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Jeffrey E. Harris, is an economist and physician who has been on the faculty of the Economics Department of the Massachusetts Institute of Technology since 1977. He received an AB (summa cum laude, 1969) from Harvard University, [1] as well as an MD (1974) and a PhD in Economics (1975) from the University of Pennsylvania. Having trained in internal medicine at the Massachusetts General Hospital (1974-1977), he maintained a medical practice at that institution until 2006. Since then, he has continued to practice as an internist at federally sponsored community health centers in Rhode Island, where the majority of his patients have poverty-level incomes and are not fluent in English.
Harris has published widely on smoking and health, [2] [3] [4] [5] [6] [7] [8] the economics of smoking and public policy toward the tobacco industry, [9] [10] [11] [12] [13] [14] [15] [16] [17] HIV/AIDS, [18] [19] [20] [21] health economics, [22] [23] [24] [25] [26] [27] [28] as well as economics [29] and statistics [30] generally. He is author of Deadly Choices: Coping with Health Risks in Everyday Life. [31]
As a graduate student, Harris collaborated with his doctoral thesis adviser, Oliver E. Williamson (Nobel Memorial Prize in Economic Sciences, 2008), in an article entitled Understanding the Employment Relation: The Analysis of Idiosyncratic Exchange. [32] This article (294 Web of Science (WoS) citations, 928 Google Scholar (GS) citations) was subsequently reproduced in several collections, [33] including Williamson's Markets and Hierarchies (1975). [34] The article has been described[ by whom? ] as "the first explicit application of the new institutional economics to internal labor markets." [35]
Based upon Harris' training in the economics of organization and his experiences as a medical resident, this article (149 WoS citations, 411 GS citations) [22] has been listed[ by whom? ] as one of the top articles in the last four decades of scholarship in health economics. [36] Reproduced in several collections, [37] [38] the article was cited[ by whom? ] in the first generation of health economics textbooks as the Harris Model: "The hospital, under Harris' account, is the scene of continual conflict within an organization inherently split into two parts, what Harris describes as a noncooperative oligopoly game." [39]
Based upon his participation in the Diesel Impacts Study Committee of the National Academy of Sciences, Harris collaborated with William H. DuMouchel in an article entitled Bayes Methods for Combining the Results of Cancer Studies in Humans and Other Species (181 WoS citations, 228 GS citations). [30] [40] As recounted by Sharon Bertsch McGrayne in The Theory That Would Not Die, [41]
"Several civilian researchers tackling hitherto intractable problems concerning public health, sociology, epidemiology, and image restoration did experiment during the 1980s with computers for Bayes. A major controversy about the effect of diesel engine emissions on air quality and cancer inspired the first attempt. By the 1980s cancer specialists had solid data about the effects of cigarette smoke on people, laboratory animals, and cells but little accurate information about diesel fumes. William H. DuMouchel from MIT’s mathematics department and Jeffrey E. Harris from its economics department and Massachusetts General Hospital teamed up in 1983 to ask, 'Could you borrow and extrapolate and take advantage of information from non-human species for humans?' ... Thanks to mice and hamster studies, DuMouchel and Harris were able to conclude that even if light-duty diesel vehicles captured a 25% market share over 20 years, the risk of lung cancer would be negligible for the typical urban resident compared to the typical pack-a-day cigarette smoker. ... Today, Bayesian meta-analyses are statistically old hat, but DuMouchel and Harris made Bayesians salivate for more big-data methods—and for the computing power to deal with them."[ citation needed ]
Motivated by his contributions to the 1979 and 1980 Surgeon General’s Reports, Harris developed a method to reconstruct the smoking rates of successive birth cohorts of men and women throughout the 20th century, based upon individual smoking histories reported in large-scale cross-section surveys. The resulting article, published in the Journal of the National Cancer Institute in 1983 (148 Wos citations, 210 GS citations), [4] spawned a series of studies tracking the birth cohort-specific relationships between smoking rates and disease incidence. [42]
In an article entitled Improved Short-Term Survival of AIDS Patients Initially Diagnosed with Pneumocystis carinii Pneumonia, 1984 through 1987 (101 WoS citations, 131 GS citations), [18] Harris was one of the first investigators to report a significant gain in life expectancy for AIDS patients, which he attributed to the introduction in 1986 of zidovudine, the first antiretroviral agent.[ citation needed ]
Harris collaborated with Dr. Michael Thun and his colleagues at the American Cancer Society to study the relationship between cigarette tar yield and the risk of cancer in the Cancer Prevention Study II (CPS-II) cohort (57 WoS citations, 136 GS citations, 36,000 downloads from British Medical Journal website). [7] This prospective cohort study of over 900,000 men and women remains the standard citation for the conclusion that, while cigarette smoking increases the risk of lung cancer compared to nonsmokers, there is no difference in lung cancer risk between those who smoke medium tar cigarettes, low tar cigarettes and very low tar cigarettes. [43]
