Boston University School of Public Health tobacco control integrity watchdog Professor Michael Siegel, a physician, has selected the United States Surgeon General as winner of the 2010 Tobacco Control Lie of the Year Award. The runner-up award went to Free & Clear.

Dr. Siegel's popular tobacco policy blog, The Rest of the Story: Tobacco News Analysis and Commentary, presented the top 10 finalists for the "2010 Tobacco Control Lie of the Year Award" before selecting quarterfinalists, and yesterday the winner and runner-up.

"It saddens me to even have one lie to write about - but to have 10 different anti-smoking organizations disseminating lies (and this is just a small sampling) is a sign of the sad state of affairs in tobacco control these days," wrote Dr. Siegel.

"The saddest part to me is that we do not need to lie to support solid and proven public policies to reduce the morbidity and mortality from tobacco use," he wrote. "The truth is, and should be, enough."

According Dr. Siegel, "the Surgeon General's office takes the award for disseminating widely throughout the media the blatant lie that even brief exposure to secondhand smoke can cause cardiovascular disease and that inhaling even the smallest amount of tobacco smoke causes cancer."

The prevailing sentiment of "Rest of the Story" blog readers was that the Surgeon General's office deserves the award because of "the sheer magnitude of the impact of this lie."

"Given the influence of the Surgeon General's statements on anti-smoking groups and the prominence of the Surgeon General's statements in the media, the assertion that even a brief tobacco smoke exposure can cause heart disease and lung cancer is likely to be used successfully by anti-smoking groups to support an ever-increasingly aggressive agenda of banning smoking just about everywhere."

Dr. Siegel has questioned banning smoking in outdoor areas such as beaches and parks where there is no evidence of harm to public health. Without medical evidence he sees these tactics as attempts to coerce cessation or smoker punishment.

The Surgeon General's Lie

A December 9, 2010 press release by the Office of the Surgeon General quoted the 2010 Surgeon General Report as asserting that, "Even brief exposure to secondhand smoke can cause cardiovascular disease and could trigger acute cardiac events, such as heart attack."; (2) "Inhaling even the smallest amount of tobacco smoke can also damage your DNA, which can lead to cancer."

Entitled, "A Report of the Surgeon General: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease," Dr. Siegel's explains the implications of the assertions.

"Based on the Surgeon General's statements, walking past a smoker on the street could cause a person to develop cardiovascular disease and cancer," wrote Dr. Siegel in his December 13 blog.

"Fortunately, it is simply not true that even brief exposure to secondhand smoke can cause cardiovascular disease. Luckily, it takes many years of exposure before the process of atherosclerosis (hardening of the arteries) can occur," he explained.

"If brief tobacco smoke exposure could cause heart disease, we would sadly see many young people in their twenties and thirties walking around with cardiovascular disease, and many dying from it at those ages. Even active smoking does not generally lead to heart disease unless you smoke for many years. Thus, it is simply untrue to assert that brief exposure to secondhand smoke can cause cardiovascular disease."

Dr. Siegel concedes that,"while the press release may be correct in suggesting that a brief exposure to tobacco smoke could cause a heart attack (although only in someone with pre-existing heart disease), it is completely false in claiming that a brief exposure can cause cardiovascular disease."

He notes that there is nothing in the Surgeon General's report which supports the assertions that a brief exposure to secondhand smoke can cause cardiovascular disease or cancer. "These assertions basically come out of nowhere. They have been manufactured to create a sense of public hysteria, but they are unsupported by any science whatsoever."

Runner-Up Free & Clear

Dr. Siegal awarded second place to Free & Clear, the nation's largest telephone counseling stop smoking service, for falsely asserting that its smoking cessation program has a 45% six-month success rate, when its own research found only a 21% success rate using intention-to-treat analysis.

The Free & Clear lie selected was that, "Using an integrated mix of medication support, phone-based cognitive behavioral coaching and web-based learning and support tools the Quit For Life Program produces an average quit rate of 45% for employers, making it 9 times more effective than quitting 'cold turkey.'"

Science? Imagine only counting satified customers willing to talk with you. It's a lie that the Internet Archives indicates was a tiny bit smaller on August 28, 2008 when Free & Clear claimed "an average quit rate of 43%, making the Quit For Life Program at least 8 times more effective than quitting 'cold turkey.'"

And it's a gross exaggeration Free & Clear was still making two years later on July 7, 2010, the day it announced that Dr. Tim McAfee, Free & Clear's co-founder and Chief Medical Officer, had been appointed the nation's #1 smoking cessation position, the Director of the Centers for Disease Control's Office on Smoking and Health.

"What Free & Clear does not tell the consumer is that the quit rates reported on the site are known not to be accurate, as they are based only on survey responders and ignore respondents who are lost to follow-up, who we know are most likely those who have failed to quit smoking," wrote Dr. Siegel.

"In my view, this is fraudulent marketing, because the company is knowingly providing a quit rate that is invalid -- essentially by definition the true quit rate is substantially lower than that which is being advertised."

Dr. Siegel stated that his rationale for "the choice of Free & Clear as the runner-up for the 2010 Tobacco Control Lie of the Year Award is presented by John Polito who wrote: Intentionally advertising a 17% quitting rate as 45% is a massive distortion that is helping Free & Clear make millions. While the other 9 misrepresentations are serious, none appear directly motivated by raw greed."

"The U.S. government's (Fiore's) bible on quitting rates is the 2008 Clinical Practice Guideline for Treating Tobacco Use and Dependence. The last paragraph on page 23 of the Guideline states: 'All of the new meta-analyses conducted for the 2008 Guideline were based exclusively on intent-to-treat data,'" he quoted me has having written.

"Guideline evidence Table 1.3 (above link at page 28) combines the results from 9 studies which examined pro-active telephone counseling. It found six-month quitting rates ranging from 13.8% to 17.3%, producing a combined abstinence rate of 15.5%, with a rather modest 1.6 estimated odds ratio over minimal or no self-help (which would include unassisted cold turkey quitters)."

"Now contrast that with this Free & Clear's page, which makes the following unqualified assertion: 'Quit For Life Program produces an average quit rate of 45% for employers, making it 9 times more effective than quitting 'cold turkey.' Two giant fibs," I'd written.

"Remember, we're talking about the nation's largest telephone quit smoking service, the 90 trained, at-home Free & Clear counselors that smokers talk to when calling 1-800-QUIT-NOW, probably the most expensive telephone quit counseling service on earth. The 1-800-QUIT-NOW number also appears on the U.S. government's official quitting site. Oklahoma is paying Free & Clear more than $900,000 per year, and 'on average, the program has so far cost $700 to $835 for every person who has quit smoking.'"

"How many smokers understand how Free & Clear calculated its 'responder rate' or what a responder rate even is. Any," I'd asked? "Where does it tell us the percentage or number of smokers who actually 'responded?' Another secret? What incentive does Free & Clear have to use diligence in following up with non-responders when it knows that the reason many don't want to talk to it is because they're still smoking? None."

"It's why Free & Clear deserves the award," I wrote. "By doing less and redefining quitting it makes itself look 3 times better than all other telephone counseling studies. It knows its representation is fraudulent yet with tens of millions at stake it feels the risks are worth the reward. Unless we somehow holds Free & Clear's feet to the fire, the health lies are profitable."

And there's a frightening link between the misrepresentations of the Surgeon General and Free & Clear. The only phone number given within the Surgeon General's secondhand smoke press release of December 9, 2010 is that of Free & Clear. "Smokers can also call 1-800-QUIT-NOW for help," the Surgeon General's Office writes.

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