fight every single
community in this country. It’s one of the better ways of getting at them. That’s why they always
go to the legislature try and preempt. They try to say, oh no, no, we’re not going to allow those
cities to do those things. See they can control fifty states, but tens of thousands of communities
that’s a little harder so be involved with those in your community that are interested in this and then
help people to begin to understand how dangerous this second-hand environmental smoke is, it’s
becoming more knowledgeable. I think in a sense we’re kind of on the trend of where we are now
with seatbelts. It shouldn’t have to take that long but you know ten, fifteen years ago you were
lucky if you saw someone buckling up. Now it’s the other way around. It’s more unusual to see
someone not buckled up. It’s taken law change, but it’s taken a mental attitude change with the
public as well. Yes sir.
4. The mental attitude is a very important element. One of the things that’s so bothersome is
that so many people’s mental attitudes come from television and now it is absolutely shocking, at
least to me to me to find these soap operas and television dramas where gratuitously the actors
smoke a cigarette. Is there anything that can be done barring the freedom of the reformation act
and all that is there any way to litigate against them?
Well, the question is how about the increased use of tobacco in movies, TV, and all the rest and
I you know I haven’t seen any statistics I'm sure somebody’s done a study somewhere, but I
guarantee as far as I’m concerned, maybe I’m just a little more sensitive to it, seems like every other
person is smoking, never mind the fact you walk out this door that isn’t what’s happening in the real
world in this country. There’s a couple things, first of all in our settlement we were the first state to
get a national ban on paying anyone. If you're aware of anybody getting paid by the industry to
actually smoke a cigarette in one of those let us know we’ll go right to court and it can be enforced
very quickly in Minnesota directly and you know that’d be fun you could really hit them hard, but
assuming that they’re actually complying with the court order and not paying it seems to me
someone must be getting paid. Why is there more of that happening? Why is it? Is it the
screenwriters that are getting paid to write it in, I mean it’d be interesting. That’s a nice
investigation to take place. Maybe someone from public health and a county attorney's office or a
district attorney’s office could begin digging in a little bit; it’d be kind of interesting. I must say it
is just a really bad thing. The other thing is you step out of this country and particularly you go into
developing countries what is the first thing you see that’s American? It’s Marlboro, it’s Camel, it’s
sickening I mean for us to be delivering that message to the world as a first opportunity to
understand what the United States is all about is just tragic so, but we have to, we have to work to
change it and be willing to get into it. Yes sir.
5. Would it be strategically helpful or not to compare the public health stress of tobacco and
handguns to those of weapons of mass destruction?
Yeah I think it would. It is a weapon of mass destruction. It’s the worst kind. It’s everywhere.
You know we worry about anthrax maybe breaking out in one or two, three places like that, but
think about it every time there’s a cigarette in there and you’re in that room you’re in trouble. I
think that that would be a very interesting parallel. Now the problem is that you’ve got to convince
the public that that indeed we’re still at that stage where a part of the public doesn’t see it as the
most dangerous thing and it’s because the other is hyped. It’s not that anthrax and all the rest are
not dangerous it’s that this is equally as dangerous, but it’s been with us so long. You have to
remember this product is uniquely American; it’s been with us for five hundred years. You know
next time you go to Congress and you get that wonderful tour and you look around and you look at
all that wonderful stuff on the ceiling take a look there’s tobacco leaves all over the place. The next
time you’re in the, you get that tour and you go and you look down into, onto the desk of the
speaker of the House of Representatives don’t worry about what the speaker’s saying or not saying
look at the ingrained beautiful wood filling that’s in there, it’s tobacco leaves. This was part and
parcel of how we became this nation. So, I think that’s just representative of how much we have to
undo and it’s going to take some time, but we need to be persistent at it. This industry’s persistent
at it. It’s already figured out that it’s not going to grow anymore here in this United States, it just
wants to get as much money as it can while it can it’s growing elsewhere. So this is the cash cow
feeding the rest of the world addiction. So we need to make sure that we cut it off as soon as we
can here and help the rest of the world cut it off there too and frankly people say that weapons of
mass destruction are dangerous let me give you another parallel, as many of you know the principle
producer of tobacco in China is the Chinese government. They own most of the tobacco farms.
Now you try and say to those people and they also know they know the disaster that is waiting for
them if they don’t get at the problem of undoing the addiction. They can see it in the hundreds of
billions of dollars that they’re going to have to pay down the road and the hundreds of millions of
people that will die every year, so they know what the costs are, but they have got a very touchy
situation. If you immediately try and say and maybe you could in that country, you say, no,
smoking tomorrow, where do all those all those people that are on those farms go to get jobs? They
go to cities and when they don’t find jobs in cities what do they do? They rise up, they form unions,
they do all sorts of things that communist nations don’t like, so it’s a political problem. It is indeed
very much parallel to weapons of mass destruction. I never really thought of it that way, but that’s a
good parallel. So, we have to be able to figure out how to help people worldwide make this
transition out of this addiction that unfortunately is uniquely American.
