Wednesday, 22 May 2013

Day 146. A tale of two crises

A funny thing happened mid-morning during the second day of testimony by Imperial Tobacco's expert witness on "awareness" of the risks of smoking. A natural public health parable unfolded after the huissier (bailiff) approached the bench and whispered a message to the judge.

As Justice Riordan conveyed to the room that the water in the court water was not fit to drink, the huissier worked his way around the lawyers, removing from each desk the pitcher of water that is set there each morning.

In a room filled to with blackberries, ipads and computers, it didn't take long for everyone to be aware that the water was potentially unsafe, and for a common knowledge of the city-wide boil advisory to be established.

The courtroom
drinking fountain
lies covered
until water safety
can be assured.
Yet this did not prevent further action on the part of those who supplied the water or who had responsibility for the well-being of those inside the justice building.

To the contrary - soon there were signs on every water outlet in the building, and the drinking fountains were blocked by plastic covers. (What's more, no one was saying the risks were not proven, the controls were excessive, or the warnings took up too much space!...)

It was a modern John Snow moment. The pump handle was disabled without anyone actually getting ill.

While this public health response was unfolding, David Flaherty, professor emeritus of history and former Privacy Commissioner of British Columbia, continued his year-by-year review of the history of tobacco and health in Quebec since 1950.

By comparison, his telling was a story of non-response.

It took half an hour for the water-warnings to be erected. But it took more than a day and a half in Mr. Flaherty's chronology to get from the early 1950s "cancer by the carton" health scares to the 1971 agreement of the companies to print warnings on the packages. The day was almost over before Mr. Flaherty told the court about the development of Canada's first regulated health warnings, imposed at the end of the 1980s.

The scenic route

"Don't give me a roadmap - drive me!" Justice Riordan said yesterday to Neil Paris before this fresh face on Imperial Tobacco's large legal team began his extended dialogue with the historian.

With Mr. Paris at the wheel, the ride was smooth and steady, if somewhat slow. His extended itinerary passed by more than one hundred news reports, each of which was displayed on the overhead screens.

Dr. Flaherty's steady narration illustrated each stop on the way. And if all the road-stops began to look the same, and all the stories began to sound he same - well, that is the nature of packaged tours. As if to keep his passengers interested, Mr. Flaherty's comments often ranged beyond the facts in his report and revealed his own memories and perceptions of events.

His readable report (Exhibit 20063) is the guide for this historical road trip. Today we passed through the half decades 1965-1969 (20063.5), 1970-1974 (20063.6), 1975-1979 (20063.7), 1980-1984 (20063.8), 1985-1989 (20063.9); and 1990-1994 (20063.10).

The passengers on this occasion were every bit as well behaved as the tour leaders. The plaintiffs sat essentially silent, but for the scratching of their pens as they took occasional notes. There were no pit stops for objections! Justice Riordan was the only one who asked 'are we nearly there yet' - and he kept these inquiries or any suggestions to a minimum. Although he followed closely, he asked few questions and seemed to take few notes.

All in all it was an undramatic day on the road. It was, however, a long one. The effort was greatest on the witness, who commented mid day that it was like "giving three graduate lectures in a row." 

Hugging the middle of the road

Outside of the industry, I would think there are few Canadian scholars who have worked on tobacco issues as long as David Flaherty (his efforts date from 1988). But then again, maybe there are others like him, who have kept their work invisible from the public for decades, and who have not made themselves known in the multi-disciplinary academic networks of tobacco researchers.

For that reason, if no other, it was interesting to note how this researcher filtered the information he received, and how his understanding of developments in Canada compare with the views of other researchers who have worked in the same field over the same period of time.

As he spoke to the judge, the witness seemed to try to steer a middle road between the views of the companies for whom he has worked for two decades and what one might almost call common knowledge of the harmful behaviour of those companies over history, including the period of his contracts.

He spoke respectfully of many of the pioneers of tobacco control - like Dr. Norman Delarue, Barry Mather, Rachel Bureau, Marcel Boulanger. In positive terms, he described Gar Mahood and David Sweanor of the Non-Smokers Rights Association as activists in the style of the civil rights movements. He presented the adoption of tobacco control regulations as "progress."

He expressed no views against the measures eventually adopted by government. To the contrary, he derided the way airplanes were once divided down the aisle into smoking and non-smoking areas. He did not seem proud as a British Columbian that his province is the only one to allow cigarettes to be sold in pharmacies. He said that as "as president of an opera, I am glad we are not faced with that temptation [to accept tobacco industry sponsorship] in 2013" .

Colour commentary

Mr. Flaherty's oral testimony contained many personal insights that were not shared in his written report.

He identified the rise of smoking among women (which occurred during the period of increased awareness of health effects) as a matter of concern because "women should be smarter than males and should not be taking up the habit, or that women are better than men."

He noted that "feminist magazines like MS magazine were not paying attention to smoking issues," but did not refer to the long-established link between the presence of health stories in women's magazines with the volume of advertising placed in them.

He repeated his perception that governments and opinion leaders were concerned that reduction in smoking would cause difficulties to government budgets. "I cannot underestimate too much the amount the industry paid in taxes to pay for the total health establishment ...we are talking about significant money! Ministers of Finance were quite sensitive to the potential loss of income if people stopped smoking."

He perceived that "anti-smokers" were indeed against smokers. "The anti smoking activists, professional and otherwise, had decided that the only thing to do was to denormalize smoking by stigmatizing smokers and that became their goal."

He noted that in France lung cancer rates were lower than in Canada, but said it was "because they do not smoke the same kind of tobacco." (If this is common knowledge, it is not shared by those who have found the black tobacco formerly used in French cigarettes to be MORE dangerous, or who have concluded that the 20 year delay in high levels of tobacco use in  France compared with countries like Britain resulted in a time-lag in cancer rates.)

Mr. Flaherty suggested that he accepts that human frailties (not a term he used) may play a role in smoking. Yesterday, he attributed  the "gap between knowledge and belief" as a reason that "We all know you shouldn't talk in your cell phone while you're driving your car; some people do it." Today he explained that "people who engage in risky behaviour often look for a rationale for their behaviour."

Still in the news means it is still a problem.

Although his report is aimed at addressing the point in time when the health risks and addictiveness of smoking were common knowledge, in his presentation of events after the 1970s, Mr. Flaherty spoke more today of the social concern that this knowledge did not resolve the tobacco problem. He described a "great sense of frustration that somehow a solution had to be found to the smoking problem." 

It was the failure to resolve the problem, he said, that led to smoking getting so much media play. "From my point of view how could they give even more news coverage ... the fact that they do indicates how important the issue it is." 

A useful contribution

Close to the end of the day, looking nowhere near as tired as he would have been entitled to after more than six hours' concentrated effort, Mr. Flaherty revealed a researcher's pride in his 20-year effort. "I am pleased that this is going to be in the public record .... [I think it is] a useful contribution." 

Tomorrow, Mr. Flaherty's testimony will continue, including the cross-examination by the plaintiffs' counsel.