Harris has served as Consulting Scientific Editor, Contributor, and Senior Reviewer to U.S. Surgeon General's Reports on Smoking and Health (1979–1983, 1986, 1988, 1989, 1996). He has served as a member of several committees of the National Academy of Sciences and the Institute of Medicine, including the Diesel Impacts Study Committee, the Committee to Study the Prevention of Low Birth Weight, the Committee on National Strategies toward Acquired Immunodeficiency Syndrome, the Committee on Risk Characterization, and the Committee on Reducing Tobacco Use. Harris has served as consultant to governmental agencies, including the U.S. National Cancer Institute, U.S. Department of Energy, U.S. Environmental Protection Agency, U.S. Department of Agriculture, U.S. Federal Trade Commission, U.S. Department of Veterans Affairs, U.S. Department of Justice, U.S. Internal Revenue Service, Massachusetts Department of Public Health, Minnesota Attorney General, New York City Department of Health, New Hampshire Association of Counties, the Attorney General of Canada, and the Australian Competition and Consumer Safety Commission. He has consulted for nonprofit public interest organizations, including the American Cancer Society. He has also served as a physician member of the Massachusetts Board of Registration in Medicine (1978-1980).[ citation needed ]
Harris has given invited testimony before the Committee on Ways and Means, U.S. House of Representatives; the Committee of the Judiciary, U.S. House of Representatives; the U.S. Senate Judiciary Committee; the U.S. Senate Committee on Agriculture; the U.S. Senate Democratic Task Force; and the Massachusetts Department of Public Health. In 2003, he gave expert testimony in Price v. Philip Morris, a class-action lawsuit alleging fraud in the marketing and sale concerning light cigarettes, in which the trial court entered a $10.1 billion judgment against the defendant. [44] In 2004, he gave expert testimony in United States v. Philip Morris et al., in which the trial court found that tobacco manufacturers had violated the Racketeer Influenced and Corrupt Organizations (RICO) Act. Harris has offered expert testimony in other cases involving the tobacco and pharmaceutical industries.
Harris’ role as an expert witness at trial in Cipollone v. Liggett , the first lawsuit in which a jury held the tobacco industry responsible for an individual smoker's death, has been subject to reviews. As recounted by Richard Kluger in his Pulitzer Prize-winning Ashes to Ashes: [45] "Harris tellingly contrasted the tobacco companies' conduct with that of the canning industry, which had adopted new sterilizing methods when botulism was traced to its careless procedures, and the pharmaceutical industry, which had put a skull-and-crossbones warning on preparations found to be toxic when ingested. Such measures were in marked contrast to the conduct of Philip Morris, Harris said, which in the 'Thirties had introduced the humectant diethylene glycol-- a compound later found to be harmful to the kidneys-- based on a minimum of testing..." Harris' unpublished Expert Report on the State of the Art, which was submitted in the Cipollone litigation, itself spawned an inquiry into the role of historians as experts in tobacco-related litigation. [46] As recounted by Robert Proctor in Golden Holocaust, [47] "In a memo titled 'Witness Development,' Arnold & Porter's Janet L. Johnson emphasized to STIC's State-of-the-Art Subcomittee their need to develop a 'storyteller' to tell 'our version' of the history of the recognition of tobacco hazards. Jeffrey Harris's expert report for Cipollone had presented a detailed chronicle of the discovery of lung cancer hazard, identifying evidence from the 1930s and the strong case for proof by 1957. The industry wanted to counter the testimony without having to address when a link had actually been established. 'Instead of trying to defend the issue of whether and when a link between cigarette smoking and lung cancer was established, we should consider focusing our testimony on defending 1954, attacking Harris' 1957 date on which a link was 'proven,' and demonstrate that it was not proven in 1957 with post-57 statements by medical experts about the existence of a controversy'."[ citation needed ]
Since he spent the summer of 2005 in a community health center in Guatemala, Harris has developed connections with researchers and policy makers throughout the Spanish-speaking world. He has served as visiting faculty and has given lectures, principally in Spanish, in Guatemala (Universidad Francisco Marroquin), Mexico (Instituto Nacional de Salud Pública), the Dominican Republic (Pontificia Universidad Católica Madre y Maestra, Universidad Tecnológica de Santiago), Spain (University of Las Palmas de Gran Canaria, University of La Laguna, University of Salamanca, Pompeu Fabra University), Costa Rica (Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, University of Costa Rica), Uruguay (Fondo Nacional de Recursos, University of the Republic) and Chile (University of Chile, Pontifical Catholic University of Chile). In 2008, Harris was named Huésped Distinguido (Distinguished Guest and Honorary Citizen), City of Salamanca, Spain. In 2011, he received a Fulbright Specialist Award from the U.S. Department of State to establish collaborative connections with academic colleagues in Uruguay. His recent collaborative research work includes studies of physician specialty choice in Spain [48] [49] [50] [51] and the evaluation of Uruguay's tobacco control campaign. [52] [53] [54] Since 2013, he has embarked on a series of collaborative projects in Chile sponsored by the MIT Sloan Latin America Office and the MIT MISTI/Chile Program.[ citation needed ]
A cigarette is a narrow cylinder containing psychoactive material, typically tobacco, that is rolled into thin paper for smoking. Most cigarettes contain a "reconstituted tobacco" product known as "sheet", which consists of "recycled [tobacco] stems, stalks, scraps, collected dust, and floor sweepings", to which are added glue, chemicals and fillers; the product is then sprayed with nicotine that was extracted from the tobacco scraps, and shaped into curls. The cigarette is ignited at one end, causing it to smolder; the resulting smoke is orally inhaled via the opposite end. Most modern cigarettes are filtered, although this does not make them safer. Cigarette manufacturers have described cigarettes as a drug administration system for the delivery of nicotine in acceptable and attractive form. Cigarettes are addictive and cause cancer, chronic obstructive pulmonary disease, heart disease, and other health problems.
