Philippe Boucher's Rendez-vous with . . . Bob Jaffe, MD

Rendez-vous with . . . Bob Jaffe, MD

Founder Washington DOC,
Clinical associate professor University of Washington medical school
Seattle , Washington State, USA
By Philippe Boucher

Rendez-vous 103
Wednesday, June 13 , 2001

PB : Thank you Bob for accepting our rendez-vous.
May I ask you to introduce yourself ?

Bob Jaffe : I'm a family physician and health activist who has worked on tobacco control and media-related issues for the past 21 years. My grandfather died of lung cancer, my aunt from laryngeal cancer, two uncles suffered heart attacks and another aunt died from emphysema. All of them had their lives shortened by smoking tobacco products. On my hospital rounds, during my training, the most common cause of illness and premature death was tobacco. At the same time, cigarettes were smoked everywhere, including doctor's lounges and the patient rooms. In some VA hospitals, cigarettes were passed out to sick and dying patients. Tobacco billboards and promotions were everywhere. It made me outraged.

In 1980, I testified in favor of no-smoking sections in Seattle restaurants. Afterwards, a restaurant owner angrily told me that I had no right to influence whether people smoked in his business. At the time, I was discouraged by the lack of effective interventions to reduce tobacco use.

Q1. The first memories that come to my mind when I think about your actions as a tobacco control advocate are when you were demonstrating walking in a giant cigarette "Mr. Butts" like costume and when you were telling how you used to rush into airplanes, grab the magazines to rip off all the cigarette ads. Maybe you can tell us about your involvement with DOC and how you started Kickbutts in Seattle?

BJ: In 1979,I read about a couple of family physicians, Alan Blum (see Rendez-vous 50) and Rick Richards, founders of Doctors Ought to Care (DOC), proposing that the AMA divest tobacco funds from their retirement portfolio. They testified about how tobacco companies manipulated the media, targeting children, young women and minority groups. They were among the first physicians to correlate corporate crime and irresponsible business practices with specific deaths and diseases. They were exciting role models for a young doctor.

I invited Dr. Blum to the University of Washington and was so infected by his ideas, I started Washington DOC. We gathered together a group of physicians and other health and media activists, and took on the tobacco industry and their advertising campaign. We were teaching school children how the tobacco industry was targeting them during the day. We worked hard at night putting messages on billboards, showing how they were killing people with their products.

One of my co-conspirators, Dr. Michael Lippman, was arrested for spray-painting cancer warnings on a billboard in Seattle. His arrest got him an interview on National Public Radio, and we began to receive more public support. We used our limited funding to hire an advertiser to develop counter-advertising. As our funding improved, so did our counter-marking. Our efforts included,
  • Mr. Butts costumes that were used to picket local tobacco-sponsored events.
  • Counter-ads on radio, TV, bus-boards, posters and T-shirts.
  • A smoke-free monster truck that raced at the1989 Camel and Monster Race.
  • A smoke-free boomerang team that rejected a Philip Morris sponsorship.
  • The Statue of Nicotina, a chain-smoking Statue of Liberty with a reader board that spelled out the current number of US children getting addicted each day and the total number of adults dying.
  • We worked with activists across the country to shame Philip Morris for sponsoring the 200th anniversary of the Bill of Rights, while simultaneously addicted children and killed adults.

Q2. You were very much involved in the drafting of a comprehensive tobacco control program for Washington State. Then the settlement came. Can you tell us, from your own perspective, how you assess the way things have been going in Washington State? Are you fully satisfied? half frustrated? Could/should things be organized differently?

BJ: Washington State has been a national leader in the Tobacco Wars. After watching California and Massachusetts raise their tobacco taxes, Washington raised theirs to 82.5 in 1994, the highest in the country. Unfortunately, none of our taxes were being dedicated a long-term effort to reduce tobacco.

