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Biomedical subjects

Ruth E Malone

Publications and source records attributed to Ruth E Malone.

At least 19 recordsLinked to original sources
PubMed2006

'We will speak as the smoker': the tobacco industry's smokers' rights groups.

INTRODUCTION: The tobacco industry usually keeps its commercial and political communications separate. However, the images of the smoker developed by the two types of communication may contradict one another. This study assesses industry attempts to organize 'smokers' rights groups,' (SRGs) and the image of the smoker that underlay these efforts. METHODS: Searches of the Legacy Tobacco Documents Library, the British American Tobacco documents database, and Tobacco Documents Online. RESULTS: 1100 documents pertaining to SRGs were found, including groups from across Europe and in Australia, New Zealand, and Hong Kong. From the late 1970s through the late 1990s they were active in numerous policy arenas, particularly the defeat of smoke-free laws. Their strategies included asserting their right to smoke and positioning themselves as courteous victims of tobacco control advocates. However, most SRGs were short-lived and apparently failed to inspire smokers to join in any significant numbers. CONCLUSION: SRGs conflated the legality of smoking with a right to smoke. SRGs succeeded by focusing debates about smoke-free policies on smokers rather than on smoke. However, SRGs' inability to attract members highlights the conflict between the image of the smoker in cigarette ads and that of the smokers' rights advocate. The changing social climate for smoking both compelled the industry's creation of SRGs, and created the contradictions that led to their failure. As tobacco control becomes stronger, the industry may revive this strategy in other countries. Advocates should be prepared to counter SRGs by exposing their origins and exploiting these contradictions.

Attitude to Health↗
PubMed2006

Making big tobacco give in: you lose, they win.

OBJECTIVES: To better understand how the tobacco industry responds to tobacco control activists, we explored Philip Morris's response to demands that consumers in developing countries be informed about smoking risks, and analyzed the implications of negotiating with a tobacco company. METHODS: We reviewed internal tobacco industry documents and related materials, constructed a case history of how Philip Morris responded to a shareholder campaign to require health warnings on cigarettes sold worldwide, and analyzed interactions between (1) socially responsible investment activists, (2) Philip Morris management, (3) institutional investors, and (4) industry competitors. RESULTS: After resisting for 11 years, Philip Morris unilaterally reversed direction, and proposed its own labeling initiative. While activists celebrated, Philip Morris's president detailed privately how the company would yield little and benefit disproportionately. Activists portrayed the tobacco industry as preying on the poor and uneducated and used delegitimization to drive a wedge between the industry and its financial and political allies. When Philip Morris "gave in" to their demands, it exchanged negative publicity for positive public relations and political credibility. CONCLUSIONS: Tobacco companies can appear to accommodate public health demands while securing strategic advantages. Negotiating with the tobacco industry can enhance its legitimacy and facilitate its ability to market deadly cigarettes without corresponding benefits to public health.

Community Participation↗
PubMed2006

"It's like Tuskegee in reverse": a case study of ethical tensions in institutional review board review of community-based participatory research.

Community-based participatory research (CBPR) addresses the social justice dimensions of health disparities by engaging marginalized communities, building capacity for action, and encouraging more egalitarian relationships between researchers and communities. CBPR may challenge institutionalized academic practices and the understandings that inform institutional review board deliberations and, indirectly, prioritize particular kinds of research. We present our attempt to study, as part of a CBPR partnership, cigarette sales practices in an inner-city community. We use critical and communitarian perspectives to examine the implications of the refusal of the university institutional review board (in this case, the University of California, San Francisco) to approve the study. CBPR requires expanding ethical discourse beyond the procedural, principle-based approaches common in biomedical research settings. The current ethics culture of academia may sometimes serve to protect institutional power at the expense of community empowerment.

Adult↗
PubMed2006

Melanin and nicotine: A review of the literature.

The role of melanin in nicotine uptake and metabolism has received little attention. Because nicotine has been shown to accumulate in tissues containing melanin, exploring links between melanin and nicotine may provide additional clues to understanding smoking behavior and disease effects. To examine the scientific literature on the relationship between melanin and nicotine, we conducted a PubMed search. We also searched online archives of internal tobacco industry documents. We retrieved and reviewed 82 published research papers related to melanin and nicotine or melanin and metabolism of other drugs, and 150 relevant internal tobacco industry documents. The published literature suggests that nicotine may accumulate in human tissues containing melanin and this retention may increase melanin synthesis. Existing research on the relationship between melanin and nicotine lacks an adequate consideration of this relationship's potential impact, if any, on nicotine metabolism, level of nicotine dependence, and ability to quit smoking. Differential accumulation of nicotine in melanin-containing tissues could have implications for individuals with high levels of melanin.