The tobacco industry comprises those persons and companies engaged in the growth, preparation for sale, shipment, advertisement, and distribution of tobacco and tobacco-related products. It is a global industry; tobacco can grow in any warm, moist environment, which means it can be farmed on all continents except Antarctica.According to the WHO Framework Convention on Tobacco Control “tobacco industry” means tobacco manufacturers, wholesale distributors and importers of tobacco products; The treaty provides its 181 member states the duty of "In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law."
Tobacco smoke is an aerosol produced by the incomplete combustion of tobacco during the smoking of cigarettes and other tobacco products. Temperatures in burning cigarettes range from about 400 °C between puffs to about 900 °C during a puff. During the burning of the cigarette tobacco, thousands of chemical substances are generated by combustion, distillation, pyrolysis and pyrosynthesis. Tobacco smoke is used as a fumigant and inhalant.
Tobacco smoking is the practice of burning tobacco and ingesting the smoke that is produced. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is believed to have begun as early as 5000–3000 BC in Mesoamerica and South America. Tobacco was introduced to Eurasia in the late 17th century by European colonists, where it followed common trade routes. The practice encountered criticism from its first import into the Western world onwards but embedded itself in certain strata of a number of societies before becoming widespread upon the introduction of automated cigarette-rolling apparatus.
Smoking cessation is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. Nicotine withdrawal often makes the process of quitting difficult.
Snus is a moist powder smokeless tobacco product originating from a variant of dry snuff in early 18th-century Sweden. It is placed inside the lip for extended periods. Snus is not fermented. Although used similarly to American dipping tobacco, snus does not typically result in the need for spitting and, unlike naswar, snus is steam-pasteurized.
Passive smoking is the inhalation of smoke, called secondhand smoke (SHS), or environmental tobacco smoke (ETS), by persons other than the intended "active" smoker. It occurs when tobacco smoke enters an environment, causing its inhalation by people within that environment. Exposure to secondhand tobacco smoke causes disease, disability, and death. The health risks of secondhand smoke are a matter of scientific consensus. These risks have been a major motivation for smoke-free laws in workplaces and indoor public places, including restaurants, bars and night clubs, as well as some open public spaces.
Tobacco package warning messages are warning messages that appear on the packaging of cigarettes and other tobacco products concerning their health effects. They have been implemented in an effort to enhance the public's awareness of the harmful effects of smoking. In general, warnings used in different countries try to emphasize the same messages. Warnings for some countries are listed below. Such warnings have been required in tobacco advertising for many years, with the earliest mandatory warning labels implemented in Iceland in 1969. Implementing tobacco warning labels has been strongly opposed by the tobacco industry, most notably in Australia following the implementation of plain packaging laws.
Tar is the common name for the resinous, partially combusted particulate matter made by the burning of tobacco and other plant material in the act of smoking. Tar is toxic and damages the smoker's lungs over time through various biochemical and mechanical processes. Tar also damages the mouth by rotting and blackening teeth, damaging gums, and desensitizing taste buds. Tar includes the majority of mutagenic and carcinogenic agents in tobacco smoke. Polycyclic aromatic hydrocarbons (PAH), for example, are genotoxic via epoxidation.
