Unhealthful News 115 – Goals are not predictions; sometimes they are not even goals

Numerous headlines over the past few days have reported that the US will/could/should/is expected to have inflexible indoor smoking bans everywhere in the country by 2020, or some variant on that theme (here are some examples).  The thing is that this is merely some people’s goal, and contrary to many of the reports, there was no study supporting the claim.  Moreover there was not even anything “newsworthy”, since there was not even any change in the arbitrary goal.

So what generated the “news”?  There was a simple matter-of-fact report in Morbidity and Mortality Weekly Report (MMWR), CDCs weekly blog.  It is actually a newsletter that predates blogging, but these days the most useful way to think of it is as a blog, to avoid confusing it with a journal or even a carefully-edited periodical.  The report was about the enactment of indoor smoking bans from 2000-2010, and it seemed to be just fine for what it was.

But it also included the tangential observation that the US government’s “Healthy People 2010” goals included enacting exception-free nationwide indoor smoking bans in any space where someone is employed, which did not happen.  So the wish was just carried over to “Healthy People 2020” and the report said this “is achievable if current activity in smoke-free policy adoption is sustained nationally and intensified in certain regions, particularly the South”.  Yeah, that warrants headlines about 2020 being the time to expect nationwide laws – an arbitrary date from an old list of goals combined with a report that simply recounts past events and has no forward-looking analysis.  But wait, there is a one-sentence assertion by a random group of analysts working at CDC, so stop the presses.  This is what passes for health news.

(Someone looking for a more interesting story might focus on how the US government goal was to enact these laws, but they failed and are now wondering if it can be done ten years later.  For those not familiar with the US system, the explanation is simple:  Most laws are controlled by state and local governments and not all of them share the feds’ goal.  The beauty of federalism is that different states and localities can try out different policies, and if they are really important, people can vote with their feet.  Of course, the feds have a habit of thwarting this system in many cases where variety and local freedom is useful and, indeed guaranteed by the Constitution.  Perhaps the confidence in the 2020 goal should be read as the federal government hinting it will withhold funds to force all states to adopt the “right” laws, the usual tactic for ignoring the rights of the states under the Constitution.  Reporting that would be a much more interesting and genuine news story.)

That one phrase from the report that is quoted above was not all that was written.  As with many MMWR reports, the analysts’ useful information is accompanied by an “Editorial Note”.  This one, like many such notes in MMWR, is longer than the actual study report.  Like I said, it is a blog, not a journal or even really the technical report series it is supposed to be.  The editorial waxes about how the existing laws are “remarkable public health achievements” though the data to support that claim is pretty sketchy.  More important, the editorial makes clear that whoever was writing does not consider sufficient laws that allow for any exception whereby consenting adults can gather and smoke, and suggests that restrictions on smoking at home should be added to the goals.

I am not writing this to comment on the anti-tobacco extremists and slippery slopes – there has been plenty written about those.  Rather, this story is a reminder that for any issue with political implications, the health press often take a break from being overly-credulous science reporters and instead become typically-credulous policy reporters.  That is, they report whatever someone in a position of power asserts as if it were information, and report government goals, no matter how extremist, naive, or unpopular, as if they were god-given.  There are few Americans who would insist that if some states chose to allow well-ventilated smoking sections in bars or casinos, or refuse to force old men at the American Legion (a private club for military veterans) to relive their days in Korea by going out into the snow to smoke, that this would be a terrible thing.  And it seems like there is a good chance that some states will allow at least some such exceptions, thwarting the inflexible CDC goals, if they are not blackmailed by Washington. 

I suspect that the debate on this matter will have matured enough by in 2021, or perhaps even become largely moot, so that we will not see a spate of naive stories about how the goal will be met by 2030.  But given the anti-tobacco activist enclaves of the government and the quality of the press corps, I am not willing to rule out the possibility.


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