Animals↗
PubMed2006

How the health belief model helps the tobacco industry: individuals, choice, and "information".

OBJECTIVE: To analyse trial and deposition testimony of tobacco industry executives to determine how they use the concepts of "information" and "choice" and consider how these concepts are related to theoretical models of health behaviour change. METHODS: We coded and analysed transcripts of trial and deposition testimony of 14 high-level executives representing six companies plus the Tobacco Institute. We conducted an interpretive analysis of industry executives' characterisation of the industry's role as information provider and the agency of tobacco consumers in making "choices". RESULTS: Tobacco industry executives deployed the concept of "information" as a mechanism that shifted to consumers full moral responsibility for the harms caused by tobacco products. The industry's role was characterised as that of impartial supplier of value-free "information", without regard to its quality, accuracy and truthfulness. Tobacco industry legal defences rely on assumptions congruent with and supported by individual rational choice theories, particularly those that emphasise individual, autonomous decision-makers. CONCLUSIONS: Tobacco control advocates and health educators must challenge the industry's preferred framing, pointing out that "information" is not value-free. Multi-level, multi-sectoral interventions are critical to tobacco use prevention. Over-reliance on individual and interpersonal rational choice models may have the effect of validating the industry's model of smoking and cessation behaviour, absolving it of responsibility and rendering invisible the "choices" the industry has made and continues to make in promoting the most deadly consumer product ever made.

Choice Behavior↗
PubMed2005

The ethics of industry experimentation using employees: the case of taste-testing pesticide-treated tobacco.

In the United States, companies that use their own funds to test consumer products on their employees are subject to few regulations. Using previously undisclosed tobacco industry documents, we reviewed the history of that industry's efforts to create internal guidelines on the conditions to be met before employee taste testers could evaluate cigarettes made from tobacco treated with experimental pesticides. This history highlights 2 potential ethical issues raised by unregulated industrial research: conflict of interest and lack of informed consent. To ensure compliance with accepted ethical standards, an independent federal office should be established to oversee industrial research involving humans exposed to experimental or increased quantities of ingested, inhaled, or absorbed chemical agents.

Conflict of Interest↗
PubMed2005

Taking it to the streets: responses of African American young adults to internal tobacco industry documents.

Since the Master Settlement Agreement of 1998 between 46 states and the major tobacco companies forced the release of over 30 million pages of previously secret internal tobacco industry documents, researchers have been exploring how information in the documents can be useful for advancing public health efforts. Previous research shows that the tobacco industry has made massive efforts to target marginalized communities, not only through typical advertising channels but also through establishing financial and other ties with influential leadership groups. However, no previous studies have explored how members of targeted groups might respond at the grassroots level to actual internal tobacco industry documents about such targeting. This exploratory focus group study, which invited urban African American participants to comment on previously secret internal tobacco industry documents, suggests that such documents may be useful in efforts to socially denormalize tobacco use, promote critical reflection about community targeting, and mobilize individuals toward quitting.

Adult↗
PubMed2005

What makes an ad a cigarette ad? Commercial tobacco imagery in the lesbian, gay, and bisexual press.

OBJECTIVES: To determine the extent of commercial tobacco imagery in the lesbian, gay, and bisexual (LGB) press. METHODS: Content analysis of all advertising containing tobacco related text or imagery in 20 LGB community periodicals, published between January 1990 and December 2000. RESULTS: 3428 ads were found: 689 tobacco product ads, 1607 ads for cessation products or services, 99 ads with a political message about tobacco, and 1033 non-tobacco ads that showed tobacco (NAST). Although cessation ads were numerically dominant, tobacco product ads and NAST occupied more space and were more likely to use images. NAST almost never had an anti-tobacco message. Formal sponsorship between tobacco and other companies was very rare. Lesbian periodicals had proportionally more NAST and fewer cessation ads. CONCLUSIONS: Cigarette ads were outnumbered by NAST. Although these ads do not usually show brands, and are unlikely to be the result of formal sponsorship agreements, they may be "selling" smoking. Tobacco control advocates should persuade editors to refuse tobacco product ads and those with gratuitous tobacco imagery.

Advertising↗
PubMed2005

Advanced nursing training in health policy: designing and implementing a new program.

