Dr. Steven E. Larson, president of the California Medical Association, was walking a fine line the other day, or trying to.
“No one should smoke. It has no benefit. Yes, we’d like to outlaw it if we could,” he said, speaking of tobacco.
Understandably, the California Medical Association is funding a 2016 initiative to raise the tobacco tax by $2, to $2.87 per pack, and for the first time tax electronic cigarettes.
Yes, docs would win, too. Physicians’ reimbursement for treating people without private insurance would rise. But by adding $2 to the cost of a pack, kids would be priced out of smoking tobacco and vaping nicotine, and more adults might quit. All for the good of public health.
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Less understandable, the California Medical Association last week endorsed the initiative pushed by Lt. Gov. Gavin Newsom and billionaire Sean Parker that would legalize the recreational use of marijuana. By legalizing it, Larson said, the state could better regulate it.
“We support both of these for the same reasons. We don’t want the public to smoke. We want to regulate it so children don’t use it,” Larson said.
Clean bills of health in the form of endorsements from doctors can be powerful, as admen knew many decades ago when they built campaigns around phony health claims for certain brands of cigarettes.
Copy from an ad, circa 1930, reads: “20,679 Physicians say ‘Luckies are less irritating,’ ” as a red-cheeked Dr. Feelgood smiles at a pack of Lucky Strikes. “It’s toasted,” the ad says, as if “toasted” tobacco would be less damaging.
As the California Medical Association issued its endorsement, professor Stanton Glantz of the UC San Francisco medical school, and UCSF researcher Rachel Barry issued their 66-page diagnosis of the Newsom-Parker initiative, concluding that it could transform the marijuana business into the next tobacco industry.
“It is shocking, actually. I think they didn’t read the initiative. At the very least, they were sold a bill of goods,” Glantz said of the medical association’s decision to endorse the initiative.
Glantz has spent four decades teaching at UCSF. He is a preeminent tobacco researcher, and an anti-smoking warrior. Thousands of prospective health practitioners have gone through his intro to bio-statistics class, and listened to his lectures about the science, politics and history of tobacco.
That’s the issue. He knows the history; we ought to learn from it.
He likens the Newsom-Parker initiative to Proposition 188, a failed 1994 initiative funded by tobacco giant Philip Morris that claimed it would regulate tobacco but instead would have weakened regulation.
“There is a lot of slipperiness,” Glantz said. “Little details make a huge difference.”
Marijuana legalization advocates denounced Barry and Glantz, saying they misunderstand cannabis. Certainly, the researchers are buzz kills, but their warning is worth heeding. They support legalization. No one should be locked up for smoking weed. But marijuana should be regulated in ways that reduce its use, and not left in the hands of a for-profit industry that would fight to expand market share and gain clout as revenue rolls in.
The initiative would place the bulk of the regulation in the hands of a new bureau within the Department of Consumer Affairs, which polices barbers, mechanics, morticians, nurses, mechanics, dentists, doctors and other licensed professionals, with varying degrees of aggressiveness. The new board would include marijuana entrepreneurs, like placing tobacco company executives in charge of limiting secondhand smoke.
Glantz and Barry say the California Department of Public Health is better equipped to deal with an intoxicant that can cause brain damage. In the past 25 years, the health department has presided over a decline in smoking, from 24 percent to about 12 percent. Public health experts would seek to limit potency and stop entrepreneurs from spiking their products with chemicals that would lure customers, or add “contaminants ... not safe for consumption or inhalation.”
Wayne C. Johnson, a Sacramento consultant who likely will be involved in the campaign against legalization, can imagine a new ad campaign, similar to the ones from the 1920s, ’30s and ’40s. A grinning guy in a white smock might say something like, “When I need to relax before surgery, I smoke a blunt.” He’s toasted.
“The signal it sends is that they are utterly hypocritical,” Johnson said of the medical association’s endorsement. “You can’t support legalizing smoking marijuana, but say, ‘We’re still against marijuana and still against smoking.’ ”
But the California Medical Association is a heavyweight and does what it pleases. It has spent $6 million on lobbying since 2013, and has set aside $6 million and counting to push for the initiative to raise the tobacco tax.
The question lingers: Why would the medical association risk its brand by endorsing the marijuana legalization initiative, in a year when the doctors’ top priority is to pass a tobacco tax that would boost Medi-Cal reimbursement rates for doctors? No doubt, some doctors believe legalization is the way to limit use. But maybe some horse-trading is going on.
The tobacco industry has beat tobacco tax hikes many times before and is capable of spending tens of millions again. Doctors and their allies – dentists, health plans, hospitals and labor – have money and therefore power. But they could use more.
Don’t be surprised if Parker and other rich backers of marijuana legalization toss some money into the tobacco-tax initiative. If they get their way, the marijuana backers will have plenty to pass around.