When state attorneys general began a lawsuit against Big Tobacco, our own AG, Christine Gregoire, joined them and became one of the lead attorneys in developing a national settlement. I worked with her, the Department of Health and community leaders from across the state to design a tobacco control program that could be funded by the settlement. We completed it in November 1998, just as the national settlement was announced.

Washington tobacco control and public health organizations united to steer all settlement funds into tobacco control and public health. Our tobacco control program grew from $2 million to $15 million a year. While this didn't meet CDC recommendations for our state, it allowed us to get started. The public health community has successfully worked to protect that funding, and is presently working on another tax increase.

Q3. . There is an attempt to put on the next ballot an initiative that would raise state tobacco taxes (by 50 cents per pack?) and allocate part of the monies to fund tobacco control efforts. Is it because the legislature cannot be trusted to do it on its own (like it has been the case in so many other states)? In this initiative the money would go to the Department of Health. Some states have given the bulk of the tobacco control funds to independent foundations not the Health Department. Does this solution give more influence to the voluntary health agencies? Isn't there a risk of creating a new bureaucracy out of touch with the advocates who pushed for the taxes? How do you make sure the program is accountable to the people (since we know the legislature does not care that much).

BJ: After fighting for tobacco settlement funds and not being satisfied by the amount of money dedicated long-term for reducing tobacco addiction rates, we decided to start another tax initiative t dedicate tobacco taxes toward the state's program.

The legislature has a big funding agenda and tobacco control, along with public health funding, is often ignored. Sometimes, the only solution is to by-pass the legislators, and allow voters to directly fund public programs that our elected officials ignore.

I would prefer to see a non-profit, non-governmental organization make budgetary and programmatic decisions on tobacco control, but it hasn't been politically feasible. The Secretary of our Department of Health and our Attorney General are strong supporters of tobacco control, and our state program is moving in the right direction.

I have been involved in guerilla activity and public health program development. The guerilla warfare is much more fun, but the larger, more frustrating and complex tobacco control campaign is longer lasting and more effective. Every component of the tobacco control movement, every person who is working on this issue, has a role and a purpose. Some of are there to blow the bugle or fire the first shots, while others are needed to raise funds and balance budgets. We may disagree on tactics and approaches, but we generally agree on the goal of reducing tobacco use rates and the need to regulate the tobacco industry.

Q4 . How do you feel about NRTS? should they be part of a comprehensive tobacco control program? if so, how should they be offered? at the market price? at a reduced price? for free? what is the situation now in Washington State?

BJ: Nicotine replacement therapy (NRT) is a part of the tobacco control campaign. While the primary effort should be to regulate the industry and prevent to growth of new nicotine addicts, we must provide effective programs to those who are addicted and ready to quit.

Group Health/Kaiser has developed an effective program, "Free and Clear" that combines NRT with mass media messages, health provider interventions, and phone counseling. They are showing significantly reductions among adult smokers and several other states are using their programs.

NRT alone doesn't have much of an impact on tobacco addiction rates, but if incorporated into a comprehensive, long-term intervention, it increases quit rates.

Q5. We can see a big promotional effort by the industry toward the young adults: numerous ads involving bars, concerts, promotional items widely distributed. What can/should be done?

BJ: The tobacco industry is like a river of slime rushing down a hill. You can put up a barrier, like TV or billboard restrictions, and it just rolls off in another unrestricted direction. When restrictions came out of the Settlement, it poured marketing and advertising dollars into college age youth through promotions in bars and live music performances, public events, websites, magazines and anything that hasn't already been regulated or restricted. They have effectively marketed their addictive product for over a century. If we want to stop that river of slime, we need to patiently work together to build a bigger dam.

Q6. Is there anything else you would like to add?

BJ: I have had a wonderful time working for tobacco control over the past 21 years. I have been honored to work with many people across the country that are heroes in the global effort to save lives and improve the health of our communities.

PB: Thank you Bob for taking the time to be with us today.

Rendez-vous is supported by a contract from the Robert Wood Johnson Foundation
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