Although the nursing profession has a growing role in the health policy arena, the rapidly changing health care environment means that clinicians need a sophisticated understanding of health policy. Nurses are assuming leadership roles in advocacy, research, analysis, and policy development, implementation, and evaluation, contributing to a growing need to educate nurses to specialize in health policy research and analysis. This article provides an overview of a new master's and doctoral educational program specializing in health policy for advanced practice nurses who are culturally diverse and sensitive to issues of diversity. The program, currently in its third year of operation at the University of California San Francisco, School of Nursing, is addressing the gap in nursing education and practice expertise in health policy. The program is supported through funding by the Department of Health and Human Services Health Resources and Services Administration, Advanced Nurse Training program.

Curriculum↗
PubMed2005

Assessing the policy environment.

This article proposes a basic framework for assessing the policy environment. Environment is a key concept in nursing's much-discussed "metaparadigm," but the policy environment is rarely considered. Too often, bedside nurses do not recognize the policy dimensions of clinical practice issues. Yet nursing assessment involves identifying and appraising aspects of patients' situations that are salient to their responses to actual or potential health problems. Policy may be such a salient factor, as it shapes the physical aspects of patients' surroundings; the relationships possible between practitioners and patients; the institutions in which health care is offered; and, on a broader scale, the prospects for global survival. This article proposes a question-based framework for clinical practice nurses to use in assessing the policy environment.

Health Policy↗
PubMed2005

The tobacco industry and pesticide regulations: case studies from tobacco industry archives.

Tobacco is a heavily pesticide-dependent crop. Because pesticides involve human safety and health issues, they are regulated nationally and internationally; however, little is known about how tobacco companies respond to regulatory pressures regarding pesticides. In this study we analyzed internal tobacco industry documents to describe industry activities aimed at influencing pesticide regulations. We used a case study approach based on examination of approximately 2,000 internal company documents and 3,885 pages of U.S. Environmental Protection Agency documents obtained through Freedom of Information Act requests. The cases involved methoprene, the ethylene bisdithiocarbamates, and phosphine. We show how the tobacco industry successfully altered the outcome in two cases by hiring ex-agency scientists to write reports favorable to industry positions regarding pesticide regulations for national (U.S. Environmental Protection Agency) and international (World Health Organization) regulatory bodies. We also show how the industry worked to forestall tobacco pesticide regulation by attempting to self-regulate in Europe, and how Philip Morris encouraged a pesticide manufacturer to apply for higher tolerance levels in Malaysia and Europe while keeping tobacco industry interest a secret from government regulators. This study suggests that the tobacco industry is able to exert considerable influence over the pesticide regulatory process and that increased scrutiny of this process and protection of the public interest in pesticide regulation may be warranted.

Conflict of Interest↗
PubMed2004

Selling off or selling out? Medical schools and ethical leadership in tobacco stock divestment.

Medical and health science schools occupy a prestigious place in U.S. society. When they express a position on tobacco use--either by action or silence--that expression is consequential. Recognizing this, the tobacco industry has worked to sustain and exploit relationships with academic health sciences institutions. Corporate contributions to medical research are more visible, but institutional investments in tobacco stocks are also crucial to these relationships. The American Medical Association divested (sold) its tobacco holdings in 1986, urging others to do the same. Yet, as late as 2004, at least five of the leading dozen medical schools have not divested, and those that have seem reluctant to publicize their actions. The authors use internal tobacco industry documents and secondary source material to describe and analyze Philip Morris's response to two cases of threatened academic divestment. In each case, the world's largest tobacco company succeeded in minimizing the impact of divestment activities--in the first, by muting the consequences of a divestment, and in the second, by convincing university decisionmakers to recommend against tobacco stock divestment. In addition to arguing that tobacco divestment would lead to other pressures or be ineffective, the company exploited university concerns about losing corporate research funding as a key element of its antidivestment strategy. If academic medical centers regard protection of the public's health as a primary mission, divestment from tobacco holdings is essential; profiting from tobacco either through investments or research funding undermines this mission. Silent divestment squanders opportunities for ethical leadership and public dialogue.

Conflict of Interest↗
PubMed2003

Distal nursing.

This paper considers the spatial dynamics of nurse-patient relationships within hospitals, primarily in the USA, under conditions of organizational restructuring, and situates them within social theoretical perspectives on space. As a human practice to which relationship is considered essential, nursing depends upon sustaining an often taken-for-granted proximity to patients. But hospital nursing, I argue in this paper, is increasingly constrained by spatial-structural practices that disrupt relationship and reduce or eliminate such proximity. Three kinds of proximity are threatened: physical, narrative, and moral. Examining these proximities through a place-space lens suggests that nursing is increasingly "distal" to patient care. There are potentially dangerous implications in this loss of proximity.

Ethics, Institutional↗