The Comprehensive Smoking Education Act of 1984 is an act of the Congress of the United States. A national program established in order to improve the availability of information on health risks related to smoking, to amend the Federal Cigarette Labeling and Advertising Act so that cigarette warning labels would be different, and for other reasons, the Comprehensive Smoking Education Act was enacted with a purpose to, as stated in Section 1 of the Act, "provide a new strategy for making Americans more aware of any adverse health effects of smoking, to assure the timely and widespread dissemination of research findings and to enable individuals to make informed decisions about smoking". Adopted by Congress in 1984 and effective October 12, 1984, the Comprehensive Smoking Education Act created a rotational warning system that required all cigarette packages and advertisements to rotate the following four warnings every three months:
Tobacco use has predominantly negative effects on human health and concern about health effects of tobacco has a long history. Research has focused primarily on cigarette tobacco smoking.
A cigarette filter, also known as a filter tip, is a component of a cigarette, along with cigarette paper, capsules and adhesives. It was introduced in the early 1950s. It does not make cigarettes less unhealthy.
Herbal cigarettes are cigarettes that usually do not contain any tobacco, instead being composed of a mixture of various herbs and/or other plant material. However, Chinese herbal cigarettes contain tobacco and nicotine with herbs added, unlike European and North American herbal cigarettes which have tobacco and nicotine omitted. Like herbal smokeless tobacco, they are often used as a substitute for standard tobacco products. Herbal cigarettes are considered a "non-smoking aid." European countries advertise herbal cigarettes as a cessation smoking aid. Herbal cigarettes are also used in acting scenes by performers who are non-smokers, or—as is becoming increasingly common—where anti-smoking legislation prohibits the use of tobacco in public spaces. Herbal cigarettes can carry carcinogens which can have health implications.
Smoking is a practice in which a substance is burned and the resulting smoke is breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have been rolled into a small square of rice paper to create a small, round cylinder called a "cigarette". Smoking is primarily practised as a route of administration for recreational drug use because the combustion of the dried plant leaves vaporizes and delivers active substances into the lungs where they are rapidly absorbed into the bloodstream and reach bodily tissue. In the case of cigarette smoking these substances are contained in a mixture of aerosol particles and gases and include the pharmacologically active alkaloid nicotine; the vaporization creates heated aerosol and gas into a form that allows inhalation and deep penetration into the lungs where absorption into the bloodstream of the active substances occurs. In some cultures, smoking is also carried out as a part of various rituals, where participants use it to help induce trance-like states that, they believe, can lead them to spiritual enlightenment.
Ventilated cigarettes are considered to have a milder flavor than regular cigarettes. These cigarette brands may be listed as having lower levels of tar ("low-tar"), nicotine, or other chemicals as "inhaled" by a "smoking machine". However, the scientific evidence is that switching from regular to light or low-tar cigarettes does not reduce the health risks of smoking or lower the smoker's exposure to the nicotine, tar, and carcinogens present in cigarette smoke.
A Frank Statement to Cigarette Smokers was a historic first advertisement in a campaign run by major American tobacco companies on January 4, 1954, to create doubt by disputing recent scientific studies linking smoking cigarettes to lung cancer and other dangerous health effects.
Ernst Ludwig Wynder was an American epidemiology and public health researcher who studied the health effects of smoking tobacco. His and Evarts Ambrose Graham's joint publication of "Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of 684 Proved Cases" appeared in the Journal of the American Medical Association. It was one of the first major scientific publications identifying smoking as a contributory cause of lung cancer.
With gender-targeted marketing, including packaging and slogans, and promotion of women smoking in movies and popular TV shows, the tobacco industry was able to increase the percent of women smoking. In the 1980s, tobacco industries were made to have the surgeon general's warning printed on each packaging of the tobacco products. This slowed the rate of women smoking but later slightly increased after the advertisements started to look more present day and more appealing packaging, that appealed to the younger generation. In more recent times, cigarette smoking has been banned from public places and will continue to help decrease smoking rates in the United States. Cigarette smoking has serious health effects.
The tar derby is the period in the 1950s and early 1960s marked by a rapid influx in both cigarette advertising focused on tar content measurements to differentiate cigarettes and brand introduction or repositioning focusing on filter technology. The period ended in 1959 after the Federal Trade Commission (FTC) Chairman and several cigarette company presidents agreed to discontinue usage of tar or nicotine levels in advertisements.
The scientific community in United States and Europe are primarily concerned with the possible effect of electronic cigarette use on public health. There is concern among public health experts that e-cigarettes could renormalize smoking, weaken measures to control tobacco, and serve as a gateway for smoking among youth. The public health community is divided over whether to support e-cigarettes, because their safety and efficacy for quitting smoking is unclear. Many in the public health community acknowledge the potential for their quitting smoking and decreasing harm benefits, but there remains a concern over their long-term safety and potential for a new era of users to get addicted to nicotine and then tobacco. There is concern among tobacco control academics and advocates that prevalent universal vaping "will bring its own distinct but as yet unknown health risks in the same way tobacco smoking did, as a result of chronic exposure", among other things.