6. If you’ll allow me I’d like to move away from tobacco for a second and ask you a question
about alcohol. Even thinking about second hand smoke and driving under the influence as part
of the social and health consequences and I’m just always curious how we ended up with one
projection regarding tobacco, and not regarding alcohol. Do you have any thoughts on that?
I do. I think I tried to mention and I want you to understand I deeply respect what all of the
other states have done in a way they came at it differently than we did. We decided we were going
to try this case and we were going to dig down. We were very fortunate in Minnesota having very
strong local antitrust laws and consumer protection laws, market laws, not all of the other states
have that in the same fashion as we do. What they did was they said we are going to amass such a
great number of litigants on our side that the industry will have to cave in and in a sense that’s what
happened so the combination of the two we actually got the best of both worlds. We got the kind of
money that was needed to flow and we got the documents and all the rest, so it kind of worked out,
but in this situation in Minnesota in particular we were able to go after them because we had a clear
understanding that they had colluded illegally colluded together; that they had violated very specific
laws in Minnesota. I would assume that if you could find the evidence that would show that the
alcohol industry did the same kind of collaboration, illegal colluding together, setting and fixing
prices and working together to not investigate things, to not work at this then I think you probably
would have at least in parallel a very strong case and I’m beginning to see that kind of parallel in
some respects with the gun industry as I’ve mentioned here, just in one instance with their denial of,
their supposed denial of knowing what’s going on. I think also what we’ve got to do is dissuade
people from the unbelievable amount of marketing that takes place with the alcohol industry. I
mean every time you see the ad it says down there please drink responsibly and now we see big
public health studies that say hey, you know, have a glass of wine today and you’re not going to
have a heart attack never mind the fact that you might have heart disease or any other kind of
complication that comes along with it. We’ve gotten ourselves, still the public is kind of feeling,
well it’s ok to have a drink. What we need to have them understand is maybe it’s ok under some
circumstances, but here are the legitimate real risks and here is a very large part of our population
that is seriously at risk. So it seems to me we’ve got to take a bit of a different approach, but there
maybe some litigative stances particularly if we can find that kind of collusion and it might be there
you never know. I mean we’re very fortunate what happened out in California. We had, just a
background a little bit on what we, before 1994 we had talked a couple of years we had talked with
some people saying you know something is wrong here. Something’s going on with that industry,
but we didn’t have the information that would really prove it and one of the obligations of a public
attorney and frankly a private attorney is not to bring the litigation, not to sue unless you can prove
the case beyond a reasonable doubt and so we didn’t have the information. Well Mr. Wigand or
whoever, whoever showed up, whoever dropped that wonderful little box of documents right in
front of Stan Glantz’s office and with his wonderful perception of, oh, these I shouldn’t have and
runs over and gives it to the library and says here do with it what you want, you know, they’re not
mine. So that by the time the lawyers, literally the lawyers from the tobacco industry showed up at
his door later on that day saying we want our documents back, you’re not allowed to have them, it’s
illegal, those were stolen, he honestly could say I don’t have them. Well where are they? I took
them over to the library, they’re not mine. By the time they got to the library they were on the
Internet and that’s what happened literally. And so what happened was then Waxman,
Congressman Waxman holds the hearing and that’s where they all stood up and said all that, but
they also disclosed all of those documents. That’s when we said wait a moment, the things we’ve
been thinking are happening, here it is, it happened. So then we started saying ah ha, time to go and
that was the deal. Then of course I had a good friend of mine say are you nuts Humphrey? Do you
know what’s going to happen to you politically? I said yeah I do, but that’s ok. Anyway, thank
you, thank you so much.
Thanks Skip I think we can see that Jesse Ventura wasn’t the first wrestler to be politician. I
just love the way your eyes start working when some of these new challenges come to light and you
start thinking of new things you can do and new battles to fight. It’s really inspiring to us all. We
have some tobacco farms that could use scorching here and we could throw a few post-1956 flags
on top.
I’m not touching that stuff.
That’s the great thing about being in academia. You can really say what you’re thinking except
at a faculty meeting. We got, we would like to present you with a, for your work in the United
States of America present you with a memento of the DeHaan lecture that will get you to think even
bigger.
Oh, my gosh you are kind. Thank you. Thank you. Do I dare open it?
Sure.
Good. Oh my gosh. Oh my goodness. How do we get it out of there is right. Oh my goodness
look at that. Isn’t that beautiful? Oh my gosh. Thank you. You better stuff it back in there. My
goodness that is gorgeous.
Now it’s one glass of wine and cheese.